Low Sodium Levels Research Articles

63 Utilization of vasopressin and norepinephrine in neonates with cardiorespiratory compromise: A multicenter retrospective cohort study in Canada

Abstract Background Data regarding neonatal clinical experience with Vasopressin (VA) and Norepinephrine (NE) are limited to small studies. The lack of large-scale studies with safety and efficacy data is preventing the widespread adoption of these agents. Objectives To describe epidemiological data on utilization of NE and VA in neonates including their indications, effectiveness and overall outcomes across 3 tertiary Neonatal Intensive Care Units (NICU) in Canada. Design/Methods This retrospective cohort study involved neonates who received NE or VA between January 1, 2015-December 31, 2020 at 3 tertiary NICUs. Data regarding demographic information, indications of use, dosing details, and clinical outcomes were described using mean, standard deviations (SD), frequencies and percentages. When appropriate, a comparative analysis was performed using Mann-Whitney U tests or the chi-square test as appropriate. Post-initiation changes in physiological variables and laboratory parameters over time were analyzed using repeated measure ANOVA. Results 133 neonates (VA:70, NE:63) were included in this study. Baseline demographic features, clinical characteristics at initiation, indication of use, dosing details and clinical response in neonates exposed to both agents are summarized in Table 1. VA was commonly used for oxygenation failure due to persistent pulmonary hypertension of the newborn (PPHN), while NE was commonly used for hypotension due to septic shock. NE was frequently used as a 1st line inotropic agent, whereas VA was used more as an additive agent [30 (47.6%) vs 12 (18.6%); p=<0.001]. During treatment, lower sodium levels were recorded in the VA group vs the NE group [126.5 (8.6) vs 132 (7); p=.035], but other safety parameters were similar. The time to reach predefined stability parameters were similar in both groups. Significant improvement in physiological parameters were seen over time with both agents (Figure 1). Mortality within 7 days of use was high in the cohort, but comparable between VA and NE groups [18 (25.7%) vs 22 (34.9%), p=0.206]. Other neonatal morbidities were comparable between groups (Table 1). Conclusion This multicenter study provides pragmatic insights into the current use of NE and VA in neonates. Our study reports the effective use of each agent in distinct patient subgroups. This cohort represented neonates with high illness severity; however, exposure to either agent did not independently increase the risk of mortality or adverse outcomes. Further prospective studies exploring its optimal use and cardiopulmonary effects would be interesting.

Mind the Gap: Influence of Monoclonal Immunoglobulin on Anion Gap in Multiple Myeloma

Abstract Background Multiple myeloma (MM) is a plasma cell disorder in which anion gap and sodium measurement are critically influenced by the presence of abnormal protein concentrations. This study investigates the relationship between anion gap, pseudohyponatremia, and monoclonal immunoglobulin levels (IgG, IgA, IgM), particularly the common IgG. Focusing on the clinical implications of these laboratory results. Methods We retrospectively analyzed data from 136 patients diagnosed with MM, focusing on anion gap values, monoclonal immunoglobulin levels, and sodium levels. The patients were categorized based on their anion gap values (<8) into five groups (anion gap=3, 4, 5, 6, and 7). Monoclonal immunoglobulin levels were standardized to the same units as the anion gap for direct comparison. Additionally, we investigated the pseudohyponatremia by examining sodium levels in these patients. Results Among the 136 MM patients, 70 patients’ anion gap were lower than 8. A negative correlation between MM monoclonal immunoglobulins and anion gap values were observed. The anion gap decreased from 7 to 3 as the IgG average levels ranged increasing from 1755 mg/dL to 2655 mg/dL (RI 610-1616 mg/dL). Similarly, the anion gap decreased from 6 to 3 as the IgM average levels ranged increasing from 1170 mg/dL to 2880 mg/dL (RI 35-242 mg/dL). Additionally, a number of low sodium levels (<136 mmol/L) was observed in each group. Conclusion Our study highlights the negative impact of MM monoclonal immunoglobulins, particularly IgG and IgM, on the anion gap. Both laboratory and clinical personnel should be aware of these phenomena, might prevent unnecessary diagnosis, streamlining patient management and avoiding potential mismanagement.

Integrating mineral elements and metabolite features to distinguish Lotus seeds from different geographic origins

The characteristics of lotus seeds (LS) are influenced by variety and environment. However, it remains unknown the difference of metabolites and elements of LS from different origins. In this study, an accurate quantification method (97–107 %) for 20 mineral elements in LS was developed, and a metabolomic method was established to identify a total of 323 metabolites in LS. Mineral composition analysis revealed significant variations in the mineral element contents among LS samples from seven geographical regions. LS were rich in potassium (14,710 mg/kg), manganese (67.19 mg/kg), with a low level of sodium (210 mg/kg). A total of 10 mineral elements and 117 metabolites (p < 0.05 and VIP > 1) were identified as the potential geographical markers of LS by integration analysis. The linear discriminant analysis model showed high prediction accuracy. This study provides strong experimental evidence to maintain the authenticity and quality of LS in the food industry.

