Higher Urine Output Research Articles

Urine Output and Development of Acute Kidney Injury in Sepsis: A Multicenter Observational Study.

Acute kidney injury (AKI) is common in sepsis and a urine output <0.5 mL/kg/h associated with increased mortality is incorporated into AKI diagnosis. We aimed to identify the urine-output threshold associated with increased AKI incidence and hypothesized that a higher urine output than a specified threshold, which differs from the predominantly used 0.5 mL/kg/h threshold, would be associated with an increased AKI incidence. This was a post-hoc analysis of a nationwide prospective observational study. This study included adult patients newly diagnosed with sepsis and requiring intensive care. Urine output on the day of sepsis diagnosis was categorized as low, moderate, or high (<0.5, 0.5-1.0, and >1.0 mL/kg/h, respectively), and we compared AKI incidence, renal replacement therapy (RRT) requirement, and 28-day survival by category. Estimated probabilities for these outcomes were also compared after adjusting for patient background and hourly fluid administration. Among 172 eligible patients, AKI occurred in 46.3%, 48.3%, and 53.1% of those with high, moderate, and low urine output, respectively. The probability of AKI was lower in patients with high urine output than in those with low output (43.6% vs 56.5%; P = .028), whereas RRT requirement was lower in patients with high and moderate urine output (11.7% and 12.8% vs 49.1%; P < .001). Patients with low urine output demonstrated significantly lower survival (87.7% vs 82.8% and 67.8%; P = .018). Cubic spline curves for AKI, RRT, and survival prediction indicated different urine-output thresholds, including <1.2 to 1.3 mL/kg/h for AKI and <0.6 to 0.8 mL/kg/h for RRT and mortality risk. Urine output >1.0 mL/kg/h on the day of sepsis diagnosis was associated with lower AKI incidence. The urine-output threshold was higher for developing AKI than for RRT requirement or mortality.

Prognostic value of first 24-hour urine output in patients with acute myocardial infarction in intensive care units: a retrospective study based on the MIMIC-IV database.

To investigate the effect of first 24-hour (24-h) urine output (UO) on in-hospital and 1-year mortality in patients admitted to intensive care units due to acute myocardial infarction. This was a retrospective cohort study based on the medical information mart for intensive care IV database involving patients admitted to intensive care units due to acute myocardial infarction. Patients were classified as low UO (LUO), high UO (HUO), and middle UO with a first 24-h UO below 800ml, over 2500ml, or in between, respectively. The primary outcome was in-hospital mortality and the secondary outcome was 1-year mortality. A total of 4337 patients were involved. Taking middle UO group as reference, after adjusting for confounders including age, gender, height, weight, comorbidity, occurrence of cardiogenic shock, revascularization, blood pressure, creatinine, N-terminal pro-brain natriuretic peptide, and use of loop diuretics, LUO was independently associated with higher in-hospital mortality [odds ratio 4.05, 95% confidence interval (CI): 3.12-5.26], while HUO was an independent protective factor (odds ratio 0.52, 95% CI: 0.35-0.77). In the multivariant Cox regression model, LUO was an independent risk factor for 1-year mortality (hazard ratio 2.65, 95% CI: 2.16-3.26), while HUO did not show significant association. In patients admitted to intensive care units due to acute myocardial infarction, first 24-h UO <800ml was a strong predictor for higher in-hospital and 1-year mortality, while first 24-h UO over 2500ml was associated with lower in-hospital mortality but not long-term mortality.

Percutaneous nephrolithotomy for adult renal transplant de novo graft lithiasis: a single center analysis and systematic review of the literature.

