Increase In Serum Creatinine Research Articles

Effect of tonsillectomy combined with steroid pulse therapy upon IgA nephropathy depending on proteinuria status at diagnosis: a nationwide multicenter cohort study in Japan.

The effects of tonsillectomy combined with steroid pulse (TSP) therapy for IgA nephropathy (IgAN) are little known. Therefore, we examined the effects of TSP therapy on the kidney outcomes of IgAN in a large, nationwide cohort study in Japan. Between 2002 and 2004, 632 IgAN patients with ≥ 0.5g/day proteinuria at diagnosis were divided into three groups with mild (0.50-0.99g/day; n = 264), moderate (1.00-1.99g/day, n = 216), or severe (≥ 2.00g/day; n = 153). Decline in kidney function and urinary remission were compared among the three groups after TSP therapy, corticosteroid (ST) therapy, or conservative therapy during a mean follow-up of 6.2 ± 3.3years. 10.6% and 5.9% of patients in the ST and conservative therapy group underwent tonsillectomy. The rate of urinary remission at the final observation was significantly higher in the TSP therapy group than in the ST or conservative therapy groups (mild proteinuria: 64%, 43%, and 41%; moderate proteinuria: 51%, 45%, and 28%; severe proteinuria: 48%, 30%, and 22%, respectively). In contrast, the rate of a 50% increase in serum creatinine was lower in groups TSP therapy, than ST or conservative therapy (mild proteinuria: 2.1%, 10.1% and 16.7%; moderate proteinuria: 4.8%, 8.8% and 27.7%; severe proteinuria: 12.0%, 28.9% and 43.1%, respectively). In multivariate analysis, TSP therapy significantly prevented a 50% increase in serum creatinine levels compared with conservative therapy in groups with moderate and severe proteinuria (hazard ratio, 0.12 and 0.22, respectively). TSP significantly increased the rate of proteinuria disappearance and urinary remission in IgAN patients with mild-to-moderate urinary protein levels. It may also reduce the decline in kidney function in patients with moderate-to-severe urinary protein levels.

Early Creatinine Changes After Aortic Valve Replacement and Late Survival, Heart Failure, and Chronic Kidney Disease in a National Registry

BackgroundThe impact of small increases in serum creatinine after surgical aortic valve replacement (SAVR) that fail to meet the acute kidney injury stage 1 criteria is unknown. The aim of this study was to investigate prognosis after primary SAVR in patients with small increases in postoperative serum creatinine. MethodsThis observational cohort study included all adult patients who underwent primary SAVR in Sweden from 2009 to 2022. The primary outcome was all-cause mortality. Secondary outcomes were chronic kidney disease and heart failure. Regression standardization addressed confounding. ResultsIn 16,766 patients, 4074 (24.2%) had no change in postoperative serum creatinine, 5764 (34.3%) had a small increase in postoperative serum creatinine (0.06 mg/dL ≤ Δserum creatinine <0.3 mg/dL), and 2753 (16.4%) fulfilled the Kidney Disease Improving Global Outcomes acute kidney injury stage 1 criteria. The mean age was 67 years, and 31% of patients were female. No significant difference in long-term all-cause mortality was observed in the no change group at 13 years compared with the small increase group (absolute survival difference, 2.3% [95% CI, 0%-4.6%]). A stepwise increase in the risk of 30-day mortality was observed with increasing changes in serum creatinine. At 13 years of follow-up, there was a significant difference in the risk of chronic kidney disease (absolute difference, 2.8% [95% CI, 1.0%-4.5%]) and heart failure (absolute difference, 3.5% [95% CI, 1.3%-5.7%]) between the no change and small increase groups. ConclusionsA small increase in postoperative serum creatinine after SAVR was associated with an increased risk of adverse outcomes. The acute kidney injury definition may benefit from including more reliable and specific biomarkers together with small creatinine increases to detect kidney injury.

Evaluation of some Biochemical and Hematological Parameters in Patients with Chronic Kidney Disease

Background: Chronic kidney disease is a condition that results from an indefinite change in the structure and function of the kidneys. A slow, steady progression characterizes it and is irreversible. Objectives: This study aims to evaluate the findings of certain biochemical and hematological tests in samples from Iraqi CKD patients. Methods: This study included 90 subjects, where 70 patients with chronic kidney disease and 20 healthy individuals. Blood samples were collected from the patients during their visits to Ghazi Al-Hariri Surgical Specialties' Hospital- Medical City, Baghdad, Iraq. Age, sex and body mass index were assessed for each participant followed by renal function tests [serum blood urea, creatinine, uric acid and estimated glomerular filtration rate], and complete blood count. Also, serum levels of uromodulin and cystatin C were measured statistically studies were carried out using analysis of variance (ANOVA). Results: the study demonstrated a highly significant (P&lt;0.001) increase in blood urea, serum creatinine and uric acid levels, while a significant (P&lt;0.05) decrease in estimated glomerular filtration rate levels in patients compared to the control group. On the other hand, it showed a highly significant (P&lt;0.001) decrease in hemoglobin and hematocrit values and a significant (P&lt;0.05) decrease in the red blood cell count. Patients had revealed a significant (P&lt;0.05) increase in cystatin C level and a decrease in uromodulin level when compared to the control group. conclusion: the present study shows that chronic kidney disease patients have upregulated renal function parameters blood urea, serum creatinine and with downregulated estimated glomerular filtration rate, while hematological disorder was more prevalent in patients. On the other hand, cystatin C level revealed an increase while uromodulin level showed a decrease in Iraqi patients.

