Lower Serum Creatinine Research Articles

Low serum creatinine, a surrogate marker of muscle mass, correlates with insulin sensitivity in nonhuman primates.

Decreased serum creatinine levels are associated with increased risk of type 2 diabetes (T2DM) in humans, however, its association with muscle mass and insulin sensitivity have not been studied in NHPs. Retrospective data of 229 adult NHPs were studied for association of serum creatinine levels with muscle mass and onset of T2DM. Serum creatinine levels were positively correlated with lean muscle mass in nondiabetic (non-DM), male and female NHPs. Aged NHPs had significantly reduced lean muscle mass and corresponding creatinine levels compared to young age groups (p < .001). Creatinine was positively correlated with insulin sensitivity in nonDM male NHPs and significant decrease in creatinine was observed in T2DM (p < .001) compared to same age group nonDM NHPs. The pathophysiology of T2DM in NHPs is similar to humans, low creatinine further provides utility of surrogate biomarkers of lower muscle mass and risk factor for T2DM NHPs.

Early treatment with terlipressin in patients with hepatorenal syndrome yields improved clinical outcomes in North American studies.

Hepatorenal syndrome type 1 (HRS-1) is a serious complication of advanced cirrhosis and a potentially reversible form of acute kidney injury that is associated with rapidly deteriorating kidney function. Liver transplantation remains the only curative treatment for decompensated cirrhosis. However, terlipressin, a vasopressin analog, successfully reverses HRS-1, and may improve patient survival while awaiting liver transplantation. Patients with higher baseline serum creatinine have a reduced response to treatment with terlipressin. These post hoc analyses examined pooled data from 352 patients with HRS-1 treated with terlipressin in 3 North American-centric, Phase III, placebo-controlled clinical studies (i.e. OT-0401, REVERSE, and CONFIRM)-across 3 serum creatinine subgroups (i.e. <3, ≥3-<5, and ≥5mg/dL)-to further delineate their correlation with HRS reversal, renal replacement therapy-free survival, and overall survival. Serum creatinine was significantly associated with HRS reversal in univariate and multivariate logistic regression analyses (P<0.001). The incidence of HRS reversal inversely correlated with serum creatinine subgroup (<3mg/dL, 49.2%; ≥3-<5mg/dL, 28.0%; ≥5mg/dL, 9.1%). At Day 30 follow-up, renal replacement therapy-free survival was significantly higher for patients with HRS-1 in the lower serum creatinine subgroups than in the higher subgroup (<5 vs. >5mg/dL; p=0.01). Terlipressin-treated patients with HRS-1, with a lower baseline serum creatinine level, had a higher overall survival (p<0.001) and higher transplant-free survival at Day 90 (p=0.04). Patients with HRS-1 and lower serum creatinine levels who were treated with terlipressin had higher HRS reversal and survival outcomes, highlighting the significant need to identify and treat patients with HRS-1 early when they often have lower serum creatinine levels, and likely a greater response to terlipressin.

Vasoconstrictor Therapy for Acute Kidney Injury Hepatorenal Syndrome: A Meta-Analysis of Randomized Studies.

