Mean Creatinine Research Articles

Predisposing factors of kidney function recovery after postrenal obstruction

Background: Renal function recovery in postrenal acute kidney injury (AKI) patient is not always achieved and risk factor for chronic disease. Factors that affect of kidney function recovery include duration of symptoms, AKI stage and degree of hydronephrosis. The aim of the study is to determine the correlation of predisposing factors of renal function recovery in postrenal AKI patient.Methods: A prospective observational analytic study with a cross-sectional study approach that involves postrenal AKI with urinary tract stones formers from August to November 2017. Renal function recovery was assessed by comparing creatinine levels before obstruction and after obstruction (3rd and 7th day) and be correlated by the duration of symptoms, AKI stage, and degree of hydronephrosis.Results: 66 patients were included in the analysis of this study. Renal function recovery was found in 29 patients (43.9%) at 3rd day and 47 patients (71.2%) on the 7th-day post obstruction. There was a significant difference in mean creatinine levels before and after obstruction (p <0.0001). Both duration of symptoms, AKI stage, and hydronephrosis showed correlation on renal function recovery on 3rd and 7th day after obstruction (p < 0.05). In logistic regression analysis, hydronephrosis was the most correlated predisposing factor for renal function recovery in 3rd and 7th day after obstruction (p = 0.0001).Conclusion: Factors duration of symptoms, AKI stage, and degree of hydronephrosis significant correlated to renal function recovery after post-renal AKI. Degree of hydronephrosis was the most correlated predisposing factors.

Gentamicin Alone Is Inadequate to Eradicate Neisseria Gonorrhoeae From the Pharynx.

Centers for Disease Control and Prevention (CDC) guidelines recommend 240 mg gentamicin plus 2 g azithromycin for the treatment of gonorrhea in cephalosporin-allergic patients. The efficacy of gentamicin alone in the treatment of pharyngeal gonorrhea is uncertain. Between September 2018 and March 2019, we enrolled men who have sex with men with nucleic acid amplification test-diagnosed pharyngeal gonorrhea in a single-arm, unblinded clinical trial. Men received a single 360-mg intramuscular dose of gentamicin and underwent test of cure by culture 4-7 days later. The study measured creatinine at enrollment and test of cure, serum gentamicin concentration postdose to establish peak concentration (Cmax), and standard antimicrobial minimum inhibitory concentrations (MICs) by agar dilution. The trial was designed to establish a point estimate for gentamicin's efficacy for pharyngeal gonorrhea. We planned to enroll 50 evaluable participants; assuming gentamicin was 80% efficacious, the trial would establish a 95% confidence interval (CI) of 66%-90%. We planned interim analyses at n = 10 and n = 25. The study was stopped early due to poor efficacy. Of 13 enrolled men, 10 were evaluable, and only 2 (20% [95% CI, 2.5%-55.6%]) were cured. Efficacy was not associated with gentamicin Cmax or MIC. No participants experienced renal insufficiency. The mean creatinine percentage change was +5.2% (range, -6.7% to 21.3%). Six (46%) participants experienced headache, all deemed unrelated to treatment. Gentamicin alone failed to eradicate Neisseria gonorrhoeae from the pharynx. Clinicians should use caution when treating gonorrhea with the CDC's current alternative regimen (gentamicin 240 mg plus azithromycin 2 g) given increases in azithromycin resistance and gentamicin's poor efficacy at the pharynx. NCT03632109.

Association between blood transfusion and serum creatinine as a major risk factor in patients undergoing cardiac surgeries: An observational study

Background: Blood transfusion is associated with altered serum creatinine levels. However, there are not many studies available to substantiate the cause of acute kidney injury (AKI) in patients undergoing cardiac surgeries. Aims and Objectives: The present study was aimed to assess and analyze serum creatinine levels, after blood transfusion (post-operative) in patients undergoing cardiac surgery and to assess its significance as a potential diagnostic and prognostic serum biomarker in predicting renal dysfunction. Materials and Methods: An observational study was performed after obtaining the Institution’s Ethical Committee approval. Patients (n = 162) who underwent cardiac surgeries were considered for the study and were evaluated for alterations in serum creatinine levels and creatinine clearance rate, before (pre-operative) and after blood transfusion (post-operative). Analysis of variance, paired t-test, Chi-square test, and logistic regression test were used. Results: Statistically significant difference (P < 0.0001) in mean creatinine levels as well as creatinine clearance rate was observed in 70 patients who were at a greater risk of developing AKI (post-operative). Post-operative median creatinine level as well as creatinine clearance rate were also significantly different (P < 0.001) in AKI group, compared to non-AKI group. Mean difference between pre- and post-operative serum creatinine, for congenital procedure, was statistically significant (P < 0.001). Conclusion: Blood transfusion is often associated with altered serum creatinine levels, leading to unfortunate adverse effects of potentially renal dysfunction. Therefore, better blood conservation and anesthetic techniques should be studied upon to prevent excessive bleeding and avoid unnecessary blood transfusion.

