Initial Creatinine Research Articles

Carbon dioxide (CO2) as an alternative contrast agent in percutaneous transluminal angioplasty procedures for chronic limb-threatening ischemia patients with chronic kidney disease

Background: Chronic limb-threatening ischemia (CLTI) is a very morbid illness that significantly reduces quality of life. The severity of this disease may necessitate revascularization or amputation. Arteriography is frequently performed for the planning of revascularization. Patients with compromised kidney function need alternative contrast agents. CO2 may be utilized in lower extremity vascular diagnostics and intervention, especially in patients at risk for contrast-induced nephropathy (CIN). Case Illustration: An 80-year-old female with bilateral leg pain and leg swelling had an ulcer on her toe for 2 weeks. She had a history of intermittent claudication for 1 year, hypertension for 5 years, kidney stones for 2 years, and chronic kidney disease for 1 year. She underwent an ECG, laboratory, USG, DUS, and CT-angiography examination. From her laboratory result, her initial creatinine was 5.02 mg/dL (eGFR 8 mL/m/1.73 m2). After good hydration, it became 1.28 mg/dL (eGFR 39 mL/m/1.73 m2). After a CT-angiography procedure, her creatinine level was increased (3.7 mg/dL; eGFR 10.9 mL/m/1.73 m2). She was diagnosed with CLTI Rutherford V Fontain 3 left lower extremity. She suggested doing an angioplasty procedure with a safer contrast agent. An angioplasty procedure was done at RSSA Malang with CO2 contrast. After the procedure, her leg pain improved, and her creatinine didn’t elevate. Conclusion: CO2 angiography might be used as a safe alternative contrast medium in patients with CLTI, which benefits the preservation of renal function and prevents limb amputations. Keyword: chronic limb-threatening, chronic kidney disease, CO2 angiography, contrast-induced nephropathy, peripheral artery disease

7439 Mercury toxicity presenting as Pheochromocytoma

Abstract Disclosure: A. Ansar: None. K. McNerney: None. B.A. Marshall: None. Background: Mercury intoxication is a rare cause of hypertension in children and can mimic other endocrinopathies such as pheochromocytoma. Mercury affects catecholamine metabolism and can cause elevated catecholamine levels, thereby incorrectly suggesting a catecholamine-secreting tumor. Clinical Case: An 8-year-old girl presented to the ED with progressive night sweats, intractable migratory myalgias, hypertension and tachycardia. Patient was in her usual state of health until 2 weeks before presentation when she started to have worsening intermittent pains in her chest, arms, back, and knees. She also experienced restlessness and inability to sleep. On presentation she was hypertensive, with blood pressure of 146/116 mm Hg while calm, heart rate 125 bpm, afebrile. She was anxious, irritable, and seemed uncomfortable. Her skin was dry and rough with a scaly eczematous rash on the arms and legs. She had persistently elevated blood pressure in upper and lower extremities, unremarkable echocardiogram and electrocardiogram, and a normal result on fundoscopic examination. Her initial electrolytes, creatinine, and urinalysis were all normal and remained so on serial evaluations. Urine drug screen was negative. Thyroid function panel showed normal TSH with slightly elevated Free T4 2.28 ng/dL (0.9-1.7), but a normal Free T3 3.9 pg/mL (2.0-4.4) and Free T4 by equilibrium dialysis 1.8 ng/dL (0.8 - 2.0). CT of the chest, abdomen and pelvis was negative and did not show any lesions. Plasma renin activity was 4.6 ng/mL/hour, supine, (<2.0) and plasma aldosterone level < 4.0 ng/dL (< 40 supine) were normal. 24-hour urinary norepinephrine was 90 μg/24h (13-65), epinephrine 37 μg/24h (0.2-10), urine metanephrines 195 μg/24h (18-144), urine normetanephrines 305 μg/24h (29-145), all elevated. Further history taking revealed that patient was taking Ayurvedic supplements prepared by hand by medicinal personnel in India for 3 months prior to presentation. These were stopped 2 weeks prior to her presentation, when she first became symptomatic. Her blood mercury level was 11 ng/mL (n <9), and urinary mercury excretion 67 μg/24 hours (n<10), both obtained 3 weeks after stopping supplementation. She was started on oral chelation therapy with succimer 10 mg/kg/day. Her hypertension was controlled with doxazosin. One week after initiation of therapy, her symptoms improved, and she became normotensive. Her acrodynia and irritability resolved. Urine metanephrine levels will be repeated at upcoming clinic follow up. Conclusion: Mercury toxicity should be considered in the differential of pheochromocytoma to avoid extensive diagnostic testing and morbidity associated with it. Lead, mercury, and arsenic have been detected in traditionally prepared Ayurvedic supplements. A careful history of intake of supplements can be important in cases with unusual symptomatology. Presentation: 6/3/2024

Prevalence and progression of chronic kidney disease among adults undergoing creatinine testing in South African public healthcare facilities: a study leveraging data from South Africa’s National Health Laboratory Service (NHLS)

BackgroundChronic kidney disease (CKD) has emerged as a substantial global health challenge, with a marked rise in associated mortality. However, it often goes undetected until advanced stages, particularly in low-income...