Type 1 hepatorenal syndrome (HRS) is a rapid deterioration in kidney function in patients with cirrhosis. Data on efficacy of vasoconstrictors for type 1 HRS have shown mixed results. Literature searched for randomized controlled trials comparing pharmacological therapy for HRS vs placebo or another drug for HRS. Primary outcome was HRS reversal (serum creatinine <1.5mg/dL on 2 readings), and secondary outcomes were liver transplant (LT) free survival and serious adverse events (SAE). Sixteen studies on 1244 patients (mean age 50.3 yrs., 67.5% males, serum creatinine of 3.07 mg/dL, serum sodium 127.2 mEq/liter, and Model for End-stage Liver Disease (MELD) score of 30.9, and Child-Pugh score 11) with type 1 HRS treated with vasoconstrictors vs placebo or another drug were analyzed. All the patients received intravenous albumin infusion. (A) terlipressin vs placebo: Odds of HRS reversal were 3.3 folds with terlipressin without difference on LT-free patient survival. Terlipressin was associated with higher odds of SAE. (B) Nor-epinephrine (NE) vs terlipressin: No difference on HRS reversal, LT-free survival, and SAE. (C) Terlipressin or NE vs midodrine and octreotide: 91% lower odds of HRS reversal with midodrine and octreotide. There were no differences on SAE (10 of 64 vs 10 of 58, P= .812). Non-responders vs responders had higher mean MELD score (29 vs 27.8), P= .014 and serum creatinine (3.5 vs 3.1), P= .027. Terlipressin and NE are similar and superior to midodrine octreotide combination for HRS reversal. No therapy improves LT-free patient survival. Response to treatment is better with lower baseline serum creatinine and MELD score. The risk of adverse effects is similar with terlipressin and NE. Studies are needed as basis to identify candidates with best response to treatment with excellent safety profile.

Prognostic significance of low basal serum creatinine levels in internal intensive care unit patients.

This study aimed to show the relationship between low creatinine level and mortality in the internal Intensive Care Unit (ICU) based on the view that there may be a relationship between low creatinine level and mortality in patients admitted to the ICU. This retrospective, single center study was performed in the ICU. Patients older than 18 years who stayed in the ICU for more than 24 hours were included in the study. Patients were evaluated for age, gender, albumin, creatinine levels and length of hospital stay in the analysis. Patients were divided into 7 groups according to serum creatinine levels: group 1: creatinine ≤ 0.4; group 2: 0.4 < creatinine ≤ 0.6; group 3: 0.6 < creatinine ≤ 0.8; group 4: 0.8 < creatinine ≤ 1.0; group 5: 1.0 < creatinine ≤ 1.2; group 6: 1.2 < creatinine ≤ 1.4; group 7: creatinine > 1.4 mg/dL. Creatinine level of 0.7-0.8 mg/dL was considered as reference and cox regression analysis was performed. Of 2,359 patients admitted to the ICU, 699 died (29.6%). Mortality relationship according to the accepted creatinine levels of the patients showed a U-shaped distribution, and ICU mortality increased in both low and high creatinine levels. At low creatinine levels (creatinine ≤ 0.4 mg/dl), the mortality rate was 71.4% for men and 10.7% for female (p < 0.001). Cox regression analysis showed that group 1 and group 2 increased mortality (HR: 0.721, 95% CI; 0.555-0.936, HR: 0.509, 95% CI; 0.285-0.909, respectively). In patients admitted to ICU, lower creatinine acceptance is associated with increased ICU mortality and reduced survival.

Effects of nonsurgical periodontal therapy on serum creatinine level in systemically healthy individuals with periodontitis: An interventional study.

Several studies have suggested a relationship between periodontitis and serum creatinine levels. Both low and high serum creatinine levels have been reported in individuals with periodontitis. The impact of periodontal therapy on serum creatinine levels has not been fully investigated yet. The aim of the study is to estimate the influence of nonsurgical periodontal therapy (NSPT) on serum creatinine levels in systemically healthy individuals with periodontitis at stage II and stage III with grade A and grade B. Sixty-eight systemically healthy individuals included in the study were divided into Group A (GA) (Periodontally healthy) and Group B (GB) (Periodontitis: stage II and III with grade A and grade B). Gingival index, sulcular bleeding index, probing pocket depth, clinical attachment level, body mass index, and serum creatinine levels were recorded at baseline for both GA and GB, 90 days after NSPT for GB only. Collected data were analyzed statistically. Serum creatinine levels in GB were significantly higher when compared with GA and serum creatinine levels in GB before and 90 days after NSPT were statistically insignificant. Serum creatinine levels were higher in individuals with periodontitis when compared with periodontally healthy individuals and NSPT has no considerable influence on the serum creatinine levels in individuals with periodontitis. Further studies are required to confirm these findings.