Sterile water and regional citrate anticoagulation: A simple CRRT strategy for safe correction of severe hyponatraemia.

Hyponatraemia is a prevalent electrolyte disturbance observed in critically ill patients. The rapid correction of low plasma sodium levels by continuous renal replacement therapy (CRRT) carries the risk of developing osmotic demyelination syndrome (ODS), which can be prevented by implementing an individualized CRRT method. This study aims to introduce a CRRT protocol for the safe and gradual correction of severe hyponatraemia. This retrospective case series study was conducted in an intensive care unit (ICU). All four patients with severe hyponatraemia (<125 mmol/L) and renal failure between October 1, 2022, and September 30, 2023, were treated by CRRT with sterile water and regional citrate anticoagulation (RCA). Data on patient demographics, laboratory biochemical parameters, urine outputs and CRRT-related adverse events were collected. Laboratory parameters and urine outputs were compared by paired t-tests before and after CRRT. After CRRT, sodium levels were significantly increased (112.7 ± 6.7 vs. 141.9 ± 2.8 mmol/L, p = .005). Abnormal urine outputs, potassium, creatinine and bicarbonate were corrected (p for all <.05). Safe and gradual correction of hyponatraemia and internal environmental dysregulation was achieved in all patients without any complications related to CRRT, particularly ODS. It is a novel and simple strategy to correct severe hyponatraemia effectively while ensuring the safety of patients that can be easily implemented by experienced nurse staff. The sterile water-based protocol for postfilter dilution is safe to correct severe hyponatraemia with RCA and can be easily performed by experienced critical care nurses according to the precalculated formula. CRRT-trained, experienced ICU nurses are competent to initiate and adjust sterile water infusion discretely to prevent overcorrection of hyponatraemia.

FREQUENCY OF ACUTE KIDNEY INJURY IN CASES OF LIVER CIRRHOSIS: A CROSS-SECTIONAL STUDY

Acute kidney injury (AKI) frequently complicates the clinical course of liver cirrhosis, impacting patient outcomes significantly. Understanding the epidemiology of AKI in this population is crucial for timely intervention and management. Objective: To assess the frequency and clinical outcomes of acute kidney injury in patients with liver cirrhosis. Methods: Following ethical approval, this descriptive cross-sectional study was conducted at the Department of Nephrology from December 2023 to June 2024. A total of 231 patients aged 18 years and older with a confirmed diagnosis of liver cirrhosis were included. The frequency of AKI was determined using standard criteria. Data analysis was performed using SPSS 24, employing Independent samples t-tests to evaluate differences between patients with and without AKI, with a significance level set at P &lt; 0.05.Results: Among the 231 cirrhotic patients (mean age: 52.5±10.61 years; 83.1% male), AKI was identified in 55 patients (23.8%). Patients with AKI exhibited higher mean serum creatinine (2.99±0.44 mg/dL) and blood urea nitrogen (66.64±9.92 mg/dL), along with lower sodium levels (129.37±4.14 mmol/L) and elevated total bilirubin (5.23±1.37 mg/dL) compared to their non-AKI counterparts. The average length of hospital stay was significantly longer for AKI patients (14.35±3.22 days) compared to non-AKI patients (7.37±1.92 days), and mortality was higher in the AKI group (12.7% vs. 1.7%). Conclusion: Our study highlights a significant prevalence of AKI among patients with liver cirrhosis, particularly affecting those with viral hepatitis B and C. The findings emphasize the need for vigilant monitoring and early therapeutic interventions in this vulnerable population to improve outcomes.

Oral Complications Due to Medication in Stevens-Johnson Syndrome Patient with Systemic Involvement

Background: Stevens-Johnson Syndrome (SJS) is a drug-induced hypersensitivity reaction involving mucocutaneous with various trigger factors including drugs and herpes simplex virus. Objective: This case report aimed to discuss oral complications due to medication in SJS patients with systemic disease involvement. Case: A 51-year-old man was referred to the Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, at Hasan Sadikin Hospital from the dermatology and venereology department complaining of pain in the oral cavity, especially when eating and drinking two months before, with a history of phenytoin, salbutamol and theophylline therapy. Extraoral examination showed erosive lesions and tended to bleed serosanguinolenta crusts on the lips. Intraoral there were erosive lesions and white plaque on the tongue, buccal mucosa, labial mucosa, and palate, as well as dental caries and calculus. Blood examination showed low hemoglobin, hematocrit, erythrocytes, lymphocytes, monocytes, SGOT, and sodium levels, while HbA1c, random, fasting, and 2 HPP glucose levels were high. Reactive Anti-HSV-1 IgG and rheumatoid factor. KOH examination showed positive spores, hyphae, pseudohypha, and budding cells. The diagnosis was SJS-associated oral lesions with HSV-1 virus infection, oral candidiasis accompanied with diabetes mellitus. For diabetes mellitus treatment, he was referred to the internal medicine department. Case Management: The therapy was 0.9% NaCl for lip compress, acyclovir tablet, nystatin oral suspension, chlorhexidine digluconate 0,12% mouthwash, folic acid, and vitamin B12. Oral lesions were improved significantly after diabetes mellitus was treated. Conclusion: The SJS patient was susceptible to complications in the oral cavity, especially fungal and viral infections due to the received medication.

