MDRD Equation Research Articles

Comparison of MDRD equations and the old equations CKD-EPI against new equations CKD-EPI in patients with kidney transplantation when used 51Cr-EDTA to measure glomerular filtration

BackgroundWhen estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. ObjectiveTo analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. ResultsThe mean measured GFR was 43.0 ± 11.4 (18.2–79.4) ml/min/1.73 m2, with creatine levels of 1.42 ± 0.46 (0.60–4.33) mg/dl and cystatin C levels of 1.45 ± 0.53 (0.42–3.48) mg/l. This correlated moderately with creatinine (r=–0.61, p < 0.001) and cystatin C (r=–0.52, p < 0.001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1 ml/min/1.73 m2 for MDRD, +16.4 ml/min/1.73 m2 for 2009-CKD-EPI, +15 ml/min/1.73 m2 for CKD-EPI with cystatin C and +14.1 ml/min/1.73 m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60 ml/min/1.73 m2. ConclusionsThe 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equation is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.

Comparación de las ecuaciones MDRD y de las antiguas ecuaciones CKD-EPI frente a las nuevas ecuaciones CKD-EPI en pacientes con trasplante renal cuando se emplea 51Cr-EDTA para medir el filtrado glomerular

BackgroundWhen estimating the glomerular filtration rate (GFR) in kidney transplant patients, significant differences have been found between MDRD and the 2009 CKD-EPI equations, and reference techniques. ObjectiveTo analyse and compare the performance of MDRD and the 2009 and 2012 CKD-EPI equations against 51Cr-EDTA plasma clearance in measuring GFR in 270 kidney transplant patients after one year. ResultsThe mean measured GFR was 43.0±11.4 (18.2–79.4)ml/min/1.73m2, with creatinine levels of 1.42±0.46 (0.60-4.33)mg/dl and cystatin C levels of 1.45±0.53 (0.42-3.48)mg/l. This correlated moderately with creatinine (r=–0.61, P<.001) and cystatin C (r=–0.52, P<.001). Using linear regression techniques, it was found that creatinine, cystatin C, gender and age only explained 52% of GFR total variance. All equations overestimated GFR, with a mean bias of +11.1ml/min/1.73m2 for MDRD, +16.4ml/min/1.73m2 for 2009-CKD-EPI, +15ml/min/1.73m2 for CKD-EPI with cystatin C, and +14.1ml/min/1.73m2 for 2012-CKD-EPI with creatinine and cystatin C. eGFR by MDRD and the 2009 CKD-EPI equation correlated better with 51Cr-EDTA than CKD-EPI with creatinine and/or cystatin C. The overestimations were negatively correlated with creatinine and cystatin C levels, most significantly for CKD-EPI with creatinine and/or cystatin C when GFR was greater than 60ml/min/1.73m2. ConclusionsThe 2012 CKD-EPI equations with creatinine and/or cystatin C significantly overestimate GFR in stage 1 and 2 chronic kidney disease. The MDRD equations is therefore recommended in these cases. The reference method used to measure GFR seems to heavily influence the bias of the equations.

Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation

Introduction: Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population.&#x0D; Methods: All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors we rerecorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation.&#x0D; Results: A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the studyperiod. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011).&#x0D; Conclusion: Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation.

Comparison of glomerular filtration rate estimation using Jaffé and enzymatic creatinine assays in diabetic patients.

Diabetic kidney disease (DKD) develops an end-stage renal failure and is a major cause of death in diabetic patients. A GFR below 60ml/min per 1.73m2 is one of the main markers of DKD. Therefore, the development of an accurate test for diagnosis and monitoring of the mentioned disease would be essential. Here, we examined the impacts of two different kits with different methods for creatinine measurement on the GFR values. Blood samples were collected from 80 diabetic patients referring to the clinical laboratory. The levels of serum creatinine were assessed using Jaffé and enzymatic assays by kits from two different manufacturers. Then to assess the eGFR levels, the MDRD equation was used. Further descriptive parameters of both methods and correlation of methods were also calculated. Descriptive analysis of the data demonstrates a slight increase in the serum creatinine measured by Jaffé assay which leads to a substantial decrease in the levels of eGFR compared to the eGFR calculated by the enzymatic assay. Moreover, eGFR over 60mL/min/1.73 m 2 in enzymatic assay was observed in 27.5% of participants while eGFR of the same participants was below 60mL/min/1.73m 2 when it was measured by Jaffé method. Consequently, 27.5% positive discordant cases were reported by Jaffé assay followed by misclassifying them as DKD patients compared with the enzymatic assay. While using Jaffé assay, a low level of eGFR is observed which generates more misclassification into the DKD group and demands to an inclusive consideration by physicians in order to diagnose and monitor the DKD patients.

