Initial Glomerular Filtration Rate Research Articles

#1179 Early change of eGFR predicts long-term renal event in patients with hypertensive chronic kidney disease using a RAS blocker

Abstract Background and Aims The renin-angiotensin-aldosterone inhibitor (RASI) is one of the important medications for chronic kidney disease (CKD) with potential decrease of glomerular filtration rate (GFR) after initiation. There are few studies about the effect of GFR change by the RASI on variations of GFR and albuminuria. Method This observational cohort study was the extension of an open-label, case-controlled randomized clinical trial (NCT01552954) including adult hypertensive CKD patients with estimated GFR ≥30 ml/min/1.73 m2 and random urine albumin-to-creatinine ratio (UACR) ≥ 30 mg/g creatinine. In the trial phase, the angiotensin receptor blocker (ARB: Olmesartan 40 mg/day) was prescribed to participants after cessation of RASIs for 8 weeks of screening phase. (0-week). Participants had the second visit at 8 weeks after initiation of ARB (8-week) with randomization into the intensive education for low salt diet and the conventional education. Third visit was conducted at 16 weeks after 0-week (16-week). After 27 (19∼38) months later, we recruited participants for the cohort observation and finished at 38 (29∼48) months after 0-week visit. We grouped patients by tertiles of percent change of initial GFR during the first 8 weeks (from 0-week to 8-week) (pcGFRi) and compared the change of UACR from 24-hour urine and estimated GFR during trial and observational period. Results We analyzed data from 174 people finished 38-month observation among 235 participants enrolled for the trial phase. Initial GFR and 24-h urine UACR were 67 ± 24 ml/min/1.73 m2 and 829 ± 829 mg/g cr, respectively. There were −16.0 (−41.5∼−8.1) %, −2.8 (−7.3∼1.6) %, and 8.3 (1.8∼28.4) % pcGFRi in the first tertile group (group 1), the second tertile group (group 2), and the third tertile group (group 3), respectively. There were no differences in age, gender, GFR, 24-hour UACR, and 24-hour sodium excretion among the tertile groups at 0-week visit. The pcGFRi and the tertile group showed positive correlation with GFR change during 16 weeks of the trial, however, were not related to the percent change of 24-hour UACR during the trial phase. They were also positively correlated to the percent change of GFR during whole study period of 38 months (factor B = 8.180 and p-value< 0.001 for the group and factor B = 0.801 and p-value< 0.001 for pcGFRi), although, they did not show relationships with the percent change of 24-hour UACR during whole study period and UACR at last visit. The GFR slopes per year during 38 (29∼48) months were −2.9 (−4.0∼ −1.8), −1.3 (−2.4∼-0.3), and 0.1 (−1.0∼1.2) ml/min/1.73 m2/year in group 1, group 2, and group 3, respectively (p = 0.001 by the ANCOVA test). The relative risks to estimate GFR decrease ≥ 30% during whole study period were 0.237 (0.07∼0.798) (p = 0.020) and 0.035 (0.004∼0.302) (p = 0.035) in group 2 and group 3 compared to group 1, respectively. The AUC to estimate GFR decline ≥ 30% by the pcGFRi was 0.787 (0.685∼0.889, p< 0.001). The cut-off value 7.25% of pcGFRi estimates GFR decline ≥ 30% with 71.4% sensitivity and 70.9% specificity. Conclusion The decline of GFR by initiation of RASI predicts long-term renal event of GFR decline ≥ 30% in users of RASI, strongly. We need to compare the renal outcomes between RASI users with initial decrease of GFR and non-users to make guideline adjusting RASI usage according to initial change of GFR with RASI prescription.

#412 Influence of SGLT2I on tubulointerstitium in DKD patients with moderate renal dysfunction

Abstract Background and Aims In the FAGOTTO study (jRCTs041200069) to evaluate changes of renal hemodynamics on initial glomerular filtration rate (GFR) dip induced by Sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients (pts) with type 2 diabetic kidney disease (DKD) and moderate renal dysfunction, we reported that SGLT2 inhibition maintained the levels of glomerular filtration fraction (FF) and renal vascular resistance (RVR) during decrease in GFR as well as renal plasma and blood flow. In this sub analysis, we evaluated if GFR dip by SGLT2i might induce tubulointerstitial disorder by measuring urinary biomarkers. Method The FAGOTTO study was a 12-week multicenter, open-label, randomized (1:1), parallel-group study treated with Canagliflozin (Group CA) or control groups (Group CO) in DKD pts with 30 ≤ estimated GFR (eGFR) ≤ 60 mL/min/1.73 m2. Urinary biomarkers including liver-type fatty-acid binding protein (L-FABP), N-acetyl-glucosaminidase (NAG), β2-microglobulin (β2MG) and monocyte chemoattractant protein-1 (MCP-1) were measured at baseline, 4 weeks and 12 weeks after start of the trial. The adjusted mean and SE for changes were calculated at each time point by a linear mixed model with baseline values, time point, and interaction of the treatment group as the fixed effects. We compared these changes between treatment the groups the Tukey-Kramer method to correct for multiplicity. Results The adjusted mean changes in L-FABP at the 4-week and 12-week time point after trial start were estimated −0.35 and −0.17 μg/gCr in Group CA and 0.06 and 1.23 μg/gCr in Group CO in a linear mixed model, respectively. Similarly, the changes were estimated 2.63 and 3.71 U/gCr in Group CA and 1.38 and −1.21 U/gCr in Group CO in NAG, 317.7 and 291.4 μg/gCr in Group CA and 416.6 and 375.1 μg/gCr in Group CO in β2MG and 19.6 and 64.6 pg/gCr in Group CA and −7.7 and −2.7 pg/gCr in Group CO in MCP-1, respectively. When compared the changes in L-FABP, NAG, β2MG and MCP-1 between Group Ca and Group Co by Tukey-Kramer multiple-comparison test, there were no significant differences in any biomarkers. (Figure). Conclusion In this analysis, no significant difference in any of these biomarkers was detected in Group CA compared to those in Group CO at 4 weeks and 12 weeks after administration of SGLT2i. Although further studies should be needed to conclude, transient decrease in GFR after administration of SGLT2i might not be involved with tubulointerstitial damage and our study gives one evidence as a safety information in use of SGLT2i to DKD pts with moderate renal dysfunction.