Prospective Comparison of Urinary Measured Creatinine Clearance With eGFR and Cystatin C Based Cis-eGFR, Including Kinetic eGFR in the Immediate Post-transplant Period With Prompt Allograft Function

IntroductioneGFR and KeGFR have not been compared, with urinary measured creatinine clearance (mCrCl) or serum Cystatin C eGFR, soon after kidney transplant with prompt primary function. The study aims to compare post-KTx, urinary mCrCl, and eGFRCysC with eGFR and KeGFR. MethodPost-KTx, urine was collected every 12 hours from 25 of the 34 consenting subjects to calculate mCrCl and compare with MDRD-4, Jelliffe eGFR, Cockcroft-Gault Creatinine-Clearance, and KeGFR by Chen and Brater formulae. Serum CysC levels were also measured in the last 14 subjects to compare with creatinine, mCrCl, and eGFRCysC. FindingsAt 12 to 96 hours post-KTx (n=25), mCrCl was 55.8% to 13.6% higher than MDRD-4 eGFR. The mean CysC level (n=14) was 58% to 14% lower than creatinine for up to 3.0 days post-KTx, with higher MDRD-4 eGFRCysC. Chen and Brater KeGFR were significantly lower than mCrCl and eGFR (figure-1B, table-1). Within three days post KTx, a 50% decrease in creatinine provided ≥ 50 mL/min CrCl in 90% of cases (mean mCrCl 61.7± 22.8). This difference was greater when the initial creatinine was higher with the rapid decrease in creatinine. Conclusion1) Post-KTx eGFR/KeGFR formulae underestimate mCrCl. 2) Serum CysC levels were lower than creatinine, corresponding higher eGFRCysC. 3) A 50% decrease from initial serum creatinine; mean mCrCl was 61.7±22.8 mL/min, and 90% of them have mCrCl > 50 mL/min. Post KTx, until creatinine is stabilized, recipients are often receiving subtherapeutic dosing of renally adjusted medications. More prospective studies are necessary, including radioisotope clearance.

#2994 Nephrotoxicity post injection of iodized PDC in patients with renal failure in the emergency room

Abstract Background and Aims Nephropathy following injection of iodinated contrast media (PDC) is the leading cause of iatrogenic acute renal failure. Several associated factors have been identified, including renal function before the procedure. Objective To study the incidence of nephrotoxicity post venous-injection of iodinated PDC in patients with impaired renal function. Method This was a prospective, descriptive, single-center study over a six-month period. Patients aged over 14 years and having undergone an injection of iodinated contrast products for diagnostic or therapeutic purposes were included. We excluded patients with stage IV renal insufficiency (Cl ≤ 29 ml/min) with or without indication for extra-renal purification. Nephropathy in this context was defined by an elevation in baseline plasma creatinine of more than 25% in the 48 to 72 hours following injection. Results During the study period, 135 patients were collected with a mean age of 46 ± 18 years and range of 16 to 97 years. The gender ratio was 3.2 with a male predominance. Thirty-two patients had impaired renal function on admission, of which seven patients (5.2%) were known to have chronic renal failure and twenty-five patients (18.5%) had impaired renal function discovered on admission. The mean renal clearance was 90.9 ± 36.3 ml/min with extremes ranging from 30 ml/min to 176 ml/min. More than half of the patients had normal renal function (Stage G1 according to the KDIGO 2022 classification) (n = 79, 58.5%). The incidence of nephropathy post venous-injection of iodized PDCs was 15.6%. 111 patients (82.8%) benefited from per-procedure hydration protocol. In univariate analysis, chronic renal failure or discovered on admission was associated with the risk of worsening renal function with a statistically significant difference, p respectively at 0.007 and 0.009. Furthermore, the correlation between the worsening of renal function as a function of initial plasma creatinine showed that initial plasma creatinine was higher in patients who developed iodinated contrast nephropathy with a statistically significant difference, p = 0.005, a sensitivity of 57% and a specificity of 78%. ROC curve analysis showed an AUC of 0.691; 95% CI [0.567-0.815], with a discriminant Cut off of plasma creatinine at 90.5 µmol/l. Conclusion The incidence of post-iodized PDC injection nephropathy was high in emergency room. Among the independent associated factors identified, chronic renal insufficiency or discovered on admission which requires special precautions, especially through optimal hydration.