Daratumumab in Patients with Multiple Myeloma and Renal Impairment - Real-World Data from a Single-Center Institution

Background: Renal impairment is a frequent complication of multiple myeloma (MM) associated with poor prognosis and decreased overall survival; and can complicate drug dosing, limit treatment options and lead to a higher incidence of adverse events. Daratumumab is an anti-CD38 monoclonal antibody indicated for the treatment of patients with MM which does not require dose modification in the setting of renal impairment. Real-world data regarding its efficacy in patients with renal impairment and the rate of renal response are lacking. Methods: We performed a retrospective, single-center analysis of patients with relapsed/refractory MM treated with daratumumab as monotherapy or in combination with novel agents. Patients were grouped by renal function as calculated by their eGFR using the MDRD equation: &lt;30, 30-59, &gt;=60 mL/min/1.73m2. Renal response was defined as an eGFR &gt;= 60 in two consecutive visits for patients with baseline renal impairment. Results: We identified 91 patients who started treatment with daratumumab between 2015-06-11 and 2018-08-16. The median age was 69 years old (range 40-93) and 25% were over the age of 75; 49 patients (54%) were female. Six patients (9%) were Hispanic, 16 (20%) were African American and 57 (71%) were Caucasian. High-risk cytogenetics were present in 58% of patients; defined as the presence of a complex karyotype, 1q gain, t(4;14), t(14;16), t(14;20) or del17p. Patients underwent a median of 5 prior lines of therapy (range 1-13), 45% had received an autologous stem cell transplant, 91% had been exposed to an immunomodulatory agent, 96% to a proteasome inhibitor, and 89% to both. Upon initial treatment, 53 patients (58%) had an eGFR &gt;=60 mL/min/1.73m2, while 27 (30%) and 11 (12%) patients had an eGFR of 30-59 and &lt;30 mL/min/1.73m2, respectively. The overall response rate (ORR) was 81% with a very good partial response (VGPR) or better of 47% and an unconfirmed complete response rate (uCR) of 23%. The median progression-free survival (mPFS) was 17.5 months while median overall survival (mOS) was not reached. There was no difference in mPFS or mOS between renal function groups. Of the 38 patients with baseline renal impairment (eGFR &lt;60 mL/min/1.73m2), 11 patients (29%) achieved a renal response, however, none of these patients had severe renal impairment. When compared to patients with chronic renal impairment, those with acute renal impairment were more likely to achieve a renal response (80% vs 21%, p=0.02). No significant difference in mPFS or mOS was observed by renal response (mPFS: 25.7m vs 17.5m, p=0.2; mOS: NR vs NR, p=0.8). Each renal function group was well balanced for the above parameters, including adverse events of interest and concurrent myeloma therapy as shown in the table, except where indicated (*). Discussion: The results of this analysis provide comparable efficacy - independent of the degree of baseline renal impairment - to the results seen in clinical trials of combination therapy with daratumumab. Furthermore, the high renal response rate (29%) seen, as compared to the one in the subgroup analysis of ENDEAVOR (15%), highlights the utility of daratumumab in reversing renal end-organ damage in patients with relapsed/refractory MM without an increase in adverse events compared to patients with preserved renal function. These results suggest that daratumumab may be able to abrogate the adverse prognostic factor that impaired baseline renal function portends. A limitation of this study is its retrospective nature, the confounding effect of concurrent myeloma therapy and the small number of patients included with renal impairment. Table Disclosures Coleman: Merck: Research Funding; Pharmacyclics: Speakers Bureau; Kite Pharmaceuticals: Equity Ownership; Gilead, Bayer, Celgene: Consultancy, Research Funding, Speakers Bureau. Niesvizky:Takeda, Amgen, BMS, Janssen, Celgene: Consultancy, Research Funding. Rossi:Janssen, Celgene, Amgen: Consultancy; BMS: Research Funding.