#3048 Short and long term follow up of living Tunisian kidney donors

Abstract Background and Aims Over the years, concerns have increased about the harmlessness of kidney donation. This is more relevant in an Arab Muslim developing country like Tunisia, where lack of cadaveric donors is continuously leading to an increase in living donor numbers. The aim of this study is to evaluate the safety of nephrectomy as well as medical and surgical outcomes among LKDs, both short and long terms. Method Longitudinal monocentric study, involving a cohort of 106 LKDs in which nephrectomies were performed between November 2007 and April 2015. Donors that attended their follow-up visits after donation as per the European Renal Best Practice group recommendations by the European Renal Disease Association were included.10 Because of the irregularity of visits, we defined visits as follows: M1=from hospital discharge to the 3rd month, M3=from the 3rd month to 6th month, M6=from the 6th month to the 1st year, Y1=from the 1st year to 2nd year, Y2=from the 2nd year to the 4th year, and Y4=4 years and more. At the time of evaluation, we looked for the presence or history of renal events (i.e., elevation of serum creatinine level or proteinuria). We also detected by periodical check- up the presence or history of other physical or biological affections such as the presence of hypertension (HTN), diabetes mellitus (DM), sugar intolerance, hyperlipidemia, or hyper-uricemia (Table 1). Results 92 donors were included in the follow-up analysis after following exclusion criteria. The mean age at the time of nephrectomy was 42.8 ± 10 years with the sex ratio 0.6. and 27% of our donors were mothers. Twenty-two percent of the donors were obese and 4% were hypertensive. The median initial glomerular filtration rate (GFR) was 105 mL/min/1.73 m2. The surgical approach was costal lumbotomy in 96% of cases and laparoscopy for four cases. The kidneys were removed from the left side in 93% of cases. Postoperative mortality was zero and early postoperative morbidity was low. The median duration of hospital stay was nine days. During follow-up, 14% attended all recommended visits. The median follow- up duration was 26 months. After two years post donation, the prevalence of HTN was 28% and obesity was 26%. The prevalence of GFR decline (50–59 mL/min) was 14% using formula by modification of diet in renal disease. None of our donors reached stage 4 or 5 CKD. Twelve had proteinuria and one donor had diabetes, a comparable prevalence of morbidities to the general population Conclusion Our results are strong arguments for harmlessness of renal donation but emphasize the importance of a careful and science-based selection process. Post donation follow-up, seemingly insufficient in our study, is the only guarantor of short- and long-term safety for donors and therefore helps to encourage the act of donating in other potential donors.

Factors affecting the sodium-glucose cotransporter 2 inhibitors-related initial decline in glomerular filtration rate and its possible effect on kidney outcome in chronic kidney disease with type 2 diabetes: The Japan Chronic Kidney Disease Database.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors often cause a transient decrease in glomerular filtration rate (GFR) shortly after the initiation, referred to as the 'initial drop'. However, the clinical significance of this initial drop in real-world practice remains unclear. Using the nationwide Japan Chronic Kidney Disease Database, we examined factors that affected the initial drop, in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). We also evaluated the effects of the initial drop on a composite kidney outcome (a decline in GFR of ≥50% or progression to end-stage kidney disease). Data from 2053 patients with CKD and T2DM newly prescribed an SGLT2 inhibitor were analysed. The follow-up period after SGLT2 inhibitor administration was 1015 days (interquartile range: 532, 1678). Multivariate linear regression models revealed that the concomitant use of the renin-angiotensin system inhibitors and diuretics, urinary protein levels ≥2+, and changes in GFR before the initiation of the SGLT2 inhibitor were associated with a larger initial GFR decline (β = -0.609, p = .039; β = -2.298, p < .001; β = -0.936, p = .048; β = -0.079, p < .001, respectively). Patients in the quartile with the largest initial GFR decline experienced a higher incidence of the subsequent composite kidney outcome than those in the other quartiles (p < .001). The concomitant use of renin-angiotensin system inhibitors and diuretics, higher urine protein levels and pre-treatment GFR changes were associated with a larger initial GFR decline. Of these factors, the use of a diuretic had the largest effect. Furthermore, patients with CKD and T2DM experiencing an excessive initial GFR drop might be at a higher risk of adverse kidney outcomes.

Impact of very high doses of contrast media on acute kidney injury rates in patients admitted with ST-elevation myocardial infarctions

