Including Serum Creatinine Levels Research Articles

Metabolic Characterization of Deceased Donor Kidneys Undergoing Hypothermic Machine Perfusion Before Transplantation Using 13C-enriched Glucose.

The provision of a metabolic substrate is one mechanism by which hypothermic machine perfusion (HMP) of kidneys provides clinical benefit. This study aimed to describe de novo metabolism in ex vivo human kidneys undergoing HMP before transplantation using 13C-labeled glucose as a metabolic tracer. Cadaveric human kidneys were perfused with modified clinical-grade perfusion fluid (kidney perfusion solution [KPS-1], Organ Recovery Systems), in which glucose was uniformly enriched with the stable isotope 13C ([U-13C] glucose). The sampled perfusion fluid was analyzed using a blood gas analyzer, and metabolic profiling was performed using 1-dimensional and 2-dimensional nuclear magnetic resonance spectroscopy and mass spectrometry. Functional outcome measures included serum creatinine levels and the development of delayed graft function. Fourteen kidneys were perfused with the modified KPS-1 and successfully transplanted. The mean duration of HMP was 8.7 h. There was a sustained increase in the conversion of glucose into de novo glycolytic end products, such as lactate, in donor kidneys during HMP. There was no significant association between functional outcomes and metabolism during the HMP. De novo anaerobic metabolism was indicated by continuing lactate production, as indicated by increasing concentrations of universally 13C-labeled lactate ([U-13C] lactate) in perfusion fluid from all kidneys. This was more evident in donation after circulatory death donor kidneys. Our study is the first to use [U-13C] glucose to describe the metabolism during HMP. The consequences of an initial warm ischemic insult on circulatory death in donor kidneys continue during the preservation period.

Влияние чрескожного коронарного вмешательства на функцию почек у больных ИБС

To investigate the impact of PCI on renal function in IHD patients and identify risk factors for CIN development. Background. Contrast-induced nephropathy (CIN) is a common complication among patients with ischemic heart disease (IHD) undergoing percutaneous coronary intervention (PCI). Understanding the pathogenesis, risk factors, and preventive measures of CIN is essential for reducing morbidity and mortality. Materials and methods. An analysis was conducted on patients with IHD who underwent PCI with contrast media administration. Renal function indicators, including serum creatinine levels and glomerular filtration rate, were assessed pre- and post-procedure. Clinical manifestations, CIN incidence, and associated risk factors were evaluated. Results.The incidence of CIN varied based on baseline renal function and comorbidities. Key risk factors included elevated baseline serum creatinine, diabetes mellitus, and advanced age. Hydration therapy was effective in reducing the incidence of nephropathy. Conclusion. PCI increases the risk of CIN in IHD patients, particularly in those with predisposing risk factors. Comprehensive renal function assessment and preventive measures are recommended prior to the procedure to minimize risk.

Unlocking Precision Medicine for Prognosis of Chronic Kidney Disease Using Machine Learning.

Chronic kidney disease (CKD) is a significant global health challenge that requires timely detection and accurate prognosis for effective treatment and management. The application of machine learning (ML) algorithms for CKD detection and prediction holds promising potential for improving patient outcomes. By incorporating key features which contribute to CKD, these algorithms enhance our ability to identify high-risk individuals and initiate timely interventions. This research highlights the importance of leveraging machine learning techniques to augment existing medical knowledge and improve the identification and management of kidney disease. In this paper, we explore the utilization of diverse ML algorithms, including gradient boost (GB), decision tree (DT), K-nearest neighbor (KNN), random forest (RF), histogram boost (HB), and XGBoost (XGB) to detect and predict chronic kidney disease (CKD). The aim is to improve early detection and prognosis, enhancing patient outcomes and reducing the burden on healthcare systems. We evaluated the performance of the ML algorithms using key metrics like accuracy, precision, recall, and F1 score. Additionally, we conducted feature significance analysis to identify the most influential characteristics in the detection and prediction of kidney disease. The dataset used for training and evaluation contained various clinical and demographic attributes of patients, including serum creatinine level, blood pressure, and age, among others. The proficiency analysis of the ML algorithms revealed consistent predictors across all models, with serum creatinine level, blood pressure, and age emerging as particularly effective in identifying individuals at risk of kidney disease. These findings align with established medical knowledge and emphasize the pivotal role of these attributes in early detection and prognosis. In conclusion, our study demonstrates the effectiveness of diverse machine learning algorithms in detecting and predicting kidney disease. The identification of influential predictors, such as serum creatinine level, blood pressure, and age, underscores their significance in early detection and prognosis. By leveraging machine learning techniques, we can enhance the accuracy and efficiency of kidney disease diagnosis and treatment, ultimately improving patient outcomes and healthcare system effectiveness.