The Effect of Contrast Rationing on the Development of Acute Kidney Injury During the Global Contrast Shortage

BackgroundIn April of 2022, the COVID-19 pandemic resulted in a global shortage of intravenous contrast media (ICM), which led our health care system to implement rationing measures. Study ObjectivesWe set out to determine if the reduction in ICM use was associated with a change in the incidence of acute kidney injury (AKI). MethodsWe conducted a multicenter retrospective cohort analysis to compare the incidence of AKI in patients who presented before and after ICM rationing. Adult patients who had a CT of the abdomen performed who had at least 2 creatinine measurements, at least 24 h apart, were included. The maximum increase in creatinine was determined by subtracting the maximal creatinine obtained within 7 days with the initial creatinine. The primary outcome was the development of AKI. ResultsA total of 2168 patients met inclusion criteria (1082 before; 1086 after). There was no significant difference in age, gender, comorbid conditions, disposition, or initial estimated glomerular filtration rate between groups. In the prerationing group, 87.7% of patients received ICM compared to 42.7% after. There was no significant difference in the development of AKI between groups (11.1% vs. 11.0%), including when stratified by baseline renal function and adjusted for age, sex, race, comorbid conditions, and emergency severity index. ConclusionsThe dramatic reduction in ICM use that resulted from the global shortage was not associated with a change in the incidence of AKI. This reinforces the results of previous studies which have failed to find evidence of a relationship between ICM administration and AKI.

Analysis of Vancomycin Dosage and Plasma Levels in Critically Ill Adult Patients Requiring Extracorporeal Membrane Oxygenation (ECMO).

Introduction: Critically ill patients undergoing extracorporeal membrane oxygenation (ECMO) exhibit unique pharmacokinetics. This study aimed to assess the achievement of vancomycin therapeutic targets in these patients. Methods: This retrospective cohort study included patients on ECMO treated with vancomycin between January 2010 and December 2018. Ninety patients were analyzed based on ECMO connection modality, baseline creatinine levels, estimated glomerular filtration rate (eGFR), renal replacement therapy (RRT) requirements, and vancomycin loading dose administration. Results: Twenty-three percent of the patients achieved the therapeutic range defined by baseline levels. No significant differences in meeting the therapeutic goal were found in multivariate analysis considering ECMO cannulation modality, initial creatinine level, initial eGFR, RRT requirement, or loading dose use. All trough levels between 15 and 20 mcg/mL achieved an estimated area under the curve/minimum inhibitory concentration (AUC/MIC) between 400 and 600, almost all trough levels over 10 mcg/mL predicted an AUC/MIC >400. Discussion: Achieving therapeutic plasma levels in these patients remains challenging, potentially due to factors such as individual pharmacokinetics and pathophysiology. A trough plasma level between 12 and 20 estimated the therapeutic AUC/MIC for all models, proposing a possible lower target, maintaining exposure, and potentially avoiding adverse effects. Despite being one of the largest cohorts of vancomycin use in ECMO patients studied, its retrospective nature and single-center focus limits its broad applicability.

Patient characteristics associated with acute kidney injury following coronary angiography

Objective The objective of this study was to identify patient characteristics associated with acute kidney injury (AKI) post-coronary angiography with or without percutaneous coronary intervention. Methods This retrospective, single-center study analyzed 350 patients from October 1, 2017 to September 30, 2018. The primary endpoint was AKI, defined as a rise in creatinine >0.3 mg/dL within 48 hours of coronary angiography. Results AKI occurred in 41 of 350 patients (8.8%). Patients experiencing AKI had a higher incidence of hypertension (100%; P = 0.005), hyperlipidemia (98%; P = 0.001), diabetes mellitus (68%; P = 0.0005), and heart failure (37%; P = 0.0057). AKI occurred in 30 of 185 (16%) and 11 of 165 (6.7%) patients undergoing femoral and radial access, respectively. AKI incidence was not significantly affected by contrast dose (99 ± 9 vs 93 ± 3 mL; P = 0.52), fluoroscopy time (10.3 min [IQR 6.3, 17.7] vs 8.5 min [IQR 4.5, 13.9]; P = 0.2), or preprocedural computed tomography with contrast (P = 0.66). Multivariable regression showed significantly higher AKI among patients with peripheral artery disease (odds ratio [OR] = 12.4; 95% confidence interval [CI] 3.4–33.6; P = 0.0001), multivessel coronary artery disease (OR = 11.9; 95% CI 2.3–61.1; P = 0.003), and initial creatinine >1.5 mg/dL (OR = 4.4; 95% CI 1.4–13.6; P = 0.01). Conclusion Peripheral artery disease, multivessel disease, and creatinine >1.5 mg/dL were associated with a higher risk of AKI in patients undergoing coronary angiography in this single-center retrospective cohort.