Changes over time in creatinine clearance and comparison of emergent adverse events for HIV-positive adults receiving standard doses (300 mg/day) of lamivudine-containing antiretroviral therapy with baseline creatinine clearance of 30-49 vs ≥50 mL/min.

A retrospective analysis of the randomized controlled DART (Development of AntiRetroviral Therapy in Africa; ISRCTN13968779) trial in HIV-1-positive adults initiating antiretroviral therapy with co-formulated zidovudine/lamivudine plus either tenofovir, abacavir, or nevirapine was conducted to evaluate the safety of initiating standard lamivudine dosing in patients with impaired creatinine clearance (CLcr). Safety data collected through 96 weeks were analyzed after stratification by baseline CLcr (estimated using Cockcroft-Gault) of 30–49 mL/min (n = 168) versus ≥50 mL/min (n = 3,132) and treatment regimen. The Grade 3–4 adverse events (AEs) and serious AEs (for hematological, hepatic and gastrointestinal events), maximal toxicities for liver enzymes, serum creatinine and bilirubin and maximum treatment-emergent hematology toxicities were comparable for groups with baseline CLcr 30–49 versus CLcr≥50 mL/min. No new risks or trends were identified from this dataset. Substantial and similar increases in the mean creatinine clearance (>25 mL/min) were observed from baseline though Week 96 among participants who entered the trial with CLcr 30–49 mL/min, while no increase or smaller median changes in creatinine clearance (<7 mL/min) were observed for participants who entered the trial with CLcr ≥50 mL/min. Substantial increases (> 150 cells/ mm3) in mean CD4+ cells counts from baseline to Week 96 were also observed for participants who entered the trial with CLcr 30–49 mL/min and those with baseline CLcr ≥50 mL/min. Though these results are descriptive, they suggest that HIV-positive patients with CLcr of 30–49 mL/min would have similar AE risks in comparison to patients with CLcr ≥50 mL/min when initiating antiretroviral therapy delivering doses of 300 mg of lamivudine daily through 96 weeks of treatment. Overall improvements in CLcr were observed for patients with baseline CLcr 30–49 mL/min.

Iron Chelation and Ferritin below 500 Mcg/L in Transfusion Dependent Thalassemia: Beyond the Limits of Clinical Trials

Introduction The current therapeutic management of transfusion dependent thalassemia (TDT) is based on regular blood transfusion and iron chelation therapy. Transfusion iron overload remains one of the major causes of morbidity and mortality in these patients because of the accumulation in heart, liver and endocrine glands. Three iron chelators are available in clinical practice: deferoxamine (DFO), deferiprone(DFP) and deferasirox (DFX). Guidelines clearly recommend when to start iron chelation, while discontinuation criteria are not well defined. Authorised product information state that we should consider interrupting DFX if serum ferritin (SF) falls consistently below 500mcg/L. This cut off was arbitrarily determined and there are no studies evaluating the effects of chelators in presence of SF below 500 mcg/L. In our clinical practice at Rare Diseases center of Fondazione IRCCS Ca' Granda Policlinico in Milan we do not completely interrupt iron chelation in TDT patients for SF levels below 500 mcg/L. Aims and methods Aim of our study was to evaluate the appearance of adverse events due to the assumption of iron chelation therapy in those TDT patients who had SF below 500 mcg/L. In this study we retrospectively evaluated renal and liver function from 2008 throughout December 2018 in TDT patients on DFX who presented SF below 500 mcg/L for 24 consecutive months. DFX dose are all expressed with the new tablets formulation dose. We evaluated SF, iron intake, LIC and MIC, renal and hepatic function. .A total of 5076 observations were collected, with 99.5 average per patient. We evaluated the relationships among variables with correlation models with random intercept Results One hundred ninety-two TDT patients are regularly followed at our center. They receive regular transfusion treatment and iron chelation therapy to prevent secondary iron overload. 51 out of 192 patients (32 F, 19 M, aged 44 ± 7 years) treated with DFX presented mean SF below 500 mcg/L for at least 24 consecutive months. Hematological and iron status parameters are described in Table 1. We found a strong correlation between SF and LIC (p&amp;lt;0.001) and for SF&amp;lt;500 mcg/L no hepatic iron overload was observed. Conversely we did not found a correlation between SF and MIC. For SF values below 500 mcg/L there was a minimal increase in creatinine levels, however the mean creatinine values remained within the normal range.Moreover, creatinine variation between two consecutive evaluation was below 0.3 mg/dl, cut off for acute kidney injury. Similar results were observed for liver function. Although a minimal increase of mean ALT value was observed for SF below 500 mcg/L, it remained within the normal range. None of our patient showed ALT level indicative of liver damage (ALT&amp;gt; 10 x upper limit of normal) We evaluated the relation between SF and DFX dose. Mean DFX dose decreases according to SF reduction. However, for SF value &amp;lt; 240 mcg/L, DFX dose remained stable at an average of 14 mg/kg per day. Conclusion According to our preliminary data, administration of DFX in TDT patients in presence of SF below 500 mcg/L is safe. Creatinine and ALT fluctuations, that usually remain within the range of normality, are mild, and transient and do not require specific treatment. Consistently with previously published data by Cohen et al, we show that a mean dosage of DFX of 14 mg/Kg die of film-coated tablet (20 mg/Kg of dispersable formulation) are necessary to balance an iron intake of 0.3 mg/kg die in absence of iron overload. Based on these results we suggest that in TDT patients with a continuous iron intake, iron chelation should be continued even when ferritin is below 500mcg/L. Monitoring of liver and kidney function tests are recommended in patient's follow up, as well as tailoring iron chelation. Disclosures Cappellini: Vifor Pharmaceutical: Membership on an entity's Board of Directors or advisory committees; CRISPR Therapeutics: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Honoraria; Novartis: Membership on an entity's Board of Directors or advisory committees; Genzyme/Sanofi: Honoraria, Membership on an entity's Board of Directors or advisory committees. Motta:Sanofi-Genzyme: Honoraria, Membership on an entity's Board of Directors or advisory committees.