Effects of statin use on serum creatinine phosphokinase levels in normal thyroid function.

Statins are common lipid-lowering agents used in dyslipidemia. However, they increase serum creatinine phosphokinase (CPK) levels. Currently, there are no studies on the effect of thyroid-stimulating hormone (TSH) levels on CPK levels after statin administration. Therefore, this study aimed to investigate CPK level alterations after statin administration according to TSH quartiles in participants with euthyroidism. This retrospective analysis included 25,047 patients with euthyroidism. CPK levels were measured before and 6 months after statin administration. Normal TSH levels were divided into four quartiles, and the CPK levels and proportions of patients with normal CPK levels after statin administration for each TSH quartile were evaluated. The baseline CPK level was significantly higher in the lowest TSH quartile (Q1) compared to the other quartiles but decreased after statin administration. Thus, the difference between the CPK levels and the other quartile groups was not significant. The proportion of patients with normal CPK levels was also significantly lowest in Q1 before statin administration; however, no significant difference was noted in the ratio among each group after statin administration. These findings were consistent with the findings of the analysis according to statin intensity. In patients in the lowest TSH quartile of the normal TSH range, the CPK level decreased, and the proportion of normal CPK levels increased significantly after statin administration. However, similar changes were not observed in other TSH quartiles. Therefore, further studies are required to mechanistically confirm these conclusions.

Long-Term Renal Function with Cardiac Contractility Modulation Therapy

Introduction: Cardiac implantable electrical devices are able to affect kidney function through hemodynamic improvements. The cardiac contractility modulation (CCM) is a device-based therapy option for patients with symptomatic chronic heart failure (HF) despite optimized medical treatment. The long-term cardiorenal interactions for CCM treated patients are yet to be described. Methods: CCM recipients (n = 187) from the Mannheim Cardiac Contractility Modulation Observational Study (MAINTAINED) were evaluated in the long-term (up to 60 months) for changes in serum creatinine, estimated glomerular filtration rate (eGFR), other surrogate markers of kidney function, and the chronic kidney disease (CKD) stage distribution. With regard to kidney function at baseline, the patients were furthermore grouped to either advanced CKD (aCKD, CKD stage ≥3, eGFR≤59 mL/min/1.73 m2, n = 107) or preserved kidney function and mild CKD (pCKD, CKD stages 1–2, eGFR≥60 mL/min/1.73 m2, n = 80). The groups were compared for differences regarding kidney function, New York Heart Association classification (NYHA), biventricular systolic function, HF hospitalizations and other parameters in the long-term (60 months). Results: CKD stage distribution remained stable during the entire follow-up (p = 0.65). An increase in serum creatinine (1.47 ± 1 vs. 1.6±1 mg/dL) with a corresponding decline of eGFR (58.2 ± 23.4 vs. 54.2 ± 24.4 mL/min/1.73 m2, both p < 0.05) were seen after 60 months but not before for the total cohort, which was only significant in pCKD patients in terms of group comparison. Mean survival (54.3 ± 1.3 vs. 55.3 ± 1.2 months, p = 0.53) was comparable in both groups. Improvements in NYHA (3.11 ± 0.46 vs. 2.94 ± 0.41–2.28 ± 0.8 vs. 1.94 ± 0.6) and LVEF (24.8 ± 7.1 vs. 22.9 ± 6.6–31.1 ± 11.4 vs. 35.5 ± 11.1%) were likewise similar after 60 months (both p < 0.05). The aCKD patients suffered from more HF hospitalizations and ventricular tachycardias during the entire follow-up period (both p < 0.05). Conclusions: The kidney function parameters and CKD stage distribution might remain stable in CCM treated HF patients in the long-term, who experience improvements in LVEF and functional status, regardless of their kidney function before. An impaired kidney function might be associated with further cardiovascular comorbidities and more advanced HF before CCM, and could be an additional risk factor of HF complications afterward.

Impact of Nusinersen on Neurofilament, Creatinine Levels, and Motor Function in Pediatric Spinal Muscular Atrophy Rehabilitation: A Biomarker Analysis