SAT246 Ectopic (Penile) Calcification in 1, 25 Vitamin D Induced Hypercalcemia

Abstract Disclosure: J. Berquist: None. D.S. Reddy: None. A 60-year-old male with a history of well controlled type 2 diabetes and HTN presented with acute renal failure (initial creatinine 19.9 mg/dL, GFR 11). Kidney biopsy during admission was consistent with acute tubular necrosis and mild diabetic nephropathy. Serum calcium was normal at that time. He received temporary dialysis and eventually discharged home with improved (though still elevated) creatinine. On follow up labs a month later, he was noted to have high serum calcium. He was temporarily lost to follow up and was readmitted four months later due to persistent severe hypercalcemia. Peak serum calcium on his new admission was 13.2 mg/dL. Phosphorus level three months prior was 5.9 mg/dL, though had now improved to 2.7 mg/dL. Other labs this admission include creatinine 2.54 and GFR 33 (which was consistent with previous months), PTH 11 pg/mL, 25-OH Vitamin D 10 ng/mL, 1,25-Dihydroxy Vitamin D elevated at 84.8 pg/mL and magnesium low at 1.5 mg/dL. SPEP and UPEP were both negative and PTHrP was not measured. Kappa/Lamda free light chain ratio was mildly elevated at 1.77 (0.26-1.65). QuantiFERON Gold, HIV, Beta-2 microglobulin, ANA, and flow cytometry were negative. He received calcitonin x 2, IVF, zoledronic acid, and denosumab (three days later), which improved his calcium to 11.5 by discharge 11 days later. He underwent a CT Chest/Abdomen/Pelvis, T spine, and L spine that were remarkable for multiple bilateral partially calcified pulmonary nodules and hepatic steatosis with splenomegaly. PET CT showed 20 hypermetabolic osseous lesions throughout axial skeleton, multiple pulmonary, liver, and splenic lesions and lymphadenopathy in the head, neck, chest, abdomen. There was also diffuse calcification of the penile corpora. Pathology via biopsies of a retroperitoneal lymph node as well as bone marrow showed non-caseating granulomas. Lastly, 1-2 months ago, he noticed pain and hardening of his penis. On exam, there is a deep firmness with palpation and distal penile tenderness. There are no cutaneous lesions on the penis or anywhere else on the skin. Calciphylaxis was a consideration, but isolated penile involvement is rare. Additionally, it is rare to develop calciphylaxis without end stage renal disease. A review of the literature showed many cases of penile calciphylaxis, though none were without cutaneous involvement. Sarcoidosis of the penis is also very rare and cases in the literature cite either a cutaneous or intraurethral lesion. This case appears unique in the findings of penile calcification palpable on exam and visible on imaging, without any cutaneous manifestations, in the setting of previous though recovered acute renal failure and 1, 25 Vitamin D-mediated hypercalcemia in sarcoidosis. Presentation: Saturday, June 17, 2023

Early renal replacement therapy in coronavirus disease 2019-infected patients with acute kidney injury

Background Acute kidney injury (AKI) is developing as a frequent and significant coronavirus illness [coronavirus disease 2019 (COVID-19)] sequela owing to the spread of the virus in 2019. A few trials, meanwhile, have focused on AKI managed with renal replacement therapy (AKI-RRT). Aim To evaluate the effectiveness of early renal replacement treatment in COVID-19 AKI cases. Patients and methods A total of 100 individuals with AKI and confirmed COVID-19 infection participated in this case–control research. All participants were split into two groups: group A included 50 COVID-19-confirmed diagnosis patients with AKI and group B included 50 COVID-19-confirmed diagnosis patients without AKI. Following ICU admission, we collected laboratory results, physiological parameters, drugs, therapies, and organ support (including RRT), as well as clinical events like mortality. Results Use of invasive ventilation, vasopressor, deep sedation, and RRT was significantly higher in group A. When compared with patients with AKI who did not get RRT, 14 (28%) patients who had RRT were younger, had greater creatinine and blood urea nitrogen levels, and experienced oliguria more often. Five patients had at least one session of intermittent hemodialysis, and all patients experienced continuous venovenous hemofiltration. Considering mortality, hospital mortality and 60-day mortality rate were significantly higher in group A. However, there was no substantial variation between the two groups regarding ICU mortality, 28-day mortality, and RRT mortality. Age, baseline creatinine, and effective RRT were the independent predictors linked to 60-day mortality in the multiple logistic regression analysis. Conclusion Patients with AKI who need RRT had a nonsignificantly higher death rate than COVID-19-infected patients without AKI. Age, initial creatinine, and RRT effectiveness were all independent variables linked to 60-day mortality.

Impact of thrice-weekly cotrimoxazole prophylaxis on creatinine and potassium plasma levels in kidney transplant recipients.