Sacubitril/valsartan in chronic kidney disease, the nephrologist point of view

IntroductionSacubitril/valsartan reduces cardiovascular morbidity and mortality in patients with systolic dysfunction (SD). The aim of the present study was to assess the evolution of chronic kidney disease (CKD) patients after initiating sacubitril/valsartan. MethodsWe included 66 consecutive CKD patients with SD followed up in outpatient care. Patients had to meet the inclusion criteria of having a New York Heart Association class II to IV, receiving maximum tolerated doses of optimal medical therapy and CKD stages 1–4. At baseline, comorbidities and epidemiological data were collected and low doses of sacubitril/valsartan were initiated. At month 1 and 3, doses of sacubitril/valsartan were increased up to the maximum doses if tolerated. In each visit, renal function and cardiac biomarkers were recorded. All the data were analyzed at the end of follow up (6 months). ResultsOf the 66 patients, 42 (63 %) were men, with a mean age of 73±15 years. Mean creatinine at baseline was 1.42±0.5mg/dl (glomerular filtration rate (GFR) estimated by CKD-EPI was 50±19ml/min/1.73m2) and mean left ventricular ejection fraction (LVEF) was 31±9 %. At the end of follow up, LVEF improved from 31±9%–39±15 % (p<0.001). After one month of treatment, renal function improved up to 53±21ml/min/1.73m2, p=0.005. For the remaining follow-up time, GFR remained stable (mean at end of follow-up 51±18ml/min/1.73m2). Seven patients (10.6 %) withdrew from treatment. ConclusionIn our experience, sacubitril/Valsartan is safe in CKD, offering stability in CKD progression after 6 months.

242.6: Outcome of kidney transplantation from donation after circulatory death.

Background: The use of organs from donors after circulatory death (DCD) has become standard practice in solid organ transplantation in most of the countries. However, it has not contributed much to increase the transplant numbers in India due to lack of proper guidelines for withdrawal of life support in the country’s Transplantation of Human Organs Act 1994. Transplantation of kidneys procured from DCD is being done by only a few centres in the country. This study reviews the outcome of kidney transplantation from donation after circulatory death at our centre. Methods: A retrospective, single-centre analysis of transplantation of kidneys procured from DCD donors. Out of 275 deceased donor transplants performed at our hospital form Feb 2011-Nov 2018, 24 were procured from 15 DCD donors. Seven donors had a cardiac arrest after the first brain death certifying committee evaluation. Five donors had cardiac arrest after brain death certification. Two donors were refused brain death certification due to confounding factors. One patient with terminal lung disease had cardiac arrest in ICU. After declaration of death, chest compressions were continued in 11/15 donors to maintain circulation and ventilation was continued till organ retrieval. Rapid organ retrieval was done using double balloon triple lumen catheter. All recipients received ATG or Simulect induction along with Tacrolimus, Mycophenolate and steroids. Results: During the study period thirty kidneys retrieved from 15 DCD donors, kidneys from 2 donors were not used for transplant due to high resistance during perfusion. One more kidney was not utilized as potential recipient withdrew consent at advanced stage. Rest 24 kidneys were used for transplant. 13 donors had head injury, one had CVA and one had terminal lung failure as cause of death. Mean donor age was 32.8 ± 13.6 years. Mean recipients age was 42.5 ± 11.3 years. All except 5 recipients required dialysis in postoperative period. One kidney had primary non functional whereas in one with dual kidney transplant, both kidneys had to be removed due to persistent severe interaoperative hypotension in the recipient. One graft was lost at 6 years. Mean warm ischemia time was 35.04 ± 11.0 minutes. Mean cold ischemia time was 06:51hrs. Mean creatinine at discharge was 1.49 ± 0.39 mg% and at the last follow-up of 33.9 + 22.7 months was 1.37 + 0.55mg %. Conclusions: Kidney transplantation from DCD donors yields good results in the long term. These DCD grafts may be a good option to cope with increasing organ shortages in order to expand the donor pool.

