History Of Chronic Kidney Disease Research Articles

Association between Glucose-lowering Treatments and Risk of Diabetic Retinopathy in People with Type 2 Diabetes: A Nationwide Cohort Study.

Glycaemic variability is possibly linked to the development of diabetic retinopathy, and newer second-line glucose-lowering treatments in type 2 diabetes might reduce glycaemic variability. This study aimed to investigate whether newer second-line glucose-lowering treatments are associated with an alternative risk of developing diabetic retinopathy in people with type 2 diabetes. A nationwide cohort of people with type 2 diabetes on second-line glucose-lowering treatment regimens in 2008-2018 was extracted from the Danish National Patient Registry. Adjusted time to diabetic retinopathy was estimated with a Cox Proportional Hazards model. The model was adjusted for age, sex, diabetes duration, alcohol abuse, treatment start year, education, income, history of late-diabetic complications, history of non-fatal major adverse cardiovascular events, history of chronic kidney disease, and history of hypoglycaemic episodes. Treatment regimens of metformin + basal insulin (HR: 3.15, 95% CI: 2.42-4.10) and metformin + glucagon-like peptide-1 receptor agonist (GLP-1-RA, HR: 1.46, 95% CI: 1.09-1.96) were associated with an increased risk of diabetic retinopathy compared with metformin + dipeptidyl peptidase-4 inhibitors (DPP-4i). Treatment with metformin + sodium-glucose cotransporter-2 inhibitor (SGLT2i, HR: 0.77, 95% CI: 0.28-2.11) was associated with the numerically lowest risk of diabetic retinopathy compared with all regimens investigated. Findings from this study indicate that basal insulin and GLP-1-RA are suboptimal second- line choices for people with type 2 diabetes at risk of developing diabetic retinopathy. However, many other considerations concerning the choice of second-line glucose-lowering treatment for type 2 diabetes patients should be taken into account.

A Review of Focal Segmental Glomerulosclerosis Classification With a Focus on Genetic Associations

Focal segmental glomerulosclerosis (FSGS) defines a distinct histological pattern observed in kidney tissue, that is linked to several distinct underlying causes, all converging on the common factor of podocyte injury. It presents a considerable challenge in terms of classification due to its varied underlying causes and the limited correlation between histopathology and clinical outcomes. Critically, precise nomenclature is key to describe and delineate the pathogenesis, subsequently guiding the selection of suitable and precision therapies. A proposed pathomechanism-based approach has been suggested for FSGS classification. This approach differentiates between primary, secondary, genetic, and undetermined causes, aiming to provide clarity. Genetic FSGS from monogenic mutations can emerge during childhood or adulthood, and it is advisable to conduct genetic testing in cases where there is a family history of chronic kidney disease, nephrotic syndrome, or resistance to treatment. Genome-wide association studies have identified several genetic risk variants, such as in apolipoprotein L1 (APOL1), which play a role in the development of FSGS. Currently, no specific treatments have been approved to treat genetic FSGS; however, interventions targeting underlying cofactor deficiencies have shown potential in some cases. Furthermore, encouraging results have emerged from a phase 2 trial investigating inaxaplin, a novel small molecule APOL1 channel inhibitor, in APOL1-associated FSGS.

Severe acyclovir induced neurotoxicity in an elderly woman with end-stage renal disease and herpes zoster : A case report

Acyclovir (ACV) is a widely utilized antiviral medication for treating herpes simplex virus, cytomegalovirus, and varicella-zoster virus (VZV). Despite its usefulness, ACV can lead to adverse effects like acute renal impairment. ACV is predominantly eliminated through the kidneys, and in cases of renal impairment, there exists a potential for elevated levels, posing a risk of subsequent neurotoxicity. This case highlights the challenges posed by ACV use in patients with compromised renal function. A 64-year-old female presented with unconsciousness persisting for several hours. She had recently self-administered acyclovir (5x800 mg) to manage a herpes zoster outbreak. She had history of Chronic Kidney Disease (CKD) Stage V but refused hemodialysis. She had irregular heart rate of 140-180 beats per minute (with EKG confirming Atrial Fibrillation Rapid Response), a respiratory rate of 26 breaths per minute. Other vital sign was stable. Physical examination identified herpes zoster lesions on the right abdomen. Laboratory results shown blood urea nitrogen of 266 mg/dL, creatinine 13.2 mg/dL, and potassium of 6.9 mmol/L . A month earlier, the level of blood urea nitrogen was 100 mg/dL and creatinine was 7.9 mg/dL, indicating a progressive deterioration in renal function. Given the severity of the patient's condition, hemodialysis was initiated. Over the course of five days, there was a notable improvement in both the patient's clinical condition and level of consciousness.