Effects of pre-existing metformin therapy on platelet count, serum creatinine, and hospitalization in COVID-19 patients with diabetes mellitus

&lt;abstract&gt; &lt;p&gt;COVID-19 infected individuals with type 2 diabetes mellitus are at higher risk of COVID-19 related complications. Previous studies have yielded varying results regarding the effect of metformin, an antidiabetic drug, on the clinical outcomes of COVID-19 patients. In this retrospective observational study, we aim to assess the impact of pre-existing oral antidiabetic treatment on the clinical outcomes of COVID-19.&lt;/p&gt; &lt;p&gt;We analyzed in-patient data from hospital records, enrolling 150 COVID-19 patients with pre-existing diabetes mellitus. Among them, 75 were treated with metformin, while the remaining 75 were not. Exclusion criteria included patients with type I diabetes mellitus and those above 85 years of age. Fisher's exact test, Chi square test and unpaired t-test were used to analyze the data. There were no significant differences between the two groups in terms of age, gender, or drugs prescribed, aside from metformin. However, the metformin-treated group exhibited a significantly higher proportion of moderately ill patients compared to the non-metformin-treated group (P = 0.0011). Nonetheless, no statistically significant differences were observed between the groups regarding oxygen support requirement or duration of hospital stay. Notably, the metformin group showed distinct variations in haematological parameters, including lower serum creatinine levels (P = 0.0049), platelet count (P = 0.02) and HbA1c levels (P = 0.01). In conclusion, pre-existing metformin treatment did not impact the duration of hospital stay or the need for oxygen support in COVID-19 patients. However, the treatment did exert influence on other essential parameters.&lt;/p&gt; &lt;/abstract&gt;

The relationship between premature ventricular complexes and index of cardiac-electrophysiological balance

Premature ventricular complexes are common in healthy individuals' ambulatory monitoring. The index of cardiac-electrophysiological balance may predict malignant ventricular arrhythmias. This study investigated the relation between Premature ventricular complex burden and index of cardiac-electrophysiological balance in 24-h Holter monitoring. A total of 257 patients who were admitted to a cardiology outpatient clinic without structural heart disease and underwent 24-h Holter monitoring were included in the study. Demographic features, laboratory parameters, and electrocardiographic and echocardiographic values of all patients were obtained from the hospital database. Patients were categorized into the following four groups according to their premature ventricular complex burden: ≤5% premature ventricular complexes as group 1, >6 and ≤10% premature ventricular complexes as group 2, >11 and ≤20% premature ventricular complexes as group 3, and >20% premature ventricular complexes as group 4. QRS, QT, and T peak to end interval were measured by resting electrocardiography. QT interval was corrected using Bazett's formula. T peak to end interval/QT, T peak to end interval/corrected QT interval, index of cardiac-electrophysiological balance, and corrected index of cardio-electrophysiological balance ratios were calculated. There was no significant difference between groups regarding cardiovascular risk factors. In group 4, beta-blocker usage was significantly higher, and the serum magnesium levels were significantly lower than in other groups. There was no difference in QT duration or index of cardiac-electrophysiological balance values; however, corrected index of cardio-electrophysiological balance was significantly lower in the highest premature ventricular complex group (5.1, 5.1, 4.8, 4.7, p=0.005). In multivariate backward logistic regression analyses, it was found that lower corrected index of cardio-electrophysiological balance, lower serum magnesium levels, lower serum creatinine levels, larger left atrium size, and higher T peak to end interval were associated with higher premature ventricular complexes. Corrected index of cardio-electrophysiological balance is a novel and noninvasive marker that can predict premature ventricular complex burden in patients with structurally normal hearts.

Clinical Efficacy of Huangkui Capsule Plus Methylprednisolone for Immunoglobulin A Nephropathy and Its Effect on Renal Function and Serum Inflammatory Factors.