Graft stones in renal transplant recipients pose a unique challenge, finding effective interventions to ensure optimal graft function and patient well-being. Various methods of stone clearance have been described for graft stones, including percutaneous nephrolithotomy (PCNL). While PCNL is a promising approach for managing graft stones, specific outcomes and associated characteristics for this approach have not been comprehensively evaluated before. This study aims to evaluate the safety and efficacy of the use of PCNL as the primary intervention of graft stones by assessing stone-free rates (SFR), treatment impact on graft function, and perioperative complications. A retrospective clinical audit was performed for all transplants performed in a single center from 2007 to 2022, which included all graft lithiasis patients who were treated with PCNL. Both perioperative parameters and post-operative outcomes were collected. In addition, a systematic review including articles from MEDLINE, Embase, Web of Science yielded 18 full-text articles published between 1/1/2000 and 15/11/2023. The results pertaining to patients who underwent PCNLs for graft stones were cross-referenced and thoroughly evaluated. The review encompassed a comprehensive analysis of clinical data, postoperative outcomes, and procedural details. The protocol for the systematic review was prospectively registered on PROSPERO (CRD42023486825). In our center, 6 graft lithiasis patients were treated with PCNL. The initial SFR was 83.3%. SFR at 3months and 1year were both 100.0%. SFR at 3years was 66.7%. Other centers reported initial SFR of 82.6-100.0% (interquartile range). SFR at 3months, 1year, 3years was not well reported across the included studies. Incidence of graft lithiasis ranged from 0.44%-2.41%. Most common presentations at diagnosis were oliguria/anuria/acute kidney injury and asymptomatic. Reported complications included blood loss, transient hematuria, high urine output, sepsis, and damage to surrounding structures. The most commonly reported metabolic abnormalities in transplant lithiasis patients included hyperuricemia and hyperparathyroidism. PCNL is a practical and efficient choice for addressing graft lithiasis, demonstrating excellent stone clearance and minimal perioperative complications. These findings show the importance of PCNL as a primary intervention in this complex patient population.

Assessment of the Diuretic Properties of Rice Bean Accessions Using a Mouse Model and Identification of Active Polyphenolic Compounds.

Rice bean [Vigna umbellata (Thunb.) Ohwi and Ohashi], an annual legume in the genus Vigna, is a promising crop suitable for cultivation in a changing climate to ensure food security. It is also a medicinal plant widely used in traditional Chinese medicine; however, little is known about the medicinal compounds in rice bean. In this study, we assessed the diuretic effect of rice bean extracts on mice as well as its relationship with the contents of eight secondary metabolites in seeds. Mice gavaged with rice bean extracts from yellow and black seeds had higher urinary output (5.44-5.47 g) and water intake (5.8-6.3 g) values than mice gavaged with rice bean extracts from red seeds. Correlation analyses revealed significant negative correlations between urine output and gallic acid (R = -0.70) and genistein (R = -0.75) concentrations, suggesting that these two polyphenols negatively regulate diuresis. There were no obvious relationships between mice diuresis-related indices (urine output, water intake, and weight loss) and rutin or catechin contents, although the concentrations of both of these polyphenols in rice bean seeds were higher than the concentrations of the other six secondary metabolites. Our study findings may be useful for future research on the diuretic effects of rice bean, but they should be confirmed on the basis of systematic medical trials.

#1651 Urinary oxygen partial pressure: closely associated with hourly urine output induced by furosemide in patients with acute renal injury

Abstract Background and Aims Urine oxygen level, an indicator of kidney medullar oxygenation, is promising for predicting the onset of acute kidney injury (AKI). Furosemide, a commonly used diuretic in ICU, significantly increases urine output and is believed to change kidney medullar oxygenation. We monitored the longitudinal change of urinary oxygen partial pressure during bolus or pump administration of furosemide, aiming to describe the reaction pattern in an AKI-susceptible patient population. Method The prospective observational pilot study included seven adult patients in the ICU because of cardiac surgery or sepsis. We monitored the continuous urinary oxygen partial pressure for 8-24 hours through a device placed between the urinary catheter and collecting bag during furosemide administration, recorded hourly urine output simultaneously from a urine bag, and followed the patients in the hospital for the onset and development of AKI. Results We recruited three female patients and four male patients with an average age of 54 years and a medium of 5 days in ICU with an AKIN stage I of AKI during their hospital stay. None of them developed more severe stage AKI or required any kidney replacement therapy. We found a reverse correlation pattern between hourly urine output and urinary oxygen partial pressure. Specifically, the urine oxygen level dropped during urine volume increase caused by furosemide bolus administration and abolished by furosemide administration through a pump with more stable urine output. The paired t-test showed a significant increase in average urine oxygen level (mean difference = 21.2 mmHg, p = 0.044) recorded during the “high hourly urine output” period compared to the “low hourly urine period”. Conclusion We first found a drop in urinary oxygen partial pressure during the high urine output period elicited by bolus furosemide administration. It shed light on the confounding factors in AKI predicating during possible furosemide administration.