Outcomes in Multiple Myeloma Based on Comorbidities and Race

Background: Comorbidities and other patient factors in multiple myeloma (MM) can affect treatment decision making. While chemotherapy selection for MM in Medicare populations is different between blacks and non-blacks, including decreased use of bortezomib (BTZ) and hematopoietic cell transplant (HCT), data from the Veterans Health Administration (VHA) has previously shown no difference in selection. Little is known about the interaction between race and comorbidities on treatment of MM. In order to understand possible effects of race and comorbidities in management of MM, we studied initial treatment patterns in a nationwide population of United States veterans cared for in the VHA. Methods: Patients with MM were identified by the VHA Central Cancer Registry between July 1, 2006 and December 31, 2013 and followed through December 31, 2014. Age, sex, race, body mass index (BMI), Charlson comorbidities index (CCI) from ICD9 codes prior to diagnosis, hemoglobin (hgb), albumin, renal function via MDRD equation (GFR), and HCT were collected. Treatment data was collected from pharmacy records, all patients had to receive treatment within 6 months of diagnosis. T-test and chi-square analyses were used to compare continuous and categorical variables respectively. Logistic regression modeling was used to assess the association between receipt of MM treatments, race, and comorbidities. Cox proportional hazards regression modeling was used to assess the association between race and overall survival at five years while controlling for known prognostic factors. The study was approved the Saint Louis VA Medical Center institutional review board. Results: 2940 patients were identified with MM, of which 884 (30.1%) were black. Black patients were younger with increased mean CCI, lower mean BMI, higher GFR at diagnosis and 1-2 years prior to diagnosis, with higher rates of anemia and albumin below 3 g/dL compared to non-black patients (Table 1). Black patients had significantly higher rates of renal disease (37.2% vs. 26.0%, p&amp;lt;0.001), diabetes (38.8% vs. 32.6%, p=0.001), complicated diabetes (19.0% vs. 14.7%, p=0.001), mild liver disease (13.2% vs. 7.5%, p&amp;lt;0.001) based on CCI calculated from ICD codes. Black patients were less likely to be treated with lenalidomide (LEN) in their initial regimen (21.3% vs. 26.1%, p=0.03) or have HCT in one year (7.5% vs. 10.6%, p=0.01), more likely to be treated with BTZ (43.8% vs. 37.1%, p=0.001), and there was no difference in treatment with THAL (20.9 vs 20.6%, p=0.85) or in the number of therapies in the initial regimen (2.0 vs. 2.0, p=0.62). After adjusting for GFR and CCI, black race remained associated with decreased use of LEN (Odds Ratio 0.76, 95% CI 0.62-0.92). After controlling for age, race, CCI, BMI, anemia, GFR, albumin, HCT within 5 years, patients had improved survival at 5 years when initially treated with LEN (HR 0.71, 95% CI 0.61-0.82) and thalidomide (THAL) (HR 0.85, 95% CI 0.74-0.98), but not with BOR (HR 0.92, 95% CI 0.82-1.05). After adjusting for age, CCI, BMI, anemia, GFR, albumin, HCT within 1 year, LEN, BTZ, and THAL as initial treatment, black patients had improved survival (HR 0.79, 95% CI 0.71-0.89) compared to non-blacks at 5 years. Conclusions: Disparities in treatment exist for black patients with MM in the VHA, despite improved mortality compared to non-blacks. Black patients in the VHA are younger, with higher CCI, particularly renal disease, diabetes and liver disease. Interestingly, actual measurements of GFR at diagnosis and 1 year prior are higher in blacks which is contrary to the increased rate of renal disease assessed by ICD9 codes. Clinicians may misperceive renal function due to higher baseline creatinine levels in blacks, which could lead to attribution of renal comorbidity and reduced use of LEN in black patients. Further evaluation of the interaction between race, comorbidities, and treatment is warranted. Disclosures Schoen: Pharmacyclics: Research Funding. Carson:Flatiron Health, Inc., which is an independent subsidiary of the Roche Group: Employment, Research Funding; Roche: Equity Ownership. Sanfilippo:Bristol-Myers Squibb: Speakers Bureau; Pfizer: Membership on an entity's Board of Directors or advisory committees; Bayer: Membership on an entity's Board of Directors or advisory committees; AstraZeneca: Other: Travel Expenses; NHLBI: Research Funding.

Comparison between three different equations for the estimation of glomerular filtration rate in predicting mortality after coronary artery bypass

BackgroundThis study was undertaken to compare the accuracy of chronic kidney disease-epidemiology collaboration (eGFRCKD-EPI) to modification of diet in renal disease (eGFRMDRD) and the Cockcroft-Gault formulas of Creatinine clearance (CCG) equations in predicting post coronary artery bypass grafting (CABG) mortality.MethodsData from 4408 patients who underwent isolated CABG over a 11-year period were retrieved from one institutional database. Discriminatory power was assessed using the c-index and comparison between the scores’ performance was performed with DeLong, bootstrap, and Venkatraman methods. Calibration was evaluated with calibration curves and associated statistics.ResultsThe discriminatory power was higher in eGFRCKD-EPI than eGFRMDRD and CCG (Area under Curve [AUC]:0.77, 0.55 and 0.52, respectively). Furthermore, eGFRCKD-EPI performed worse in patients with an eGFR ≤29 ml/min/1.73m2 (AUC: 0.53) while it was not influenced by higher eGFRs, age, and body size. In contrast, the MDRD equation was accurate only in women (calibration statistics p = 0.72), elderly patients (p = 0.53) and subjects with severe impairment of renal function (p = 0.06) whereas CCG was not significantly biased only in patients between 40 and 59 years (p = 0.6) and with eGFR 45–59 ml/min/1.73m2 (p = 0.32) or ≥ 60 ml/min/1.73m2 (p = 0.48).ConclusionsIn general, CKD-EPI gives the best prediction of death after CABG with unsatisfactory accuracy and calibration only in patients with severe kidney disease. In contrast, the CG and MDRD equations were inaccurate in a clinically significant proportion of patients.

P3759Comparison of equations for renal function assessment and major adverse outcomes in atrial fibrillation: an analysis from the EORP-AF long-term general registry

Abstract Background Several equations exist to estimate creatinine clearance according to serum creatinine values and baseline characteristics. The CKD-EPI equation is usually recommended in general population, while the Cockroft-Gault (CG) equation has been used in atrial fibrillation (AF) clinical trials. Purpose To perform a comparison between 6 different equations for evaluation of renal function in AF patients. Methods We calculated CKD-EPI, CG, body surface area adjusted CG (CG BSA), MDRD, BIS1 and FAS equations in AF patients enrolled in the EORP-AF Long-Term General Registry. Outcomes at 1-year follow-up were considered. Results Renal equations were calculated in 7725 patients. According to CKD-EPI mean (SD) creatinine clearance was 69.14 (21.06) mL/min/1.73 m2. Taking CKD-EPI as reference, the MDRD equation showed the highest agreement (weighted kappa [95% CI]: 0.843 [0.833–0.852]), while CK showed the lowest agreement (weighted kappa [95% CI]: 0.593 [0.580–0.606]. The remaining equations showed moderate agreement. Cox regression analysis showed that all equations were inversely associated with all major adverse outcomes [Figure]. The CKD-EPI equation showed modest predictive ability for the three outcomes (c-statistics: any TE/ACS/CV Death: 0.63379; CV Death: 0.68512; All-Cause Death: 0.67183), with all other equations reporting higher c-statistics (delta-c statistic ranging from +0.01497 for FAS equation for any TE/ACS/CV Death to +0.04547 for CG BSA for all-cause death) for all outcomes (all p&lt;0.0001, for any equation for any outcome). Compared to CKD-EPI, all the other equations showed an improvement in prediction of outcomes, according to IDI and NRI, with the exception of FAS equation for any TE/ACS/CV Death. CG BSA equation showed the greatest improvement in prediction of outcomes compared to CKD-EPI (relative IDI: 21.9% for any TE/ACS/CV Death, 28.8% for CV Death, 34.4% for All-Cause Death). Cox Regression Analysis Conclusions Compared to CKD-EPI equation, all the other equations for creatine clearance has stronger associations with adverse outcomes, with the CG BSA reporting the higher yield for all the outcomes considered.