Background: Spinal amyotrophy is a rare, neurodegenerative disease, with progressive evolution, disabling until death in severe forms, but for which 3 disease-modifying drugs have recently been approved (in the last 8 years). In this context, it became necessary to find predictive factors for the evolution of patients and for the effectiveness of the treatment applied to personalize the therapy to obtain the best results according to the particularities of each patient. Objective: The objective of this retrospective study is to analyze the evolution of different clinical (motor functional scales) and paraclinical biomarkers (level of pNF-H neurofilaments in serum and cerebrospinal fluid and of serum creatinine) under treatment with nusinersen in various types of spinal muscular atrophy (SMA). Methods: We analyzed the biomarkers values for a group of 69 pediatric patients diagnosed with SMA in different stages of treatment over three years, depending on the type of SMA, the number of copies of the SMN2 gene, and the age at initiation of therapy. Results: We observed significant increases in the levels of pNF-H neurofilaments in both cerebrospinal fluid (CSF) and serum, with correlations to the age of symptom onset in patients and an inverse relationship to the number of copies of the SMN2 gene. These levels decreased during treatment with nusinersen, coinciding with increased serum creatinine values and improved motor functional assessment scores. The most pronounced effects were noted in patients with severe forms of the disease, such as SMA type 1, mainly when treatment was initiated at a younger age. Conclusion: The evolution of patients under disease-modifying treatments should be analyzed both for the evolution on specific motor functional scales, as well as against the biomarkers of neuronal degradation: pNF-H, present in CSF and serum, and serum creatinine, a marker of muscle activity. Administering the disease-modifying treatment promptly after diagnostic confirmation halts neural degradation and enhances the patient's motor function. Keywords: spinal muscular atrophy; neurofilaments; cerebrospinal fluid; biomarkers; nusinersen; creatinine; motor evolution

Continuous Urine Output-Based Alert Identifies Cardiac Surgery–associated Acute Kidney Injury Earlier Than Serum Creatinine: A Prospective and Retrospective Observational Study

Objective(s)Acute kidney injury (AKI) is defined and staged by reduced urine output (UO) and increased serum creatinine (SCr). UO is typically measured manually and documented in the electronic health record, making early and reliable detection of oliguria-based AKI and electronic data extraction challenging. We investigated the diagnostic performance of continuous UO, enabled by active drain line clearance, based alerts (Accuryn AKI Alert), compared to AKI stage 2 SCr criteria and their association to length of stay (LOS), need for continuous renal replacement therapy (CRRT), and 30-day mortality. DesignProspective and retrospective observational study. SettingNine tertiary centers. ParticipantsCardiac surgery patients. InterventionsNone. Measurements and Main Results522 patients were analyzed. AKI stages 1, 2, and 3 were diagnosed in 32.18%, 30.46%, and 3.64% of patients based on UO compared to 33.72%, 4.60%, and 3.26% of patients using SCr, respectively. Continuous UO-based alerts diagnosed stage ≥1 AKI 33.6 (IQR= [15.43, 95.68]) hours before stage ≥2 identified by SCr. A SCr-based diagnosis of AKI stage ≥2 has been designated a Hospital Harm by the Centers for Medicare & Medicaid Services. Using this criterion as a benchmark, AKI alerts had a discriminative power of 0.78. AKI Alert stage 1 was significantly associated with increased ICU and hospital LOS and CRRT, and stage ≥2 alert with mortality. ConclusionsAKI Alert based on continuous UO, enabled by active drain line clearance, detected AKI stages 1 and 2 before SCr. Early AKI detection allows for early kidney optimization, potentially improving patient outcomes.

Changes in pre-haemodialysis serum creatinine levels over 2years and long-term survival in maintenance haemodialysis.

Pre-haemodialysis (HD) serum creatinine levels are reliable and inexpensive markers of muscle mass and important predictors of survival in patients with stable chronic HD. We aimed to assess whether changes in pre-HD serum creatinine levels during a 2-year period are linked to long-term patient survival. We retrospectively analysed patients enrolled in a periodic HD quality assessment program. Of the 21846 participants in the fourth HD quality assessment program, 13765 were presented in the fifth, of which 10299 eligible patients were included in this study. We assessed the change in serum creatinine levels over 2years. The patients were categorized into the following three groups: stable group (patients with change in serum creatinine<1mg/dL during 2years of HD, n=5664), increasing group (patients with increase in serum creatinine≥1mg/dL, n=2419) and decreasing group (patients with decrease in serum creatinine≥1mg/dL, n=2216). The duration of HD at baseline was 62-83months, with diabetic kidney disease being the most common cause of kidney failure in 36.4% of patients. The 5-year patient survival rates in the stable, increasing and decreasing groups were 69.1%, 71.3% and 66.8%, respectively. The decreasing group had poorer patient survival than the other two groups (P=0.083 for stable vs. increasing group; P=0.011 for stable vs. decreasing group; P<0.001 for increasing vs. decreasing group). There was no significant difference in the cardiovascular event-free survival rate among the three groups. Multivariable Cox regression analyses revealed the highest hazard ratio (HR) for mortality in the decreasing group (HR 1.33, 95% confidence interval [CI] 1.21-1.45, P<0.001 vs. stable group; HR 1.50, 95% CI 1.34-1.69, P<0.001 vs. increasing group). The increasing group exhibited a lower risk of mortality than the stable group (HR 0.88, 95% CI 0.81-0.97, P=0.008). Subgroup analyses based on age, HD vintage, sex, Charlson comorbidity index score, presence of diabetes and baseline serum creatinine level tertiles revealed that the decreasing group exhibited the highest mortality among all subgroups. Our results demonstrate that changes in pre-HD serum creatinine levels over 2years of HD were associated with all-cause mortality in patients undergoing HD. This finding suggests a simple and promising approach for clinicians in the prognosis and management of patients undergoing HD.

Thiazide Discontinuation in Chronic Kidney Disease Hypertension Management: A Retrospective Chart Review.