Association between sarcopenia and new-onset chronic kidney disease among middle-aged and elder adults: findings from the China Health and Retirement Longitudinal Study

BackgroundSarcopenia is a senile syndrome of age-related muscle loss. It is thought to affect the development of chronic kidney disease and has a serious impact on the quality of life of the elder adults. Little is known about the association between sarcopenia and new-onset chronic kidney disease in middle-aged and elder adults. Using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS), we conducted a longitudinal analysis to investigate the association between sarcopenia status and new-onset chronic kidney disease in middle-aged and elder adults in China.MethodsThe study population consisted of 3676 participants aged 45 or older selected from 2011 CHARLS database who had no history of chronic kidney disease at the baseline and completed the follow-up in 2015. A multivariate cox regression model was employed to examine the association between sarcopenia and the incidence of new-onset chronic kidney disease.ResultsFollowed up for 4 years, a total of 873 (22.5%) new cases of chronic kidney disease occurred. Among them, participants diagnosed with sarcopenia (HR1.45; 95% CI 1.15–1.83) were more likely to develop new-onset chronic kidney disease than those without sarcopenia. Similarly, patients with sarcopenia were more likely to develop new-onset chronic kidney disease than those with possible sarcopenia (HR 1.27; 95%CI 1.00-1.60). Subgroup analysis revealed that elder adults aged between 60 and 75 years old (HR 1.666; 95%CI 1.20-22.28), with hypertension (HR 1.57; 95%CI 1.02–2.40), people with sarcopenia had a significantly higher risk of developing new-onset chronic kidney disease than those without sarcopenia (all P < 0.05).ConclusionMiddle-aged and elder adults diagnosed with sarcopenia have a higher risk of developing new-onset chronic kidney disease.

A fatal outcome due to a continuous dosage of gentamicin: a case report

Summary Gentamicin, an aminoglycoside antibiotic, exerts its bactericidal effect primarily through the inhibition of ribosomes in Gram-negative bacteria. It has a concentration-dependent pharmacodynamic effect, making an extended-interval dosage preferable. The total dose is, therefore, usually administered as a single daily dose instead of divided portions two or three times a day. This dosage has shown an excellent efficacy because an appropriate peak concentration is obtained, whilst the risk of nephrotoxicity is reduced as this is correlated with the residual concentration of gentamicin. In the European Medicines Agencies Summary of Products Characteristics, it is stated that deterioration of kidney function could be expected in 1/10 to 1/100 patients treated with gentamicin. We present a 92-year-old female patient with a weight of 39 kg, history of chronic kidney disease (CKD) and chronic heart failure that presented a fatal nephrotoxicity due to a prescription error of gentamicin.

Three-Year Cardiovascular Outcomes of Telmisartan in Patients with Hypertension: An Electronic Health Record-Based Cohort Study.

Telmisartan exhibits superior efficacy in controlling 24-hour blood pressure (BP) compared with other angiotensin receptor blockers (ARBs). However, data on its cardiovascular effects in patients with hypertension are limited. This study aimed to evaluate the cardiovascular outcomes in patients taking telmisartan compared to those taking other ARBs. This multicenter retrospective study used data from the Korea University Medical Center database, built from electronic health records. A total of 19,247 patients taking two or more antihypertensive medications were identified. Patients prescribed telmisartan (telmisartan users) were compared with those prescribed an ARB other than telmisartan (other ARB users). The primary outcome was major adverse cardiac events (MACE), a composite of cardiovascular death, myocardial infarction, stroke, and hospitalizations due to heart failure. The adjusted outcomes were compared using 1:1 propensity score (PS) matching. Overall, 3,437 (17.9%) patients were telmisartan users. These patients were more likely to be younger and male and less likely to have a history of chronic kidney disease, dialysis, or heart failure. In the PS-matched cohort, BP control was similar in both groups; however, telmisartan users exhibited significantly lower visit-to-visit BP variability. The adjusted 3-year MACE rate was similar between telmisartan users (4.6%) and other ARB users (4.7%, log-rank p = 0.75), with comparable safety profiles. In real-world practice, telmisartan showed cardiovascular outcomes similar to those of other ARBs in patients with hypertension taking two or more antihypertensive drugs.