MO292: Clinical Characteristics, Management and Outcomes of Critically ill COVID-19 Patients Undergoing CRRT: Comparison Between the First Two Pandemic Waves

BACKGROUND AND AIMSAcute kidney injury (AKI) is a common complication of coronavirus disease-19 (COVID-19), which, particularly in critically ill patients requiring continuous renal replacement therapy (CRRT), is associated with an elevated mortality risk [1, 2]. However, knowledge about COVID-19 pathogenesis and management is evolving, and clinical practice is changing rapidly. Here, we evaluated if this process had an impact on the management and outcome of AKI patients.METHODSWe performed a retrospective observational study on critically ill adult COVID-19 patients who received CRRT in the intensive care unit (ICU) during the first two pandemic waves before the availability of COVID-19 vaccines: the first one from March to August 2020 (first) and the second one (second) from September to December 2020.RESULTSOverall, we considered 63 patients, aged 65 (60–69) years, 76.2% males. The main comorbidities were diabetes (DM), cardiovascular disease (CVD) and chronic kidney disease (CKD). Among them, 28 (44%) were in the first group and 35 (66%) in the second group. There were no significant differences in general characteristics, such as in comorbidities, except for a higher prevalence of CVD in the first group (Fig. 1). Lab examinations at ICU admission, including serum creatinine level (sCr), were not different between the two groups. While all patients required respiratory support, non-invasive ventilation was more prevalent in the second wave. Notably, during this period, decapneization combined with CRRT was introduced. Regarding drugs, we found that in the second group, hydroxychloroquine was abandoned, tocilizumab use was reduced and heparin administration significantly increased. The AKI time course was similar between the patients of the two waves (Fig. 2). There were no significant differences in CRRT techniques. However, in the second, the use of additional CRRT-devices, in particular adsorption-based filters, significantly increased. In most cases, citrate anticoagulation was used in both groups. Looking at the outcomes, we found no significant difference between the two waves. Indeed, 17 (60.2%) and 22 (62.8%) patients died in the ICU in the first and second groups, respectively. The length of ICU hospitalization, days on CRRT, invasive ventilation and DM were significantly related to overall mortality; time of ICU hospitalization was the only remaining significant at multivariate Cox regression. Overall, 21 (33%) patients survived hospitalization. At the 6 months after the discharge, 3 of them died, 3 were on HD and 15 were dialysis-free, even if 6 of them presented CKD.FIGURE 1:Clinical characteristics and ICU management of critically ill COVID-19 patients undergoing CRRT.FIGURE 2:Kidney function and management of critically ill COVID-19 patients undergoing CRRT.CONCLUSIONOur data confirm the high complexity and mortality of COVID-19 patients undergoing CRRT. Comparing the first two pandemic waves, we found that the patients also presented similar characteristics in terms of renal function and AKI time course. Regarding treatments, we observed some significant modifications in the management of ventilation, drug administration and dialysis membranes, mainly because of the results of ongoing clinical trials. However, these changes did not impact patients’ outcomes.These data support the view that only game-change strategies, such as vaccination or infection-specific drugs, may impact the presentation and outcome of COVID-19 patients undergoing CRRT.Finally, patients surviving this condition deserve special attention in the follow-up.

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction.

BackgroundRotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.ObjectivesThis study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI.MethodsAll possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison.ResultsA total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease.ConclusionRA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.

Effects of LDL apheresis on proteinuria in patients with diabetes mellitus, severe proteinuria, and dyslipidemia

Patients with diabetes mellitus and severe proteinuria present with poor renal prognoses, despite improvements in diabetes and kidney disease therapies. In this study, we designed a low-density lipoprotein (LDL)-cholesterol apheresis treatment for patients with diabetic nephropathy (DN)/diabetic kidney disease and severe proteinuria. This was a multicenter prospective LICENSE study to confirm the impact of LDL apheresis on proteinuria that exhibited hyporesponsiveness to treatment. In addition, we sought to determine the efficacy and safety of LDL apheresis by comparing the outcomes to those of historical controls in patients with diabetes, refractory hypercholesterolemia, and severe proteinuria. This was a prospective, multicenter study, including 40 patients with diabetes, severe proteinuria, and dyslipidemia. LDL apheresis was performed 6-12 times over a 12-week period. The primary endpoint was the proportion of patients with a decrease in proteinuria excretion of at least 30% in the 6months after starting therapy. The secondary endpoints included serum creatinine levels and laboratory variables, which were evaluated 4, 6, 12, 18, and 24months after therapy initiation. LDL apheresis was performed on 40 registered patients with diabetes. The proportion of cases in which proteinuria decreased by 30% or more after 6months of LDL apheresis was 25%, which was similar to that of historical controls. The overall survival and end-stage kidney disease-free survival rates were significantly higher in the LICENSE group compared to those in historical controls. Our results suggest that LDL apheresis may be effective and safe for patients with diabetes, proteinuria, and dyslipidemia. Trial registration number: jRCTs042180076.