Assessment of long term outcomes after buccal mucosal graft urethroplasty: the impact of chronic kidney disease.

ABSTRACTObjectives To compare and assess various outcomes and success of buccal mucosal graft urethroplasty (BMGU) in patients with CKD versus patients having normal renal function.Material and Methods This was a retrospective, single centre study, during period 2013 to 2017. Patients were grouped into two groups. Group 1 had patients with estimated Glomerular Filtration Rate (eGFR)>60mL/min/1.73m2 while group 2 had patients with eGFR <60mL/min/1.73m2. eGFR was calculated according to the MDRD equation. The two groups were compared with regard to various outcomes like length, location of stricture, technique of graft placement, intra-operative blood loss (haemoglobin drop), duration of hospital stay, post-operative complications and recurrence.Results A total of 223 patients were included in study with group 1 had 130 patients and group 2 had 93 patients. Mean age of patients with CKD were higher (47.49 years versus 29.13 years). The mean follow-up period was comparable between both groups (23.29 months and 22.54 months respectively). Patients with CKD had more post-operative Clavien Grade 2 or higher complications (p=0.01) and a greater recurrence rates (p<0.001) than in non-CKD patients. On multivariate analysis, age and CKD status was significant predictor of urethroplasty success (p=0.004) (OR= 14.98 (1.952-114.94, 95% CI).Conclusions CKD patients are more prone to post-operative complications in terms of wound infection, graft uptake and graft failure and higher recurrence rates following BMGU.

Donor Factors Affecting Short Term Graft Outcome in Live Donor Kidney Transplantation

Introduction: Since the beginning of renal transplant, the objective has been to increase the patient and graft survival, both short term and long term. Data relating to donor factors affecting short term survival at 6 months in live donor kidney transplantation has been scarce. This single center study tries to examine the predictors of short term graft outcome at six months in recipients of live donor kidney transplants and explore which donor characteristics are the most useful in predicting the post-transplant graft function in Nepalese population. Methods: All patients who underwent kidney transplantation between May 2015 to July 2016 were included in the study. The patients who expired during follow were excluded. The clinical and laboratory parameters of the donors were recorded. The recipients were followed up for six months post transplantation. The eGFR of the recipients and the occurrence of rejection were recorded at the end of six months post transplantation. Results: A total of 82 donor-recipient pairs underwent living donor renal transplantation at our hospital during the study period. One recipient who expired during follow up was excluded. The mean age of donor was 45.20 ± 11.226 years of which 55 (67.9%) were female and 26 (32.1 %) were male. The mean eGFR of the donor calculated from Cockcroft Gault equation was 81.98 ± 18.11. The eGFR of the recipient at the end of six months post transplantation calculated form the MDRD equation was 67.76 ± 20.94. A total of 7 patients (8.6%) had rejection that were biopsy proven. Only donor eGFR was found to be significantly associated with eGFR of the recipient at six months post transplantation (p=0.034). Body mass index of the donor was significantly associated with rejection in the recipient at six months post transplantation (p=0.011). Conclusion: Our study demonstrates that the donor eGFR and body mass index are independent and important factors affecting the short term graft outcome at six months post transplantation.

CORRELATION BETWEEN SERUM CREATININE &amp; URINE ALBUMIN IN DIABETIC NEPHROPATHY PATIENTS: A STUDY IN A TERTIARY LEVEL HOSPITAL OF BANGLADESH

Serum creatinine is a very common tool of renal assessment in diabetic nephropathy. Specially due to its availably and cost-effectiveness, serum creatinine has been a popular choice among the clinicians even in rural areas. Also, the staging of diabetic nephropathy is done on the basis of eGFR which is calculated mainly with serum creatinine level. Sometimes, clinicians , even overlook the other investigations ,such as urine routine examinations or ultra sonogram of kidney, when the serum creatinine level is within normal limit.&#x0D; This study aims at observation of existing correlation between serum creatinine and urine albumin in diabetic nephropathy patients. This cross sectional observational study has been conducted on 50 patients in a period of 6 months in the medicine department of Dhaka Medical College Hospital.&#x0D; 50 diabetic patients admitted to Dhaka Medical College Hospital were enrolled in this study after fulfilling inclusion and exclusion criteria. Among the total 50 patients, 34 patients were diagnosed on the basis of microalbuminuria and the rest had raised urinary total protein. No correlation was found between serum creatinine and urine albumin or urine total protein. Staging of the kidney disease was done according to eGFR (calculated by MDRD equation). Only 41.37% of the patients with microalbuminuria, showed eGFR consistent with its staging while 31.5% of the patients with proteinuria showed respective expected eGFR. The rest of the patient’s eGFR was inconsistent with the staging. And the difference between the mean serum creatinine in two groups was insignificant.&#x0D; This study has shown that, the serum creatinine has no linear correlation with urinary albumin in diabetic nephropathy patients. So, commonly used serum creatinine based formula to calculate the eGFR can misinterpret the staging of the disease which can delay the appropriate treatment thereafter.&#x0D; Keywords: Diabetic Nephropathy, Proteinuria, Microalbuminuria, Serum Creatinine

Methods and reporting of kidney function: a systematic review of studies from sub-Saharan Africa.