Sodium-Glucose Cotransporter 2 Inhibitors and Nephrolithiasis Risk in Patients With Type 2 Diabetes

Type 2 diabetes (T2D) is associated with an increased risk of kidney stones. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) might lower the risk of nephrolithiasis by altering urine composition. However, no studies have investigated the association between SGLT2i use and nephrolithiasis risk in patients receiving routine care in the US. To investigate the association between SGLT2i use and nephrolithiasis risk in clinical practice. This new-user, active comparator cohort study used data from commercially insured adults (aged ≥18 years) with T2D who initiated treatment with SGLT2is, glucagon-like peptide 1 receptor agonists (GLP-1RAs), or dipeptidyl peptidase 4 inhibitors (DPP4is) between April 1, 2013, and December 31, 2020. The data were analyzed from July 2021 through June 2023. New initiation of an SGLT2i, GLP-1RA, or DPP4i. The primary outcome was nephrolithiasis diagnosed by International Classification of Diseases codes in the inpatient or outpatient setting. New SGLT2i users were 1:1 propensity score matched to new users of a GLP-1RA or DPP4i in pairwise comparisons. Incidence rates, rate differences (RDs), and estimated hazard ratios (HRs) with 95% CIs were calculated. After 1:1 propensity score matching, a total of 716 406 adults with T2D (358 203 pairs) initiating an SGLT2i or a GLP-1RA (mean [SD] age, 61.4 [9.7] years for both groups; 51.4% vs 51.2% female; 48.6% vs 48.5% male) and 662 056 adults (331 028 pairs) initiating an SGLT2i or a DPP4i (mean [SD] age, 61.8 [9.3] vs 61.7 [10.1] years; 47.4% vs 47.3% female; 52.6% vs 52.7% male) were included. Over a median follow-up of 192 (IQR, 88-409) days, the risk of nephrolithiasis was lower in patients initiating an SGLT2i than among those initiating a GLP-1RA (14.9 vs 21.3 events per 1000 person-years; HR, 0.69 [95% CI, 0.67-0.72]; RD, -6.4 [95% CI, -7.1 to -5.7]) or a DPP4i (14.6 vs 19.9 events per 1000 person-years; HR, 0.74 [95% CI, 0.71-0.77]; RD, -5.3 [95% CI, -6.0 to -4.6]). The association between SGLT2i use and nephrolithiasis risk was similar by sex, race and ethnicity, history of chronic kidney disease, and obesity. The magnitude of the risk reduction with SGLT2i use was larger among adults aged younger than 70 years vs aged 70 years or older (HR, 0.85 [95% CI, 0.79-0.91]; RD, -3.46 [95% CI, -4.87 to -2.05] per 1000 person-years; P for interaction <.001). These findings suggest that in adults with T2D, SGLT2i use may lower the risk of nephrolithiasis compared with GLP-1RAs or DPP4is and could help to inform decision-making when prescribing glucose-lowering agents for patients who may be at risk for developing nephrolithiasis.

The application of 5E rehabilitation management mode in the nursing of patients with aortic dissection complicated by obstructive sleep apnea.