Development and validation of prediction equations for the assessment of muscle or fat mass using anthropometric measurements, serum creatinine level, and lifestyle factors among Korean adults.

BACKGROUND/OBJECTIVESThe measurement of body composition, including muscle and fat mass, remains challenging in large epidemiological studies due to time constraint and cost when using accurate modalities. Therefore, this study aimed to develop and validate prediction equations according to sex to measure lean body mass (LBM), appendicular skeletal muscle mass (ASM), and body fat mass (BFM) using anthropometric measurement, serum creatinine level, and lifestyle factors as independent variables and dual-energy X-ray absorptiometry as the reference method.SUBJECTS/METHODSA sample of the Korean general adult population (men: 7,599; women: 10,009) from the Korean National Health and Nutrition Examination Survey 2008–2011 was included in this study. The participants were divided into the derivation and validation groups via a random number generator (with a ratio of 70:30). The prediction equations were developed using a series of multivariable linear regressions and validated using the Bland–Altman plot and intraclass correlation coefficient (ICC).RESULTSThe initial and practical equations that included age, height, weight, and waist circumference had a different predictive ability for LBM (men: R2 = 0.85, standard error of estimate [SEE] = 2.7 kg; women: R2 = 0.78, SEE = 2.2 kg), ASM (men: R2 = 0.81, SEE = 1.6 kg; women: R2 = 0.71, SEE = 1.2 kg), and BFM (men: R2 = 0.74, SEE = 2.7 kg; women: R2 = 0.83, SEE = 2.2 kg) according to sex. Compared with the first prediction equation, the addition of other factors, including serum creatinine level, physical activity, smoking status, and alcohol use, resulted in an R2 that is higher by 0.01 and SEE that is lower by 0.1.CONCLUSIONSAll equations had low bias, moderate agreement based on the Bland–Altman plot, and high ICC, and this result showed that these equations can be further applied to other epidemiologic studies.

AB0920 APPLICATION OF THE EULAR 2016 GUIDELINES FOR URATE-LOWERING THERAPY IN CLINICAL PRACTICE (DATA OF A SIX-MONTH PROSPECTIVE STUDY)