Globally, chronic kidney disease (CKD) is an emerging public health challenge but accurate data on its true prevalence are scarce, particularly in poorly resourced regions such as sub-Saharan Africa (SSA). Limited funding for population-based studies, poor laboratory infrastructure and the absence of a validated estimating equation for kidney function in Africans are contributing factors. Consequently, most available studies used to estimate population prevalence are hospital-based, with small samples of participants who are at high risk for kidney disease. While serum creatinine is most commonly used to estimate glomerular filtration, there is considerable potential bias in the measurement of creatinine that might lead to inaccurate estimates of kidney disease at individual and population level. To address this, the Laboratory Working Group of the National Kidney Disease Education Program published recommendations in 2006 to standardize the laboratory measurement of creatinine. The primary objective of this review was to appraise implementation of these recommendations in studies conducted in SSA after 2006. Secondary objectives were to assess bias relating to choice of estimating equations for assessing glomerular function in Africans and to evaluate use of recommended diagnostic criteria for CKD. This study was registered with Prospero (CRD42017068151), and using PubMed, African Journals Online and Web of Science, 5845 abstracts were reviewed and 252 full-text articles included for narrative analysis. Overall, two-thirds of studies did not report laboratory methods for creatinine measurement and just over 80% did not report whether their creatinine measurement was isotope dilution mass spectroscopy (IDMS) traceable. For those reporting a method, Jaffe was the most common (93%). The four-variable Modification of Diet in Renal Disease (4-v MDRD) equation was most frequently used (42%), followed by the CKD Epidemiology Collaboration (CKD-EPI) equation for creatinine (26%). For the 4-v MDRD equation and CKD-EPI equations, respectively, one-third to one half of studies clarified use of the coefficient for African-American (AA) ethnicity. When reporting CKD prevalence, <15% of studies fulfilled Kidney Disease: Improving Global Outcomes criteria and even fewer used a population-based sample. Six studies compared performance of estimating equations to measured glomerular filtration rate (GFR) demonstrating that coefficients for AA ethnicity used in the 4-v MDRD and the CKD-EPI equations overestimated GFR in Africans. To improve on reporting in future studies, we propose an ‘easy to use’ checklist that will standardize reporting of kidney function and improve the quality of studies in the region. This research contributes some understanding of the factors requiring attention to ensure accurate assessment of the burden of kidney disease in SSA. Many of these factors are difficult to address and extend beyond individual researchers to health systems and governmental policy, but understanding the burden of kidney disease is a critical first step to informing an integrated public health response that would provide appropriate screening, prevention and management of kidney disease in countries from SSA. This is particularly relevant as CKD is a common pathway in both infectious and non-communicable diseases, and multimorbidity is now commonplace, and even more so when those living with severe kidney disease have limited or no access to renal replacement therapy.

Higher 24-hour urine Na/K and albumin-to-creatinine ratio are subclinical organ damage markers in hypertensive patients from Blida (Algeria)

The aim of this study was to evaluate the relationship between ACR (albumin-to-creatinine ratio) and markers of TOD (target organ damage) in treated hypertensive patients. We enrolled 859 consecutive essential hypertensives (mean age 55 ± 10 years, 444 females) without known cardiovascular disease (CVD). LVMI was assessed by echocardiography by using the Devereux formula. eGFR was calculated by the MDRD equation. In a 24-hour urine collection, sodium/potassium ratio and ACR were measured. Valid 24-h ambulatory BP monitoring were analyzed. Participants were grouped in 4 groups: normotensives, isolated daytime hypertensives (IDHT), isolated nocturnal hypertensives (INHT), and both-hypertensives having both daytime and nocturnal hypertension. The 24-hour urine sodium (24HUNa) was 151.7 ± 71.4, 158.4 ± 69.3, 168.7 ± 68.8 and 177.1 ± 70.7 mmol/24 hour, respectively. The 24-hour urine potassium (24HUK) was 52.4 ± 17.8, 54.1 ± 16.2, 59.8 ± 20.7 and 62.1 ± 20.4 mmol/24 hour and the 24-hour urine sodium/potassium ratio (24HUNa/24HUK) were 3.1 ± 2.2, 3.3 ± 1.5, 3.2 ± 2.7 and 3.0 ± 2.3 respectively. Compared to NT group, INHT had higher 24HUNa ( P = 0.01), and both-HT had higher 24HUNa and 24HUNa/24HUK ( P < 0.01 and 0.01, respectively). There was no difference in 24HUNa, 24HUNK and 24HUNa/24HUK between INHT and both-HT. In multivariate analysis controlled with age, gender, body mass index, estimated glomerular filtration rate, INHT showed significantly higher 24HUNa/24HUK than NT ( P < 0.02). ACR exhibited significant association with LVMI (r = 0.312, P = 0.01) and eGFR ( r = –0.122, P = 0.01). In additional analysis, ACR was associated with TOD and decreased renal function (eGFR < 60 ml/min). Specifically, ACR exhibited a significant association with the number of TOD and this association was independent of age and gender ( P < 0.01). The results of present study suggest that high ratio of sodium/potassium may be a risk of isolated nocturnal hypertension and both-hypertension. Our findings support the close relationship between ACR and TOD in hypertension, as well as, the predictive value of ACR as a predictive of TOD.