MANAGEMENT OF DIABETES INSIPIDUS AFTER SUBLABIAL TRANSSPHENOIDAL HYPOPHYSECTOMY SURGERY

MANAGEMENT OF DIABETES INSIPIDUS AFTER SUBLABIAL TRANSSPHENOIDAL HYPOPHYSECTOMY SURGERY

A patient diagnosed with new-onset type 1 diabetes and Addison's disease at initial presentation.

A previously healthy 17-year-old female presented to the emergency department with complaints of vomiting, shortness of breath, and tachycardia. She was found to have an elevated blood glucose and was admitted for presumed new onset type 1 diabetes mellitus (T1DM). During the admission, she was noted to have frequent episodes of hypoglycemia despite conservative insulin dosing and high urine output with glucosuria, which seemed out of proportion to her glucose levels and fluid status. She also had persistent hyponatremia despite normalization of blood glucose. Further work-up was initiated to investigate alternative or additional diagnoses to explain these atypical findings. Adrenocorticotropic hormone (ACTH) level was elevated, consistent with the diagnosis of Addison's disease, which led to the subsequent diagnosis of autoimmune polyglandular syndrome type II (APS-2). This is one of the first reports in the literature of concurrent diagnosis of T1DM and Addison's disease at initial presentation and demonstrates the importance of not anchoring to one diagnosis. This case shows the importance of considering multiple diagnoses and investigating atypical signs and symptoms. This case highlights the importance of a thorough history including review of systems. Hyponatremia and recurrent hypoglycemia in a person with type 1 diabetes should raise suspicion for adrenal insufficiency. This case makes us consider the screening for Addison's disease in a person with new onset type 1 diabetes in addition to autoimmune thyroid disease and celiac disease. People with an autoimmune disease should be monitored for other autoimmune diseases in the future.

Predictive Factors of Successful Double J Stent Insertion Among Advanced Cervical Cancer Patients.

Cervical cancer remains the most lethal and prevalent cancer among women. Obstructive uropathy is a common complication of advanced cervical cancer, caused by the expanding tumor. One of the recommended treatments for this condition is the implantation of a double J (DJ) stent. However, this procedure is challenging due to the unique characteristics of the patient. The objective of this study was to identify the variables that influence the successful insertion of a DJ stent in women with advanced cervical cancer. This retrospective study included women who attempted to have a DJ stent implanted at the General Hospital of Adam Malik in Medan, Indonesia, between January 2020 and December 2022, and were diagnosed with advanced cervical cancer. The inclusion criteria were limited to cervical cancer patients in stages III-IV, according to the International Federation of Gynecology and Obstetrics (FIGO) staging standard, who underwent an attempt at DJ stent insertion. Patients who underwent a nephrostomy and received a DJ stent were excluded from the study. The participants were divided into two groups based on the success of the DJ stent implantation. The analysis was conducted using the logistic regression test and the Chi-square test. The study included 88 patients with advanced-stage cervical cancer, of whom 45 underwent nephrostomy and 43 received a DJ stent. The analysis revealed that lower levels of hydronephrosis (odds ratio (OR): 18.203, P = 0.001), urea (OR: 4.207, P = 0.037), and creatinine (OR: 6.923, P = 0.004), higher levels of urine output (OR: 8.26, P = 0.003), and lower cervical cancer stage (OR: 4.125, P = 0.022) were all predictors of successful DJ stent insertion. For women with advanced cervical cancer, lower degrees of hydronephrosis, urea, and creatinine levels, higher urine output, and lower cervical cancer stage were all predictive factors for successful DJ stent implantation.