Prevalence and Correlates of Chronic Kidney Disease in Patients with Hypertension in Rural Malawi.

The prevalence of chronic kidney disease (CKD) in patients with hypertension is very high in Africa. We investigated the prevalence and correlates of CKD in patients with hypertension (defined as currently taking hypertension drugs at enrolment or systolic blood pressure ≥ 160 mmHg and / or diastolic blood pressure ≥ 110 mmHg) attending longitudinal care in rural Malawi, where currently no data on prevalence of CKD in patients with hypertension exists. We retrospectively reviewed medical records of all hypertensive patients who were screened for CKD between January 2018 and April 2019. Screening was done using serum creatinine, and CKD epidemiology formula was used to estimate the glomerular filtration rate (eGFR). We used Kidney Disease: Improving Global Outcomes definitions of renal insufficiency and CKD. Descriptive statistics were used to describe the variables and logistic regression analysis was used to identify correlates of CKD. During the study duration, 1197 patients with hypertension were screened for CKD. The mean creatinine and eGFR was 0.90 mg/dl (Confidence Interval (CI) 0.85–0.94 mg/dl) and 84.1 ml/min/1.73m2 (CI 82.7–85.4 ml/min/1.73m2) respectively. About half of the patients had a normal eGFR (48.3%, n = 578) and 36.3% (n = 435) had mildly decreased eGFR. The prevalence of renal insufficiency was 15.4% (CI 13.4–17.5, 184/1197) and the prevalence of CKD was 7.1% (CI 5.7–8.7%). By eGFR category in the CKD patients, 41.2% (n = 35), 31.8% (n = 27), 24.7% (n = 21) and 2.3% (n = 2) had CKD stage 3a, 3b, 4 and 5 respectively. CKD was strongly associated with age and diabetes. We found moderately high renal insufficiency and CKD in this cohort. We propose investing in screening for CKD in patients with hypertension in other clinics in Malawi.

Is obesity a contraindication for kidney donation?

To enlarge the donor pool, kidney donors with obesity have been considered. We hypothesized that it is safe for patients with obesity to serve as living kidney donors. In this single-center retrospective analysis, we examined the effect of obesity (body mass index (BMI) of 30-35kg/m2) on glomerular filtration rate (GFR) and creatinine in patients undergoing laparoscopic donor nephrectomy. Other outcomes included intraoperative, 30-, and 90-day complications. We examined the trajectory between patients with obesity versus patients without obesity over time using mixed effects models for the outcomes of creatinine in mg/dL and GFR in mL/min/1.73m2. RESULTS: Among donors with obesity versus donors without obesity, there were no significant differences in demographics or comorbidities. Baseline creatinine in donors with obesity was significantly greater than that of donors without obesity (p = 0.02). Operative time was significantly longer in donors with obesity versus without obesity (p = 0.03). There was no significant difference in 30-day morbidity between donors with obesity versus without obesity (6.52 vs. 3.57%, respectively; p = 0.38). The rate of graft complications was 8.7% in donors with obesity versus 7.1% in donors without obesity (p = 1.0). 90-day complications were infrequent, and not significant different between the groups. At 6, 12, and 24-month postoperative follow-up, the mean creatinine level in patients with obesity was not significantly different from that of patients without obesity (1.23 vs. 1.31, 1.23 vs. 1.26, and 1.17 vs. 1.19 at 6, 12, and 24months, respectively). Mean GFR was also not significantly different at 6, 12, and, 24months. Postoperative creatinine and GFR changes were not significantly different in patients with obesity versus without obesity after laparoscopic donor nephrectomy. These findings suggest that carefully screened living kidney donors with obesity do not experience decreased postoperative renal function.