Background:The EULAR 2016 guidelines on gout management provide for a consecutive regimen of urate-lowering medications; however, the possibility of reaching the target uric acid level when using the regimen has not been studied in clinical practice.Objectives:To assess the possibility of reaching the target uric acid level when following the EULAR 2016 guidelines on gout management with use of different xanthine oxidase inhibitors available in Russia.Methods:This monocentric prospective study included 83 gout patients (79 (95%) male and 4 (5%) female patients) with the mean age of 51.3±10.9 years old. The inclusion criterion was indications for urate-lowering therapy in accordance with the EULAR 2016 guidelines. The exclusion criteria were the following: absolute contraindications to all of the study drugs, GFR &lt;30ml/min/1.73m2, and NYHA class III-IV heart failure.At urate-lowering therapy initiation, the patients were prescribed allopurinol with the starting dose of 100mg/day; the dose was titrated until the target uric acid level was reached (maximum up to 900mg/day), and in the patients with GFR between 30 and 60ml/min/1.73m2 – up to 300mg/day. In case of insufficient efficacy of allopurinol (unachieved target uric acid level of &lt;360µmol/L, for the patients with severe gout of &lt;300µmol/L) or development of adverse reactions, allopurinol was replaced with febuxostat with the starting dose of 80mg/day and dose titration up to 120mg/day if necessary. The laboratory tests included serum creatinine level, uric acid level, AST, ALT, creatine phosphokinase, glucose; clinical blood test. The following parameters were assessed: possibility of reaching the target uric acid level when following the suggested regimen, and frequency of development of adverse reactions when using allopurinol and febuxostat.Results:37 (45%) patients had the target uric acid level of &lt;360µmol/L and 46 (55%) pts – of &lt;300µmol/L. The recommended therapy regimen allowed 77 (93%) patients under study to reach their target uric acid level.The target uric acid level was achieved by 44 (53%) out of 79 patients on allopurinol, of whom 36 (82%) received 100-600mg/day, and 8 (18%) – 700-900mg/day. Of the patients with GFR of &gt;60ml/min/1.73m2, 32 (73%) patients achieved their target uric acid level and of those with GFR &lt;60ml/min/1.73m2 – so did 12 (27%).Then the patients on allopurinol with unachieved target uric acid level were prescribed febuxostat (in 30 (77%) cases because of inefficacy of the allopurinol therapy, in 9 (33%) patients because of their development of adverse reactions where 5 pts had a more than doubled level of transaminase (ALT, AST), 2 pts had skin itch and 2 pts had hives).In total, 39 patients received febuxostat, of whom 4 pts were with initial intolerance for allopurinol in past history, and 35 pts after therapy with maximum dose of allopurinol. A febuxostat dose of 80mg/day was associated with achievement of the target uric acid level in 14 (42%) patients and that of 120mg/day – in 19 (58%) patients, therefore, total 33 (85%) patients reached their target uric acid level. Four patients on febuxostat developed adverse reactions: 3 patients had a more than doubled serum transaminase level (ALT, AST) and 1 patient had hives. Also, an insignificant increase in the mean GFR was registered from 73±21.4ml/min/1.73m2 to 78.4±22.5ml/min/1.73m2 which did not differ between the two drugs.Conclusion:The recommended regimen of xanthine oxidase inhibitors in their maximal doses secures reaching the target uric acid level in 93% patients. In 47% patients, allopurinol in maximal doses (up to 900mg/day) does not significantly increase the possibility of reaching the target uric acid level, even though it demonstrates high tolerance.Disclosure of Interests:Maria Chikina: None declared, Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium, Olga Sheliabina: None declared

AB0921 COMPARISON OF EFFICACY AND SAFETY OF DIFFERENT ANTI-INFLAMMATORY DRUGS AT INITIATION OF URATE-LOWERING THERAPY IN PATIENTS WITH GOUT (PRELIMINARY DATA)

Background:NSAIDs, colchicine and glucocorticoids are used for prevention of acute arthritis in gout patients, yet there is little data on their comparative efficacy.Objectives:Comparison of efficacy and safety of different anti-inflammatory drugs used for prevention of acute arthritis at initiation of urate-lowering therapy in gout patients.Methods:This monocentric prospective study included 79 gout patients (75 (94.9%) male and 4 (5.1%) female patients) with the mean age of 51.3±10.9 years old. The inclusion criteria were the following: established gout (ACR/EULAR 2015 criteria), aged 18-80, serum uric acid level &gt;360µmol/L, absence of urate-lowering therapy at baseline and at least one gout flare within past three months. The exclusion criteria were: absolute contraindications to all of the study drugs, GFR &lt;30ml/min/1.73m2.All of the patients were prescribed urate-lowering therapy (allopurinol or febuxostat), the dose was titrated until the target serum uric-acid level (&lt;360µmol/L) was achieved. Simultaneously, preventive anti-inflammatory therapy was initiated and the drug for each patient was chosen individually: colchicine 0.5mg/day or any NSAID in minimal anti-inflammatory dose or prednisolone 7.5mg/day. The analysis of the data included 3-month comparative evaluation of the efficacy of the preventive therapy against the following parameters: frequency of gout flare and duration thereof, VAS pain intensity of flare. The laboratory tests included serum creatinine level, uric acid level, AST, ALT, creatine phosphokinase, glucose; clinical blood test before, two weeks and three months after the initiation of the therapy.Results:NSAIDs were received by 14 (17.7%) patients, colchicine by 56 (70.9%) and glucocorticoids by 9 (11.4%) patients. There were no differences initially in age, GFR or lab test values.Three months later, the gout flares frequency median lowered to 1 [0;2] flare (p&lt;0.01). The frequency of gout flares did not depend on the chosen drug and was 1 [0;1] for NSAIDs, 1 [0;2] for colchicine and 1 [1;2] for glucocorticoids.40 (50.6%) patients out of 79 did not have a single flare. The patients who received NSAIDs (57.1%) and colchicine (42.9%) experienced no gout flares more often than those who received glucocorticoids (37.5%), but the differences were not significant.However, the VAS pain intensity of gout flares in the patients who received NSAIDs (30.7±12.9mm) was lower than in those who received colchicine (42.1±12.3mm) and glucocorticoids (42.2±8.4mm) (p&lt;0.05 for both).The duration of gout flares on different drugs was not significantly different and was on average 3 [1.5;4] days for the patients on NSAIDs, 5 [3;7] days for those on colchicine and 5 [4;6] days for the patients who received glucocorticoids.The NSAID therapy was discontinued in two cases, in which the serum transaminase levels (AST, ALT) more than doubled; the colchicine therapy - because of development of diarrhea in two patients and of myopathy in one.Conclusion:Efficacy of and tolerance to a three-month course of preventive therapy with NSAIDs and glucocorticoids in gout patients are comparable to that with colchicine. In case of development of gouty arthritis, preventive use of NSAIDs is characterized by lower pain intensity than as against colchicine or glucocorticoids.Disclosure of Interests:Maria Chikina: None declared, Maxim Elisеev Speakers bureau: Novartis, Menarini Group, Alium