Prognostic Biomarkers and AKI: Potential to Enhance the Identification of Post-Operative Patients at Risk of Loss of Renal Function.

Acute kidney injury (AKI) is a common complication after surgery and the more complex the surgery, the greater the risk. During surgery, patients are exposed to a combination of factors all of which are associated with the development of AKI. These include hypotension and hypovolaemia, sepsis, systemic inflammation, the use of nephrotoxic agents, tissue injury, the infusion of blood or blood products, ischaemia, oxidative stress and reperfusion injury. Given the risks of AKI, it would seem logical to conclude that early identification of patients at risk of AKI would translate into benefit. The conventional markers of AKI, namely serum creatinine and urine output are the mainstay of defining chronic kidney disease but are less suited to the acute phase. Such concerns are compounded in surgical patients given they often have significantly reduced mobility, suboptimal levels of nutrition and reduced muscle bulk. Many patients may also have misleadingly low serum creatinine and high urine output due to aggressive fluid resuscitation, particularly in intensive care units. Over the last two decades, considerable information has accrued with regard to the performance of what was termed "novel" biomarkers of AKI, and here, we discuss the most examined molecules and performance in surgical settings. We also discuss the application of biomarkers to guide patients' postoperative care.

Permissive Hypotension Has No Deleterious Impact on Fluid Balance or Kidney Function.

Mean arterial hypotension between 55 and 65 mm Hg could be tolerated safely in the absence of tissue hypoperfusion, but the consequences on fluid balance and kidney function remain unknown. During a 1-year period, we retrospectively collected data of consecutive septic patients admitted for sepsis with a mean arterial pressure (MAP) less than 65 mm Hg despite fluid resuscitation. Medical 18-bed ICU in a tertiary teaching hospital. Septic patients with a MAP less than 65 mm Hg despite initial resuscitation. In our ICU, MAP between 55 and 65 mm Hg was tolerated in the absence of peripheral hypoperfusion (permissive hypotension) or corrected using norepinephrine (septic shock group) when peripheral tissue hypoperfusion was present. Ninety-four consecutive septic patients were included, 15 in the permissive hypotension group and 79 in the septic shock group. Median age was 66 years (57-77 yr) and 42% were women. The main sources of infection were respiratory (45%) and abdominal (18%). Severity was more important in septic shock group with higher Sequential Organ Failure Assessment score (7 [5-10] vs. 4 [1-6]; p < 0.0001), more frequent organ support therapy and ultimately higher mortality (38 vs. 0%; p < 0.01). The total volume of crystalloids infused before ICU admission was not different between groups (1930 ± 250 vs. 1850 ± 150 mL; p = 0.40). Within the 6 first hours of ICU stay, patients in the permissive hypotension group received less fluids (530 ± 170 vs. 1100 ± 110 mL; p = 0.03) and had higher urinary output (1.4 mL [0.88-2.34 mL] vs. 0.47 mL/kg/hr [0.08-1.25 mL/kg/hr]; p < 0.001). In addition, kidney injury evaluated using KDIGO score was lower in the permissive hypotension group at 48 hours (0 hr [0-1 hr] vs. 1 hr [0-2 hr]; p < 0.05). In septic patients without clinical peripheral hypoperfusion, mean arterial hypotension between 55 and 65 mm Hg could be tolerated safely without vasopressor infusion and was not associated with excessive fluid administration or kidney damage.