Thiazides are utilized in general hypertension management, however, their role in chronic kidney disease (CKD) hypertension management remains unclear. Although data support thiazide efficacy in advanced CKD, the adverse effect profile (including estimated glomerular filtration rate [eGFR] decline and electrolyte abnormalities) may lead to thiazide discontinuation. The authors assessed the thiazide discontinuation rate in Kaiser Permanente Southern California members with moderate-to-severe CKD and hypertension. This study was a multicenter retrospective analysis evaluating Kaiser Permanente Southern California members with hypertension and CKD 3B or 4 who filled a thiazide prescription in 2021, with follow-up through 2022. The outcomes were thiazide discontinuation rate, reason for thiazide discontinuation, time to thiazide discontinuation, and discontinuing practitioner specialty. Mean changes in blood pressure and eGFR from baseline were also evaluated. Of the 401 patients followed for 1 year after thiazide initiation, 65 patients discontinued a thiazide (discontinuation rate: 16.2%, mean time to discontinuation: 7.5 months). Of the 201 patients followed for 2 years after thiazide initiation, 57 patients discontinued a thiazide (discontinuation rate: 28.4%, mean time to discontinuation: 15.5 months). The most commonly documented thiazide discontinuation reason was increased serum creatinine (30% of total reasons at 1 year and 39% of total reasons at 2 years). Most patients with hypertension and CKD 3B or 4 continued on a thiazide with favorable blood pressure lowering effects and modest eGFR decline. Thiazides may be considered viable antihypertensive options with close renal function monitoring for patients with moderate-to-severe CKD.

Evaluating prescription of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in patients with diabetes and albuminuria.

Although guidelines recommend the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) in patients with diabetes, hypertension, and albuminuria, their use remains suboptimal in several developed countries. Limited data are available on ACEi/ARB use in developing countries. Here, we assessed the use of ACEi/ARB and identified factors contributing to their underutilization at Hatyai Hospital, Thailand. This retrospective cross-sectional study was conducted using data from the Hatyai Hospital database. Adult patients with diabetes, hypertension, and albuminuria were included. Clinical data and laboratory results were extracted. Furthermore, this study recorded pre-specified conditions that influenced physicians' decisions regarding the prescription of ACEi/ARBs in patients who did not adhere to guidelines. Of 4,655 eligible patients, 500 patients were selected. The average age of the patients was 66.3 years, and 59.6% were female. The adherence rate was 72.4%. Multivariate logistic regression analysis found a significant association between non-adherence and chronic kidney disease (CKD) stage (OR = 1.29, 95% CI: 1.04-1.60, p = 0.019). The most common pre-specified condition contributing to non-adherence was "no condition identified" (69.8%). Among the cases of non-adherence, 21.7% were due to ACEi/ARB discontinuation after acute kidney injury, followed by hyperkalemia (5.1%) and a moderate increase in serum creatinine (4.3%). ACEi/ARB therapy was suboptimal in patients with diabetes, hypertension, and albuminuria. Non-adherence was associated with CKD stage, possibly because of concerns about adverse events and healthcare-related factors.

Incidence and Risk Factors for Acute Kidney Injury in PICU of Dr. Mohammad Hoesin Hospital Palembang

Introduction. Acute kidney injury (AKI) is a heterogeneous group of conditions characterized by a sudden decrease in the glomerular filtration rate, manifested by an increase in serum creatinine or oliguria. In the Pediatric Intensive Care Unit (PICU), AKI is one of the most common conditions found. Several factors, including age, infection, sepsis, shock, heart disease, mechanical ventilation, and multiple organ failure cause the increase in the incidence of AKI in children. This study aimed to determine the incidence and risk factors for AKI in critically ill children in the PICU of Dr. Mohammad Hoesin Hospital Palembang. Methods. This study was an observational analytic with a cross-sectional design. This study used secondary data based on the medical records of patients treated at the PICU. Critically ill children aged 1-18 years who were treated at the PICU of Dr. Mohammad Hoesin Hospital Palembang in the period of 1 January 2020 to 31 December 2021 were included while existing kidney dysfunction before being admitted to PICU and not fulfilled medical records were excluded to the study. Results. AKI incidence in PICU was 46.7%. There were significant risk factors for AKI which are age (p 0.025), sepsis (p 0.019), shock (p 0.002), mechanical ventilation used (p 0.043), nephrotoxic drugs (p 0.039), and fluid overload (p 0.039). Conclusion. This study found that age, sepsis, shock, mechanical ventilation, nephrotoxic drugs, and fluid overload, were significant risk factors for the incidence of AKI in critically ill children in PICU.

Incidence of contrast-associated acute kidney injury: a prospective cohort.

Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.

Maternal and Fetal Prognosis in Pregnant Women with Renal Disease Associating Urinary Tract Infection.