Abstract Introduction Previous studies have shown that in patients with ST-elevation myocardial infarctions (STEMI) maybe the main contributor of acute kidney injury (AKI) is the STEMI itself with its hemodynamic sequelae and to a lesser extent contrast media induced nephropathy (CIN). However, the possible impact of very high doses of contrast media (CM) on kidney function in this context remains unclear. Aim of the present study was therefore to investigate, how very high doses of CM influenced AKI-rates in patients admitted with STEMI. Methods Patients admitted with STEMI between 2006 and 2022 to a large German heart center entered analysis. A very high dose of contrast media was defined as &amp;gt;250 ml. AKI was defined by KDIGO-criteria (2012). To minimize impact of confounders patients were grouped by initial TIMI-risk-score and initial renal function (glomerular filtration rate (GFR)) in a 3x3 format. Results Of a total of 8845 patients included, 547 patients (6.2%) received a CM-dose &amp;gt;250 ml with an average CM-amount of 318.2±64 ml vs. 135.8±48 ml in the control group. A multivariate model revealed that patients receiving very high CM-doses were more likely to be older (OR 1.31, 95% CI 1.1-1.6, p&amp;lt;0.01) and to have more extensive STEMIs (CK&amp;gt;2000 U/ml: OR 1.33, 95% CI 1.1-1.6), while they were less likely to be female (0.77, 95% CI 0.6-0.9,p=0.01) and less likely to have undergone successful percutaneous coronary intervention (PCI): OR 0.51, 95% CI 0.4-0.6, p&amp;lt;0.01. Patients receiving very high doses of CM were more likely to develop AKI: 21.6% vs. 14.9,%, p&amp;lt;0.01. This significant impact remained after adjusting in a multivariate model (OR 1.42 95% CI 1.1-1.9, p&amp;lt;0.01). When stratifying patients into nine groups (3x3) both, initial TIMI-risk-score for STEMI and a lower GFR were associated with a marked increase in AKI-rates, with the lowest AKI-rate at 3.4% in patients with a low TIMI-risk and an initial GFR of 60-89 ml/min and the highest AKI rate at 37.8% in patients with a high TIMI-risk score and a GFR&amp;lt;60 ml/min (table (A)). However, the impact of very high CM-amounts on AKI-rates in this pre-stratified cohorts was inconsistent and only independently associated with a higher AKI-risk in 1 out of 9 groups (marked by astrisk*, table (B)). Conclusions STEMI-Patients receiving very high amounts of contrast media during emergency cardiac catheterization were on average older with larger infarctions and showed lower rates of successful percutaneous coronary interventions (PCI). For the majority of these patients even very high amounts of contrast media were not independently associated with higher rates of acute kidney injury. AKI-rates were more likely to be determined by overall risk and initial renal function.

#6260 PREDICTING KIDNEY FUNCTION AND END-STAGE KIDNEY DISEASE IN ANCA-ASSOCIATED VASCULITIS USING ANCA, C-REACTIVE PROTEIN AND C3

Abstract Background and Aims Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are systemic autoimmune diseases that involve small- and medium-sized blood vessels. AAV compromises the overall survival of patients, and its kidney involvement can lead to end-stage kidney disease (ESKD). Our aim was to determine whether the serum C3, C-reactive protein (CRP) and ANCA levels could predict kidney survival. Method We retrospectively reviewed patients with AAV and kidney involvement (n = 62) from 2006 to 2022. Demographic, clinical and laboratory data were collected. Patients’ ANCA title were measured by ELISA, and Glomerular Filtration Rate (GFR) was estimate by CKD-EPI equation. ANCA, C3 and CRP were measure at diagnosis, remission, and last follow-up. ANCA was analyzed as continuous and categorical variable. We analyzed factors associated with dialysis dependency at diagnosis and evolution to ESKD. Multivariable adjusted Cox regression analysis was performed for assessing predictive variables associated with dialysis outcome. Results The cohort included 62 total patients, with median age of 69 (63-77) years old, 44% were female, 35.5% (n = 22) presented with alveolar haemorrhage, 82.3% (n = 51) were MPO-ANCA+ and 4 patients had concomitant anti-GBM+. At admission, the median ANCA title was 80.5 UI/mL (36.75- 112.25), C3 was 108.5 mg/dL (90-130.25) and CRP 7.5 mg/dL (2.14-14.34). The GFR was 11.17±11.16 at admission and 24% of patients required dialysis at admission (n = 15). At 3 months 30% (n = 19) required dialysis, 10% at 6 months (n = 6) and 5% at 1 year (n = 3). The median time until dialysis was 488.98 (0-5702) days. Twenty (32.3%) patients died during the study period. The title of ANCA at admission, as categorical variable, did not associate with requirement of kidney replacement therapy during follow-up (p = 0.870) nor as a continuous variable (p = 0.523). Considering C3 and CRP, only low C3 at last follow-up correlates with ESKD (p = 0.028). Median C3 at last follow-up was 91.5 mg/dl (79.5-107) in ESKD patients and 114.5 mg/dl (92-142.75) in patients that do not require dialysis. In the cox regression analysis of kidney survival, C3 levels at last follow-up were significantly associated with a shorter time until dialysis (p = 0.006). In a multivariate analysis, including age and gender, C3 levels at last follow-up lost significance to predict time until ESKD (p = 0.083, model p = 0.005). Initial GFR was not correlated with ANCA title at admission (r = 0.220, p = 0.205) nor as a categorical variable (p = 0.592). At remission, GFR was not correlated with ANCA title (r = 0.383, p = 0.349). Considering factors associated with the need for dialysis at admission, only CRP levels at admission were significantly higher (p = 0.035) in those who required dialysis. ANCA title and C3 at admission did not correlate with dialysis at admission (p = 0.875, p = 0.702). In multivariate analysis, including age and gender, CRP maintain its significancy (p = 0.036, model p = 0.044). Conclusion C3 and CRP levels have been studied as possible factors predicting kidney survival, however, results are not consistent. CRP is a marker of inflammation and C3 represents complement activity, these serologic markers could be important to identify patients at risk for ESKD. In our study CRP levels seems to be related to dialysis requirement at admission. These patients should be followed more closely and carefully to improve kidney survival.