High urinary output as a predictor of hypoparathyroidism post total-thyroidectomy

High urinary output as a predictor of hypoparathyroidism post total-thyroidectomy

Triglyceride glucose-body mass index and cardiovascular mortality in patients undergoing peritoneal dialysis: a retrospective cohort study

BackgroundRecent studies have shown that triglyceride glucose-body mass index (TyG-BMI) is associated with the risk of ischemic stroke and coronary artery disease. However, little attention has been given to the association between TyG-BMI and cardiovascular disease (CVD) mortality in patients undergoing peritoneal dialysis (PD). Therefore, this study aimed to explore the relationship between TyG-BMI and CVD mortality in southern Chinese patients undergoing PD.MethodsIncident patients receiving PD from January 1, 2006, to December 31, 2018, with baseline serum triglyceride, glucose, and body mass index (BMI) information, were recruited for this single-center retrospective cohort study. TyG-BMI was calculated based on fasting plasma glucose, triglyceride, and BMI values. The association between TyG-BMI, CVD and all-cause mortality was evaluated using a multivariate-adjusted Cox proportional hazard regression model.ResultsOf 2,335 patients, the mean age was 46.1 ± 14.8 years; 1,382 (59.2%) were male, and 564 (24.2%) had diabetes. The median TyG-BMI was 183.7 (165.5–209.2). Multivariate linear regression showed that advanced age, male sex, history of CVD, higher levels of albumin and low-density lipoprotein cholesterol, and higher urine output were correlated with a higher TyG-BMI (P < 0.05). During a median follow-up period of 46.6 (22.4–78.0) months, 615 patients died, of whom 297 (48.2%) died as a result of CVD. After adjusting for demographics and comorbidities, TyG-BMI was significantly associated with an increased risk of CVD mortality (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.05–2.17) and all-cause mortality (HR 1.36, 95% CI 1.05–1.75). After full adjustment, the 28% risk of CVD mortality (HR 1.28, 95% CI 1.13–1.45) and 19% risk of all-cause mortality were elevated (HR 1.19, 95% CI 1.09–1.31) when TyG-BMI increased by 1 stand deviation (SD) (34.2).ConclusionsA higher baseline TyG-BMI was independently associated with an increased risk of CVD and all-cause mortality in patients receiving PD.

Evaluation of Proenkephalin A 119–159 for liberation from renal replacement therapy: an external, multicenter pilot study in critically ill patients with acute kidney injury

IntroductionRecent evidence suggests an association of plasma Proenkephalin A 119–159 (penKid) with early and successful liberation from continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury. However, these exploratory results are derived from a monocentric trial and therefore require external validation in a multicenter cohort.MethodsData and plasma samples from the “Effect of Regional Citrate Anticoagulation versus Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney Injury—A Randomized Clinical Trial” (RICH Trial) were used for this validation study. PenKid was measured in all plasma samples available at CRRT initiation and at day 3 of CRRT. Patients were categorized into low and high penKid groups with a cutoff at 100 pmol/l. Competing-risk time-to-event analyses were performed. Competing risk endpoints were successful and unsuccessful liberation from CRRT, the latter meaning death or initiation of a new RRT within one week of discontinuation of primary CRRT. Then penKid was compared to urinary output.ResultsLow pre-CRRT penKid levels at CRRT initiation were not associated with early and successful liberation from CRRT compared to patients with high pre-CRRT penKid levels [subdistribution hazard ratio (sHR) 1.01, 95% CI 0.73–1.40, p = 0.945]. However, the landmark analysis on day 3 of ongoing CRRT demonstrated an association between low penKid levels and successful liberation from CRRT (sHR 2.35, 95% CI 1.45–3.81, p < 0.001) and an association between high penKid levels and unsuccessful liberation (sHR 0.46, 95% CI 0.26–0.80, p = 0.007). High daily urinary output (> 436 ml/d) was even stronger associated with successful liberation (sHR 2.91, 95% CI 1.80–4.73, p < 0.001) compared to penKid.DiscussionThis study suggests that penKid may be a competent biomarker to monitor the recovery of kidney function during CRRT. This is in line with previous findings and investigated this concept in a multicenter cohort. Again, low penKid was associated with early and successful CRRT liberation, but was outperformed by high daily urinary output. The findings of this study now warrant further evaluation in prospective studies or a randomized controlled trial.Trial registration The RICH Trial was registered at clinicaltrials.gov: NCT02669589. Registered 01 February 2016.

Incremental hemodialysis in pediatric patients.