Pregnancy related acute renal injury is a challenging diagnosis, mainly due to, among other factors, the physiological decrease in blood nitrogen retention parameters. As a consequence, the criteria required to establish the diagnosis may be first met as a result of the complications that appear, especially hypertension. The maternal and fetal complications which may occur in pregnancies with renal failure can be worsened by the relative immunodeficiency during pregnancy, which represents an elusive mechanism that is associated with a high risk of urinary tract infection (UTI). Therefore, the risk for intensive care unit admission, or developing sepsis, or preterm birth can increase. The present study aims to investigate whether the superimposition of UTI over an altered renal function leads to a worsened maternal and fetal prognosis. We performed an observational retrospective study that included pregnant women with increased serum creatinine levels, both with and without UTI. Thus, we analyzed 47 pregnant women who delivered in our unit between 1 January 2021 and 1 September 2023. Patients were divided into three groups: an acute renal injury (AKI) group (n=16), a chronic kidney disease (CKD) group (n=8) and a control group (n=23) which included patients with serum creatinine levels between 0.80-1 mg/dL. We evaluated the maternal and fetal complications in all three groups, taking into consideration the comparison between maternal and fetal parameters in women with UTI. Our study highlighted an important difference between fetal weight at delivery by patients with AKI associating UTI and the two remaining groups (1395 ± 992.50 grams compared to 2340 grams in the CKD group and 3103.33±83.86 grams in the control group, respectively). There was no statistically significant difference regarding preterm birth, intrauterine grow restriction, stillbirth or neonatal intensive care unit (NICU) admission. Preterm birth had a higher incidence in all patients with AKI (87.5% compared to 50% and 34.78%, respectively). Neonatal complications are important in pregnant women with AKI and CKD, irrespective of the UTI diagnosis. Most fetal complications occurred in patients diagnosed with AKI. The correlations highlighted by us should be studied further.

Evaluation of Cisplatin-Induced Acute Kidney Injury in Patients Coprescribed Serotonin Receptor Antagonists: A Retrospective Analysis.

Cisplatin is an effective first line therapy for a variety of cancers. Cisplatin is highly emetogenic and resulting volume depletion can contribute to acute kidney injury (AKI). Anti-emetic drugs such as 5-hydroxytryptamine type 3 receptor antagonists (5-HT3RAs) are commonly prescribed to prevent this complication. Preclinical studies suggest first generation 5-HT3RAs may alter the renal clearance and increase cisplatin toxicity. This retrospective study evaluated whether different 5-HT3RAs modify the risk of AKI in patients receiving cisplatin. Patients with cancer who received cisplatin between January 1, 2010 and December 31, 2016 were included. Patients over 18 years old with available data for baseline and post-treatment serum creatinine, cisplatin cumulative dose, and administration of 5-HT3RAs including first generation (ondansetron, granisetron, and ramosetron) and second generation (palonosetron) were analyzed. AKI defined as 1.5x increase in serum creatinine. Fisher's exact and Wilcoxon rank-sum tests were used to assess univariable associations between baseline covariates and AKI, and logistic regression for multivariable associations with AKI. Of 8703 patients identified with cisplatin exposure, 6889 were included. A total of 3881 (56.3%) patients received at least one 5-HT3RA, including palonosetron (3750, 54.4%), ondansetron (1399, 20.3%) and granisetron (11, 0.2%). AKI developed in 1666 (24.2%) patients following cisplatin. Patients who received any 5-HT3RAs were less likely to experience AKI as compared to patients that did not (22.6% vs 26.2%, p=0.001). Older age, male gender, African ethnicity, and cumulative cisplatin dose were univariately associated with higher risk for AKI (P<0.001). After adjusting for these variables, use of any of these antiemetic drugs was protective for AKI (OR 0.84, 95% CI: 0.75, 0.94; P= 0.003) with no difference detected between type of 5-HT3RA. Nephrotoxicity continues to be a concern following cisplatin therapy. Given its emetogenic nature, use of antiemetic drugs such as 5-HT3RAs can lessen emesis and lower risk of kidney injury. This retrospective analysis supports use of any 5-HT3RAs to lower risk of AKI.

The impact of MELD exception points for hydrothorax on posttransplant mortality: a propensity score-matched analysis.

Hepatic hydrothorax is a challenging complication of end-stage liver disease, and.patients with this complication can receive model for end-stage liver disease (MELD) exception points if they meet specific criteria as defined by United Network for Organ Sharing (UNOS). This research aimed to analyze the effect of receiving MELD exception points for hepatic hydrothorax on posttransplant mortality, using a national transplant database. Patients >18 years in the UNOS database awaiting liver transplant between 2012 and 2023 were identified based on their petition for MELD exception points. Using a 1: 1 propensity score-matched analysis, 302 patients who received MELD exception points for hepatic hydrothorax were compared with 302 patients who did not receive MELD exception points.Demographic, clinical and laboratory values were compared. The primary outcome was posttransplant mortality. Multivariate logistic regression controlled for potential confounders. No significant difference was observed in mean age (58.20 vs 57.62 years), mean initial MELD score (16.93 vs 16.54), or mean Child-Pugh score (9.77 vs 9.74) in patients with hepatic hydrothorax receiving MELD exception points versus their matched cohort who did not recieve exception points. The proportion of males was slightly higher among patients who received MELD exception points (57.6% males vs 53.6% males). A majority of patients in both groups had Child-Pugh grade C (>56%). Patients receiving MELD exception points for hepatic hydrothorax had a statistically significant 44% decrease in the odds of posttransplant death compared to those who did not (OR 0.56; 95% CI 0.37-0.88; P = 0.01). Among the combined cohort, each year increase in age resulted in a 3.9% increase in mortality (OR 1.04; 95% CI 1.01-1.07; P = 0.005), and every one-unit increase in serum creatinine resulted in a 40% increase in mortality (OR 1.40; 95% CI 1.03-1.92; P = 0.03). Receiving MELD exception points for hepatic hydrothorax is associated with a significant reduction in the odds of posttransplant mortality. These findings underscore the importance of MELD exception points for hepatic hydrothorax among patients with decompensated cirrhosis, potentially improving patient prioritization for liver transplantation and influencing clinical decision-making.