Kidney Transplantation From Circulatory Death Donors: Monocentric Experience

BackgroundDonation after circulatory death (DCD) is an accepted strategy to widen organ procurement worldwide. Authorized centers in Italy are spreading, increasing kidney transplantation (KTX) from DCD donors (40 in 2017 vs 24 in 2016). In this study, we describe DCD KTX activity at the University of Modena and Reggio Emilia (Modena, Italy) since its beginning in November 2017. MethodsWe retrospectively studied DCD KTX performed in our center from November 2017 to June 2018. We considered donor characteristics (age, sex, cause of death) and recipient clinical data (length of hospital stay, serum creatinine, estimated glomerular filtration rate, delayed graft function [DGF]), primary nonfunction [PNF], HLA match). All the grafts underwent in situ normothermic (ExtraCorporeal Membrane Oxygenation-ECMO) and ex situ hypothermic oxygenated perfusion (HOPE) with Kidney Assist machines. We monitored ex situ perfusion solution biochemical (lactate dehydrogenase [LDH] and lactate) and dynamic (resistance and flow) parameters. A kidney biopsy was performed for allocation strategy according to Karpinski score. ResultsWe performed 6 kidney transplants (3 single and 3 double); the mean recipient (57.5 ± 4.9) and donor age (57.3 ± 7.5) were similar. Mean ECMO duration was 3 h 27 ± 57 min, HOPE was 4 h 47 min ± 119 min, lactate sample values (collected every 15 minutes from the beginning of perfusion) were always lower than1.6 mmol/L, and LDH maximum value was 400 UI/L. Median cold ischemia time was 11 h 18 min. Mean Karpinski score was 3.6; mean HLA match 1.7.We experienced 1 DGF (16.6%), no PNF, with a mean hospital stay of 14.6 days, mean creatinine at hospital discharge 2 ± 1.04 mg/dL), and mean eGFR 53.8 ±27.3 mL/min); at 1 month, mean creatinine and eGFR were 2 ± 1.34 mg/dL and 59.8 ± 24.5 mL/min, respectively. ConclusionsDCD is a promising resource for increasing organ donation. The Emilia Romagna regional organization allowed short ischemia times, with solid KTX outcomes, supporting further development of this program.

Hematobiochemical and Immunological Responses of Rats Treated with Multi-strain Probiotics and Infected with Trypanosoma brucei.

The effects of treatment with probiotics on the immunological and hematobiochemical changes in Trypanosoma brucei infection were investigated. Probiotic strains used are Bifidobacterium BB-12, Lactobacillus acidophilus LA-5, Lactobacillus delbrueckii LBY-27, Lactobacillus paracasei LC-01, and Streptococcus thermophilus STY-31. Thirty rats randomly assigned to five groups were used in the experiment. Groups A to C received 1 × 109 CFU, 5 × 109 CFU, and 10 × 109 CFU of the multi-strain probiotics daily and respectively from day 0 post-supplementation (PS) to termination. Group D and E were the infected and uninfected controls respectively. On day seven PS, groups A to D were challenged intraperitoneally with approximately 1 × 106 trypanosomes. Parasitemia, nitric oxide level, hematobiochemical parameters, and antibody titer to heterologous antigen stimulation were monitored post-infection. By days 7 and 16 PS, probiotics-treated groups had significantly lower (p < 0.05) mean creatinine concentration than the controls; however, on day 7 PS, there were no significant variations in the leukocyte counts (LC), total erythrocyte counts (TEC), and the packed cell volume (PCV) in all experimental groups. Following infection, by day 16 PS, the pre-patent period, parasitemia levels, and antibody titer were similar in all infected groups. Furthermore, the probiotics-treated groups and the infected control had significantly lower PCV, TEC, and LC values when compared to the uninfected control, and probiotics treated groups (A and C) had only marginally lower nitric oxide levels than the infected control. Treatment with the probiotic strains gave a creatinine-lowering effect, was innocuous to the hematopoietic system, but was not sufficiently immunostimulatory in trypanosomosis.

Hypomagnesemia is associated with new-onset diabetes mellitus following heart transplantation

BackgroundDiabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 21% and 35% of survivors being affected within 1 and 5 years following HT, respectively. Magnesium deficiency is common among HT patients treated with calcineurin inhibitors and is a known risk factor for DM in non-HT patients. We therefore investigated the association between serum Mg (s-Mg) levels and new-onset diabetes after transplantation (NODAT).MethodsBetween 2002 and 2017, 102 non-DM HT patients were assessed. In accordance with the mean value of all s-Mg levels recorded during the first year post-HT, patients were divided into high s-Mg (≥ 1.8 mg/dL) and low s-Mg (< 1.8 mg/dL) groups. The endpoint was NODAT, defined according to the diagnostic criteria of the American Diabetes Association.ResultsBaseline clinical and demographic characteristics for the high (n = 45) and low s-Mg (n = 57) groups were similar. Kaplan–Meier survival analysis showed that 15-year freedom from NODAT was significantly higher among patients with high vs low s-Mg (85% vs 46% log-rank test, p < 0.001). Consistently, multivariate analysis adjusted for age, gender, immunosuppression therapies, BMI and mean creatinine values in the first year post-HT, showed that low s-Mg was independently associated with a significant > 8-fold increased risk for NODAT (95% CI 2.15–32.63, p = 0.003). Stroke rate was significantly higher in patients with low s-Mg levels vs high s-Mg (14% vs 0, p = 0.025), as well as long term mortality (HR 2.6, 95% CI 1.02–6.77, p = 0.05).ConclusionsLow s-Mg level post-HT is an independent risk factor for NODAT in HT patients. The implications of interventions, focusing on preventing or correcting low s-Mg, for the risk of NODAT and for clinical outcomes should be evaluated.