Effect of Post-Transplant Cardiac Angiographic Procedures on Post-Transplant Renal Function

Cardiac interventions often are performed before and after renal transplant for coronary artery disease. The aim of this study was to investigate whether post-transplant cardiac coronary procedures affect post-transplant renal function. We retrospectively included renal transplant recipients who underwent renal transplant procedures at Baskent University between April 28, 1997 and January 20, 2020. We analyzed the effect of cardiac catheterization in renal transplant recipients between 6 and 12 months post-transplant with post-transplant renal function assessed by glomerular filtration rate (GFR). We compared the effect of the type of coronary intervention on GFR change in group 1, whereby group 1 was divided into 2 subgroups (coronary artery bypass grafting [CABG] and stenting). Group 1 included patients who underwent cardiac intervention, whereas group 2 included those who had not undergone cardiac intervention. In all, 108 patients underwent coronary angiography; 45 (41.7%) had normal coronaries or minimal coronary artery disease (CAD); 37 (34.3%) underwent stent implantation; 26 (24.1%) underwent CABG. The mean post- transplantation GFR of all patients after cardiac catheterization was 84.26+25.91 (mL/min/1.73 m2). The final, after 12 months mean GFR of all patients was 69.55+27.05. The final GFR was significantly lower than the initial post-renal GFR value in patients who underwent cardiac intervention but not in non-intervened patients. Invasive cardiac revascularization procedures showed a negative effect on post-transplant renal function in renal transplant recipients. All renal transplant recipients who underwent cardiac intervention survived the intervention, and there was no mortality. The reason for this outcome was assumed to be because of the short follow-up period.

Predictors of acute kidney injury in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock who underwent percutaneous coronary intervention

Objective: to study predictors of acute kidney injury (AKI) in patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) who underwent percutaneous coronary intervention. Materials and methods: 109 patients with STEMI complicated by CS were studied after interventional intervention (mean age 63.1±10.1 years). The observation group included 33 patients with AKI, and the comparison group — 76 patients without AKI. AKI was diagnosed with an increase in plasma creatinine level by ≥26.5 mmol/l from the baseline level within 48 hours or by ≥1.5 times from its known or assumed basal level. To identify predictors of AKI, the method of simple and multiple logistic regression was used. Results: among patients with AKI, patients aged over 70 years (54.5% vs 15.8%, p&lt;0.001), with concomitant chronic kidney disease (57.6% vs 26.3%, p=0.002), chronic heart failure with a low ejection fraction (69.7% vs 36.8%, p=0.001), an initial glomerular filtration rate of less than 60 ml/min/1.73 m2 (54.5% vs 22.4%, p=0.001) and a left ventricular ejection fraction below 40% (75.8% vs 51.3%, p=0.022) and a three-vascular lesion of the coronary arteries (63.6% vs 40.8%, p=0.028) were significantly more often observed. Conclusions: AKI in patients with STEMI complicated by CS after intracoronary intervention was associated with an age older than 70 years, the presence of a left ventricular ejection fraction of less than 40% and a glomerular filtration rate of less than 60 ml/min/1.73 m2.

Prognostic Factors for the Therapeutic Performance of Cisplatin in Head and Neck Malignancies.

IntroductionFor squamous cell carcinoma of the head and neck (HNSCC), cisplatin is used as primary or adjuvant (radio)chemotherapy. In terms of dosage, two main regimens are used, weekly 40mg/m2 or 3-weekly 100mg/m2. For an optimal outcome, the highest possible cumulative total dose of cisplatin is aimed for. The selection of the scheme is patient-specific, but the factors for the selection of the optimal scheme have not yet been conclusively researched. The aim of this study was to find correlations between initial laboratory values and the cumulative total dose of cisplatin, as well as any correlations between early laboratory values or their dynamics and later laboratory values or their dynamics to provide support in the selection of the chemo regimen.Material and MethodsIn this retrospective study, the clinical data and laboratory values, namely glomerular filtration rate (GFR), hemoglobin, albumin, leucocyte, erythrocyte and platelet count, over the course of time of 79 patients with HNSCC who had received chemotherapy with cisplatin in our clinic between 2018 and 2021 were evaluated.ResultsPatients on 3-weekly regimens achieved a higher mean cumulative total dose of cisplatin than patients on weekly regimens (214.18 ± 65.95 vs 183.33 ± 65.2 mg/m2). Significant positive correlations were seen for total cumulative dose of cisplatin with initial GFR (p=0.001, Pearson’s r=0.364), initial hemoglobin (p=0.035, r=0.237), initial erythrocyte (p=0.002, r=0.337), and initial albumin (p=0.002, r=0.337). There were no significant correlations for initial leucocyte or platelets. Regarding the dynamics of the laboratory values under the first chemo administration, no correlation was found with later laboratory values or dynamics.Discussion and ConclusionAs in other prospective studies, our retrospective analysis found a higher cumulative total dose in the 3-weekly regimen. As this seems to correlate positively with patient outcome, superiority of the 3-weekly regimen over the weekly regimen can be assumed. Functioning organ systems, especially of the bone marrow and kidneys, are associated with an increased cumulative total dose and can therefore be regarded as predictive factors. Regular monitoring of laboratory values is nevertheless essential throughout the entire course of chemotherapy.

Lower extremity CT angiograms and their effect on kidney function in orthopedic trauma patients

ObjectivesTo evaluate the frequency of unindicated CT Angiograms (CTAs) obtained at our institution and the association between contrast-induced nephropathy (CIN) and decreased glomerular filtration rate (GFR). DesignRetrospective case series SettingAcademic Level 1 trauma center Patients/participantsPatients aged 18 years and older with CTAs following lower-extremity (LE) trauma between 2010-2018. InterventionCTAs performed in 257 LEs and corresponding pre- and post-contrast renal function labs in these LE trauma patients. Main outcome measurementsThe primary outcome was vascular injury requiring intervention. Secondary outcomes were CIN and the association of CIN with decreased GFR and injury severity score (ISS). ResultsThere was no indication (no hard signs of vascular injury, ABI>0.9) for CTA in 121 patients (61%) of the total 199 patients. Of the 78 patients with signs of vascular injury or ABI<0.9, 35 (45%) had positive CTAs and 15 (19.2%) required vascular intervention. Of the 121 unindicated patients, 26 (21%) had positive CTAs and 1 (0.008%), a knee dislocation, required vascular intervention. In 155 patients with renal function labs, initial GFR<60ml/min was a risk factor for CIN as compared to GFR>60ml/min (p=0.001). Rate of CIN did not correlate with Injury Severity Score (ISS). ConclusionsCTAs are obtained more often than indicated and initial GFR<60ml/min is a risk factor for developing CIN, irrespective of the trauma burden. CTAs should be reserved for when hard signs of vascular injury or ABI<0.9, especially in those patients with decreased renal function. Level of EvidenceLevel IV