The association between urinary sodium and the risk of dementia: Evidence from a population-based cohort study

BackgroundSodium intake reduction is crucial for cardiovascular health, however, its lasting impact on dementia remains unclear. MethodsWe included 458,577 UK Biobank participants without dementia at baseline. We estimated 24-h urinary sodium (E24hUNa) using spot urinary parameters and obtained the incidence of all-cause dementia, Alzheimer's disease, and vascular dementia from multiple sources. ResultsThe mean E24hUNa was 3.0 g (1st-99th percentile: 1.5 g–5.1 g). Over a mean follow-up of 13.6 years, 7886 (1.7 %) participants developed all-cause dementia, including 3763 (0.8 %) Alzheimer's disease and 1851 (0.4 %) vascular dementia. In the restricted cubic spline model, we identify a potential cutoff of 3.13 g for E24hUNa, below which each 1 g decrease in E24hUNa was associated with 21 % (95 % confidence interval [CI] 1.11–1.34) higher all-cause dementia risk and 35 % (95 % CI 1.11–1.63) higher vascular dementia risk (P-value <0.001 for non-linearity). The hazard ratios were 1.15 (95 % CI, 1.07–1.24) for all-cause dementia and 1.21 (95 % CI 1.04–1.40) for vascular dementia among individuals with E24hUNa below 3.13 g compared to those with E24hUNa higher than 3.13 g. LimitationsOne of the major limitations is the estimation of 24-h urinary sodium with spot urine samples. ConclusionsAn E24hUNa level below 3.13 g, equivalent to 3.37 g daily sodium intake, is associated with increased risks of all-cause and vascular dementia. This exploratory study suggests a potential lower limit below which the risk of dementia increases with a lower sodium level. Future studies are necessary to validate our findings.

Electrolytes, Zinc and Vitamin D3 in COVID-19 Patients with Cardiovascular Complications.

COVID-19 is strongly linked to cardiovascular disease, with direct myocardial injury and systemic inflammation as common mechanisms. Pre-existing or infection-induced cardiovascular disease worsens the outcomes for COVID-19 patients. To estimate the serum electrolytes (Na+, K+, Ca++, Zn) and vitamin D3, the study depended on ichroma ii device for Vitamin D3 and Chemistry Analyzer for electrolytes in patient samples. A study was conducted on 192 individuals diagnosed with COVID-19, including 35 critical cases, 53 severe cases, 54 moderate cases, and 50 individuals in a control group. The age group with the highest prevalence of infection was between 50‒69 years, while the lowest prevalence was observed in those under 30 years. The study found significant decreases in calcium, potassium, sodium, zinc, and vitamin D3 levels among COVID-19 patients compared to the control group. Zinc and vitamin D3 levels showed a significant correlation with sex, with males experiencing a decline in zinc levels and females having lower vitamin D3 levels. The concentration of calcium, sodium, and zinc showed a negative correlation with age, with older patients having the lowest levels. COVID-19 patients with chronic cardiac issues and high blood pressure exhibited the lowest levels of these markers. The severity of the disease also had a detrimental impact on electrolyte levels, zinc, and vitamin D3, with critical cases showing the lowest levels. The complications such as heart failure were associated with lower levels of potassium, sodium, and zinc. In conclusion, the study revealed significant associations between COVID-19 and decreased electrolyte levels, zinc, and vitamin D3. Sex and age were found to be correlated with these markers. Patients with chronic cardiac issues and high blood pressure exhibited the lowest levels of these markers. The severity of the disease was also linked to lower electrolyte levels, zinc, and vitamin D3. Complications such as heart failure were associated with decreased levels of potassium, sodium, and zinc.

Neutrophil percentage-to-albumin ratio is a potential marker of intravenous immunoglobulin resistance in Kawasaki disease

Intravenous immunoglobulin (IVIG) resistance in Kawasaki disease (KD) was associated with coronary artery lesions. Neutrophil percentage-to-albumin ratio (NPAR) is an index of mortality in several inflammatory diseases. This study focused on the association of NPAR with IVIG- resistance in KD. Clinical and laboratory data of 438 children with KD before IVIG treatment were retrospectively analyzed. Notably, high NPAR was associated with older age, high WBC, NP, ALT, total bilirubin and CRP, as well as with high the incidence of IVIG-resistance, and with low hemoglobin (Hb), PLT, ALB and sodium levels. NPAR (OR: 2.366, 95% CI: 1.46–3.897, p = 0.001) and Hb (OR: 0.967, 95% CI: 0.944–0.989, p = 0.004) were independent risk factors for IVIG-resistance. NPAR showed linear relation with IVIG-resistance (p for nonlinear = 0.711) and the nonlinear correlation was found between IVIG-resistance and Hb (p for nonlinear = 0.002). The predictive performance of NPAR was superior to Beijing model (z = 2.193, p = 0.028), and not inferior to Chongqing model (z = 0.983, p = 0.326) and the combination of NPAR and Hb (z = 1.912, p = 0.056). These findings revealed that NPAR is a reliable predictor of IVIG-resistance.