Percutaneous transluminal angioplasty alone versus stent placement for the treatment of transplant renal artery stenosis

The purposes of this retrospective study were to assess the efficacy of endovascular techniques for the treatment of transplant renal artery stenosis (TRAS) by analyzing technical and clinical success and to compare the results of percutaneous transluminal angioplasty (PTA) alone to those of stenting. A retrospective analysis was conducted on 31 patients who underwent endovascular treatment for TRAS between January 2012 and December 2017. There were 23 men and 8 women with a mean age of 60.5±14 (SD) years (range: 24-81 years). Ten patients (10/31; 32%; 8 men, 2 women; median age, 63 years) were treated with PTA alone and 21/31 (68%; 15 men, 6 women; median age, 65 years) with metallic stent placement. Several variables including serum creatinine level, glomerular filtration rate, arterial blood pressure value, antihypertensive medication obtained before and after treatment were compared. Technical success was assessed for each procedure. Clinical success was defined as a 15% drop in serum creatinine level, a decrease greater than 15% in mean blood pressure values or a decrease greater than 10% in mean blood pressure values with a reduction in the number of antihypertensive drugs needed for hypertension control. Technical success was obtained in all patients [31/31; 100%; 95% confidence interval (CI): 89-100%] and clinical success in 27/31 patients (87%; 95%CI: 71-95%). Four patients (4/31; 13%; 95%CI: 5-29%) underwent repeat endovascular intervention. Mean serum creatinine level and mean arterial blood pressure values were significantly lower after treatment (177.4 and 93.8μmol/l, respectively) compared to before treatment (319.4 and 106.7μmol/l, respectively) in the stent group but not in the group treated with PTA alone (P=0.0012 and P=0.002, respectively). The endovascular approach is safe and effective in the management of TRAS and stenting, depending on the morphology of the stenosis, should be the treatment of choice when possible.

Association of Abnormal Renal Profiles and Proliferative Diabetic Retinopathy and Diabetic Macular Edema in an Asian Population With Type 2 Diabetes

The comorbidity of chronic kidney disease and diabetic retinopathy (DR) is well known. However, to our knowledge, no cohort study has demonstrated the effect of chronic kidney disease on the development or progression of DR. To investigate the association of chronic kidney disease with the development of DR and diabetic macular edema (DME) in type 2 diabetes. This 8-year prospective cohort study that was conducted in 2 medical centers in Taiwan included 2135 patients with type 2 diabetes. The baseline and mean follow-up renal profiles including serum creatinine level, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio (ACR). Diabetic retinopathy and DME were detected with nonmydriatic fundus photography. Cox regression analyses was used to evaluate the hazard ratios (HRs) for the renal profiles of new-onset DR, proliferative DR, and DME. The mean (SD) age of the study participants was 63.4 (11.9) years and 1025 (48%) were women. A higher serum creatinine level (HR of 2.358 for an increase of 1 mg/dL [to convert to micromoles per liter, multiply by 76.25]; 95% CI, 1.901-2.924; P < .001), an estimated glomerular filtration rate of less than 60 mL/min/1.73m2 (40-60: HR, 2.235; 95% CI, 1.351-4.035; P = .002; 30-45: HR, 2.625; 95% CI, 1.436-4.798; P = .002; <30: HR, 5.488; 95% CI, 2.739-10.993; P < .001), and a urinary albumin to creatinine ratio (ACR) of more than 30 mg/g (31-300: HR, 3.202; 95% CI, 2.029-5.053; P < .001; >300: HR, 6.652; 95% CI, 3.922-11.285; P < .001) at baseline were all associated with the development of proliferative DR. A baseline urinary ACR of more than 30 mg/g (31-300: HR, 1.563; 95% CI, 1.078-2.267; P = .02; >300: HR, 2.707; 95% CI, 1.640-4.470; -2.707; P < 0.001) was associated with the development of DME. After adjusting the baseline values, the mean follow-up renal profiles, including a higher serum creatinine level (HR, 2.369 per mg/dL; 95% CI, 1.704-3.293; P < .001), an estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (HR, 4.215; 95% CI, 1.265-14.039; P = .02), and a urinary ACR of more than 30 mg/g (31-300: HR, 2.344; 95% CI, 1.200-4.503; P = .01; >300: HR, 4.193; 95% CI, 1.638-10.735; P = .003) were still correlated with new-onset PDR during the follow-up periods. Abnormal renal profiles at baseline, including a high serum creatinine level, low estimated glomerular filtration rate, and high urinary ACR, were associated with the development of PDR in patients with type 2 diabetes. A high baseline urinary ACR was associated with DME. Abnormal mean follow-up renal profiles were still correlated with new-onset PDR after adjusting for baseline values. Aggressive treatment for chronic kidney disease may have a role in preventing the deterioration of DR.