Cotrimoxazole (CTX) 800/160mg daily or thrice-weekly is recommended as prophylaxis of Pneumocystis jirovecii pneumonia in kidney transplant recipients. Cotrimoxazole 800/160 daily elevates plasma creatinine and potassium levels but whether the thrice-weekly regimen does so is unknown. Medical records of 225 kidney transplant recipients at Cliniques Universitaires Saint-Luc were analyzed retrospectively. All received thrice-weekly CTX 800/160 for 6months after transplantation. Monthly laboratory results, co-medications, and tacrolimus trough levels were compared. Standard statistical tests were used. One month after CTX stop, creatinine level decreased by 0.11mg/dl (8%, p = 0.029). This contrasts with its stability in previous and subsequent months. No co-medication change accounted for this decrease. The decrease averaged 0.17mg/dl (p < 0.01) in the highest initial creatinine tertile. The higher the initial creatinine level, the greater the decrease after CTX stop (p < 0.001), and urea levels remained stable after CTX stop. Potassium levels decreased by 0.09mmol/L (p = 0.021) one month after CTX stop, and decreased by 0.23mmol/L (p < 0.01) in the highest initial potassium level tertile. Our study pinpoints the impact of CTX 800/160 thrice-weekly on creatinine and potassium levels in kidney transplant recipients. This should be considered when interpreting the evolution of plasma creatinine over time, especially in patients with graft dysfunction. Thus, creatinine levels of cohorts with 6months versus lifelong CTX require different interpretations.

#4784 IDENTIFICATION OF FACTORS ASSOCIATED WITH DEATH IN DIALYSIS PATIENTS USING A MACHINE LEARNING-BASED PREDICTIVE MODEL

Abstract Background and Aims Few studies including unplanned dialysis starts have used machine learning for the prediction of death in dialysis patients. The objective of the study was to use R software algorithms to develop machine learning predictive models for the identification of death-related factors in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD). Method This study included adult patients undergoing HD and PD started in a planned or urgent manner in a dialysis center between January 2014 and January 2019. Epidemiological, clinical and laboratory data were collected. Univariate analysis was followed by ML-based analyses. Then, multivariate regressions were obtained using stepwise and Cox regression analyses. Finally, a Random Forest predictive model was generated after variables with missing values &amp;gt;30% were removed. Results Of 581 patients included, 170 died (29,2%). On univariate analysis death was associated with age, number of comorbidities, dialysis modality switching, creatinine, PTH and albumin values at dialysis initiation, presence of diabetes (DM), hospitalization, function recovery and central venous catheter (CVC) for dialysis access. Patients who started dialysis with a CVC had a worse survival (p = 0.0034) than those who did not use CVC, started HD with AVF, or received PD (Figure 1). Data were split into 20% for testing the regression model, and 80% for training the model. Data preprocessing for Cox regression included imputing some values using bag impute (decision trees), creating dummy variables, and removing collinear variables. Death was associated with older age (p &amp;lt; 0.001), fewer ESI-free months (p &amp;lt; 0.001) and lower initial creatinine (p = 0.008) (Table 1). The model C-index was 0.8099. Random forest ranked the following variables predictive of death in descending order of importance: ESI-free months; age; initial levels of creatinine, PTH and albumin; number of comorbidities; dialysis-related infection; initial phosphorus and hemoglobin; hospitalizations; male gender; modality switching (Figure 2). The agreement of the model obtained was 0.8110. Conclusion ESI-free months, age and initial levels of creatinine were associated with death on both multivariate and ML-based analyses.

Necessity of vancomycin trough concentrations to manage uncomplicated acute bacterial skin and skin structure infections: a laboratory stewardship analysis.

Recent recommendations by the American Society of Health System Pharmacists and Infectious Disease Society of America have provided guidance regarding vancomycin dosing and monitoring in serious infections (including methicillin-resistant Staphylococcus aureus); however, trough monitoring for uncomplicated acute bacterial skin and skin structure infections (ABSSSI) were not addressed. Vancomycin use appears to lead to a low incidence of acute kidney injury with short durations and a low trough goal (10-15 mg/L). Nevertheless, clinical studies have found no difference in clinical outcomes for ABSSSI regardless of vancomycin level. Therefore, it can be posed whether trough monitoring is necessary in this patient population. This is a retrospective cohort study comparing vancomycin therapy duration for ABSSSI in adult, general medicine patients who received scheduled vancomycin with an initial creatinine clearance rate of ≥50 mL/minute and had at least one vancomycin trough. The objective of this study was to determine if vancomycin treatment duration differs for patients with ABSSSI with a sub-therapeutic vancomycin trough (ST; <10 mg/L) compared with therapeutic trough (TT; ≥10 mg/L). There were 39 (67.2%) patients with ST compared with 19 (32.8%) with TT. A similar median vancomycin treatment duration for ST (48.25 hours) and TT (59.5 hours; p=0.65) was found. There was no statistical difference for hospital duration, time from last trough to vancomycin discontinuation, or incidence of acute kidney injury (p>0.05 for all). Patients with ST and TT had similar vancomycin durations and clinical outcomes. It may be prudent for institutions to address vancomycin trough laboratory stewardship and associated costs.