To assess the clinical efficacy of Huangkui capsule plus methylprednisolone for immunoglobulin A (IgA) nephropathy and its effect on renal function and serum inflammatory factors. A total of 80 patients with IgA nephropathy admitted to our hospital from April 2019 to December 2021 were recruited and assigned (1 : 1) to receive either conventional drugs + methylprednisolone tablets (observation group) or conventional drugs + methylprednisolone tablets + Huangkui capsules (experimental group), with 40 patients in each group. Outcome measures included clinical efficacy, renal function indices, serum inflammatory factor levels, and adverse events. The experimental group showed a significantly higher clinical efficacy versus the observation group (P < 0.05). Patients in the experimental group had significantly lower serum creatinine, serum urea nitrogen, fibrinogen, and 24 h urine protein levels than those in the observation group after treatment (P < 0.05). After treatment, the experimental group showed lower levels of tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and monocyte chemoattractant protein-1 (MCP-1) than the observation group (P < 0.05). The differences in the adverse events between the two groups did not come up to the statistical standard (P > 0.05). Huangkui capsule + methylprednisolone provides a feasible therapeutic option for IgA nephropathy by considerably boosting patients' renal function, successfully lowering the inflammatory response, and producing a good safety profile.

Differentiating Ductal Adenocarcinoma of the Pancreas from Benign Conditions Using Routine Health Records: A Prospective Case-Control Study.

The study aimed to develop a prediction model for differentiating suspected PDAC from benign conditions. We used a prospective cohort of patients with pancreatic disease (n = 762) enrolled at the Barts Pancreas Tissue Bank (2008-2021) and performed a case-control study examining the association of PDAC (n = 340) with predictor variables including demographics, comorbidities, lifestyle factors, presenting symptoms and commonly performed blood tests. Age (over 55), weight loss in hypertensive patients, recent symptoms of jaundice, high serum bilirubin, low serum creatinine, high serum alkaline phosphatase, low red blood cell count and low serum sodium were identified as the most important features. These predictors were then used for training several machine-learning-based risk-prediction models on 75% of the cohort. Models were assessed on the remaining 25%. A logistic regression-based model had the best overall performance in the validation cohort (area-under-the-curve = 0.90; Spiegelhalter's z = -1·82, p = 0.07). Setting a probability threshold of 0.15 guided by the maximum F2-score of 0.855, 96.8% sensitivity was reached in the full cohort, which could lead to earlier detection of 84.7% of the PDAC patients. The prediction model has the potential to be applied in primary, secondary and emergency care settings for the early distinction of suspected PDAC patients and expedited referral to specialist hepato-pancreatico-biliary services.

ECG for Detection of Left Ventricular Hypertrophy in patients with Chronic Kidney Disease

Background: Left ventricular hypertrophy is the most common cardiac event associated with chronic kidney disease. Aim: To detect LVH by electrocardiography in patients with CKD. Study design: Observational study. Methodology: It was an observational study with total of 62 CKD patients enrolled through convenience sampling. Their blood 3ml was drawn aseptically for estimation of serum creatinine. All enrolled subjects underwent electrocardiographic examination. Patients with low GFR (&lt;60ml/min/1.73m2) and high serum creatinine concentration (&gt;1.5mg/dl) were included. Data was evaluated by using SPSS vr 24. The results were presented as counts, means and standard deviation as appropriate. Results: Left ventricular hypertrophy was present in 50% of enrolled patients as depicted by ECG recording. The calculated sensitivity and specificity of ECG for LVH were 75% and 100% respectively. Almost 38.7% patients were 56-65 years of age. There were 33.9% patients in the age of 35-45 years and 27.4% was in the age of 46-55 years. The median (IQR) age was 54.50 (41.75-60) years. In our study population, median (IQR) of height was 152cm (150-156). The mean weight was 65.85 kg with standard deviation of 8.42 kg i.e., 65.85 ±8.42kg. Mean body mass index was 27.85. Practical Implication: Current project helped health providers to diagnose cardiac event at an early stage among patients of kidney fail¬ure on ECG findings thus the adverse outcomes could be prevented or delayed. Conclusion: ECG abnormalities are common in hospitalized CKD patients in local population. All hospitalized CKD patients should undergo ECG to screen for cardiovascular disease. It was thus concluded that ECG can be used as a sensitive diagnostic tool in combination with different ECG indices to detect LVH. Key words: Electrocardiography, Chronic Kidney Disease, Left Ventricular Hypertrophy and Sokolow-Lyon Voltage Index