Short-term ambient particle radioactivity level and renal function in older men: Insight from the Normative Aging Study

BackgroundWhole-body and thoracic ionizing radiation exposure are both associated with the development of renal dysfunction. However, whether low-level environmental radiation from air pollution affects renal function remains unknown. ObjectivesWe investigated the association of particle radioactivity (PR) with renal function defined by the estimated glomerular filtration rate (eGFR) and chronic kidney disease (CKD) in the Normative Aging Study. MethodsThis longitudinal analysis included 2491 medical visits from 809 white males enrolled between 1999 and 2013. The eGFR was calculated using the CKD-EPI and MDRD equations, and CKD cases were identified as those with an eGFR <60 mL/min/1.73 m2. Gross β activity measured by five monitors of the U.S. Environmental Protection Agency's RadNet monitoring network was utilized to represent PR. ResultsAmbient PR levels from 1 to 28 days prior to clinical visit demonstrated robust negative associations with both forms of eGFR, but not with the increased odds of CKD. An interquartile range higher 28-day average ambient PR level was significantly associated with 0.83-mL/min/1.73 m2 lower eGFR estimated by the CKD-EPI equation (95% confidence interval: −1.46, −0.20, p-value = 0.01). Controlling for PM2.5 or black carbon in the model slightly attenuated the PR effects on eGFR. However, in individuals with the highest levels (3rd tertile) of C-reactive protein (CRP) or fibrinogen, we observed robust associations of PR with eGFR and CKD, suggesting that systemic inflammation may modify the PR-eGFR and PR-CKD relationships. ConclusionsOur study reveals adverse health effects of short-term low-level ambient PR on the renal function, providing evidence to guide further study of the interplay between PR, inflammation, and renal health.

Long term renal recovery in survivors after OHCA

BackgroundsIn survivors of out-of-hospital cardiac arrest (OHCA), acute kidney injury (AKI) is frequent and is associated with numerous factors of definitive renal injury. We made the hypothesis that AKI after OHCA was a strong risk factor of long-term chronic kidney disease (CKD). We aimed to evaluate long-term renal outcome of OHCA survivors according the occurrence of AKI in ICU. MethodsWe used prospectively collected data from consecutive OHCA patients admitted between 2007 and 2012 in a tertiary medical ICU. AKI was defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Long-term creatinine level was the last blood creatinine assessment we were able to retrieve. The main outcome was the occurrence of CKD, defined by an estimated glomerular filtration rate (eGFR) lower than 60 mL/min/1.73m2 according to the MDRD equation. Long-term mortality was evaluated as well. Factors associated with CKD occurrence were evaluated by competing risk survival analysis (Fine Gray and Cox cause specific models). ResultsAmong the 246 OHCA patients who were discharged alive, outcome of 133 patients was available (median age 55 [iqr 46, 68], 75.2% of male). During a median follow-up time of 1.8 [0.8–2.5] years, CKD occurred in 17 (12.7%) patients and 24 (18%) patients died. A previous history of arterial hypertension (sHR = 3.28[1.15;9.39], p = 0.027; CSH = 4.83 [1.57;14.9], p = 0.006), AKI during ICU stay (sHR = 3.72[1.40;9.84], p = 0.008; CSH = 5.41[1.79;16.3], p = 0.003) and an age higher than 55 (sHR = 6.13[1.55;24.3], p = 0.009; CSH = 2.16[1.72;43.8], p = 0.006) were independently associated with CKD occurrence. AKI was not associated with long-term mortality (sHR = 0.73 [0.27;1.99], p = 0.55; CSH = 0.75 [0.28;2.01], p = 0.57). ConclusionIn OHCA survivors, CKD was a frequent long-term complication. AKI during ICU stay was a strong determinant of long-term CKD occurrence.

RISK FACTORS, CO-MORBIDITIES AND ECHOCARDIOGRAPHIC PROFILE IN MIDDLE-OLD HYPERTENSIVES

Objective: Epidemiological evidence suggests increasing proportion of elderly people. One half/two thirds of them have hypertension. The aim of the present study was to assess the risk factors, co-morbidities, and echocardiographic profile in middle-old hypertensives admitted in an Internal Medicine Departament Design and method: We enrolled 64 consecutive patients with hypertension and age between 75 and 85 years old. We retrospectively analyzed demographic, clinical and laboratory, (including thransthoracic echocardiographic parameters) features from the patient admission charts. The biochemical parameters investigated were: glucose plasma level, total, low and high density cholesterol, triglycerides, uric acid, GFR – MDRD equation. Results: 50 patients (78.1%) were females, and 14 (21.9%) males. 87.5% of patients had left ventricular concentric remodeling, and 90.6% had relaxation abnormalities assessed by pulsed Doppler transmitral flow. History of mellitus diabetes type 2 was recorded in 40.6%, ACS in 1.5%, chronic kidney disease in 23.4%, COPD in 18.7% and atrial fibrillation in 15.6%. 28.1% of the patients were overweight, and 46.8% obese. Hyperglycemia was found in 45.3% and hyperuricemia in 15.6%. Hyperlipidemia was present in 81.2% of middle-old hypertensives. In our study active smokers were 29.6% and former smokers 10.9%. Smoking was related to COPD. Conclusions: Middle-old hypertensives are mostly women, have important left ventricular concentric remodeling with diastolic dysfunction. Two third of patients had obesity or overweight, and third smokes. The frequent concomitant diseases were hyperlipidemia and diabetes. The risk factor correction and treatment of co-morbidities should be an important target in middle-old with hypertension.