Incremental hemodialysis follows the concept of adjusting dialysis dose according to residual kidney function. Data on incremental hemodialysis in pediatric patients is lacking. We conducted a retrospective analysis of children initiating hemodialysis between January 2015 and July 2020 in a single tertiary center, comparing the characteristics and outcomes of those who commenced with incremental hemodialysis vs with conventional thrice-weekly regimen. Data onforty patients, 15 (37.5%) on incremental hemodialysis and 25 (63%) on thrice-weekly hemodialysis were analyzed. No differences in age, estimated glomerular filtration rate and metabolic parameters were noted between groups at baseline, but there were more males (73 vs 40%, p = 0.04), more patients with congenital anomalies of kidney and urinary tract (60 vs 20%, p = 0.01), higher urine output (2.5 ± 1 vs 1 ± 0.8ml/kg/h, p < 0.001), lower use of antihypertensive medications (20 vs 72%, p = 0.002) and lower prevalence of left ventricular hypertrophy (6.7 vs 32%, p = 0.003) in the incremental hemodialysis group vs thrice-weekly hemodialysis. During follow up, 5 (33%) incremental hemodialysis patients were transplanted, 1 (7%) remained on incremental hemodialysis at 24months, and 9 (60%) transitioned to thrice-weekly hemodialysis at a median (IQR) time of 8.7 (4.2, 11.8) months. At last follow up, fewer patients who initiated incremental hemodialysis had left ventricular hypertrophy (0 vs 32%, p = 0.016) and urine output < 100ml/24h (20 vs 60%, p = 0.02) compared to thrice-weekly hemodialysis, with no significant differences in metabolic or growth parameters. Incremental hemodialysis is a viable option for initiating dialysis in selected pediatric patients, that may help improve patients' quality of life and reduce dialysis burden without compromising clinical outcome.

#5267 INITIAL EMERGENCY ROOM 6-HOUR URINE VOLUME IS AN IMPORTANT FACTOR FOR THE SURVIVAL OF CRITICALLY ILL PATIENTS UNDERGOING CRRT

Abstract Background and Aims It has been little known whether initial emergency room factors affect survival or renal function in critically ill patients undergoing continuous renal replacement therapy. We examined whether initial factors in ER impact survival and renal recovery in critically ill patients undergoing continuous renal replacement therapy. Method The study was a single-center, retrospective study of 332 patients for critically ill patients admitted to ICUs for continuous renal replacement therapy via emergency room from March 1, 2018 to May 31, 2021. Clinical parameters including urine output, eGFR, and serum NGAL were identified. The primary outcomes were the 30-day and 90-day mortality. Secondary outcomes were the 30-, and 90-day dialysis-free duration. Results Low urine output (LUO, defined as &amp;lt; 0.5 mL/kg/hr x 6 hours) group was significantly associated with 30-day mortality and 90-day mortality. Multivariable Cox regression analysis showed that LUO group was significantly more associated with the increased risk of 30-day mortality and 90-day mortality (hazard ratio, 1.935 and 2.141, respectively) compared to high urine output (HUO, defined as ≥ 0.5 mL/kg/hr x 6 hours) group. There was no significant association between 30-day or 90-day mortality and initial estimated glomerular filtration rate (eGFR) plasma neutrophil gelatinase-associated lipocalin (NGAL) levels. In critically ill patients undergoing continuous renal replacement therapy, HUO group and initial eGFR ≥ 30 ml/min/1.73m2 groups was associated with decreased 30-, and 90-day dialysis-free duration. However, serum NGAL had no significant relation with 30-, and 90-days RRT free durations. Conclusion During admission to emergency room, the initial low urine output is an important factor for 30-day and 90-day mortality in Critically Ill Patients Undergoing Continuous Renal Replacement Therapy.

How to interpret serum creatinine increases during decongestion.

