Creatinine Measurements Research Articles

MELD-albumin score is strongly associated with all-cause mortality in patients with acute myocardial infarction complicated by cardiogenic shock

Abstract Background Kidney and liver injury are frequent complications in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) because of hypoperfusion and venous congestion. Model of End-Stage Liver Disease replacing INR with albumin (MELD-Albumin) score quantifies liver and kidney function and has been associated with mortality in acute heart failure. Higher MELD-albumin score indicates particularly more severe hepatic dysfunction. The predictive value of MELD-albumin score has yet to be assessed in AMICS. Methods This is a retrospective, multicenter observational cohort study of 1,716 patients admitted with AMICS at two tertiary facilities in Denmark between 2010 and 2017. MELD-albumin was calculated for each patient individually from 0–72-hour peak s-albumin, s-creatinine and s-bilirubin values in patients alive beyond day 2. Patients were stratified into groups according to score (Low: 1-10, Intermediate: 11-25, High: >25). Using national health registries, we performed follow-up until a maximum of 5 years (median 3.4 years). The primary outcome was all-cause mortality. Results Of 1716 patients in the cohort, 1284 (75%) were alive beyond admission day 2. Albumin, creatinine, and bilirubin measurements were available in 764 patients (60%). The median MELD-albumin score was 17. In the comparison across high vs. intermediate vs. low score groups, the high score group revealed a significantly higher prevalence of hypertension (61 vs. 49 vs. 39%, p=0.038), diabetes mellitus (33 vs. 18 vs. 13%, p=0.003), and history of acute myocardial infarction (24 vs. 13 vs. 17%, p=0.026). Fewer had suffered out-of-hospital cardiac arrest (34 vs. 52 vs. 48%, p=0.014) and revascularization attempts (82 vs. 93 vs. 92%, p=0.007) in the high score group. No significant differences were observed in the initial hemodynamic pressures, lactate levels, left ventricular ejection fraction (LVEF), number of diseased vessels and culprit lesions between the three groups. Patients in the high score group had a 30-day mortality rate of 58%, which was higher compared to 40% in the medium- and 17% in the low score group (Figure 1, p<0.001, using the log-rank test). These findings were still significant when excluding s-creatinine from the calculations. In a Cox Regression analysis, a MELD-albumin score of >25 was associated with a hazard ratio (HR) of 4.34 for 5-year mortality (p < 0.001), whereas a score of 11-25 was associated with a HR of 2.52 (p < 0.001). When adjusting for age, diabetes, hypertension, dyslipidemia, peripheral arterial disease, STEMI, left ventricular ejection fraction and baseline lactate, scores of >25 and 11-25 were still associated with similar 4- to 2.5-fold increases in 5-year mortality risks. Conclusions This study revealed a strong association between MELD-albumin score and all-cause mortality among patients with AMICS, supporting kidney and liver function inclusion in future risk stratification models.

Dose Adjustments in Renal Failure: Does the Dettli Formula Need an Update Moving Away from Linearity?

Chronical Kidney Disease (CKD) causes deterioration of renal function with reduction of glomerular filtration (GFR). Drugs which are mainly excreted through the kidney have reduced renal elimination (Clrenal) in CKD. For decades dosage adjustments for these drugs have been computed based on GFR and clearance measurement of biomarker serum creatinine (Clcr), respectively, and according to the rule of Dettli [1-3] where the appropriate dose D compared to the normal dose (Dnorm) may be assessed through the individual elimination fraction Q:

Simultaneous Quantification of Serum Symmetric Dimethylarginine, Asymmetric Dimethylarginine and Creatinine for Use in a Routine Clinical Laboratory.

Background Symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA) are naturally occurring amino acids classed as uremic toxins by the EUTOX working group. SDMA is principally excreted through the kidneys and is a well-known renal function marker, ADMA is a potent inhibitor of nitric oxide production. Here, we describe the development of a rapid and sensitive liquid chromatography tandem mass spectrometry method for simultaneous measurement of SDMA, ADMA and creatinine. Method Serum samples were prepared by protein precipitation and dilution with acetonitrile prior to injection onto a Waters TQS-Micro. Multiple reaction monitoring was used to detect SDMA, ADMA, creatinine, and their corresponding internal standard transitions after separation with a HILIC analytical column. Sample stability and intra-individual variation studies were also assessed following ethical approval. Results The retention time for creatinine was 0.43, SDMA 1.10 and ADMA 1.14 minutes. Mean recovery for creatinine was 103%, SDMA was 100% and ADMA was 103%, matrix effects were minimal (<6%). Lower limit of quantitation for creatinine and SDMA/ADMA was 17.5 µmol/L and 0.1 µmol/L respectively. Analytical imprecision showed a coefficient of variation <10% for all analytes across the working range of the assays. Intra-individual variation for creatinine was 4.7%, SDMA 7.5% and ADMA 7.6%. Discussion We have developed a rapid assay for LC-MS/MS measurement of SDMA, ADMA and creatinine in a routine clinical laboratory. It is simple, reproducible, and easy to perform. The stability of SDMA and ADMA pre- and post-centrifugation allows for their routine use without any special sample handling requirements.

Is body composition important in the context of renal function in pediatric neurogenic bladder?