#645 Inferring trends in renal function based on a single serum creatinine with a spot urine creatinine-to-osmolality ratio in outpatient settings

Abstract Background and Aims Assessing trends in renal function can be challenging when paired serum creatinine (SCr) levels are not available, especially at the initial visit for evaluating renal function. The aim of this study was to validate the use of a spot urine creatinine-to-osmolality ratio (sUCr/Osm) as a surrogate indicator of urinary creatinine excretion rate for inferring renal function trends.1 The objective is to create a flowchart that assists in determining appropriate outpatient management based on a single SCr value with sUCr/Osm. Method The current study conducted a secondary analysis using the primary datasets provided by The Assessment, Serial Evaluation, and Subsequent Sequelae of Acute Kidney Injury (ASSESS-AKI) Study.2 The term “stable renal function” refers to the absence of an interval increase in SCr of greater than or equal to 26.5 μmol/L (0.3 mg/dL) from a visit three months earlier to the index visit. The definition of “unstable renal function” is the presence of an interval increase in SCr of 26.5 μmol/L (0.3 mg/dL) or more within the same duration. The cut-off value for sUCr/Osm was set at 7.07 when Cr is measured in μmol/L (0.08 when Cr is measured in mg/dL), which represents the 95% lower reference limit.1 A positive designation was given if the value of sUCr/Osm was not less than the 95% lower reference limit, and negative otherwise. The comparative test employed a tubular injury biomarker, urinary neutrophil gelatinase-associated lipocalin (UNGAL). The cut-off value for UNGAL was established at 100 ng/mL based on the maximum Youden's Index value. A positive result was defined as a UNGAL level less than or equal to 100 ng/mL, while a negative result was defined as a UNGAL level greater than 100 ng/mL. Results Of all the participants (N = 1, 570), 596 (38.0%) were female sex. The age (mean ± standard deviation) was 64.6 ± 13.0 years, the body mass index (BMI) was 30.1 ± 7.7 kg/m2, and the SCr level was 102.5 ± 51.4 μmol/L (1.16 ± 0.58 mg/dL). The sensitivity of sUCr/Osm in identifying “stable renal function” for all individuals was 0.926 (95% confidence interval: 0.912-0.939), with a positive predictive value of 0.906 (0.891-0.921) and an accuracy of 0.845 (0.827-0.863). These values of sUCr/Osm were either better or comparable to those of UNGAL- 0.867 (0.849-0.884), 0.917 (0.902-0.932), and 0.808 (0.788-0.827), respectively. In individuals (N = 521) with an estimated glomerular filtration rate (eGFR) of less than 60 cc/min/1.73m², sUCr/Osm also performed better or similarly to UNGAL. Table 1 provides direct comparisons between sUCr/Osm and UNGAL in identifying “stable renal function”. Conclusion To assess renal function, sUCr/Osm may be effectively used to infer the trend. Fig. 1 presents a flowchart for the corresponding management based on a single SCr-based eGFR and sUCr/Osm.

#1382 Kidney outcomes after bariatric surgery: a population-based cohort study

Abstract Background and Aims Obesity is associated with nephrolithiasis, chronic kidney disease (CKD), and kidney failure. Bariatric surgeries, including Roux en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), are effective treatments of severe obesity and may mitigate obesity-related kidney diseases such as CKD and kidney failure, but could on the other hand induce hyperoxaluria and nephrolithiasis, posing a potential risk to the kidneys. We examined the risk of nephrolithiasis, acute kidney injury (AKI), CKD, and kidney failure after bariatric surgery. Method We included individuals undergoing bariatric surgery (RYGB or SG) in Denmark between 2006 and 2018 using population-based registries. These individuals were age- and sex-matched 1:5 to a background general population cohort and a cohort with hospital-diagnosed obesity. Nephrolithiasis was identified by diagnosis codes within the Danish National Patient Registry (DNPR). AKI was defined as an increase in serum creatinine (sCr) of ≥26.5 µmol/L within 48 hours or a relative increase of ≥1.5 times within seven days or from a median outpatient baseline value. CKD was defined as the presence of two outpatient eGFR samples below 60 ml/min/1.73 m2, with a minimum interval of three months between each measurement. Kidney failure was defined by recordings of kidney transplantation or chronic dialysis in DNPR. One- and ten-year cumulative incidences (risks) were computed for each cohort accounting for the competing risk of death. Rates of incident nephrolithiasis, AKI, incident CKD, and incident kidney failure in post-bariatric-surgery patients were compared with the background population cohort and obesity cohort using multivariable Cox regression adjusting for age, sex, and Charlson Comorbidity Index (CCI)-score. Results We included 18,827 individuals with bariatric surgery (17,200 with RYGB and 1,627 with SG). Median follow-up was 8.1 years (5.2-9.2), 8.0 years (4.6-9.1), and 7.9 years (4.2-9.1) for the overall bariatric cohort, the background population cohort, and the obesity cohort, respectively. Within the bariatric cohort, the ten-year risk of nephrolithiasis was 2.8%, the one-year risk of AKI was 2.7%, while the ten-year risks of CKD, and kidney failure were 0.2% and 0.1%, respectively. When comparing the post-bariatric-surgery cohort with the general population cohort, the adjusted hazard ratio (HR) was 2.92 (95% CI; 2.61, 3.27) for nephrolithiasis, 2.60 (95% CI; 2.06, 3.28) for AKI, 0.36 (95% CI; 0.18, 0.73) for CKD, and 0.81 (95% CI; 0.49, 1.32) for kidney failure. Compared with the obesity cohort, the adjusted HRs for adverse events were at 1.73 (95% CI: 1.56, 1.91) for nephrolithiasis, 1.63 (95% CI; 1.38, 1.92) for AKI, 0.41 (95% CI; 0.26, 0.66) for CKD, and 0.65 (95% CI; 0.42, 0.98) for kidney failure. Conclusion Individuals with bariatric surgery had a higher ten-year rate of nephrolithiasis and a higher one-year rate of AKI, but reduced rates of CKD and kidney failure within ten years after surgery compared with both the background cohort and the obesity cohort.