P1899Heparin and low-molecular-weight heparin switch associated with an increase in bleeding complications in patients on apixaban undergoing catheter ablation: The AMPER ABLATION study

Abstract Background The aim of this study was to identify the factors associated with bleeding complications in patients taking apixaban and undergoing a catheter ablation in everyday clinical practice. Methods AMPER ABLATION is a multicenter, observational, prospective study of patients with non valvular atrial fibrillation (AF) undergoing a catheter ablation. Eligible patients had been taking apixaban (2.5 or 5 mg twice daily) for ≥3 weeks before the procedure, and were followed for 30 days afterwards. Results A total of 595 patients (65 [interquartile range 59, 72] years, 67% male, mean CHA2DS2-VASc score 1.85±1.37) were enrolled at 25 academic/nonacademic centers in France; 524 patients (88%) were receiving apixaban 10 mg/day and 71 (12%) 5 mg/day. 323 patients (54%) underwent an AF ablation, and 272 (46%) an atrial flutter (AFL) ablation. The most prevalent concomitant disorders were hypertension (51% of patients), diabetes (15%) and vascular disease (10%). Mean creatinine concentration was 1.06±0.28 mg/dL, median weight was 83±18 kg and mean creatinine clearance (Cockcroft-Gault) was 82±34 mL/min. The management of apixaban in the periprocedural period was left to the investigator's preference. Overall, 264 patients were switched to unfractionated heparin or enoxaparin (238 for AF ablations and 26 for AFL ablations). The median duration of switch was 29 hours. Complications were reported at 30 days, and included 12 bleeding events (1 tamponade needing drainage, 1 pericardial effusion without drainage, 7 International Society on Thrombosis and Haemostasis [ISTH] non major bleedings for AF ablations and 1 pericardial effusion without drainage, and 2 ISTH non major bleedings for AFL ablations) and 1 embolic event (non disabling stroke for an AF ablation). Comparing patients with and without a bleeding event revealed a higher rate of heparin or low-molecular-weight heparin (LMWH) switching in patients with a bleeding event (60% vs 35%; p=0.02). A switch to heparin or LMWH was the only factor associated with an increase rate of bleeding (odds ratio 2.5; [CI 95%; 1.1, 7.1]; p=0.01). Conclusion Heparin or LMWH switch in the periprocedural AF and AFL-ablation period is associated with an increased rate of bleeding complications at 30 days. Acknowledgement/Funding Financial support from BMS

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.

P6403Predictors of bleeding in elderly patients with myocardial infarction: data from the real world

Abstract Background The population of elderly patients with acute myocardial infarction (MI) is clearly underrepresented in contemporary clinical trials. This population presents a higher risk of both cardiovascular and bleeding events, making the decision of the antithrombotic strategy particularly challenging. Purpose To characterize the antithrombotic therapy used in patients with MI and age ≥75 years, and to identify predictors of major bleeding and cardiovascular events in this population. Methods Retrospective analysis of patients with a diagnosis of MI and age ≥75 years included in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and January 2018. Logistic regression analysis was used to identify predictors of major bleeding and of the combined endpoint of in-hospital mortality and reinfarction. Results The analysis included 17.868 patients of which 30.1% with age ≥75 years. This population had a mean age of 82±5 years, 57% were male and 36% had a diagnosis of STEMI. On admission 10% presented with Killip-Kimball (KK) class III or IV, 14% were on atrial fibrillation (AF), and the mean Hb and creatinine levels were 13±2 g/dl and 1.6±1.2 mg/dl, respectively. In comparison with younger patients, this population had higher Grace and Crusade scores (178 vs 139, and 41 vs 24, respectively). Most elderly patients (74%) underwent coronary angiography (71% by radial artery access) and 75% were submitted to percutaneous revascularization, 9% to surgery, and 1% to an hybrid strategy. Aspirin was used in 96% of patients, clopidogrel in 82%, ticagrelor in 13% (vs 25% of younger patients; p&lt;0.001), and glycoprotein IIb/IIIa inhibitors (GPI) in 11%. Most patients were anticoagulated with enoxaparin (68 vs 56% of younger patients; p&lt;0.001), 22% with unfractionated heparin (vs 30%; p&lt;0.001), and 13% with fondaparinux (vs 14%; p=0.018). Complications were more common in the elderly population, including mechanical complications (1 vs 0.5%), atrioventricular block (5 vs 3%), stroke (1 vs 0.6%), major bleeding (3 vs 1%), in-hospital death (8 vs 2%) and reinfarction (2 vs 1%) (p&lt;0.001 for all). In multivariate logistic regression analysis, the predictors of major bleeding were diastolic blood pressure (BP) on admission &lt;50 mmHg, maximum creatinine ≥2 mg/dl and the use of GPI. The predictors of the combined endpoint were a diagnosis of STEMI, previous history of cancer, chronic kidney disease or demencia, and the presence on admission of an heart rate &lt;60 bpm, systolic BP &lt;90 mmHg or ≥180 mmHg, KK class &gt; I, AF, left bundle branch block, and left ventricle systolic dysfunction. Conclusions This study reflects the contemporary national reality of the management of elderly patients with MI. Overall, this population has a high risk of major bleeding, but several characteristics are associated with an even higher risk, such as the hemodynamic profile, renal function, and the use of GPI.