Effect of Vitamin E on Serum Creatinine level on Gentamicin Induced Nephrotoxicity in Long Evans rats

Background: The kidneys are one of the vital organs of our body to excrete metabolic waste products, drugs and chemicals in the form of urine. Objectives: This study was carried out to observe the effect of Vitamin E on gentamicin-induced nephrotoxicity by assessing serum creatinine level in Long Evans rats. Materials and Methods: The experimental study was carried out on 40 Long Evans rats of both sex with the weight ranges from 172-255 gm and the age ranges from 7 to 10 weeks. The rats were divided into four groups- Group A (control) received normal saline, group B, C and D received gentamicin for 6 days, rats of group C received vitamin E capsule for 9 days with gentamicin whereas, group D received vitamin E capsule with gentamicin for total 10 days. Serum creatinine level was measured at the end of experiment. Results: The mean (mean+ SD) serum creatinine levels in group A, B, C and D were 0.98+0.34, 2.36+ 0.44, 1.39+0.18 and 1.30+0.18 respectively. The differences between the groups were highly significant (p&lt;0.001) in group A&amp;B, B&amp;C and B&amp;D whereas the difference between C&amp;D was not significant (p&gt;0.50). Serum creatinine level on the normal saline control (group A) was within normal limit (0.98mg/dl). Serum creatinine level in gentamicin treated (group B) rats were more in comparison to gentamicin and vitamin E treated rats (group C&amp;D) and pretreatment with longer duration group (group D) showed lower serum creatinine level than the shorter one (group C) though there was no significant difference. Conclusion: Vitamin E treatment showed some protective effects against gentamicin induced nephrotoxicity. The results also indicated that effectiveness of vitamin E depends on a suitable duration of pretreatment for better protection against gentamicin-induced nephrotoxicity. KYAMC Journal Vol. 13, No. 03, October 2022: 149-152

Dexmedetomidine versus propofol or midazolam in patients with abdominal sepsis regarding inflammatory response and capillary leak

ABSTRACT Background Abdominal sepsis patients suffer from profound intravascular fluid deficit due to concomitant inflammatory response and capillary leakage. It is reported that anti-inflammatory properties of sedative agents can control inflammatory cascade in many experimental septic conditions. We aimed to investigate the best sedative drug for inflammatory responses and capillary leak in patients with abdominal sepsis. Methods In this prospective randomized study, 60 patients with abdominal sepsis who underwent abdominal surgery and required post-operative sedation and mechanical ventilation were randomized into 3 groups in a 1:1:1 ratio. Group D (sedated with dexmedetomidine), group P (sedated with propofol), and group M (sedated with midazolam). This study was held in intensive care units of Assiut University Hospitals with primary outcome was serum IL-6 and IL-1β. Secondary outcomes were capillary leak index, lactate clearance, vasopressor requirements, total intake, total output, and fluid balance. Results Dexmedetomidine significantly reduced levels of IL-6 and IL-1β through 48 hours compared to both midazolam and propofol. Dexmedetomidine caused a significant decline in capillary leak index (p < 0.05) through 48 hours and significant higher lactate clearance (p = 0.03) in first 24 hours compared to both midazolam and propofol. Dexmedetomidine group had a significantly lower intake in first 24 hours and comparable vasopressor requirements through 48 hours. Dexmedetomidine group had a significantly higher output, lower serum creatinine levels and lower positive fluid balance compared to propofol and midazolam. Conclusions Dexmedetomidine reduced inflammatory response and capillary leak in mechanically ventilated patients with abdominal sepsis with better lactate clearance and less fluid intake.

Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort

BackgroundAcute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK).MethodsThis was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared.ResultsA total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001).ConclusionsIn critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB.Trial registration: NCT04445259.

Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery.

To assess the association between low preoperative serum creatinine and postoperative outcomes. The association between low creatinine and poor surgical outcomes is not well understood. We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications. Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively. A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.

Phosphatidylinositol 3-Kinase δ Deficiency Protects From Antimyeloperoxidase Vasculitis.

Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) is a systemic autoimmune disease in which glomerulonephritis is an important manifestation. Antibodies against myeloperoxidase (MPO) or proteinase 3 are thought to be important in pathogenesis. Phosphoinositide 3-kinase δ (PI3Kδ) mediates a number of effects in lymphocytes, but its role in myeloid cell responses is less clear. Therefore, this study was undertaken to assess this in a preclinical model of glomerulonephritis induced by the transfer of antibodies to MPO. D910A mice with inactive PI3Kδ were compared with wild-type controls. Disease protocols allowed for a comparison of experimental groups in the setting of both mild and more severe disease. Adoptive transfer experiments were performed, with flow cytometric analysis of digested kidneys taken at the end of the experiment. With mild disease, D910A mice had fewer glomerular macrophages, fewer glomerular neutrophils, and reduced albuminuria compared with wild-type controls. With more severe disease, they also had fewer glomerular crescents and lower serum creatinine levels, indicating protection from acute kidney injury. Adoptive transfer experiments showed a defect in the recruitment of D910A monocytes to the diseased kidney. Mice with inactive PI3Kδ were protected from anti-MPO vasculitis. This is due to cell intrinsic defect in the recruitment of monocytes to the kidney. These findings suggest that PI3Kδ is a potential therapeutic target in AAV.

Abstract 15083: Chronicity of Heart Failure, In-Hospital Clinical Trajectory, and Post-Discharge Outcomes Among Patients Hospitalized for Heart Failure

Introduction: Among patients hospitalized for HF, patients hospitalized with worsening chronic heart failure (WCHF) are at increased risk for morbidity and mortality compared with those who are recently diagnosed with HF. Whether there are differences in clinical course during hospitalization for HF is unclear. Methods: We pooled 735 participants hospitalized for HF in the DOSE, CARRESS, and ROSE trials. We grouped participants by whether HF was recently diagnosed (≤12 months) or WHCF (&gt;12 months). We compared changes in congestion, kidney function, and symptoms during hospitalization, as well as early post-discharge kidney and mortality outcomes. Results: Overall, 132 (18%) had recently diagnosed HF and 603 (82%) had WCHF. Compared with WCHF, patients with recently diagnosed HF tended to have lower serum creatinine and higher systolic blood pressure, ejection fraction, and serum NT-proBNP (all p&lt;0.05). In the first 72 hours, changes in body weight, global well-being visual analog scale, serum creatinine, and serum NT-proBNP, as well as net fluid loss were similar between patients with recently diagnosed versus WCHF (all p&gt;0.15) ( Figure ). Recently diagnosed HF showed improved dyspnea at 72 hours (p=0.03). There was no difference in change in serum creatinine from baseline to 60 days (p=0.75). There was a trend toward significantly increased odds of mortality during study follow-up (adjusted odds ratio 1.96 [95% confidence interval 0.97-3.94], p=0.06). Conclusion: Patients hospitalized for recently diagnosed and WCHF have generally similar in-hospital clinical trajectories, and similar changes in kidney function early post-discharge. Despite these similarities and adjustment for other clinical factors, patients with WCHF remain at increased risk for post-discharge mortality as compared with patients who are more recently diagnosed.