This study was designed to explore the effect of 5E rehabilitation mode (encouragement, education, exercise, employment, and evaluation)in patients with aortic dissection (AD) complicated by obstructive sleep apnea (OSA). Patients with Stanford type B AD (TBAD) complicated by OSA were admitted to Guangdong Provincial People's Hospital from January 2019 to December 2020. They were randomly divided into an experimental group and a control group. After discharge, patients in the control group were given routine nursing and follow-up education, whereas patients in the experimental group were given 5E rehabilitation management mode-based nursing and follow-up education. Upon the nursing intervention, the differences in polysomnography (PSG) parameters, medication adherence, quality of life, blood pressure, and heart rate of patients between the two groups were compared. Logistic regression analysis was performed to evaluate the risk factors for the occurrence of adverse aortic events. Atotal of 89 patients were enrolled, 49in the experimental group and 40 in the control group.After the intervention, the control of heart rate, systolic blood pressure, medication adherence, PSG parameters, and quality of life scores in the experimental group were significantly better than those in the control group (P<0.05). The incidence of adverse aortic events including aortic rupture and progressive aortic dilation in the experimental group was significantly lower than that in the control group (P < 0.05). Logistic regression analysis revealed that acute TBAD [odds ratio (OR) = 15.069; 95%confidence interval (CI), 1.738-130.652; P=0.014], history of chronic kidney disease (OR=10.342; 95%CI, 1.056-101.287; P=0.045), and apnea hypopnea index (AHI) ≥ 30 (OR=2.880; 95%CI, 1.081-9.51; P=0.036) were adverse factors affecting adverse aortic events; while 5E rehabilitation management mode (OR=0.063; 95%CI, 0.008-0.513; P=0.010) was a favorable factor for occurrence of adverse aortic events. The findings suggest that continuous nursing based on information carrier 5E rehabilitation management significantly enhanced medication adherence, improved patients' overall quality of life, and decreased the incidence of adverse aortic events in patientsTBAD patients and OSA.

Hyperuricemia-Induced Acute Kidney Injury in the Context of Chronic Kidney Disease: A Case Report

ABSTRACT Hyperuricemia is an independent risk factor for acute kidney injury and chronic kidney disease. Hyperuricemia-induced acute kidney injury most commonly occurs in patients who experience tumor lysis syndrome. Herein, we report an unusual case of hyperu-ricemia-induced acute kidney injury via a crystal-dependent mechanism in a patient with chronic kidney disease. A 30-year-old Asian male patient was transferred to our hospital presenting with acute kidney injury and elevated blood uric acid level. The patient had a 5-year history of gout and 2-year history of chronic kidney disease. The pathological results of renal biopsy supported the diagnosis of focal proliferative immunoglobulin A nephropathy and subacute tubulointerstitial nephritis due to urate crystal deposition. After supportive treatment with prednisone acetate and febuxostat, the patient's proteinuria, serum creatinine, and uric acid levels decreased rapidly in the subsequent 2 months. Urate crystallization-induced acute kidney injury in patients with preexisting chronic kidney disease is unusually detectable in the clinic unless there are timely renal biopsy findings. In this case, the patient's condition improved and his renal function and serum uric acid levels recovered rapidly with prednisone acetate and febuxostat treatment. Early identification and close monitoring of uric acid levels and renal function are highly recommended for patients with chronic kidney disease. Renal biopsies should also be performed in a timely manner to identify the cause and initiate targeted therapy. We also briefly review the pathophysiology of acute kidney injury caused by hyperuricemia.

The study of retinopathies and choroidopathies in hypertensive cats

Systemic hypertension is a cardiovascular disease increasingly present in geriatric cats. Its consequences on the target organs are also particularly on the eye ,at the level of the retina. The afflicted individuals may present lesions of choroidopathy and hypertensive retinopathy. The objectives of the reported study were to evaluate the clinical and ophthalmological findings, the causes of systemic hypertension in these cats and to discuss the visual prognosis of the individuals. This retrospective study was carried out on a number of 14 patients. The selection criteria were represented by cats suffering from hypertensive retinopathy having a systolic blood pressure greater than 160 mmHg and having an ocular lesion: retinal vascular tortuosity, effusion, hemorrhage, retinal detachment or hyphema. Medical records were reviewed for individuals’ reports, the medical history, ophthalmic examination findings, and ocular ultrasound scans. Most cats were referred because they had decreased visual acuity (42.9%), a history of chronic kidney disease or even for hyphema, glaucoma and anisocoria. Auscultatory cardiac abnormalities were diagnosed in half of the individuals. Chronic kidney disease concomitant with systemic arterial hypertension was the most common (n=12), followed by hyperthyroidism (n=1). The four cats with blood pressure monitoring (n=4) after the administration of amlodipine showed a decrease in blood pressure.   