Impact of Age Difference, Sex Matching, and Body Mass Index Matching Between Donor and Recipient in Renal Transplant

BackgroundVarious factors influence kidney transplant (KT) outcome. The impact of age difference between donor and recipient on long- and short-term graft and patient survival in living donor KT remains unclear. ObjectiveWe aim to determine whether age difference, sex matching, and body mass index (BMI) matching between donor and recipient affect the 12-month patient and graft survival in KT. MethodWe studied a retrospective cohort of 804 patients 18 years or older with primary KT from January 2010 to December 2014. Patient renal function and patient survival were followed up for 12 months post KT. Repeated analysis of variance measurement determined if there was a significant difference in the mean creatinine levels when the sample was grouped according to the matching groups for sex, age difference, and BMI classification. Odds ratios were computed to ascertain graft loss and graft rejection. Results were considered statistically significant if P < .05. ResultsMale donor–female recipient had the lowest creatinine levels over time compared with male donor–male recipient (P < .001) and female donor–male recipient (P < .001). Older donor–younger recipient with age difference of ≥ 15 years had the highest overall creatinine (P < .001). For BMI matching, a normal donor and an underweight recipient combination resulted in the lowest mean creatinine levels over the course of 12 months (P < .001). In terms of graft rejection, odds ratio was highest for a female donor and a male recipient (P < .00a) compared with a male donor and a female recipient. For graft loss, older donors (≥ 15 years) had the highest risk (P < .001) vs those older by 11 to 15 years. ConclusionThere was significant difference in the 12-month graft function of patients when grouped according to their matching for age difference, sex, and BMI. The risk for graft rejection increases when the combination for donor-recipient is female donor–male recipient. For graft loss, this is most significant for donors who are older by ≥ 15 years than their recipients.

Investigation of Hematological and Biochemical Profiles of Tannery Workers Exposed to Chromium in Hazaribagh, Bangladesh

Occupational exposure to chromium used in mineral tanning processes cause adverse health effects on workers of leather tanning industries. This study aimed to evaluate the hematological and biochemical profiles in tannery workers of Hazaribagh, Bangladesh compared with a control group. A total of 225 participants, 121 tannery workers and 104 controls, were enrolled. All subjects completed interviewer-administered questionnaires; their physical health was examined, blood samples were collected and the hematological and biochemical parameters were analyzed. The tannery workers had mean duration of work exposure at tanneries for 13.1±9.7 years, and working hours per day of 10.7±2.3 which were significantly higher than 7.6±2.2 of the controls. Previous results showed long-term exposed tannery workers had significantly higher serum chromium concentrations than controls. The tanners had dermatological problems, infections on body surfaces, and respiratory ailments, among other complaints. The red blood cell count, hematocrit (48.91 %) and mean corpuscular hemoglobin concentration (29.39 g/dL) were lower in tannery workers but hemoglobin (14.58±1.30 g/dL) was significantly lower than in the controls (15.96±0.88 g/dL). The tanners had significantly lower neutrophil (51.31 %), higher lymphocyte (41.82 %), monocyte (2.44 %) and eosinophil (4.17 %) counts. Their mean creatinine and alkaline phosphatase values were normal but markers of liver damage, alanine transaminase (42.7±39.3 U/L) and aspartate transaminase (44.3±20.5 U/L), and liver dysfunction marker - bilirubin (1.04±0.85 mg/dL) levels were significantly higher. These findings suggest that exposure to chromium poses serious threats to the health of tannery workers who are at risk of toxicity related liver damage and hematological disorders.