Acute kidney injury is a risk factor for in-hospital mortality in patients with acute cardiovascular pathology and concomitant COVID-19

Abstract Funding Acknowledgements Type of funding sources: None. Although respiratory failure and hypoxemia are the main manifestations of COVID-19, many patients also experience worsening kidney function. Hemodynamic disorders in patients with acute cardiovascular pathology can also worsen renal function. The aim of this study was to assess kidney function and its significance for the development of in-hospital complications in patients who were hospitalized with acute cardiovascular pathology and had a co-infection with COVID-19. 139 pts with acute cardiovascular pathology who were diagnosed with COVID-19 were examined. 69 (49.6%) pts had ACS (47 pts with AMI), 33 (23.7%) pts - hypertensive urgency, 24 (17.3%) pts - ADHF, 9 (6.5%) pts - tachysystolic paroxysm of atrial fibrillation, 2 (1.4%) pts - acute pulmonary embolism, and 2 (1.4%) pts - syncope. The average age was 67.9±12.7 y.o., 70 (50.4%) pts were male. Concomitant arterial hypertension was found in 87.1%, DM – 20.9%, CHF - 30.9%, COPD – 9.4% of pts, history of AMI – 20.1% and ischemic stroke – 9.4% of pts. The initial creatinine level was 110.7±66.1 μmol/l, eGFR CKD-EPI - 63.3±20.3 ml/min/1.73m2 (eGFR&amp;lt;60 ml/min/1 ,73m2 – 46.0% of patients). Patients with eGFR&amp;lt;60 ml/min/1.73m2 were older, more often female, often had a history of AF, had a lower level of hemoglobin and blood pressure at admission, a greater number of complications (need for NIV, inotropic therapy) and higher in-hospital mortality (25.0% vs. 5.3%, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (creatinine level increase ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR&amp;lt;60 ml/min/1.73m2, p&amp;lt;0.05). These patients did not significantly differ from patients without AKI in terms of basic clinical and anamnestic characteristics, but had a lower spO2 level at admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), VTE (14.3% vs. 0.9%, p=0.070), death from of all causes (47.6% vs. 7.0%, p=0.002) and more often required organ support therapy: non-invasive/invasive lung ventilation (52.4% vs. 11.3%, p&amp;lt;0.001), inotropic therapy (57, 1% versus 5.2%, p&amp;lt;0.001). The simplified criterion of AKI (increase of creatinine level ≥ 26.5 μmol/l in comparison with the value at admission at any time during the hospital period) also made it possible to distinguish the category of patients at high risk of hospital complications and death (37.9% vs. 8.2% , p=0.004). Acute kidney injury is a powerful risk factor for in-hospital complications and mortality in patients with acute cardiovascular pathology and concomitant COVID-19 infection.

Comparison of the 2021 and 2009 chronic kidney disease epidemiology collaboration creatinine equation for estimated glomerular filtration rate in a Chinese population

ObjectivesTo retrospectively compare the clinical effects of the newly released 2021 and 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations for estimated glomerular filtration rate based on creatinine (eGFRcr) in a Chinese population with a broad spectrum of clinical characteristics using historical data. Design and methodsPatients and healthy individuals who visited the Zhongshan Hospital, Fudan University, between July 1, 2020, and July 1, 2022, were enrolled. The exclusion criteria were age < 18 years, amputees, pregnant women, patients with muscle-related diseases, and patients who had undergone ultrafiltration or dialysis. The final study population included 1,051,827 patients with a median age of 57 years; 57.24% of the enrolled individuals were men. eGFRcr was calculated using the 2009 and 2021 CKD-EPI equations and initial creatinine level. Results were evaluated statistically by sex, age, creatinine level, and CKD stage. ResultsThe 2021 equation increased the eGFRcr in all participants compared to the 2009 equation by 4.46%. The median eGFRcr deviation of the 2021 CKD-EPI equation compared to the 2009 CKD-EPI equation was 4 ml/min/1.73 m2. 903,443 subjects (85.89%) had higher eGFRcr owing to the utilization of the 2021 CKD-EPI equation, which did not cause CKD stage change. A total of 11.57% of subjects (121,666) had improved CKD stage with the 2021 CKD-EPI equation. 1.79% (18,817) had the same CKD stage with both equations, and 0.75% (7,901) had lower eGFRcr but no change in the CKD stage with the 2021 equation. ConclusionsThe 2021 CKD-EPI equation typically produces higher eGFRcr results than the 2009 version. Applying the new equation could lead to changes in the CKD stage for some patients, which doctors should consider.