Laparoscopic Conversion to Open Cholecystectomy: Is Incidental Gallbladder Cancer Any Different?

A majority of gallbladder cancers presentincidentally. Operative risk factors and outcomes for laparoscopic converted to open cholecystectomy in incidental gallbladder cancer are not well characterized. Patients with incidental gallbladder cancer and acute cholecystitis undergoing laparoscopic cholecystectomy and conversion to open cholecystectomy in the National Surgical Quality Improvement Program (NSQIP) database of the American College of Surgeons (ACS) from 2010-2019 were reviewed. The primary endpoint was risk factors for conversion to open cholecystectomy in incidental gallbladder cancer. Chi-squared test or Fisher's exact test was used for categorical variables.Continuous variables were compared using the Mann-Whitney U test. A total of 5,789 patients undergoing laparoscopic cholecystectomy were identified, of which, 50 (0.9%) had incidental gallbladder cancer. Forincidental gallbladder cancer patients, there were no differences in preoperative profile and risk factors between laparoscopic and converted to open cholecystectomy groups. Incidental carcinoma patients undergoing conversion to open cholecystectomy had lower preoperative sodium levels than the laparoscopic cholecystectomy group (P=0.007). Hospital length of stay (days) was longer for those with a conversion to open cholecystectomy for incidental carcinoma compared to non-conversion, 14 (10.8, 18.8) vs 2 (0.3, 5) (P=0.004). The patients converted to open cholecystectomy also had higher rates of postoperative sepsis (50% vs 0%, P<0.001) and reoperation than the laparoscopic cohort (50% vs 2.2%, P<0.001). Readmission and mortality rates, among other complications, were not significantly different between both surgical approaches in incidental gallbladder cancer patients. Patients with conversion to open cholecystectomy had worse outcomes including longer hospital stays and higher rates of sepsis and reoperation. It remains difficult to predict which incidental gallbladder patients will require a conversion to open surgery. Further study examining whether more complicated recovery results in worse oncologicoutcomes is warranted.

An ensemble-based machine learning model for predicting type 2 diabetes and its effect on bone health

BackgroundDiabetes is a chronic condition that can result in many long-term physiological, metabolic, and neurological complications. Therefore, early detection of diabetes would help to determine a proper diagnosis and treatment plan.MethodsIn this study, we employed machine learning (ML) based case-control study on a diabetic cohort size of 1000 participants form Qatar Biobank to predict diabetes using clinical and bone health indicators from Dual Energy X-ray Absorptiometry (DXA) machines. ML models were utilized to distinguish diabetes groups from non-diabetes controls. Recursive feature elimination (RFE) was leveraged to identify a subset of features to improve the performance of model. SHAP based analysis was used for the importance of features and support the explainability of the proposed model.ResultsEnsemble based models XGboost and RF achieved over 84% accuracy for detecting diabetes. After applying RFE, we selected only 20 features which improved the model accuracy to 87.2%. From a clinical standpoint, higher HDL-Cholesterol and Neutrophil levels were observed in the diabetic group, along with lower vitamin B12 and testosterone levels. Lower sodium levels were found in diabetics, potentially stemming from clinical factors including specific medications, hormonal imbalances, unmanaged diabetes. We believe Dapagliflozin prescriptions in Qatar were associated with decreased Gamma Glutamyltransferase and Aspartate Aminotransferase enzyme levels, confirming prior research. We observed that bone area, bone mineral content, and bone mineral density were slightly lower in the Diabetes group across almost all body parts, but the difference against the control group was not statistically significant except in T12, troch and trunk area. No significant negative impact of diabetes progression on bone health was observed over a period of 5-15 yrs in the cohort.ConclusionThis study recommends the inclusion of ML model which combines both DXA and clinical data for the early diagnosis of diabetes.

Acute Kidney Disease following Acute Kidney Injury in Children-A Retrospective Observational Cohort Study on Risk Factors and Outcomes.