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Impact of Acute Kidney Injury on Mortality of Patients Hospitalized for Complications of Cirrhosis

The mortality of hospitalized patients for complications of cirrhosis is very high. We examined the independent predictors of mortality, particularly the impact of increments in creatinine, in 339 consecutive patients (636 admissions) who were admitted for complications of cirrhosis. Clinical characteristics, biochemical parameters including serum creatinine levels at various time intervals, and mortality data were recorded for all admissions. Data were analyzed for initial as well for all repeated admissions to identify independent predictors of mortality. The in-hospital mortality, 30-day, 90-day, 180 days, and 365 days mortality were 6%, 15%, 23%, 30%, and 41% respectively. Those admitted with spontaneous bacterial peritonitis had the worst survival. Increase in creatinine was noted in 29% of patients and they had lower 30-day (78% vs.91%) and 90-day (73% vs. 82%) survival than those without increase in creatinine. Any increment in serum creatinine (≥0.1mg/dL) within 48h after admission (peak 48h - admission) was associated with a step-wise increase in mortality, but only if peak creatinine reached above 1.2mg/dL. If peak creatinine levels were below 1.2mg/dL, increases in serum creatinine had no impact on survival. Cox regression analysis showed that increments in serum creatinine of 0.3mg/dL or higher had the worst outcome (HR 2.51, CI 1.65-3.81). Etiology of cirrhosis or the use of PPI, beta blockers or rifaxamin did not predict mortality. Other independent predictors of mortality were age, reason for admission, hyponatremia, and INR. In patients with cirrhosis, any increment in serum creatinine within 48h from hospitalization is associated with a higher mortality provided the peak serum creatinine within 48h is above 1.2mg/dL.

Acute kidney injury in patients with Kawasaki disease.

Kawasaki disease was well known for coronary artery abnormalities with few reports of incidence of acute kidney injury (AKI). Our aim was to identify the rate of AKI in patients with Kawasaki disease and its associated factors. All patients with Kawasaki disease admitted to a medical center from February 2004 to August 2014 were evaluated. Data collection included serum creatinine level, serial echocardiography reports, white blood cell count, C-reactive protein level, alanine transaminase level, urine white blood cell count, and renal ultrasound reports if available. AKI was defined when a patient's serum creatinine level was higher than 1.5 times upper limits of age-specific serum creatinine levels. This cohort study included 332 patients (191 boys and 141 girls; aged 0.12 to 11.3 y, median 1.39 y) and 93 patients (28%) of them had AKI. Multivariate logistic regression revealed that age and alanine transaminase level were significantly associated with AKI (odds ratio (OR): 0.521, 95% confidence interval (CI): 0.377-0.718, P < 0.001, and OR: 1.003, 95% CI: 1.000-1.005, P = 0.017, respectively). This study demonstrated that AKI exists in substantial proportion of patients with KD. Young age and high alanine transaminase level are the main associated factors for AKI in these patients.