Factors affecting change in renal function after contrast-enhanced computed tomography in cancer patients

Objectives. Contrast-enhanced computed tomography (CECT) is the most common form of assessing the effectiveness of cancer patient treatment. However, an injection of an iodine-based contrast agent can cause acute kidney damage (AKI). To determine the frequency and factors affecting post-contrast kidney function deterioration during oncological treatment. Material and methods. Kidney function in cancer patients with solid tumors undergoing a total of 206 CECTs was retrospectively analyzed. Results. Two hundred and six CECT procedures in 79 patients (age 68.4 ± 10.6 years) were included in the study. The median eGFR before CECT according to the MDRD was 81 mL/min/1.73m2 (IQR 26). The median time between CECT and kidney function examination was 8 (IQR 8) days. In the whole group, the median eGFR change defined as the difference between eGFR after and before CECT was 0.0 (9.0) mL/min/1.73m2 and was not significant. eGFR decreased in 100/206 (48.5%) CECT procedures with the median difference = –5.0 (6.0) mL/min/1.73m2. However, clinically significant deterioration of renal function (an increase in SCr of &gt; 0.3 mg/dL) was found only in two cases (0.9%). The change in eGFR associated with CECT correlated significantly (p &lt; 0.05) with initial creatinine (r = 0.117) and urea (r = 0.158), but not with age and comorbidities. After dividing the analyzed population according to the median GFR, it turned out that in the group of patients with eGFR &lt; 81 mL/min/1.73m2, the median difference in GFR level was 1 (IQR 10), and in the group with a higher eGFR level the median was –1 (IQR 8.5), which was statistically significant (p = 0.03). The multivariate logistic regression analysis in subsequent reduced models confirmed that SCr, uric acid level, and the use of antimetabolites were the factors independently reducing the risk of deterioration of renal function after CECT. Conclusions. CECT can be responsible for kidney function deterioration; however, it has no impact on oncological treatment.

Kidney dysfunction and in-hospital complications in patients with acute cardiovascular pathology infected with COVID-19

This study aimed to assess kidney function and its significance for the development of in-hospital complications in patients hospitalized with acute cardiovascular pathology infected with COVID-19.&#x0D; Methods. This prospective cohort single-center study included 139 patients with acute cardiovascular pathology diagnosed with COVID-19. Sixty-nine (49.6%) patients had acute coronary syndrome (47 with acute myocardial infarction (AMI), 33 (23.7%) patients had hypertension, 24 (17.3%) patients had acute decompensated heart failure, 9 (6.5%) patients had tachysystolic paroxysms of atrial fibrillation, 2 (1.4%) patients had an acute pulmonary embolism, and 2 (1.4%) patients had syncope. The mean age was 67.9±12.7 years, and 70 (50.4%) patients were male. Arterial hypertension was present in 87.1% of patients, diabetes mellitus in 20.9%, congestive heart failure in 30.9%, chronic obstructive pulmonary disease in 9.4%, AMI in 20.1%, and ischemic stroke in 9.4%.&#x0D; Results. The initial creatinine level was 110.7±66.1 μmol/l and eGFR (CKD-EPI) was 63.3±20.3 ml/min/1.73m2 (eGFR&lt;60 ml/min/1.73m2 was diagnosed in 46.0% of the patients). The patients with eGFR&lt;60 ml/min/1.73m2 were older, more often female, frequently had a history of atrial fibrillation, had lower hemoglobin and blood pressure on admission, a greater number of complications (need for noninvasive ventilation, inotropic therapy), and higher in-hospital mortality (25.0% vs. 5.3 %, p=0.002). Acute kidney injury, which was evaluated according to KDIGO criteria (increase in creatinine level ≥ 26.5 μmol/l within 48 hours or ≥ 1.5 times within 7 days) was observed in 21 (15.4%) patients (12.0% in patients with eGFR≥60 ml/min/1.73m2 and 18.8% with eGFR&lt;60 ml/min/1.73m2, p&lt;0.05).&#x0D; These patients did not differ significantly in basic clinical and anamnestic data from patients without AKI but had lower spO2 on admission (86.9±11.2% vs. 93.4±5.0%, p=0.016). Patients with AKI had a significantly higher number of in-hospital complications: acute hypoxic delirium (47.6% vs. 8.7%, p=0.003), venous thromboembolism (14.3% vs. 0.9%, p=0.070), death from all causes (47.6% vs. 7.0%, p=0.002) and more often required organ supportive therapy: non-invasive/invasive pulmonary ventilation (52.4% vs. 11.3%, p&lt;0.001), inotropic therapy (57.1% versus 5.2%, p&lt;0.001). Using the simplified criterion of AKI, the category of patients at high risk for hospital complications and death could also be distinguished (37.9% vs. 8.2%, p=0.004). Vaccination against COVID-19 (at least 2 weeks before hospitalization prevented the development of AKI (16.5% vs. 5.0%, p=0.046) and tended to prevent in-hospital mortality (15.7% vs. 5.0%, p=0.076).&#x0D; Conclusions. Renal dysfunction in patients with acute cardiovascular pathology infected with COVID-19 is associated with in-hospital complications and can be prevented by prophylactic vaccination.