Background: Acute kidney disease (AKD) is a known risk factor for increased mortality and evolution towards chronic kidney disease (CKD) in adults. The data regarding AKD in children are scarce. The purpose of our study was to explore the risk factors for developing AKD based on exposures and susceptibilities in children with AKI doubled by the biological parameters from the first day of identified AKI. In addition, we followed the trajectory of AKD following an acute kidney injury (AKI) episode in children during hospital admission and after discharge with special considerations towards mortality and progression to new-onset CKD. Methods: We retrospectively evaluated 736 children, ages between 2 and 18 years old, with identified AKI during hospital admission in a tertiary care hospital from west Romania over a 9-year period. Results: AKD incidence following an AKI episode was 17%. Patients who developed AKD were older, with higher baseline serum creatinine, urea, C reactive protein and lower proteins, haemoglobin and sodium levels. In the adjusted model, no biological parameters influenced AKD development. Regarding certain exposures and personal susceptibilities in children with AKI, only anaemia independently increased the risk of AKD development by 2.47 times. However, out of the AKI causes, only the intrinsic causes of AKI independently increased the risk of progressing to AKD (glomerulonephritis by 4.94 and acute tubule-interstitial nephritis by 2.76 times). AKD increased the overall mortality by 2.6 times. The factors that independently increased the risk of CKD were AKD, acute tubular necrosis and higher baseline serum creatinine values. Conclusions: Only anaemia, glomerulonephritis and acute tubule-interstitial nephritis increased the risk of AKD development in children with AKI. AKD was an independent risk factor for mortality and new-onset CKD in children.

#327 Impact of outpatient medication on community-acquired acute kidney injury

Abstract Background and Aims Medications are a relatively common cause of acute kidney injury (AKI) in hospitalized patients and those in the intensive care unit (ICU). However, we know less about the influence of outpatient medication in patients admitted from the emergency room who already have a community-acquired AKI (CA-AKI) The purpose of this study is to analyze the impact of outpatient medication in a cohort of patients with CA-AKI admitted to the nephrology service of a tertiary level hospital. Method This is a single-center, observational, longitudinal, and retrospective study based on a cohort of patients with CA-AKI admitted to the Nephology Service of a third level hospital from January 2010 to December 2018. We analyzed the characteristics of outpatient medication in these patients and their clinical consequences during admission and follow-up after hospital discharge. Results A total of 639 patients were included in the final analyses. The mean age was 72.93 ± 13.38 years. 61.7% were men. Charlson comorbidity index (CCI) was 5.87 ± 2.4 points. The length of stay was 11.63 ± 10.14 days. In view of the Etiology of AKI, 72.1% had prerenal AKI and 27.9% non-prerenal. 436 patients had a history of previous chronic kidney disease (CKD) (68.23%). AKI KDIGO stages were: stage I, 105 cases (16.4%); stage II, 67 cases (10.5%); stage III 467 cases (63.1%). Hemodialysis (HD) was required in 114 patients (17.8%). 62 patients (9.7%) died during hospital stay. The average number of drugs ingested prior to admission was 8.45 ± 4.11 with no differences by sex. Percentage of patients taking drug groups: diuretics 62.8%; Angiotensin-converting enzyme inhibitors (ACEI) or Angiotensin receptor Blockers (ARB) 68.4%; combination of diuretics with ACEI/ARB 50.9%; Proton-pump inhibitors (PPI) 64.1%; Statins 43.5%; Beta blockers 30.7%; allopurinol 25.8%; Anticoagulants 20.2%; Metformin 13.8%; Spironolactone 13.5%. There was a significant positive correlation between age (r=0.189; p&amp;lt;0.001), baseline creatinine (r=0.258; p&amp;lt;0.001), and CCI (r=0.43; p&amp;lt;0.001), with the number of drugs. There was a significant inverse correlation between peak creatinine during admission (r=−0.170; p&amp;lt;0.001), length of stay (r=−0.109; p 0 0.006), and number of drugs. Patients with prerenal etiology consumed significantly more drugs than those with parenchymal or obstructive etiology (9.09 ± 3.9 vs 6.77 ± 4.1 and 6.92 ± 4.3 respectively) The number of drugs did not influence the AKI stage, mortality during admission, nor the need for dialysis or ICU admission. Patients taking non-potassium sparing diuretics had significantly lower sodium (137.1 ± 5.73 vs 135.75 ± 5.9 mmol/L; p=0.005) and chloride levels (99.94 ± 9 vs 98.42 ± 8.1 mmol/L; p=0.029) compared to those who did not take them. Patients taking potassium-sparing diuretics (6.49 ± 1.55 vs 5.14 ± 1.32 mmol/L; p&amp;lt;0.001), ACEI/ARBs (5.42 ± 1.44 vs 5.12 ± 1.4 mmol/L; p=0.014) or beta-blockers (5.51 ± 1.38 vs 5.24 ± 1.44 mmol/L; p=0.030) presented significantly hyperkalemia compared to those who did not take them. After performing a multivariate linear regression analysis, the only drugs that was associated with hyperkalemia were potassium-sparing diuretics (B 1.35; 95% CI 1.05-1.66; p&amp;lt;0.001). In the follow-up after discharge, patients taking 6 or fewer drugs had better survival than those taking 7 to 12, and the latter better than those taking more than 12 drugs (log rank test: Chi square 24.47; p&amp;lt;0.0001) In the univariate cox regression, the number of drugs significantly influenced survival (Exp(B) 1.069; 95% CI 1.043-1.096; p&amp;lt;0.0001). Conclusion The patients in our series with CA-AKI were polymedicated, mainly those of prerenal etiology, with a clear correlation with age, baseline creatinine and previous comorbidity and with a prominence of ACEIs/ARBs, diuretics, and PPIs. Certain drugs had a significant impact on ionic alterations, adding morbidity to the condition. The number of drugs ingested is a marker of survival after hospital discharge. It is necessary to optimize outpatient drug management to prevent the development of CA-AKI and their consequences.