CLINICAL PARTICULARITIES IN HYPERTENSIVE PATIENTS WITH RESUSCITATED CARDIAC ARREST ADMITTED TO AN EMERGENCY HOSPITAL

Objective: to assess the comorbidities, clinical particularities and laboratory findings in hypertensive patients admitted for resuscitated cardiac arrest. Design and method: A retrospective study of the medical records of 103 patients with resuscitated cardiac arrest admitted in Clinical Emergency Hospital, Internal Medicine Department between August 2014 and October 2018. Results: The study group consisted of 58 hypertensive patients from 103 patients with resuscitated cardiac arrest. Gender distribution: 60% male (35 patients) and 40% female (23 patients). Patients were aged between 41 and 93 years old, with an average age of 70 years. 67.25% of patients presented a cardiac arrest during hospitalization and 32.75% in pre-hospital setting. In 69% of cases the patients repeated the episode. 56.9% of patients presented with leukocytosis, and also 56.9% of patients had anemia (84.84% mild anemia, 3.03% moderated anemia, 12.12% severe anemia). At 65.51% of patients a blood clotting disorder was identified (based on INR values); 20.7% had thrombocytopenia and 13.8% thrombocytosis. Chronic kidney disease evaluated by MDRD equation was encountered in 83.13% of patients at admission, with the following staging: 22.41% stage G2, 12.06% G3a, 15.51% G3b, 17.28% G4, 8.62% G5. As electrolytes imbalance we noticed hyponatremia in 24.13% of cases, hypokalemia in 20.68% and hyperkalemia in 8.62%. 36.20% of patients had acidosis and 8.62% alkalosis. Regarding cardiovascular diseases, 63.79% of patients had heart failure (27% NYHA class II, 46% % NYHA class III and 27% NYHA class IV), 24.13% had a history of stroke, 19% previous myocardial infarction, 6.9% chronic peripheral arterial disease. Other comorbidities: 41.37% COPD, 37.93% diabetes mellitus Conclusions: The most common comorbidities in hypertensive patients admitted for resuscitated cardiac arrest were heart failure and chronic kidney disease. Diabetes mellitus is commonly associated with hypertension in patients with resuscitated cardiac arrest. Hyponatremia and hypokalemia are common in these patients.

SAT-156 USING KINETIC GLOMERULAR FILTRATION RATE TO CALCULATE THE RENAL ANGINA INDEX

Reliable prediction of acute kidney injury (AKI) has the potential to optimize its treatment. Recently Goldstein SL et al. (Clin J Am Soc Nephrol. 2010;5: 943–949.) proposed an empiric clinical model of renal angina to identify critically ill children who would be at higher risk of AKI. Using patient demographic factors and early signs of injury, renal angina aims to delineate patients at risk for subsequent severe AKI (AKI beyond the period of functional injury) versus those at low risk. In children the combination of the renal angina index (RAI) and AKI biomarkers has an excellent diagnostic performance. We aimed to assess the performance of a modified renal angina index (using kinetic glomerular filtration rate) in a cohort of adult critically ill patients at risk of AKI. We included 208 consecutive patients admitted to our medical ICU. Serum creatinine (sCr) was measure every 24 hours for 7 consecutive days following ICU admission. RAI was calculated 24 hours after ICU admission (day 1) using the following formula (Figure 1): Risk level (presence of sepsis, use of vasopressors and/or use of invasive mechanical ventilation, and presence of diabetes mellitus) x Injury level (changes in kidney function based on kinetic glomerular filtration rate (KeGFR). KeGFR was calculated from the change in consecutive values of sCr using the formula developed by Chen S. (J Am Soc Nephrol 2013; 24: 877–888). We used the KDIGO AKI sCr criteria to diagnose AKI. In patients with no baseline sCr available we back calculated baseline sCr using MDRD equation (for an eGFR = 75 ml/m/1.73m2). Based in our previous report (J Am Soc Nephrol 26: SA-PO 0193, 669A; 2015) we analyzed if a RAI score ≥ 6 points could predict subsequent AKI (after 48 hours). From the 208 patients enrolled in the study 101 patients developed AKI (48.6 %). Age, baseline sCr, and eGFR (CKD-EPI) we not different between patients with AKI and patients without AKI. At 24 h post ICU admission patients with AKI had lower KeGFR (47.7 ml/m vs. 81.1 ml/m; p < 0.0001). A renal angina index ≥ 6 points was able to identify individuals who developed AKI after 48 hours of ICU admission, with a ROC-AUC of 0.697 [95% CI 0.626-0.769], p < 0.0001. A renal angina index of ≥ 6 points had an odds ratio of 9.9 (95% CI 2.65 – 37.11; p < 0.0001) for subsequent development of AKI after 48 h of ICU admission. The RAI provides a clinically feasible methodology to identify critically ill patients at high risk of developing AKI before a rise in serum creatinine occurs. This tool would permit the early identification of AKI to initiate preventive and treatment strategies minimizing extension of kidney injury.