The Clinical Course and Prognostic Factors of COVID-19 in Patients with Chronic Kidney Disease, A Study in Six Centers

Coronavirus disease 19 (COVID-19), has recently emerged as a great health challenge. The novel corona virus may affect the kidneys mainly as acute kidney injury (AKI). Also, the outcome of COVID-19 may be different in patients with underlying kidney disease. The aim of this study was to compare the outcome of COVID-19 in patients with and without underlying kidney disease. This was a retrospective study on 659 hospitalized COVID-19 patients in six centers of Iran. Patients were classified into kidney (chronic kidney disease (CKD), end-stage kidney disease (ESKD) or kidney transplantation) and non-kidney groups. The clinical conditions and laboratory data were extracted from the charts. Outcome was defined as death during hospitalization or within 30 days of discharge. Among 659 COVID-19 patients (mean age: 60.7 ± 16.4, 56% male), 208 were in the kidney group (86 ESKD, 35 kidney transplants, and 87 CKD patients). AKI occurred in 41.8%. Incidence of AKI was 34.7% in non-kidney, 74.7% in CKD, and 51.4% in kidney transplant patients (P < .001). Totally 178 patients (27%) died and mortality rate was significantly higher in CKD patients (50.6 vs. 23.4%, P < .001). AKI was associated with increased mortality rate (OR = 2.588, CI: 1.707 to 3.925). Initial glomerular filtration rate (GFR) < 44.2 mL/min and elevated lactate dehydrogenase (LDH) and C-reactive protein (CRP) had significant association with mortality. We showed a higher mortality rate in COVID-19 patients with AKI and CKD. Low initial GFR and elevated LDH and CRP were associated with high mortality in COVID-19 patients.

MO449VALIDATION OF MAYO CLINIC CLASSIFICATION AS A PREDICTOR OF FUTURE RENAL FUNCTION IMPAIRMENT IN PATIENTS WITH AUTOSOMAL POLYCYSTIC KIDNEY DISEASE (ADPKD) IN A POPULATION IN THE SOUTH OF SPAIN

Abstract Background and Aims The Mayo Clinic classification (MCC) is used in patients with ADPKD to identify those who may experience a more rapid deterioration of glomerular filtration rate (GFR). It has been developed in the American population but has not been validated in other populations. Our objective was to analyze whether the CCM predictive model is valid in an ADPKD population from southern Spain and whether it can identify populations with different renal survival. Method We selected patients with ADPKD with measurements of height-adjusted total renal volume (HtTKV) performed with CT or MR and with GFR CKD-EPI&amp;gt; 15 mL / min / 1.73 m2. We estimated the GFR at the end of the follow-up using the Irazábal equation and the rate of GFR deterioration, bias and precision were calculated. We analyzed the predictive power of BC using survival analysis using the Kaplan-Meier technique and using Cox regression models. Results We included 128 patients, aged 44 ± 13 years and a follow-up time of 79 ± 45 months (median 88), at the end of which 22 (17.2%) patients had a GFR &amp;lt;10 mL / min / 1.73 m2 or were included in renal replacement therapy. The distribution of patients according to the CM classification was: 1A 4.7%, 1B 28.1%, 1C 33.6%, 1D 22.7%, 1E 10.9%. Age decreased progressively: 1A 58 ± 11, 1B 48 ± 14, 1C 46 ± 13, 1D 40 ± 8, 1E 30 ± 7 (p &amp;lt;0.001). In contrast, HtTKV increased significantly: 1A 275 ± 52, 1B 486 ± 191, 1C 887 ± 410, 1D 1222 ± 510, 1E 1324 ± 800 mL / m (p &amp;lt;0.001). While the initial GFR was not different between classes, the GFR at the end of the follow-up decreased significantly: 1A 59 ± 36, 1B 63 ± 29, 1C54 ± 35, 1D 48 ± 26, 1E 44 ± 33 mL / min / 1.73 m2 (p &amp;lt;0.001). The GFR variation rate was significantly different according to the MCC classes: 1A 1.31 ± 6.80, 1B -2.48 ± 3.12, 1C -4.13 ± 4.33, 1D -4.70 ± 2.66, 1E -6.18 ± 3.03 mL / min / 1.73 m2 / year (p = 0.008). The final GFR predicted with the Irazábal equation was not significantly different from the real one. The absolute bias of the final GFR estimated with the MC equation was 2.6 ± 16.0 mL / min / 1.73 m2 and the relative bias was 38.7 ± 110, and it was not significantly different in the MCC classes. The P10 precision was low, with values of 65.1%, 51.7% and 50% for classes 1C, 1C and 1E respectively. The rate of deterioration of the GFR was underestimated in classes 1C, 1D and 1E. In the renal survival analysis with the Cox regression analysis, we found that the MCC classification is a predictor of survival, with classes 1D and 1E having the worst prognosis. Conclusion The MCC classification is capable of identifying populations that will suffer a more rapid deterioration of the GFR and constitutes a marker of renal survival in a Spanish population of patients with ADPKD. The prediction of future GFR with the Irazábal equation is acceptable as a group, although it shows a loss of precision at the individual level, especially in patients with higher GFR at baseline.