#2887 Interdialytic weight gain and low dialysate sodium concentration in patients on chronic hemodialysis: a systematic review and meta-analysis

Abstract Background and Aims In many patients on chronic hemodialysis, interdialytic weight gain (IDWG) is greater than 4.0%-4.5% of dry weight, the value recommended by the international guidelines. High IDWG is a condition associated with risk of all-cause mortality and hospitalization and it depends on elevate intake of fluids and/or foods. More specifically, high intake of water is secondary to the disturbing and constant presence of thirst in such patients, so the limitation of the IDWG is a challenge both for the patients and the physicians. Low dialysate sodium levels can significantly reduce thirst as well as the water intake in the interdialytic period because they can increase the removal of sodium during the dialytic session, and this leads to a reduced content of sodium in the body. The present systematic review and meta-analysis aims at evaluating the efficacy of low dialysate sodium concentration on interdialytic weight gain (IDWG) in chronic hemodialysis patients. Method Studies were eligible for inclusion if they were English language papers published in a peer-reviewed journal and met the following inclusion criteria: 1) Primary research studies in adult patients (over 18 years of age), 2) Included patients with end-stage renal disease on chronic hemodialysis since at least 6 months; 3) Compared standard (138-140 mmol/l) or high (&amp;gt;140 mmol/l) dialysate sodium concentration with low (&amp;lt;138 mmol/l) dialysate sodium concentration; 4) Included one outcome of interest: interdialytic weight gain. We excluded studies on pediatric patients, pre-dialysis CKD patients, acute kidney injury patients, ESRD patients with other renal replacement therapy modalities such as peritoneal dialysis and transplant. Medline, PubMed, Web of Science, and the Cochrane Library were searched for studies comparing low or high dialysate sodium concentration. Outcome of interest was IDWG. The quality of reporting for each study was performed using the Quality Assessment Tool of Controlled Intervention Studies of the National Institutes of Health. The quality of reporting of each cross-over study was performed using the Revised Cochrane Risk of Bias (RoB) tool for cross-over trials as proposed by Ding et al. Results Nineteen studies (710 patients) were included in the analysis: 15 were cross-over and 4 parallel randomized controlled studies. In cross-over studies, pooled analysis revealed that dialysate sodium concentration reduced IDWG with a pooled MD of −0.40 kg (95% CI -0.50 to −0.30; P &amp;lt; 0.00001). The systematic review of four parallel, randomized, studies revealed that the use of a low dialysate sodium concentration was associated with a significant reduction of the IDWG in two studies, sustained and almost significant (P=0.05) reduction in one study, and not significant reduction in one study. In most studies, the frequency of intradialytic hypotensive events did not differ significantly between low and high sodium dialysate hemodialysis. The GRADE methodology was used to assess the quality of the body of retrieved evidence and studies risk of bias, inconsistency and imprecision were estimated as low. Conclusion Low dialysate sodium concentration reduces the IDWG in patients on chronic hemodialysis.

AN OPTIMAL APPROACH TOWARDS INTAKE OF SALT (LAVAN) FOR HEALTHY WELLBEING

Including salt in our dietary habits remains crucial in contemporary food consumption. However, excessive intake of salt has evolved into a widespread issue that significantly contributes to the onset and persistence of various diseases, including cardiovascular disease and high blood pressure. To avoid medical conditions, it is essential to limit our salt intake. Eliminating salt from our diet, on the other hand, may lead to low sodium levels, which can cause diseases such as hyponatremia and sudden death. As such, established guidelines exist to determine the appropriate amount of salt intake. Therefore, adhering to classical and modern salt consumption regulations is crucial to maintaining a healthy lifestyle. AIMS AND OBJECTIVE ✓ To study the importance of salt ✓ To study low-intake and high-intake salt risk factors ✓ To understand classical and modern methods for the consumption of salt.