#259 Predictive capacity and comparison of new biomarkers for AKI in patients undergoing non-cardiac surgery

Abstract Background and Aims The diagnosis of AKI, according to the KDIGO guidelines, is still based on a tangible increase in serum creatinine which, however, cannot be detected until 24-48 hours after renal damage. Unfortunately, it has not been possible to identify among the various new biomarkers the one that is potentially able to detect AKI early, to intervene promptly to preserve renal function. The aim of this study was to analyze, in a population of patients undergoing major non-cardiac surgery, the most recent urinary biomarkers to evaluate their predictive potential for AKI and compare them with creatinine levels. Method 22 patients (18 males, 4 females) with an average age of 76 (67-85) years were enrolled for the study. 22 urine samples were analyzed by: Results Carrying out a correlation between the new biomarkers for AKI (Nephrocheck, NGALds and SEPP1) with creatinine levels at different times (pre-operative, post-operative and 24 h post-operative) shows a significant correlation only with NGALds (respectively p = 0.017, p = 0.035 and p = 0.012) (Table). Subdividing patients based on the increase in creatinine levels from pre-operation to 24 hours post-operation, the only biomarker that showed an increase in values ​​was NGALds, while the others showed levels discordant with creatinine. Conclusion By analyzing the new biomarkers and comparing them with the creatinine data, it emerged that NGALds alone significantly correlated with the latter at different times. The other urinary biomarkers (Nephrocheck and SEPP1) showed no correlation with creatinine levels. Based on this outcome, it could be assumed that NGALds is the biomarker which, due to its characteristics already stated in numerous studies and its correlation with creatinine, could be used and replace the latter as an early biomarker of AKI.

#1614 Fenofibrates and chronic kidney disease – Is there anything to worry about?

Abstract Background and Aims Chronic Kidney Disease (CKD) patients have increased risk of cardiovascular disease and dyslipidemia is a frequent comorbidity. Many patients are medicated with anti-lipidemic agents to reduce atherosclerotic disease and coronary vascular events. Fenofibrates are lipid-lowering agents used to treat mixed dyslipidemia and hypertriglyceridemia and are widely used by primary care physicians. Many studies described reversible increase in serum creatinine (SCr) associated with fenofibrates use, but the underlying mechanism is poorly understood. Whether hypercreatinemia is secondary to alterations in creatinine metabolism, tubular handling, or reflects a true impairment in kidney function remains unknown. This phenomenon is also fairly unknown to many primary care providers and, as a result, patients with a SCr rise while on fenofibrates are often referred to nephrology consultation. In this study, we have analyzed the effect of fenofibrate withdrawal on SCr, eGFR and hemoglobin (Hb) in patients referred to nephrology consultation for CKD or decrease of eGFR. Our aim was to understand the impact of fenofibrates withdrawal on kidney function and to look for factors that might influence the risk of fenofibrate nephrotoxicity. Methods We conducted a retrospective observational study, reviewed electronic medical records and collected data of all adult patients discontinued on fenofibrates at first nephrology consultation, between January 2022 and October 2023. Ninety patients were included, of which four were excluded due to simultaneous suspension of antihypertensive drugs. Patients were subsequently evaluated for clinical reasons from 2 to 6 months after the first appointment, with new laboratory data collected, including Hb, SCr and lipid profile. eGFR was calculated using MDRD 4 formula. Continuous variables were compared by t-test and categorical variables were compared by chi-square test. A p value of &amp;lt; 0.05 was considered statistically significant. All data was analyzed using Stata software. Results A total of eighty-six patients were included in this study, 65% (n=56) were male, mean age of 71.2 ± 11.4 years old; all patients were medicated with fenofibrates due to dyslipidemia and 77% (n=66) were also on statins; 94% (n=81) had hypertension, 60% (n=52) had type 2 diabetes mellitus, and 20% (n=17) had ischemic cardiopathy. Ninety-two percent (n=79) were taking renin-angiotensin system inhibitors (RASi). Nearly half the patients (49% n = 42) had stage 4 CKD and 45% (n = 39) had stage 3 CKD; Main causes of CKD were presumed diabetic kidney disease (34% n = 29) and ischemic nephropathy (15% n = 13), 30% (n = 26) of patients had undetermined etiology. Upon fibrate discontinuation, mean SCr was 2.1 ± 0.6 mg/dL and mean eGFR was 31.3 ± 10.9 mL/min/1.73 m2. Mean Hb was 12.5 ± 2.0 g/dL. After fenofibrate discontinuation, eGFR significantly improved in mean 15.2 mL/min/1.73 m2 (31.3 vs 46.5 mL/min/1.73 m2, p &amp;lt; 0.0001) with a mean reduction of SCr of 0.6 mg/dL (2.1 vs 1.5 mg/dL, p &amp;lt; 0.0001). Mean Hb increased 0.4 g/dL (12.4 vs 12.7 g/dL, p = 0.112). Mean total cholesterol was 168.4 ± 56.4 mg/dL and mean triglycerides was 234.8 ± 285.3 mg/dL. Only one patient was restarted on fenofibrate due to severe hypertriglyceridemia. Fenofibrate discontinuation effect on eGFR improvement remained statistically significant when adjusted for diabetes, hypertension, CKD etiology and RASi use. Conclusion Our study reports a consistent increase in eGFR and SCr decrease following discontinuation of fenofibrate, as other reports before. A true effect on eGFR could be supported by the Hb rise, though it did not reach statistical significance. The exact mechanism by which fenofibrates increase SCr remains to be clarified. Cardiovascular disease is the main cause of death amongst CKD population and the potential benefits of fenofibrates should not be disregarded. Our results suggest that patients started on fenofibrates should be carefully selected, specially if CKD is present, and kidney function monitoring should be considered. A drop in eGFR should prompt physicians to weigh on the strict indications for fenofibrates use.