MO655PROTEINURIA DECREASE AFTER SGLT2I : WHAT CAN WE EXPECT?

Abstract Background and Aims The effect of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing proteinuria secondary to type II diabetic nephropathy is well known. However, in daily practice we might have the impression that those patients who present with a higher proteinuria at the beginning of SGLT2i treatment might not reach an equal decrease of proteinuria compared to those with lower initial proteinuria (under 1g/24h). To verify this hypothesis we analysed the evolution of our patients depending on the initial proteinuria. Method A retrospective analysis of 40 patients who had initiated treatment with SGLT2i was carried out. At the beginning of treatment, 23 patients presented proteinuria over 1 gram/24h and the other 17 presented less than 1g/24h. The decrease of proteinuria after 6 months of follow-up was analysed in each group. The variations in serum creatinine, haemoglobin and glycosylated haemoglobin were also examined. A second analysis depending on initial glomerular filtration rate (Under and over 60 ml/min) was also performed. Results In table 1 the basal characteristics of this population are shown. Analysis of the complete population showed a significant decrease of proteinuria (Initial mean proteinuria was 1636+/-1513 mg/24h vs final mean proteinuria of 1320+/-1480mg/24h, p=0.015). Furthermore, the analysis by groups depending on initial proteinuria revealed that both groups had a significant reduction of proteinuria after 6 months: A second exam depending on initial GFR was carried out, proving that those with lower initial GFR maintained a significant decreased of proteinuria after 6 months of treatment. Conclusion In our cohort, against our hypothesis, we didn´t observe lower reduction of proteinuria when we started the treatment with proteinuria above 1 g/24h. We can consider that the effect of SGLT2i doesn’t decreased in patients with higher initial proteinuria. Therefore, we should always consider and offer this therapeutic option to our ND patients.

The Correlation of Congenital Anomalies of The Kidney and Urinary Tract with Renal Function in Children

Background: Congenital Anomalies Kidney and Urinary Tract (CAKUT) are the leading cause of kidneyfailure in children and cause of 30-40% end-stage renal disease with obstructive uropathy as the main cause.CAKUT obstructive type are: vesico uretric junction obstruction (VUJO), pelvic uretric junction obstruction(PUJO), posterior uretral valve (PUV) and non-obstructive type are reflux, neurogenic and hypoplasia. Theaim of this study is to describe the effect of CAKUT on renal function in child.Methods: Retrospective study from medical records of children with CAKUT at Dr. Soetomo GeneralHospital, Surabaya, Indonesia from January 2013 - March 2018. The characteristic of sex, age range, type ofCAKUT and glomerulus filtration (GFR) value were recorded from medical record. Data processing usingdescriptive analysis with SPSS.Result: A total of 94 Children on CAKUT abnormalities, both boys and girl’s presentation equal 50%.Median age 3.0 (minimum-maximum 1.0-15.0) year. The most common CAKUT type in male were VUJO17 (36.2%) and in female neurogenic type 19 (40.4%). Median initial glomerular filtration rate 2.7 ml/min/1.73 m2. Analysis of correlation between CAKUT and renal function p=0.072 (R2=0,03). From 94children of CAKUT, only 12 (12.8%) patients have undergo surgical intervention.Conclusion: CAKUT with dominant obstructive type was more common in male and non-obstructive typein female pediatric patient. There was no significance correlation of GFR between obstructive and nonobstructive type.

Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: apatient-level meta-analysis from randomized controlled trials.

Patients with impaired kidney function have a significantly slower decrease of procalcitonin (PCT) levels during infection. Our aim was to study PCT-guided antibiotic stewardship and clinical outcomes in patients with impairments of kidney function as assessed by creatinine levels measured upon hospital admission. We pooled and analyzed individual data from 15 randomized controlled trials who were randomly assigned to receive antibiotic therapy based on a PCT-algorithms or based on standard of care. We stratified patients on the initial glomerular filtration rate (GFR, ml/min/1.73m2) in three groups (GFR >90 [chronic kidney disease; CKD 1], GFR 15-89 [CKD 2-4] and GFR<15 [CKD 5]). The main efficacy and safety endpoints were duration of antibiotic treatment and 30-day mortality. Mean duration of antibiotic treatment was significantly shorter in PCT-guided (n=2,492) compared tocontrol patients (n=2,510) (9.5-7.6days; adjusted difference in days-2.01 [95% CI,-2.45 to-1.58]). CKD 5 patients had overall longer treatment durations, but a 2.5-day reduction in treatment duration was still found in patients receiving in PCT-guided care (11.3 vs. 8.6days [95% CI-3.59 to-1.40]). There were 397 deaths in 2,492 PCT-group patients (15.9%) compared to 460 deaths in 2,510 control patients (18.3%) (adjusted odds ratio, 0.88 [95% CI 0.78 to 0.98)]. Effects of PCT-guidance on antibiotic treatment duration and mortality were similar in subgroups stratified by infection type and clinical setting (pinteraction >0.05). This individual patient data meta-analysis confirms that the use of PCT in patients with impaired kidney function, as assessed by admission creatinine levels, is associated with shorter antibiotic courses and lower mortality rates.