During decongestion in acute decompensated heart failure (ADHF), it is common to observe elevations in serum creatinine (sCr) values due to vascular congestion, a mechanism that involves increased central venous pressure that has a negative impact on the nephron, promoting greater absorption of water and sodium, increased interstitial pressure in an encapsulated organ developing "renal tamponade" which is one of main physiopathological mechanism associated with impaired kidney function. For the treatment of this syndrome, it is recommended to use diuretics that generate a high urinary output and natriuresis to decongest the venous system, during this process the sCr values can rise, a phenomenon that may bother some cardiologist and nephrologist, since raise the suspicion of kidney damage that could worsen the prognosis of these patients. It is recommended that increases of up to 0.5 mg/dL from baseline are acceptable, but some patients have higher increases, and we believe that an arbitrary number would be impractical for everyone. These increases in sCr may be related to changes in glomerular hemodynamics and true hypovolemia associated with decongestion, but it is unlikely that they are due to structural injury or truly hypoperfusion and may even have a positive connotation if accompanied by an effective decongestion and be associated with a better prognosis in the medium to long term with fewer major cardiovascular and renal events. In this review, we give a comprehensive point of view on the interpretation of creatinine elevation during decongestion in patients with ADHF.

Abstract 127: Urine Output And Mortality In Patients Resuscitated From Out Of Hospital Cardiac Arrest

Background: Urine output (UO) measurement utility after out-of-hospital cardiac arrest (OHCA) survivors who undergo targeted temperature management (TTM) is not well understood. Methods: We included 247 comatose adult patients who underwent TTM after OHCA between 2007 and 2017 and excluded those on maintenance dialysis. Groups were defined based on mean hourly UO during the first 24 hours: Group 1 (&lt;0.5 ml/kg/hr, n=73), Group 2 (0.5-1 ml/kg/hr, n=81) and Group 3 (&gt;1 ml/kg/hr, n=93). Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria were used to define and stage acute kidney injury (AKI). Multivariable analysis was used to evaluate in-hospital mortality. Results: In-hospital mortality decreased as 24-hour mean UO increased (56.2% [41/73] vs 29.6% [24/81] vs 18.3% [17/93] in Groups 1, 2 and 3, respectively; adjusted OR 0.93 per 0.1 ml/kg/h higher, 95% CI 0.87-0.99, p = 0.03), and UO &lt; 0.5 ml/kg/hr was strongly associated with in-hospital mortality (adjusted OR 4.2 [1.6-10.8], p=0.003). In-hospital mortality varied by the KDIGO stage and UO group (Figure), lowest in KDIGO stage 0 and highest in KDIGO stage 3. Both UO (adjusted OR 0.92 per 0.1 ml/kg/h higher, p = 0.002) and KDIGO stage (adjusted OR 1.62 per each stage, p = 0.002) were associated with in-hospital mortality when included in the same model. Among patients with KDIGO stage 0, lower UO portended higher mortality (Figure). Likewise, among patients with low UO (group 1), a higher KDIGO stage predicted higher mortality. Conclusion: Amongst OHCA survivors undergoing TTM, higher UO is incrementally associated with lower in-hospital mortality. The lowest mortality was observed at UO &gt;=1 ml/kg/h, suggesting this as a target for resuscitation in OHCA patients undergoing TTM. Low UO remains associated with in-hospital mortality even when accounting for AKI by creatinine criteria, suggesting that oliguria is a more sensitive prognostic marker in the early post-OHCA phase.

Perioperative fluid management and associated complications in children receiving kidney transplants in the UK

BackgroundIntravenous fluid administration is an essential part of perioperative care for children receiving a kidney transplant. There is a paucity of evidence to guide optimal perioperative fluid management. This study aimed to identify the volume of perioperative fluids administered across 5 UK paediatric kidney transplant centres and explore associations between fluid volume administered, graft function, and fluid-related adverse events.MethodsData were collected from five UK paediatric kidney transplant centres on perioperative fluid volumes administered, and incidence of pulmonary oedema, systemic hypertension, and requirement for intensive care support. Children < 18 years of age who received a kidney-only transplant between 1st January 2020 and 31st December 2021 were included.ResultsComplete data from 102 children were analysed. The median total volume of fluid administered in 72 h was 377 ml/kg (IQR 149 ml/kg) with a high degree of variability. A negative relationship between total fluid volume administered and day 7 eGFR was noted (p < 0.001). Association between urine volume post-transplant and day 7 eGFR was also negative (p < 0.001). Adverse events were frequent but no significant difference was found in the fluid volume administered to those who developed an adverse event, vs those who did not.ConclusionsThis study describes a high degree of variability in perioperative fluid volumes administered to children receiving kidney transplants. Both fluid volume and urine output were negatively associated with short-term graft function. These data contrast traditional interpretation of high urine output as a marker of graft health, and highlight the need for prospective clinical trials to optimise perioperative fluid administration for this group.Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Study Evaluating the Use of RenalGuard to Protect Patients at High Risk of AKI.