Ocular Higher-Order Wavefront Aberrations in the Japanese Adult Population: the Yamagata Study (Funagata)

To investigate the relationship between age and ocular higher-order wavefront aberrations (HOAs) in an adult Japanese population, in addition to factors associated with HOA variations. In the Yamagata Study (Funagata) cohort, 227 adult Japanese participants (aged 37-86 years) underwent systemic and ophthalmologic examinations in 2012. Ocular, corneal, and internal HOAs were measured in micrometers. From the Zernike coefficients, we calculated the root mean square of the total HOA, coma, and spherical aberration for a pupil diameter of 4 mm. Linear regression analyses were used to determine whether HOAs were associated with age or other factors. Multiple adjusted linear regression analyses demonstrated that all components of logarithmic HOAs increase with age. Ocular, corneal, and internal HOAs increased by 0.012/y (P < 0.001), 0.007/y (P = 0.010), and 0.014/y (P < 0.001), respectively. Ocular coma also significantly increased with age (0.010/y, P = 0.007), but corneal (P = 0.963) and internal (P = 0.476) coma did not. Age-related spherical aberration increased only in the internal component (0.019/y, P = 0.001). In addition to age, ocular and corneal HOAs were mainly affected by corneal indexes. Aging is associated with increases in ocular HOAs, independent of other possible confounding factors. The association of ocular HOAs with corneal parameters indicates that ocular HOAs are mainly generated by the cornea. Internal HOAs, supposedly generated from cataract progression, may be associated with systemic factors, including serum creatinine levels and blood pressure.

Ruptured Aortic Aneurysm Causing Right Hydronephrosis

A 61-year-old man was admitted with right flank pain for 3 weeks. Physical examination revealed mild costovertebral angle tenderness in the right flank. Laboratory tests, including serum creatinine level, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), and urine analysis, were normal. Ultrasonography revealed significant right hydronephrosis with an abdominal aortic aneurysm. Computed tomography (CT) scan demonstrated a 12x7-cm ruptured fusiform abdominal aortic aneurysm (AAA) continuing from the aortic bifurcation to infrenally and causing right hydroureteronephrosis (Figure 1). After informed consent was obtained, the aortic aneurysm was treated endovascularly (endovascular aneurysm repair (EVAR)) with a “Y” stent. Double J catheter insertion for right hydronephrosis due to ureteral obstruction was performed (Figure 2, 3). A follow-up CT in the first month showed an aggravated aortic hematoma with completely resolved right hydronephrosis (Figure 4). A subgroup of aortic aneurysms is inflammatory type AAAs, representing about 10%. Genitourinary symptoms are more common Ruptured Aortic Aneurysm Causing Right Hydronephrosis

The incidence of cisplatin nephrotoxicity post hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery

Background: Cisplatin is commonly used in hyperthermic intraperitoneal chemotherapy (HIPEC) for the management of peritoneal carcinomatosis. Little is known about the nephrotoxic effects of cisplatin use in HIPEC. Objectives: To report the incidence of nephrotoxicity post-HIPEC using cisplatin 50 mg/m2 plus doxorubicin 15 mg/m2. The incidence of hypomagnesemia was investigated as a secondary endpoint. Methods: This is a retrospective study evaluating patients who received cisplatin with doxorubicin during HIPEC. RIFLE classification was used to assess the development of nephrotoxicity. Variables, such as comorbidities and nephrotoxic medications were obtained. Renal function parameters were also collected, including serum creatinine levels and serum magnesium levels at baseline and at days 3, 7 and 30 after HIPEC. Perioperative urine output (UO) was also recorded. Results: Fifty-three patients were identified. Based on the RIFLE classification, two patients (3.7%) developed acute kidney injury (AKI) following HIPEC with cisplatin. One patient met criteria for renal failure and progressed to chronic renal failure. The other patient had renal injury. Comparable mean creatinine levels were observed at baseline and on day 30 following HIPEC (p > 0.05). The incidence of hypomagnesemia increased to 24.5% by day 7 (p = 0.041) and 30.1% by day 30 (p < 0.001) following HIPEC. Low intraoperative UO, angiotensin II receptor antagonist use and hypertension were associated with development of AKI (p < 0.05). Conclusion: Nephrotoxicity can complicate HIPEC with cisplatin therapy and that permanent renal dysfunction may rarely occur. More attention to be directed toward monitoring magnesium levels after cisplatin use with HIPEC.

Altered brain functional connectivity in hemodialysis patients with end-stage renal disease: a resting-state functional MR imaging study.