P0109EVALUATION AND COMPARISON OF TWO RENAL HISTOLOGICAL CLASSIFICATIONS OF IGA VASCULITIS

Abstract Background and Aims Primary IgA nephropathy (IgAN) and IgA vasculitis nephritis (IgAVN) share common features e.g. clinical, histological, pathophysiological. Their prognosis assessment is usually considered to be dependent on histological findings which are therefore useful to establish therapeutic intervention. The validated MEST-C classification is widely used for IgAN. Regarding IgAVN, various classifications are used in clinical practice. However, there is no consensus regarding their feasibility, correlations with renal outcome and their usefulness regarding therapeutic decisions. The aim of this study was to compare the Pillebout and Nochy French classification (PNC), created as a specific IgAVN prognosis scoring system MEST-C classification. Method Renal biopsies (RB) of patients with IgAVN were selected from two previous national IGAV cohorts and then reclassified according to the MEST-C and PNC classifications. For both classifications, the primary endpoint was the renal remission defined as a final glomerular filtration rate (GFR) greater than 60 ml / min. We also analyse: a) the renal survival defined as the absence of dialysis or transplantation; b) clinical-pathological correlation between the 2 classifications and c) the interobserver reproducibility. Results 372 RB from 316 patients were analysed, with 240 patients followed for at least 1 year. The median age was 48 yrs (14 to 86), with a sex ratio of 1.76 for men and a median follow-up of 4.3 years (range 1 to 22.7). Renal impairment was more severe over the age of 60 yrs. The presence of general signs, the initial GFR, and hypertension were significantly associated with renal survival. Proteinuria and albuminemia were associated with proliferative lesions (MEST-C score: E, C). The fibrous lesions (MEST-C: T and PNC stage V) were associated with GFR at the end of the follow-up. No significant association was found between the PNC stage and renal survival. Univariate analyses showed significant association with the primary outcome for the MEST-C T variable (p=0.02). However, by multivariate analysis, this association did not persist. The correlation between the observers was better for MEST-C compared with PNC (0.87 vs. 0.75). Conclusion Our results suggest that MEST-C classification has a good clinical and pathological correlation, a good reproducibility, and is interesting to evaluate the long-term renal outcome of patients with IgAVN. However, the correlation is still not perfect. Indeed, fibrosis was the only pathological feature independently associated with renal endpoints. We suggest that MEST-C is a scoring system which is not fully adapted due to the predominant inflammatory mechanism in IgAVN unlike IgAN. PNC should not be used because of the poor interobserver correlation. It is important to identify new specific IgAVN histological markers, taking into account the inflammatory mechanism, to ensure a more accurate prognostic classification, useful to guide therapeutic strategy.

HEPATITIS C TREATMENT OF RENAL TRANSPLANT AND CHRONIC KIDNEY DISEASE PATIENTS: EFFICACY AND SAFETY OF DIRECT-ACTING ANTIVIRAL REGIMENS CONTAINING SOFOSBUVIR.

Direct-acting antivirals have revolutionized hepatitis C treatment, also for patients with chronic kidney disease (CKD), but some controversy exists regarding the use of sofosbuvir (SOF) in patients with glomerular filtration rate (GFR) <30 mL/min. To evaluate the efficacy and safety of these regimens for hepatitis C treatment of patients with CKD and after renal transplantation, as well as the impact of SOF on renal function in non-dialysis patients. All patients with hepatitis C and CKD or renal transplant treated with direct-acting antivirals at a referral center in Brazil between January 2016 and August 2017 were included. Efficacy was evaluated based on viral load (HCV RNA) and a sustained virological response (SVR) consisting of undetectable RNA 12 and/or 24 weeks after the end of treatment (SVR12 and SVR24) was defined as cure. Safety was determined by adverse events and ribavirin, when combined, was administered in escalating doses to all patients with GFR <60 mL/min. The impact of SOF on renal function was determined by the measurement of baseline creatinine during and after the end of treatment and its increase was evaluated using the Acute Kidney Injury Network (AKIN) classification. A total of 241 patients (52.7% females) with a mean age of 60.72±10.47 years were included. The combination of SOF+daclatasvir was the predominant regimen in 75.6% of cases and anemia was present in 28% of patients who used ribavirin (P=0.04). The SVR12 and SVR24 rates were 99.3% and 97.1%, respectively. The treatment was well tolerated and there were no major clinically relevant adverse events, with the most prevalent being asthenia (57.7%), itching (41.1%), headache (40.7%), and irritability (40.2%). Among conservatively treated and renal transplant patients, oscillations of creatinine levels (AKIN I) were observed in 12.5% of cases during treatment and persisted in only 8.5% after the end of treatment. Of these, 2.0% had an initial GFR <30 mL/min and this percentage decreased to 1.1% after SOF use. Only 0.5% and 1.6% of the patients progressed to AKIN II and AKIN III elevation, respectively. The direct-acting antivirals were safe and efficacious in CKD patients treated with SOF-containing regimens, with the observation of high SVR rates, good tolerability and few severe adverse events. The combination with ribavirin increased the risk of anemia and the administration of escalating doses seems to be useful in patients with GFR <60 mL/min. In patients with GFR <30 mL/min, SOF had no significant renal impact, with serum creatinine returning to levels close to baseline after treatment.

465Benefit of modern P2Y12-inhibitors on long-term prognosis in patients with ST-elevation myocardial infarction with and without advanced chronic kidney disease