882. Systematic Underdosing of Oseltamivir in Hospitalized Patients with Influenza

Abstract Background Oseltamivir remains the primary treatment for seasonal influenza syndromes and early administration has been shown to increase the clinical benefit of treatment; we studied current practice and describe patient and system variables influencing dosing decisions. Methods We reviewed oseltamivir dosing in 135 adult patients in our community hospital admitted with acute influenza over two northern Hemisphere influenza seasons (2016-2017 and 2017-2018) and for whom pharmacy dosing protocols were invoked. We reviewed admitting symptoms for factors suggesting possible dehydration, the timing of treatment in relation to testing for influenza, the estimated creatinine clearance at the time of dose determination for oseltamivir, the initial dose of drug, and dose-adjustment over time. Results Patients ranged in age from 27-96 years (mean 74), with 83 males and 52 females among the 135 patients over these two seasons. Testing results were available for 131 patients and 75 (57%) were positive, while 56 (43%) were negative, and therefore treated empirically based on presenting symptoms. Ninety patients (67%) received an initial dose of 30 mg of oseltamivir, while 45 patients (33%) received an initial dose of 75 mg. Of the 90 patients who were dose-adjusted by the pharmacist to 30 mg for the initial dose, 24 (27%) had a creatinine clearance &amp;gt; 60 mL/min, and it is not clear what factors influenced those decisions. Of the 90 patients with an initial creatinine clearance of &amp;lt; 60 mL/min, 22 (24%) showed a clinically significant improvement to &amp;gt; 60 mL/min within the first 24 hours of hospitalization yet only 8 patients had their dose adjusted. Presenting symptoms did not predict patients who had rapid improvement of creatinine clearance. Of the 45 patients receiving an initial dose of 75 mg of oseltamivir, 19 (42%) had creatinine clearance values of &amp;lt; 60mL/min, and were therefore given a loading dose, followed by dose adjustment. Conclusion We found a significant percentage of patients were underdosed initially and dosing was not adjusted for changes in renal function. Reviewing and revising dosing protocols and guidelines may lead to more effective treatment for influenza and may serve as a model for future test-to-treat options for therapies for other acute viral respiratory infections in the future. Disclosures All Authors: No reported disclosures.

Effect of Initial Vancomycin Dose and Creatinine Clearance on the Attainment of Target Trough Concentration in Children.

Vancomycin is a glycopeptide antibiotic that is used to treat serious grampositive infections. However, therapeutic drug monitoring for vancomycin is not performed routinely in Vietnam in clinical practices. Monitoring of serum vancomycin concentration or trough levels is necessary to ensure the efficacy and safety of vancomycin therapy. This study aims to determine the impact of initial vancomycin dose and creatinine clearance on target trough attainment in hospitalized Vietnamese children. A prospective study with patients who received vancomycin for at least three days was conducted. Subsequently, demographic data, clinical diagnosis, vancomycin dosage, and serum creatinine levels were recorded. The vancomycin trough level was collected and creatinine clearance and adjusted vancomycin doses were calculated. A total of 40 eligible patients were enrolled. Patients' mean age, body weight, and height were 1.4 years old, 9.8 kg, and 75.5 cm, respectively. The mean vancomycin dose was 55.83 ± 19.34 mg/kg/day. The mean creatinine clearance was 80.18 ± 29.14 ml/min. The median trough level was 11.09 (7.84 - 16.46) μg/ml. There was no significant difference in the mean initial and the adjusted vancomycin doses (p = 0.062). However, there were statistically significant differences of initial (p = 0.004) or adjusted doses (p = 0.016) between groups of creatinine clearance. The trough vancomycin concentration was not statistically significant (p = 0.406) between these groups. Target trough vancomycin level may be associated with creatinine clearance but did not proportionally correspond to the vancomycin dose. Therefore, monitoring vancomycin trough levels is necessary to achieve the target trough and to ensure vancomycin efficacy and safety in treating severely infected Vietnamese children.

Effect of Serum C-Peptide Levels on the Development of Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary Angiography.

Contrast-induced nephropathy (CIN) is an important cause of morbidity and mortality, in patients with diabetes who undergo coronary angiography (CAG). It is known that serum C-peptide has renoprotective effects in diabetic nephropathy. Patients with diabetes (n = 552) who underwent CAG in our center between January 2020 and December 2021 were included, retrospectively. The patients were divided into 2 groups: not-developing CIN (group 1) and developing CIN (group 2). CIN developed in 128 (23.1%) of the patients with diabetes who underwent CAG. C-peptide, albumin, hemoglobin, hematocrit, initial creatinine, ejection fraction (EF), were significantly lower in the group that developed CIN compared with the group that did not (P < .05, for all). In correlation analysis, creatinine increase rate (ΔCr) was negatively correlated with C-peptide, hematocrit, and ejection fraction (r = -.241, P < .001; r = -.135, P < .001; r = -.194, P = .001; respectively). In logistic regression analysis, C-peptide level (Odds Ratio: .404, 95% Confidence Interval: .286-.571, P < .001) was an independent predictor of CIN. In the present study, C-peptide level was an independent predictor of CIN in patients with diabetes. This study suggests that low levels of C-peptide are associated with a greater risk of CIN.