Acute kidney injury in patients with acute coronary syndrome - risk profile

Abstract Funding Acknowledgements None. Introduction Acute kidney injury (AKI) is a strong predictor of in-hospital adverse outcomes, which is a common complication of acute coronary syndrome (ACS). Aim To analyse the risk profile of patients treated for acute coronary syndrome who develop acute kidney injury. Material and methods This is a single-centre cross-sectional cohort study on 3507 patients with ACS. The main exclusion criteria was left ventricular dysfunction. Demographical and clinical characteristics, biochemical parameters, the anatomical distribution of coronary artery disease (CAD) and the final outcomes were analysed according to RF at the moment of the indexed event. The estimated glomerular filtration rate (eGFR) was calculated by the Modification of Diet in Renal Disease Study Group Equation (MDRD), where patients with eGFR&amp;lt;60ml/min 1.73 m2 had moderate to severe renal dysfunction. Results 74 (2.1%) out of 3507 patients developed acute kidney injury (AKI). Those were predominantly males [62.2% (46), OR 1.55 (95% CI 0.98-2.47), p=0.044], significantly older (68.95±9.9. vs 62.5±11.2; p &amp;lt;0.000001), more often with preexisting HBI (OR 4.72 (95% CI 2.20-10.30, p=0.000070), HTA(OR 1.89 95%CI 1.11-3.23, p=0.020), diabetes(OR 1.88 95%CI 1.18-3.00, p=0.008), cancer(OR 2.92 95%CI 1.15-7.44, p=0.024), anaemia (beta -.104, p=0.000032), while less often were smokers (OR 0.51, 95% CI 0.31-0.83, p=0.006). They had statistically significantly higher values of cardiac troponin (beta .075, p=0.000011), stress glycemia (beta .104, p=0. 0.000019), and WBC (beta .074, p=0.000013), higher BUN (beta .325, p=0.000011), creatinine (beta .268, p=0.000016), and lower eGFR at admission (beta -.211, p=0.000032), lower sodium (beta -.101, p=0.000012), and higher potassium levels (beta .087, p=0.0008). Vice versa, total cholesterol, LDL-C and non-HDL-C (beta -.051, p=0.002, -.049, p=0.003, and -.047, p=0.005 respectively), were lower, the same for Hgb (beta -.107, p=0.000021). It is worth mentioning that 18(11.5%), of AKI patients were not PCI treated. Independent variables associated with AKI were: preexisting renal failure, cancer, and WBC. Outcomes: AKI carried a significantly higher in-hospital mortality rate (4.2% in general population, and 21.1% of all deaths were AKI patients, OR 23.01 (95% CI 14.04-47.03, p=0.00002)]. It was significantly associated with the development of pulmonary oedema (OR 17.94, 95% CI 9.67-33.26, p=0.000012), cardiogenic shock (OR 21.59, 95% CI 12.79-36.47, p=0.00006), any type of dysrhythmia (OR 1.83, 95%CI 1.53-2.18, p=0.0001), and any type of bleeding complications (OR 1.61, 95%CI 1.14-2.27, p=0.007). Conclusion AKI is a relatively rare complication in ACS patients, however is associated with significant in-hospital morbidity and mortality. Patients with pre-existing renal failure, and cancer, as well as patients who developed more pronounced inflammatory reaction were more prone to AKI.

Nutritional Composition, Bioactive Compounds, Food Applications, and Health Benefits of Pigeon Pea (Cajanus cajan L. Millsp.): A Review

ABSTRACTPigeon pea is one of the most multipurpose grain legumes in the tropical and subtropical world. It is highly resilient to climate change due to drought tolerance. It ranks sixth following common beans, chickpeas, field peas, cowpeas, and lentils globally. Pigeon pea is an excellent source of high‐quality protein, essential amino acids, and minerals. Furthermore, pigeon pea is endowed with valuable water‐soluble vitamins such as thiamin, ascorbic acid, riboflavin, and niacin. With low levels of saturated fat and sodium and being cholesterol free, pigeon peas emerge as a nutritious dietary choice. Pigeon peas are rich sources of bioactive compounds with various potential health properties, including anti‐inflammatory, antibacterial, antioxidant, anticarcinogenic, and antidiabetic effects. Pigeon peas can be consumed in diverse forms, including whole seeds, split seeds (known as dhal), vegetables using green seeds, and fresh pods. Moreover, pigeon peas find application in a variety of food products, including bread, pasta, noodles, snacks, and biscuits. Despite their nutritional and medicinal properties, pigeon peas remain among the least utilized legumes globally. This review paper aims to provide up‐to‐date information on the nutritional compositions, bioactive compounds, food applications, and health benefits of pigeon peas.