Abstract 14194: Risk Factors of Hypokalemia and Hyperkalemia in Hypertensive Emergency

Introduction: Potassium disorders are common among hypertensive patients. There is a paucity of data on the prevalence and risk factors of dyskalemia in patients with hypertensive emergency. Hypothesis: We sought to investigate the prevalence and risk factors of potassium disorders in patients presenting with hypertensive emergency. Methods: A retrospective, cross-sectional study was employed by retrieving electronic medical records (EMR) of patients with a diagnosis of hypertensive emergency admitted from September 2016–December 2021 under Yale New Haven Health system. Hypertensive emergency patients were identified using the International Classification of Diseases, Tenth Edition (ICD-10) diagnosis. We selected patients who carried the diagnosis code of hypertensive emergency (I16.1) and at least 1 additional diagnosis for concurrent end organ damage (EOD). We manually examined all the electronic medical record (EMR) (n = 2664) to assure the correct establishment of diagnosis and removed 345 patients who are hypertensive urgency misclassified as hypertensive emergency. Hypokalemia is defined as serum potassium &lt;3.5 mg/dL and hyperkalemia is defined as &gt;5.5 mg/dL. Results: Among a total of 2,319 patients included in the study, 1,157(49.9%) were women and 1162(50.1%) were men. The mean age of the patients was 67.3 years. We have941(40.6%) African Americans, , 1048( 45.2%) Caucasian, and the rest of 240 (14.2%) are either Asians or unspecified. Average systolic blood pressure on presentation was 193 mmHg and average diastolic blood pressure was 106 mmHg. 143 (6.2%) patients had hyperkalemia and 260 (11.2%) patients had hypokalemia. After multivariable adjustment, older age, lower serum bicarbonate, elevated serum sodium and elevated serum creatinine were independently associated with hyperkalemia, and younger age, African American, higher serum bicarbonate, lower serum sodium, and lower serum creatinine were independently associated with hypokalemia. Conclusions: We identify a potential clinical phenotype of hypertensive emergency patients who present with potassium disorder. The risk for hypo- and hyperkalemia in hypertensive emergency can be stratified with common laboratory results and socio-demographic variable.

Abstract 11319: Post-Operative Dialysis in Failing Fontan Patients Undergoing Heart Transplant: How Well Does the Pre-Transplant Creatinine Clearance Risk-Stratify Patients?

Introduction: The need for dialysis early post-heart transplant (HT) can be suprisng when it occurs in the setting of purportedly normal renal function pre-HT, as has been described in failing Fontan (FF) patients. Hypothesis: We hypothesized that FF patients may have an increased incidence of post-operative dialysis (POD). Methods: The Pediatric Heart Transplant Society (PHTS) database was used to identify all children ≥2 years of age with failing Fontan (FF) physiology or cardiomyopathy (CM, benchmark lesion) who underwent isolated HT from 2005-2019. The primary endpoint was POD, defined as any form of dialysis within the first 30 days post-HT. Pre-transplant estimated glomerular filtration rate (eGFR) was calculated using the modified Schwartz formula, and a subset of patients with provided supplemental data additionally had renal function evaluated by a non-creatinine-based method. Results: Of 2003 children who met the inclusion criteria, 263 had FF (13%) and 1740 had CM (87%). Whereas the mean ages were similar (FF 11.2 vs CM 12.2 years, P=0.3), FF patients were 11% shorter (134 vs. 148, P&lt;0.001) and 9 kg lighter (31.2 vs. 40.2, P&lt;0.001), and had a lower serum creatinine (0.57 vs. 0.64 mg/dl, P=0.001) but similar eGFR pre-transplant (110.2 vs. 106.7 L/min/1.73m 2 , P=0.26). In a subset of 22 FF patients with available results from 24-hour urine collection or nuclear medicine scan, the Schwartz formula overestimated the GFR in 15/22 patients by an average of 40.2 ml/min/1.73 m2 (range 2.6 to 91.8). Overall, compared to CM patients, FF patients had a 4.7-fold higher risk of requiring POD (3.8% vs. 0.8%, P&lt;0.001). Of those who required POD, the difference in 30 day post-HT mortality was not significant (40% vs. 14%, 0.3). Multivariable analysis revealed that pre-HT ECMO and longer CPB times were independently associated with POD; there was a trend toward association of higher pre-HT eGFR (P=0.06). Conclusions: Fontan patients have a ~5-fold higher risk of post-operative dialysis compared to cardiomyopathy patients, and despite a normal or even supraphysiological pre-transplant estimated CrCl. Non-creatinine-based methods independent of malnutrition status should be considered in the FF population.