Spontaneous resolution of long-standing choroidal effusion after glaucoma drainage implant surgery without significant visual deterioration : a case report

BackgroundChoroidal effusion is a common complication of glaucoma surgery. Although most cases of choroidal effusions resolve spontaneously with observation or medical management alone as intraocular pressure normalizes, surgical drainage might be needed in severe or persistent cases. Herein, we report a case of spontaneous resolution of long-standing severe choroidal effusion after Ahmed glaucoma valve implantation.Case presentationAn 85-year-old man with uncontrolled primary open-angle glaucoma and medical history of chronic kidney disease underwent uneventful Ahmed glaucoma valve implantation. On postoperative day 8, transient hypotony occurred, and large 360° peripheral choroidal detachments developed. Although the intraocular pressure increased to normal levels on postoperative day 15, choroidal effusion did not resolve. Fundus examination over 8 months showed that the large choroidal effusion persisted despite a well-controlled intraocular pressure. Laboratory test performed at preoperatively and follow-up period revealed persistently elevated potassium and creatinine levels. On postoperative 9 months, the lesion resolved spontaneously without any surgical intervention. We found that the patient’s creatinine level was normalized, pre-existing hyperkalemia was corrected, and accordingly his general condition was improved.ConclusionsConsidering the underlying medical condition may be helpful in patients with persistent choroidal effusion of an unclear etiology following glaucoma filtering surgery.

Abstract 17431: A Rare Cause of Constrictive Pericarditis in a Case of Adult T-cell Lymphoma

Introduction: Adult T-cell lymphoma (ATCL) is a rare T cell lymphoproliferative malignancy that typically presents with lymphadenopathy, hepatosplenomegaly, lytic lesions, hypercalcemia or skin lesions. Cardiac involvement is rare. Case presentation: A 66-year-old male with a history of chronic kidney disease and hypertension presented with dyspnea. Transthoracic echocardiography revealed a moderate pericardial effusion and a left ventricular ejection fraction of 45%. Further workup with MRI and transesophageal echocardiography found extensive circumferential pericardial thickening with enhancement and extensive mediastinal and hilar lymphadenopathy along with a mass along the course of the superior vena cava with extension of disease into the right atrium along the right atrial wall (Figure 1). Endobronchial biopsy of the mediastinal lymph nodes was positive for T-cell lymphoma. Chemotherapy was initiated; however, the patient decided to focus on comfort measures only. Discussion: Cardiac involvement in ATCL is rare and usually detected in postmortem autopsies. Incidence is unknown, and experience is limited to case reports. The largest case series to date found 16 patients who had antemortem diagnosis of symptomatic cardiac involvement of ATCL. The characteristic features included infiltration of the myocardium, pericardial effusion, valvular lesions, and masses in the atrium, similar to what was seen in our patient. To our knowledge, there have been no reported cases of ATCL causing constriction. Prognosis is poor, with median survival of 5 months after development of symptoms (n = 15, range 0-120 months). Conclusion: The incidence of cardiac ATCL is unknown, but it is an extremely rare occurrence. It can present with a wide variety of cardiac involvement, including constriction. The prognosis of cardiac ATCL remains poor.

Safety of Direct Oral Anticoagulants for Gastrointestinal Hemorrhage in Patients With Nonvalvular Atrial Fibrillation: A Systematic Review and Meta-analysis of Real-world Studies.

Since the introduction of Direct Oral Anticoagulants (DOACs), "real-world" studies have investigated their safety profile on gastrointestinal hemorrhage (GIH) when used by patients with Non-Valvular Atrial Fibrillation. We performed a systematic review and meta-analysis to compile and summarize this data after Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Medline and Embase were systematically searched until April 2021. Observational studies that met predefined inclusion criteria were included and hazard ratios (HRs) with 95% CI were extracted. Subgroup analyses based on DOAC doses, history of chronic kidney disease, stroke, prior exposure to VKA (vitamin K antagonist), age, gender, geographic location of population samples, as well as Leave-One-Out and Low/Moderate Risk of Bias sensitivity analyses were performed. A random effects model was used. A total of 46 studies were included. Apixaban was associated with a reduced risk of GIH compared with Dabigatran (HR: 0.67, 95% CI, 0.56 to 0.81, I2 : 53.28%), Rivaroxaban (HR: 0.56, 95% CI, 0.44 to 0.70, I2 : 79.17%), and VKA (HR: 0.68, 95% CI, 0.60 to 0.78, I2 : 71.93%). Rivaroxaban was associated with increased GIH risk compared with Dabigatran (HR: 1.19, 95% CI, 1.02 to 1.40, I2 : 72.96%) and VKA (HR: 1.16, 95% CI, 1.05 to 1.27, I2 : 81.95%). Dabigatran was associated with similar GIH risk compared with VKA (HR: 1.11, 95% CI, 0.98 to 1.26, I2 : 87.28%). Our study shows that Apixaban was associated with a reduction in GIH risk compared with Dabigatran, Rivaroxaban and VKA, whereas Rivaroxaban was associated with an increase in GIH risk compared with both Dabigatran and VKA.