A Role for the Gastrointestinal Tract in Sodium Dysregulation Associated with the Salt Sensitive Phenotype in the Dahl S Rat

Introduction: Salt sensitive hypertension in the Dahl S rat (SS) has traditionally been attributed to elevated renal sodium reabsorption, largely mediated by the renal epithelial sodium channel (ENaC). Considering the role of ENaC in the distal colon epithelium in sodium absorption in the gastrointestinal tract, we hypothesized that the salt sensitive phenotype of SS rats may in part be attributable to increased absorption of sodium in the distal colon. Methods: Adult male SS and its control, the SR rats (12-14wo), were administered either low sodium diet (LS; 0.3% NaCl, Teklad) or moderately high sodium diet (HS; 2.0% NaCl, Teklad) ad libitum for two weeks. At endpoint, fecal samples were collected, dried for 72 hours at 70°C, weighed, and homogenized in deionized water. Fecal levels of sodium per gram of dry fecal weight were measured using flame photometry. Segments of distal colon wall were dissected and mounted in the Ussing chamber filled with warm, oxygenated Kreb’s solution containing D-glucose. Amiloride hydrochloride, a selective ENaC inhibitor, was applied to the tissue apical side in increasing concentrations (0-100μM) at 10-minute intervals. Total ionic currents (Isc, A) were measured under voltage clamp and presented as change from baseline. Results: We observed significantly lower fecal sodium levels in the SS compared to SR rats on LS diet (p&lt;0.05), and a similar trend in fecal sodium levels between the SS and SR on HS diet (P=0.1). This was associated with significantly elevated amiloride-sensitive current in the distal colon of SS compared to the SR on LS and HS diets (p&lt;0.01 and p&lt;0.0001, respectively). Conclusion: Elevated amiloride-sensitive sodium current in the distal colon of SS rats is associated with decreased fecal sodium levels. This suggests increased sodium absorption in the SS rats and proposes a role for the gastrointestinal tract in sodium dysregulation associated with the salt sensitive phenotype in Dahl S rats. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Is Preeclampsia With Low Sodium Levels Associated With Increased Need for Antihypertensives? [ID 2683464

INTRODUCTION: Preeclampsia (PEC) complicates 5–10% of pregnancies. Preeclampsia and low sodium (PALS) has been reported, but risks of low sodium are not well understood. We hypothesize that PALS is associated with increased need for antihypertensives. METHODS: This was an IRB-approved retrospective cohort study of 521 PEC patients with a documented sodium level during delivery or postpartum admission at Mount Sinai Hospital (2013–2021). Primary outcomes were need for emergency antihypertensives during admission and long-acting antihypertensives at discharge. Secondary outcomes were maternal length of stay (LOS), ICU admission, and readmission for PEC. RESULTS: Patients with PALS (sodium &lt;135 mmol/L; n=111) were more likely to be nulliparous (P=.004), have lower body mass index (P=.03), and have a history of PEC (P=.047). In a multivariable logistic regression adjusting for history of PEC, chronic hypertension, aspirin use in pregnancy, multiple gestations, and PEC subtypes, patients with PALS were more likely to require long-acting antihypertensives at discharge (adjusted odds ratio [aOR] 1.79; 95% CI [1.13, 2.83]; P=.01) compared to PEC with normal sodium. Need for emergency antihypertensives, rates of maternal ICU admission and maternal readmission did not differ between groups. However, the distribution of maternal LOS differed between groups (median [interquartile range (IQR)]: 4.0 [3.0, 5.0] for normal sodium, 4.0 [4.0, 6.0] for low sodium; P&lt;.0001). CONCLUSION: Preeclampsia and low sodium is associated with increased need for long-acting antihypertensives at discharge. Preeclampsia and low sodium may represent a more severe PEC presentation, warranting closer attention to sodium levels in the management of PEC patients. Future studies with larger sample sizes are needed to assess the effects of lower sodium levels.

A Comprehensive Analysis of Renal and Endothelium Dysfunction Markers Fourteen Years after Hemorrhagic Fever with Renal Syndrome Contraction.

While the pathology of acute hemorrhagic fever with renal syndrome (HFRS) has been widely researched, details on the chronic HFRS sequelae remain mainly unexplored. In this study, we analyzed the clinical and laboratory characteristics of 30 convalescent HFRS patients 14 years after the disease contraction, mainly emphasizing several endothelial dysfunction parameters. Convalescent HFRS patients exhibited significantly higher serum levels of erythrocyte sedimentation rate, von Willebrand factor, uric acid, C-reactive protein and immunoglobulin A when compared to healthy individuals. Furthermore, 24 h urine analyses revealed significantly lower sodium and potassium urine levels, as well as significantly higher proteinuria, microalbumin levels and β2-microglobulin levels when compared to healthy individuals. First morning urine analysis revealed significantly higher levels of hematuria in convalescent HFRS patients. None of the additional analyzed endothelium dysfunction markers were significantly different in post-HFRS patients and healthy individuals, including serum and urine P-selectin, E-selectin, soluble intercellular adhesion molecule 1, vascular intercellular adhesion molecule 1 (sVCAM-1) and vascular endothelial growth factor (VEGF). However, binary logistic regression revealed a weak association of serum sVCAM-1 and urine VEGF levels with HFRS contraction. Generally, our findings suggest mild chronic inflammation and renal dysfunction levels in convalescent HFRS patients 14 years after the disease contraction.