Effect of Supplementation of Thyme and Turmeric Essential Oils on Hemato-biochemical Parameters of Japanese Quails

This experiment was undertaken to assess the influence of thyme (Thymus vulgaris) and turmeric (Curcuma longa) essential oils on hematobiochemical parameters of Japanese quails. One hundred eighty, 6-day old Japanese quail chicks were subjected to five weeks trial. Quail chicks were distributed at random into five dietary treatment groups each with three replicates of 12 quails per treatment. Quails of T0 group fed diet without essential oils (Basal diet), T1 group fed basal diet with 0.2 % thyme essential oil, T2 group fed basal diet with 0.3% turmeric essential oil, T3 group fed basal diet with combination of 0.125 % thyme essential oil and 0.075 % turmeric essential oils, T4 group fed basal diet with combination of 0.075% thyme essential oil and 0.125 % turmeric essential oils. The results revealed that Japanese quails of essential oils supplemented groups had significantly higher (p&lt;0.05) red blood cell count, packed cell volume, haemoglobin, mean corpuscular volume, mean corpuscular haemoglobin, serum protein, albumin globulin and high-density lipoprotein concentrations with best results found in T4 group. Supplementing Japanese quails with thyme and turmeric essential oils significantly lowered serum uric acid, creatinine, total bilirubin, glucose, total cholesterol, triglycerides, LDL, SGOT and SGPT activity. It can be concluded that nutritional supplementation of thyme and turmeric essential oils at 0.075 % and 0.125 % in combination improved haematological indices and most of the serum biochemical parameters in Japanese quails.

Preliminary experience of oblique occlusion technique in robot-assisted infrahepatic inferior vena cava thrombectomy: step-by-step procedures and short term outcomes

BackgroundWe aimed to compare the oncological outcomes between the oblique occlusion technique and the traditional technique for robot-assisted radical nephrectomy (RARN) with inferior vena cava (IVC) thrombectomy, and to explore the safety and effectiveness of the oblique occlusion technique.MethodsOverall, 21 patients with renal cell carcinoma (RCC) and IVC tumor thrombus (TT) were admitted to our hospital from August 2019 to June 2020. All the patients underwent RARN with IVC thrombectomy, of which the IVC oblique occlusion technique was used in 11 patients and traditional occlusion technique was used in 10 patients. The oblique occlusion technique refers to oblique blocking from the upper corner of the right renal vein to the lower corner of the left renal vein using a vessel tourniquet or a vessel clamp (left RCC with IVCTT as an example).ResultsCompared with patients in the traditional group, those in the oblique group had lower serum creatinine at follow-up (3 month) (95 ± 21.1 vs. 131 ± 30.7 μmol/L, P = 0.03). There was no significant difference in operation time [149 (IQR 143–245) min vs. 148 (IQR 108–261) min, p = 0.86], IVC clamping time [18 (IQR 12–20) min vs. 20 (IQR 14–23) min, p = 0.41], and estimated intraoperative blood loss [300 (IQR 100–800) mL vs. 500 (IQR 175–738) mL, p = 0.51] between both groups. During a 16-month (range, 15–23 months) follow-up period, two cases progressed in the oblique group and three cases progressed in the traditional group.ConclusionsThe modified IVC oblique occlusion technique procedure is relatively safe and effective in RARN with IVC thrombectomy. The IVC oblique occlusion technique may play a role in the protection of renal function.