Enhanced recovery after cardiac surgery: fluid balance and incidence of acute kidney injury

Introduction Enhanced Recovery after Cardiac Surgery (ERACS) pathways can increase patient satisfaction, reduce the length of hospital stay and stay in the intensive care unit. The reported incidence of acute kidney injury (AKI) after cardiac surgery varies from 2.5% to 40% and is associated with an increased 30-day mortality¹. We examined the effect of ERACS on the total amount of fluid administered and the incidence of AKI. Methods We retrospectively analyzed prospectively collected outcome data of patients undergoing cardiac surgery enrolled in the ERAS pathway (n = 107) compared to a historical standard care group (n = 173). The ERAS pathway included pre-operative patient education, multimodal pain management to minimize opioid usage, carbohydrate loading 2-4hrs before induction of anesthesia, tight glucose control, early postoperative invasive access and chest tube removal, early extubation, and early mobilization. Intraoperatively, 500mL of the cardiopulmonary bypass (CBP) priming fluid was replaced with albumin 5% and the patients received 250mL albumin 5% before initiation and 250mL after separation from CBP. Crystalloid boli were administered in the intensie care unit (ICU) for clinical signs of hypovolemia, increasing pressor requirements or worsening metabolic acidosis. The standard care group was treated per preexisting institutional guidelines. AKI was defined using modified KDIGO (Kidney Disease Improving Global Outcomes) criteria, patients with pre-existing renal injury were excluded. Data were compared using univariate analysis: parametric and non-parametric data were analyzed with Student's t-test and Wilcoxon rank-sum test, respectively. A p-value of less than 0.05 was considered statistically significant. Results The mean (SD) creatinine pre-operatively, at discharge, and the peak creatinine were not different between the ERACS and the standard care group (table). Less fluid was administered in the ERACS group, but the total fluid balance was not different. No significant difference exists between the occurrence of AKI between those groups; no patient developed AKI worse than KDIGO stage 1 (modified). Discussion Although the ERACS patients received less fluid than the standard care group during the hospital stay, the incidence of AKI did not differ, nor did the serum creatinine at discharge between both groups. A restrictive fluid management with intraoperative albumin administration does not increase the incidence of acute kidney injury for patients in the ERACS pathway.

The Comparison Effect Of Energy Drinks And Coffee On Creatinin Level In Rats

Objective: to compare the effect of administration of energy drinks and coffee on creatinine levels in rats.Methods: an experimental laboratory research using the post test only control group design. The study used 18 male white Sprague Dawley divided into three groups to receive one of the following treatments: 2 cc distilled water,0.072 g /2cc energy drinks and 0.9 g/cc of coffee for 14 days. The creatinine level was evaluated. Data were analyzed by One Way ANOVA test.Results: The mean creatinine level in the aquades group, energy drinks, coffee group was 0.708 mg/dl, 2.05 mg/dl 1.861 mg/dl, respectively. Post Hoc test the LSD test showed a significant difference among these groups (p &lt;0.05).Conclusion: There was a significant different effect between 0.072 g / 2cc energy drinks and 0.9 g/cc coffee on creatinine levels in rat.International Journal of Human and Health Sciences Vol. 03 No. 04 October’19 Page : 231-234

Improving medication adherence and outcomes in adult kidney transplant patients using a personal systems approach: SystemCHANGE™ results of the MAGIC randomized clinical trial.

This study determined if a SystemCHANGE™ intervention was more efficacious than attention control in increasing immunosuppressive medication adherence and improving outcomes in adult kidney transplant recipients during a 6-month intervention phase and subsequent 6-month (no intervention) maintenance phase. The SystemCHANGE™ intervention taught patients to use person-level quality improvement strategies to link adherence to established daily routines, environmental cues, and supportive people. Eighty-nine patients (average age 51.8years, 58% male, 61% African American) completed the 6-month intervention phase. Using an intent-to-treat analysis, at 6 months, medication adherence for SystemCHANGE™ (median 0.91, IQR 0.76-0.96) and attention control (median 0.67, IQR 0.52-0.72) patients differed markedly (difference in medians 0.24, 95% CI 0.13-0.30, P<.001). At the conclusion of the subsequent 6-month maintenance phase, the gap between medication adherence for SystemCHANGE™ (median 0.77, IQR 0.56-0.94) and attention control (median 0.60, IQR 0.44-0.73) patients remained large (difference in medians 0.17, 95% CI 0.06-0.33, P=.004). SystemCHANGE™ patients evidenced lower mean creatinine and BUN at 12months and more infections at 6 and 12months. This first fully powered RCT testing SystemCHANGE™ to improve and maintain medication adherence in kidney transplant recipients demonstrated large, clinically meaningful improvements in medication adherence. Clinical Trial Registration: NCT02416479.