The changes of whole brain functional connectivity in hemodialysis (HD) patients with end-stage renal disease (ESRD) are still unclear, which may be associated with multiple factors, such as elevated neurotoxins, anemia, and side effects of hemodialysis. Resting-state functional magnetic resonance imaging (rs-fMRI) data of 71 patients (43 males, 28 females; mean age, 33.4 ± 9.4 years) and 43 age- and gender-matched healthy volunteers (29 males, 14 females; mean age, 30.6 ± 8.8 years) were acquired. Neuropsychological tests including number connection test type A (NCT-A), digit symbol test (DST), line-tracing test (LTT), serial-dotting test (SDT), self-rating depression scale (SDS) and self-rating anxiety scale (SAS) were used to evaluate cognitive and psychiatric conditions in all subjects. Blood biochemistry tests including serum creatinine levels, blood urea, hematocrit, and Ca(2+) level were taken in HD patients. Forty-two connections significantly different between HD patients with ESRD and controls were found (all P < 0.05, Bonferroni corrected) and identified as connectivities of interests (COIs), among which 39 connections (92.9%) were markedly decreased in patients. Of the 39 weaker connections, 24 were related to the frontal lobe regions. Widespread weakening of cortical and subcortical network connectivity in ESRD patients was more directly related with neuropsychological impairments and anemia rather than serum creatinine level, blood urea and dialysis duration. In particular, impairments in the medial prefrontal lobe could play an important role in mediating psychological dysfunctions.

Transient renal artery stenosis during renal sympathetic denervation in a patient with resistant hypertension

A 52-year-old female was admitted to the Department of Hypertension with resistant hypertension coexistent with type 2 diabetes mellitus, two episodes of transient ischaemic attack in the past, and obesity. The patient’s arterial hypertension was uncontrolled on 6 antihypertensive medications, which included a loop diuretic and an aldosterone antagonist. During the course of the patient’s previous hospitalisation, secondary hypertension was excluded. Angio-computed tomography (CT) results showed a bilateral double renal artery with a diameter of the main trunks of more than 4 mm (corresponding angiography, Fig. 1). A denervation procedure Simplicity cathether (Medtronic) was applied. In the main left renal artery, 6 ablations were performed, with a mean impedance change of 8.82 (D,%) and temperature of 52°C without any complications. During the first ablation of the main right renal artery, with an impedance change of 20 (D,%) and a temperature of 75.3°C, oedema of the arterial wall with a significant stenosis of 80% occurred (Fig. 2). A local administration of nitroglycerine and verapamil (injected via a catheter) was ineffective. Due to the above, no further ablations have been performed. A follow-up arteriography of the right renal artery was performed 24 h later, showing a minimal stenosis in the previously affected area (corresponding angiography, Fig. 3). No clinical complications have been observed during this adverse event based on blood pressure parameters and control laboratory tests including serum creatinine level. A follow-up angio-CT of the right renal artery is scheduled in 3 months. Based on published papers, there have been no case reports of acute transient renal artery stenosis during renal denervation procedures. One case of a single structural renal artery stenosis, which occurred in the form of a late complication (i.e. after 6 months), was reported by Kaltenbach et al. (J Am Coll Cardiol, 2012; 60: 2694–2695).

Estimating GFR Among Participants in the Chronic Renal Insufficiency Cohort (CRIC) Study

Glomerular filtration rate (GFR) is considered the best measure of kidney function, but repeated assessment is not feasible in most research studies. Cross-sectional study of 1,433 participants in the Chronic Renal Insufficiency Cohort (CRIC) Study (ie, the GFR subcohort) to derive an internal GFR estimating equation using a split-sample approach. Adults from 7 US metropolitan areas with mild to moderate chronic kidney disease; 48% had diabetes and 37% were black. CRIC GFR estimating equation. Urinary (125)I-iothalamate clearance testing (measured GFR [mGFR]). Laboratory measures, including serum creatinine and cystatin C, and anthropometrics. In the validation data set, the model that included serum creatinine level, serum cystatin C level, age, sex, and race was the most parsimonious and similarly predictive of mGFR compared with a model additionally including bioelectrical impedance analysis phase angle, CRIC clinical center, and 24-hour urinary creatinine excretion. Specifically, root mean square errors for the separate models were 0.207 versus 0.202, respectively. Performance of the CRIC GFR estimating equation was most accurate for the subgroups of younger participants, men, nonblacks, non-Hispanics, those without diabetes, those with body mass index <30 kg/m(2), those with higher 24-hour urine creatinine excretion, those with lower high-sensitivity C-reactive protein levels, and those with higher mGFRs. Urinary clearance of (125)I-iothalamate is an imperfect measure of true GFR; cystatin C level is not standardized to certified reference material; lack of external validation; small sample sizes limit analyses of subgroup-specific predictors. The CRIC GFR estimating equation predicts mGFR accurately in the CRIC cohort using serum creatinine and cystatin C levels, age, sex, and race. Its performance was best in younger and healthier participants.