#2027 Activation of histone deacetylase-1 in fibroblasts and pericytes induces renal interstitial fibrosis after ischemia-reperfusion injury

Abstract Background and Aims Following an acute kidney ischemic event the chromatin remodelling enzyme, histone deacetylase-1 (HDAC1), is activated in many cell types of the kidney including fibroblasts and pericytes. During kidney injury, the fibroblasts/pericytes differentiate into the myofibroblasts and produce extracellular matrix that can lead to a permanent decline in kidney function. Pharmacological inhibition of HDACs can attenuate ischemia-reperfusion-injury (IRI) mediated interstitial fibrosis. The hypothesis of this study was that fibroblast/pericyte HDAC1 activation promotes myofibroblast differentiation and interstitial fibrosis. Method Tamoxifen inducible, fibroblast/pericyte HDAC1 knockout (KO) mice (HDAC1Fl/Fl; Col1a2-CreEr) and littermate controls (HDAC1Fl/Fl) were used. Male and female mice were given tamoxifen by ip at 8-10 weeks of age and IRI or sham surgery completed after a 2-week tamoxifen washout period. A mild, 18 min, bilateral, warm IRI model was used, and samples collected over 4 weeks. Glomerular filtration rate (GFR) was assessed using transdermal FITC-Sinistrin clearance. In vitro experiments with kidney fibroblast cells (NRK49F) overexpressing empty vector or HDAC1 were used for RNA-sequencing to determine the HDAC1-dependent myofibroblast transcriptome. Results We confirmed that HDAC1 was knockdown in myofibroblast cells from KO mice with co-localization of HDAC1 and PDGFRβ or α-smooth muscle actin in the kidneys of IRI mice. Twenty-four hours post-surgery, all IRI mice exhibited 2-3 times increase in serum creatinine and a ∼50% reduction in GFR compared to sham mice (control IRI = 513 ± 129 μl /min/100 g body mass, control sham = 1010 ± 218, n = 4-5, p = 0.02; KO IRI = 529 ± 116, KO sham = 1187 ± 59 μl/min/100 g body mass, n = 4-5, p = 0.004). Subsequent GFR measurements over the next 4 weeks showed a gradual recovery of renal function of IRI mice starting at week 2 and fully restored to sham values by week 4. However, the male control IRI mice had significant focal interstitial fibrosis 2- and 4-weeks post injury (4-week data: sham = 0.3 ± 0.09 % of cortical area, IRI = 1.2 ± 0.2%, n = 6/group, p = 0.0011) but this was attenuated in the KO male IRI mice (sham = 0.4 ± 0.07% n = 4, IRI = 0.5 ± 0.1%, n = 7, p = 0.93). The female mice, regardless of genotype, had very little kidney damage or interstitial fibrosis at 4 weeks. Transcriptomes of NRK49F cells overexpressing HDAC1 had an upregulation of 55 genes related to pro-inflammatory cytokines and tumour necrosis factor signalling and downregulation of 367 genes related to cell junctions, cytoskeleton proteins, and cell adhesion compared to the empty vector control cells. Fibroblast proliferation rates were not statistically different among the groups, suggesting HDAC1 does not affect myofibroblast proliferation but rather pro-inflammatory gene expression. Conclusion In male mice, fibroblast/pericyte activation of HDAC1 leads to the production of pro-inflammatory cytokines that we predict will lead to immune cell infiltration and crosstalk that leads to the excessive production of interstitial fibrosis following IRI.