CLINICAL CHARACTERISTICS AND PARTICULARITIES OF HYPERTENSIVE PATIENTS OLDER THAN 90 YEARS ADMITTED TO AN EMERGENCY HOSPITAL

Objective: The aim of the study was to assess the particularities and the comorbidities in hypertensive very elderly patients. Design and method: We performed a retrospective study on 119 patients admitted to a Clinical Emergency Hospital between July 2014 and December 2018. Results: Pacients in the study group were aged between 90 and 99 years, with an average age of 92 years. Gender distribution: 63% female and 37% male. 64.70% of the patients had hypertension, one of them with renal artery stenosis, all others with primary hypertension. In the subgroup of hypertensives patients 69% were female and 31% male. At admission 48% of patients had a high white blood cells count and in 30% of cases a urinary tract infection was proven. In 65% of cases was identified a nonspecific inflammatory syndrome and 48% of patients had a high erythrocyte sedimentation rate. As electrolytes imbalance we noticed hyponatremia in 19.5% of cases, hypokalemia in 28.6% and hyperkalemia in 2.6% of cases. 63.6% had anemia (87.75% mild anemia, 10.2% moderated anemia and 2.04% severe anemia). Chronic kidney disease evaluated by MDRD equation was encounterd in 90.9% of cases with the following staging: G2 30%, G3a 27.14%, G3b 25.71%, G4 14.28% and G5 2.8%. in 13% of cases the patients experienced a worsening of renal function. As comorbidities: atrial fibrillation in 39% of cases, heart failure in 76.62% (35.6% NYHA class II, 50.84% NYHA class III and 13.56% NYHA class IV), 46.75% respiratory failure, with hypoxemia - 13% of patients required non-invasive mechanical ventilation during hospitalization. 9% were diagnosed with chronic obstructive pulmonary disease. 23.4% had a history of stroke and also 23.4% of patients had diabetes mellitus. Regarding the nutrition state, 26% of patients were cachectic and 14.28% were overweight; 19.5% had bed sores. Conclusions: The most common comorbidities in hypertensive very elderly patients were chronic kidney disease, heart failure and hypoxemia. Almost all patients had primary hypertension, but we need to reconsider the medication doses and their side effects, the administration rate, the polypharmacy according the comorbidities.

SUN-284 STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE

STUDY OF CLINICAL SIGNIFICANCE OF UNRECOGNIZED RENAL DYSFUNCTION IN PATIENTS WITH ACUTE STROKE Unrecognized renal insufficiency, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 in the presence of normal serum creatinine levels, is a common co morbid condition among patients with various cardiovascular conditions. Epidemiological study demonstrated that renal insufficiency forecast long-term mortality and hence can be used to stratify risk for stroke patients. Our purpose of study is to evaluate the prevalence and clinical significance of unrecognized renal dysfunction in patients admitted with acute stroke. STUDY DESIGN: Cross sectional prospective study. STUDY DURATION: March 2017 to August 2017. INCLUSION CRITERIA: All patients admitted with acute stroke . EXCLUSION CRITERIA: Acute stroke in < 18 years ,Head injury. MATERIAL & METHODS: Our study group consisted of 100 patients with acute stroke admitted in Stanley Medical College. The detailed history of the patients has been recorded and patients underwent a detailed clinical examination. Appropiate investigations were done. The estimated glomerular filtration rate is calculated using the MDRD and CKD-EPI equation. The study groups are stratified into 3 groups according to the renal function assessment (normal renal Function, unrecognized renal insufficiency and recognized renal insufficiency). Out of the 100 patients with acute stroke included in the study, 62 have normal renal function, 31 have recognized renal insufficiency, and 7 have unrecognized renal insufficiency. Majority of the study subjects in normal renal function group were males (n=48), females in unrecognized renal insufficiency group (n=7) and males in recognized renal insufficiency group (n=24). Using single factor ANOVA test, age distribution,the mean difference of blood urea values and serum creatinine values, the mean difference of MDRD values and CKD-EPI values, the mean difference of systolic blood pressure and diastolic blood pressure ,the mean difference of hemoglobin, the mean difference of random blood sugar values were found to be statistically significant (p <0.05). Using fishers exact test,the difference in percentage of females, the difference in percentage of diabetics, the difference in percentage of subjects with dyslipidemia were found to be statistically significant (p < 0.05) In our study, modified Rankin score(MRS) was significantly higher in patients with recognized renal insufficiency compared to unrecognized renal insufficiency patients. Mortality rates are higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (29%, 28.5% and 9.6% respectively, p< 0.05). Severe disability rates at discharge are also higher in patients with recognized and unrecognized renal insufficiency compared with patients with normal renal function (72.27%, 80 %, and 32.14%) respectively, p<0.05. 1. Unrecognized renal insufficiency is found to be a common co morbidity among patients with acute stroke in our study.2. Unrecognized renal insufficiency is significantly common among older age group and more frequently in females compared to male in our study group. 3. Mortality rate and severe disability rate are higher in patients with recognized and unrecognized renal insufficiency compared to patients with normal renal function.