Outcomes of COVID-19 in multiple myeloma patients treated with daratumumab.

Despite concerns about an increased risk of adverse outcomes following coronavirus disease (COVID-19) in multiple myeloma patients treated with anti-CD38 Abs, the impact of COVID-19 on this group of patients is unclear. We tried to evaluate the clinical outcomes of these patients. We collected data from 1036 patients with multiple myeloma and enrolled 509 cases with COVID-19. We divided enrolled patients into daratumumab or nondaratumumab cohorts based on whether they had received daratumumab-based treatment within 6 months of COVID-19 infection. We applied a propensity score matching method to reduce the bias of baseline characteristics, and then compared the incidence of adverse outcomes between these two cohorts. A total of 117 patients were enrolled in the daratumumab cohort, and 392 patients in the nondaratumumab cohort. After propensity score matching, 204 patients were matched. The proportions of patients who developed COVID-19 pneumonia (59.8% vs. 34.3%, p < 0.001), were hospitalized (33.3% vs. 11.8%, p < 0.001) and developed severe disease (23.5% vs. 6.9%, p = 0.001) were higher in the matched daratumumab cohort. By multivariate analysis, daratumumab exposure was an independent risk factor for severe disease. An ECOG performance status >2 and history of chronic kidney disease were independent risk factors for COVID-19-related mortality among patients who received daratumumab-based therapy. This study suggested that multiple myeloma patients exposed to daratumumab were at a higher risk of adverse outcomes from COVID-19.

Determinants and outcomes of acute pancreatitis in patients hospitalized for COVID-19: Early pandemic experience

ObjectivesTo examine the predictors and outcomes associated with the development of acute pancreatitis (AP) in patients hospitalized with Coronavirus Disease 2019 (COVID-19). MethodsThis is an observational analysis of the 2020 National Inpatient Sample Database. The study includes adult patients who were admitted with a confirmed diagnosis of COVID-19 and stratifies them based on the presence or absence of AP during their hospitalization. Predictors of AP development between the two groups and differences in outcomes are examined. Multivariate logistic regression analysis using Stata/BE 17.0 is conducted, with adjustments made for age, sex, race, and Charlson Comorbidity Index (CCI). Statistical significance is determined at a p-value of <0.05. ResultsSignificant factors associated with an increased risk of AP in COVID-19 patients include Hispanic ethnicity, higher Charlson Comorbidity Index (CCI) score, residence in states located in the southern region, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use. COVID-19 patients who developed AP were also found to be at higher risk of adverse outcomes, including mortality, acute coronary syndrome, acute kidney injury, sepsis, septic shock, in-hospital cardiac arrest, invasive mechanical ventilation, upper gastrointestinal bleeding, prolonged length of stay, and increased healthcare cost. ConclusionsIn hospitalized patients with COVID-19, the presence of AP is associated with increased mortality and morbidity. Risk factors for developing AP in this population include Hispanic ethnicity, residence in the southern region, higher Charlson Comorbidity Index (CCI) score, history of chronic kidney disease, chronic liver disease, malnutrition, portal hypertension, and alcohol use.

Incidence and predictors of recurrent acute coronary syndrome among adult patients with acute coronary syndrome in West Amhara, Ethiopia: a multicenter retrospective follow-up study.