Abstract Background Current guidelines on the management of patients with ST-elevation myocardial infarction (STEMI) recommend the preferred use of the modern P2Y12-inhibitors ticagrelor or prasugrel regardless of the presence of chronic kidney disease (CKD), although patients with advanced stages of CKD were excluded from randomized trials. Aim of the present study was therefore to evaluate the potential benefit of modern P2Y12-inhibitors in patients with and without advanced renal disease at admission. Methods All patients admitted with STEMI between 2006–2017 from a large german heart center treated with primary percutaneous coronary intervention (PCI) entered analysis. Initial CKD was estimated with the initial glomerular filtration rate (GFR), calculated with the CKD-EPI-equation, assigning them to the groups G1-G5. Results Of 7227 patients with STEMI and primary PCI 2669 (37%) showed no relevant reduction in GFR at admission (≥90 ml/min/1.73 m2, G1), 2976 pts. (41%), a slight reduction (GFR 60–89 ml/min/1.73 m2, G2), 880 pts. (12%) a moderate reduction (GFR 45–59 ml/min/1.73 m2, G3a) and 702 pts. (10%) a moderate to severe reduction (GFR&lt;45 ml/min 1.73 m2, G3b-G5). Pts. with more advanced stages of CKD were on average older (G1: 55±11 years, G2: 66±12 years, G3a: 72±12 years, G3b-G5: 75±11 years, p&lt;0.01) and more likely to be female (G1: 19%, G2: 26%, G3a: 40%, G3b-G5: 48%, p&lt;0.01). Prasugrel/ticagrelor were less often given instead of clopidogrel in patients with advanced CKD (G1: 70%, G2: 45%, G3a: 31%, G3b-G5: 32%, p&lt;0.01). The use of ticagrelor/prasugrel was associated with a reduction in 1-year-MACCE (major adverse cardio- and cerebrovascular events)-rates in patients with no/low-grade-CKD (G1-G2), while no significant reduction in MACCE could be observed for patients with moderate to severe CKD (table). Furthermore, CKD was associated with an elevation in severe bleeding events within 1 year (G1: 1%, G2: 3%, G3a: 5%, G3b-G5: 6%, p&lt;0.01). Impact of CKD-stage on outcome CKD-stage G1 CKD-stage G2 CKD-stage G3a CKD-stage G3b-G5 1-year-MACCE-rate (%) Ticagrelor/prasugrel 4.5 11.0 27.4 47.3 Clopidogrel 9.9 15.6 26.6 50.4 Significance &lt;0.01 &lt;0.01 0.6 0.7 Conclusions These data from a large STEMI-registry demonstrate, that modern P2Y12-inhibitors were less often used in patients with CKD and their benefit regarding MACCE disappeared in advanced stages of CKD while bleeding rates increased. These results underline the special role of patients with advanced stage-CKD in STEMI and the necessity of specialized randomized trials for these patients.

Clinical characteristics of patients with vasculitis positive for anti-neutrophil cytoplasmic antibody targeting both proteinase 3 and myeloperoxidase: a retrospective study.

Anti-neutrophil cytoplasmic antibody (ANCA) may target proteinase 3 (PR3) or myeloperoxidase (MPO). Although a few patients with vasculitis have both MPO- and PR3-ANCA, the details of their clinical characteristics are not known. The objective of this study was to analyze the characteristics of patients with dual MPO- and PR3-ANCA-positive vasculitis. The medical records of patients with ANCA and vasculitis confirmed by biopsy were reviewed. The age at diagnosis, sex, and data on organ involvement of the kidney, lung, upper airways, skin, nervous system, and gastrointestinal tract were collected. Clinical variables were analyzed according to ANCA specificity. Of 85 patients with ANCA and vasculitis included in this study, 67 (78.8%) had MPO-ANCA, 10 (11.8%) had PR3-ANCA, and 8 (9.4%) had both MPO- and PR3-ANCA. Patients with MPO- PR3 + ANCA-associated vasculitis (AAV) were younger at diagnosis (median, 54.4years; p < 0.05) than patients with MPO + PR3- AAV (67.0years) or dual-ANCA AAV (MPO + PR3 + , 68.5years). The initial glomerular filtration rate in patients with MPO + PR3- AAV (22.0ml/min) was significantly lower than that in patients with MPO- PR3 + AAV (108.6ml/min, p < 0.05), but was not different from that in dual-ANCA AAV patients (16.5ml/min). Upper airway involvement also differed with ANCA type (MPO+ PR3- , 35.8% vs. MPO- PR3 + , 70.0% vs. MPO + PR3+ , 75.0%, p < 0.05). The involvement of other organs did not differ according to ANCA type. Age at diagnosis, kidney involvement, and upper airway involvement were associated with ANCA type. Patients with dual-ANCA-positive vasculitis had considerably more kidney dysfunction than patients with MPO- PR3+ AAV. They also had more upper airway involvement than patients with MPO+ PR3- AAV.

The baseline glomerular filtration rate, predictive of six-year survival in sub-Saharan African patients on antiretroviral therapy for HIV: Cohort study

BackgroundRecently, serious morbidity events associated with initial glomerular filtration rate (GFR) have been described during HIV infection, but this is insufficiently investigated in sub-Saharan Africa very affected by HIV. ObjectiveTo assess the impact of baseline GFR prevailing during the first semester of the HIV infection management on six-year survival in peoples taking antiretroviral therapy. Patients and methodsClosed retrospective cohort study. The death was the expected outcome, the baseline GFR (mL/min/1.73m2) in the first semester of the follow-up was the main exposure. Kaplan–Meier method, Cox regression were used for analysis. ResultsAccording to baseline GFR: <60, 60–89 and≥90, the six-year survival was 81.6%; 95.8% and 96.4% (P=0.067 Breslow). Adjusted hazard ratio for baseline GFR<60 and 60–89 (vs. ≥90) were respectively 5.4 (95%CI: 1.4–19.9; P=0.012) and 1.2 (95%CI: 0.3–4.0; P=0.754). The etiological fraction of deaths attributable to baseline GFR: GFR<60: 81% (95%CI: 0.31–0.95), GFR=60–89: 18.0% (95%CI: −0.7–0.8). Prognostic concordance index=0.84 (95%CI: 0.59–0.95) for GFR<60 and 0.55 (95%CI: 0.27–0.81) for GFR 60–89. DiscussionThe etiological fraction of death and prognostic concordance index associated to baseline GFR level increase significantly with decline of baseline GFR. ConclusionBaseline GFR seems to predict the six-year survival in African sub-Saharan patients treated for HIV.