Contrast-induced nephropathy (CIN) can occur after cardiovascular procedures using contrast media, which is associated with increased morbidity and mortality. RenalGuard is a closed-loop system designed to match intravenous hydration withdiuretic-induced diuresis that has shown mixed results in the prevention of CIN in previous randomized controlled trials. The STRENGTH (Study Evaluating the Use of RenalGuard to Protect Patients at High Risk of AKI) study assessed whether RenalGuard (PLC Medical Systems) is superior to standard intravenous hydration for CIN prevention in patients with chronic kidney disease undergoing complex cardiovascular procedures. STRENGTH is a multicenter, international, open-label, postmarket, prospective, randomized (1:1) study monitored by the Cardiovascular European Research Center (Massy, France) that included a total of 259 patients with moderate to severe chronic kidney disease (estimated glomerular filtration15-40mL/min/m2) requiring a complex coronary, structural, or peripheral procedure with an expected contrast injection of at least 3 times the estimated glomerular filtration rate. Patients were randomized to either RenalGuard or intravenous saline hydration according to current guidelines. The primary endpoint, the incidence of CIN at day 3 after the procedure, was similar between the 2 groups (17/107 [15.9%] in the RG group vs 15/110 [13.9%] in the control group; P = 0.62). In addition, none of the secondary endpoints differed between the 2 groups. In high-risk patients undergoing complex cardiovascular interventions in experienced centers, furosemide-induced high urine output with matched hydration using the RenalGuard system did not reduce the risk of CIN and adverse outcomes at 12months compared with conventional intravenous hydration.

Perioperative Anaesthesia Management for Aorta Dissection Patient Undergo Bentall Procedure

Introduction: aortic dissections that involve the ascending aorta (Stanford type A) are considered surgical emergencies. The mortality rate without emergency surgery is about 1% per hour for the first 48 hour, 60% by about one week, 74% by 2 weeks and 91% by 6 month. Open chest surgery with resection of dissected aorta may reduce the expected fatal outcomes to 10% as soon as the treatment provided in the first 24 hour and 20% for next 14 day. Case: A case of 42 years old man, 72 kg weight complained of sharp, tearing, pain from upper abdomen to chest and back of body since a month before admission. The pain endured for 20 minutes, patient had history of hypertension a year ago. Suspected with aortic dissection patient transferred to CVCU got therapy of antihypertension and β-blocker. Laboratory examination showed kidney disorder with enhancement of Ureum and creatinine levels. CT contras showed aortic dissection Stanford A Debakey Type I and patient scheduled for Bentall Procedure with complication Acute Kidney Injury (AKI). Perioperative anaesthesia management from preoperative with β-blocker and ramipril, induction with high dose analgetic, smooth intubation prevent increase in systolic blood pressure and heart rate, also maintain oxygen delivery to brain when DHCA started use SACP monitored with NIRS. after operation patient treated in ICU with ventilator and full sedated. Second day in ICU patient developed high creatinine levels and low urine output per hour. Renal replacement therapy is given and patient transfer to CVCU on the fifth day. Conclusion: it is still challenging to treatment of aortic dissection, started from diagnosis, preoperative management and overcoming the complication. Therefore, careful history taking, early treatment to prevented expansion of dissected aorta, CT angiography for diagnosed, intraoperative management and haemodialysis therapy should be considered to increase patient outcome.