Acute coronary syndrome (ACS) is the most common cause of morbidity and mortality in patients with coronary heart disease. Furthermore, the recurrence of this problem has significant adverse outcomes. However, there is insufficient information pertaining to this problem in Ethiopia; hence, this study aims to assess the incidence rate and identify the predictors of ACS recurrence in the West Amhara region. A retrospective follow-up study was conducted among 469 patients diagnosed with primary ACS. Data from the patient chart were collected using a pre-tested structured data extraction tool. The study employed the Weibull regression analysis model, and the effect size was measured using an adjusted hazard ratio (HR) with a 95% confidence interval (CI). The statistical significance of the findings was established based on a p-value <0.05. A total of 429 patients were included in the final analysis [average age, 60 ± 13.9 years; and 245 (57.1%) men]. A total of 53 patients (12.35%; 95% CI: 9.55%-15.83%) experienced recurrent ACS. The overall risk time was found to be 93,914 days (3,130.47 months), and the recurrence rate was 17/1,000 patients/month. The identified predictors were the typical symptoms of ACS such as syncope (HR: 3.54, p = 0.013), fatigue (HR: 5.23, p < 0.001), history of chronic kidney disease (HR: 8.22, p < 0.001), left ventricular ejection fraction of <40% (HR: 2.34, p = 0.009), not taking in-hospital treatments [aspirin (HR: 9.22, p < 0.001), clopidogrel (HR: 4.11, p = 0.001), statins (HR: 2.74, p = 0.012)], and medication at discharge [statins (HR: 4.56, p < 0.001)]. This study found a higher incidence rate of recurrent ACS. Hence, the implementation of guideline-recommended anti-ischemic treatment should be strengthened.

FRI697 Severe Hypocalcemia Due To Idiopathic Hypoparathyroidism In An Elderly Female

Abstract Disclosure: K.A. Chopra: None. Most cases of acquired hypoparathyroidism in adulthood occur after neck surgery or radiation. However, idiopathic cases, although rare, do occur in elderly patients and should be a diagnosis of exclusion after thorough investigation. 76-year-old female with a history of chronic kidney disease, anemia of chronic disease, and hypertension presented with fatigue. Labs showed calcium (Ca) 5.7(RR 8.4-10.2 mg/dL), albumin 3.5(RR 3.5-5 g/dL), magnesium 2(RR 1.6-2.5 mg/dL), phosphorus 7.8(RR 2.5-4.4 mg/dL), parathyroid hormone 9(RR 15-75 pg/mL), 25-hydroxyvitamin D 32(RR 12-99 ng/mL). Patient denied history of neck surgery or radiation. Patient denied nephrolithiasis, perioral numbness, paresthesias, family history of hypoparathyroidism. Physical exam notable for positive Chvostek sign. Neck ultrasound unremarkable, no evidence of infiltrative disease. Urine Ca was low at 6 mg/24 hour(RR 100-300 mg/24hr). ACE level 10 nmol/ml/min(RR&amp;lt;40 nmol/ml/min) and 1,25 dihydroxyvitamin D level 12(RR 18-78 pg/mL) making sarcoidosis or granulomatous disease unlikely. HIV screen negative and interferon gamma response to mycobacterium tuberculosis antigens was not detected. Ferritin elevated at 300(RR 12-150 ng/mL) but transferrin saturation was 15%(RR 15-55%), not consistent with hemochromatosis. Antiparathyroid antibodies were negative. Patient denied mucocutaneous candidiasis, however testing for underlying autoimmune polyglandular syndrome type 1 (APS type 1) and adrenal insufficiency was completed with cosyntropin stimulation test. Patient had normal response to cosyntropin with baseline cortisol 20.1 (RR 6-18.4 ug/dL) and ACTH 37.7(RR&amp;lt;52 pg/mL), 30 minute cortisol 27(RR 6-18.4 ug/dL) and 60 minute cortisol 37(RR 6-18.4 ug/dL). Patient was treated with Ca gluconate infusion (100 ml of 10% Ca gluconate in 1000 mL of normal saline) at 30 ml/hr and Ca level gradually improved. Once Ca level was greater than 8.0(RR 8.4-10.2 mg/dL), Ca drip was discontinued. Due to patient’s lack of prior neck surgery history, lack of evidence of infiltrative conditions, negative antiparathyroid antibodies, normal adrenal function (unlikely APS type 1), lack of family history, and low urine Ca (unlikely activating mutation of Ca sensing receptor), patient’s hypoparathyroidism was considered idiopathic. Patient was discharged on oral Ca carbonate, Ca acetate, and calcitriol tablets. On follow up, patient had Ca 8.5(RR 8.4-10.2 mg/dL) with symptom improvement. Although hypocalcemia is commonly encountered, it is rare to see severe hypocalcemia in an elderly patient due to hypoparathyroidism without a history of neck surgery or radiation. Therefore, it is vitally important to conduct a thorough investigation to rule out underlying causes before diagnosing idiopathic hypoparathyroidism as highlighted in our case to guide future treatment and optimize patient health. Presentation: Friday, June 16, 2023

Unusual case of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis

Metformin-associated lactic acidosis (MALA) and euglycaemic diabetic ketoacidosis (EKA) are both life-threatening endocrine emergencies. MALA is a well-documented complication of anti-glycaemic therapy in diabetics while EKA is an increasingly recognized disease entity with the advent of use of sodium-glucose co-transporter-2 (SGLT-2) inhibitors. However, the occurrence of concurrent metformin-associated lactic acidosis and euglycaemic ketoacidosis (MALKA) is uncommon and rarely reported in the literature. We report an unusual case of MALKA, in a 74-year-old gentleman with no previous history of chronic kidney disease and SGLT-2 inhibitor use, who presented with altered mental status, acute renal failure and profound high anion-gap metabolic acidosis (HAGMA) with lactaemia, ketonaemia and normoglycaemia (pH 6.965, bicarbonate 3.1, creatinine 522, glucose 6.6, lactate 17.5, ketones &gt;8). The patient was initiated on intravenous insulin infusion with dextrose-containing drip and continuous renal replacement therapy (CRRT) in the intensive care unit (ICU). The patient had a prolonged hospital stay but was eventually discharged with a normalised renal function without need for long-term dialysis. The parallel occurrence of MALA and EKA suggest a metformin-associated inhibition of gluconeogenesis. This case highlights the importance of early recognition and investigation of concurrent diabetic ketoacidosis in the presence of MALA and vice versa as MALKA benefits from both prompt institution of parenteral glucose therapy and insulin infusion and consideration of initiation of haemodialysis.

Sagliker syndrome: a rare manifestation of uncontrolled secondary hyperparathyroidism in chronic renal failure – a comprehensive case report

We present a case of a 22-year-old female patient with a history of chronic kidney disease (CKD) and secondary hyperparathyroidism, complicated by pathological fractures of both femurs and subsequent joint replacements. The patient exhibited craniofacial deformities with lytic lesions in the maxilla and mandible, airway abnormalities and cardiovascular adaptations due to hypertensive heart disease. A subtotal parathyroidectomy was performed, a combination of medications and nerve blocks was used for anesthesia induction and intubation, with subsequent bronchospasm and desaturation necessitating intervention. The surgical procedure was successful, with no further intraoperative issues.

1178 Management of SFA Disease Delineated by Disease Type – a Multicentre European Analysis

Abstract Aim The study aimed to assess how SFA disease is treated in patients with critical limb ischaemia and patients with claudication. Method Data was collected from the RandomSTOP European registry database. Patients were categorised into those with critical limb ischaemic (CLTI) and those with claudication (nCLTI). Patient demographics were stratified by sex, Rutherford classification, lesion length, smoking status, history of diabetes, history of chronic kidney disease, history of hypertension and pre-admission medications. Procedural variables were stratified by type of treatment. Post-operative complications including perforation, dissection, embolization and in hospital reintervention were compared. Chi-squared analyses were used to compare the two groups. Results Data on 1,567 patients who underwent surgery for SFA disease was analysed. 64% (n = 1,009) of patients had CLTI, and 36% (n = 558) had nCLTI. Those with CLTI were statistically significantly more likely to be older (p&amp;lt;0.0001****) and female (p&amp;lt;0.0001****). Those with CLTI were more likely to have CKD (p&amp;lt;0.0001****) and diabetes (p = 0.002**) Those with nCLTI were statistically significantly more likely to be on a statin and antiplatelet (p&amp;lt;0.0001****). Most patients underwent percutaneous transluminal angioplasty (PTA), (75% of CLTI and 84% of nCLTI) with some form of vessel preparation (the most common being Drug Coated Balooning; 36% CLTI and 64% nCLTI). Those with CLTI had greater incidence of post-operative complications including perforation (p = 0.002**), embolization (p = 0.0004***) and secondary intervention (p = 0.016). Conclusions This is one of the largest contemporary series on the real-world management of SFA disease. Vessel preparation and PTA appear to be the mainstay of managing complex SFA disease.