Neurogenic bladder due to myelomeningocele (MMC) is a significant risk factor for chronic kidney disease in children. Cystatin C (CysC) is a more accurate GFR marker than creatinine as it is unaffected by muscle mass but may be influenced by fat mass and BMI. This study evaluates: (1) GFR measurement accuracy using CysC and creatinine in MMC-related neurogenic bladder, (2) the relationship between body composition via bioelectrical impedance analysis (BIA) and renal parameters, and (3) the use of BIA for non-invasive GFR and body composition assessment. Forty children (median age 9.96years) underwent serum creatinine, CysC testing, and BIA measurements. We assessed age, sex, spinal lesion level, anthropometric measurements, BMI, and activity using Hoffer's scale. GFR was calculated using five creatinine-based formulas, three CysC-based, and three combining CysC and creatinine, including BIA GFR as an alternative approach. Creatinine-based GFR estimates were significantly higher than CysC-based GFR. Although only 30% of MMC patients met the traditional BMI criteria for overweight/obesity, 62.5% were obese based on BIA-measured body fat percentage. Significant differences were found in CysC and CysC-based GFR equations within BMI and fat mass groups. Positive correlations were observed between CysC and body weight, BMI percentiles, body fat mass and fat-to-muscle ratio. Muscle mass positively correlated with creatinine. BIA-determined fat mass percentage is a more sensitive obesity indicator than BMI in MMC patients. CysC levels and CysC-based GFR equations are influenced by body fat mass, requiring consideration of adiposity to avoid misestimating renal impairment.

Renal protective potential of pentoxifylline, chlorpromazine, and lovastatin in ischemia-reperfusion injury: An experimental study.

This study aimed to evaluate the ability of pentoxifylline when compared to lovastatin and chlorpromazine as nephroprotective substances in cases of renal ischemia and reperfusion syndrome (IRI). A total of 36 adult male animals were randomly allocated into four groups (untreated control group, pentoxifylline group, lovastatin group, and chlorpromazine group), each consisting of nine animals. All groups were submitted to experimental ischemia and reperfusion procedures. The animals were evaluated 24, 72 and 120 hours after IRI, including physical examinations, serum urea and creatinine measurements, as well as histopathological, morphometric, and stereological analyses of the renal tissue. Results indicated that 24 hours after IRI, only chlorpromazine was effective in controlling azotemia. At the 72-hour mark, both chlorpromazine and pentoxifylline exhibited efficacy. After 120 hours, all three substances demonstrated renal protective qualities. Pentoxifylline was the most effective in preserving the structural integrity of kidney tissue, followed by chlorpromazine. In conclusion, all three treatments (pentoxifylline, chlorpromazine, and lovastatin) were effective. Pentoxifylline proved to be promising in the response against acute tubular necrosis, although chlorpromazine presented earlier renoprotective effects in terms of maintaining renal function.

A-113 Evaluation of Cystatin C Ordering Trends in a Quaternary Care Health System

Abstract Background Cystatin C is an alternative and adjunct kidney biomarker to creatinine in the estimation of glomerular filtration rate (eGFR). The National Kidney Foundation and American Society of Nephrology have called for increased use of cystatin C in the evaluation of kidney function. Our institution brought cystatin C testing in-house in August 2021. The goal of this study was to evaluate the utilization and longitudinal ordering trends of cystatin C within our quaternary care health system. Methods Cystatin C is measured on a Roche cobas® c502 using an assay traceable to IFCC-certified reference material. The electronic health record system (Epic) was queried using Epic SlicerDicer to identify ordering trends within our academic medical center between July 2021 and January 2024. The frequency of unique (one-time) cystatin C orders and concomitant orders with creatinine was also conducted. An in-depth analysis and chart review was performed over a one-month period to evaluate ordering locations, underlying clinical conditions, including previous diagnosis of kidney disease, and correlations between cystatin C and creatinine measurements. Results Between July 2021 and January 2024, 11,577 tests were performed from 8,415 unique patients. Cystatin C orders remained stable since April 2022, with an average 370 orders (363-378) per month. Eighty percent of cystatin C test requests were accompanied with creatinine testing during the same encounter. In a detailed analysis of a one month period, cystatin C testing was primarily performed in patients with an existing diagnosis of kidney disease (66%) and in the evaluation of renal function in patients with a cancer diagnosis (23%). Conclusions There has been sustained adoption of cystatin C by providers at our institution. The majority of orders have occurred in patients with an underlying renal diagnosis, as well as comorbid or chronic conditions that may affect kidney function.

A-332 Identifying At-Risk Patients Pre-IV Contrast Administration via POCT Creatinine Measurement

Abstract Background The use of intravenous iodinated contrast in computerized tomography studies is associated with a small risk of acute kidney injury. Pre-existing chronic kidney disease is a recognized factor and assessment of renal function prior to contrast administration is essential. This study assessed the ability of the Abbott iSTAT creatinine assay to correctly identify IV-contrast patient risk using lab-based eGFR as the gold standard. Methods This was a retrospective study comparing POCT creatinine (whole blood, Abbott iSTAT enzymatic) and lab creatinine (plasma, Beckman Coulter AU5800 Jaffe) results on simultaneous samples collected in the emergency department. Anonymised data records were extracted from the laboratory database for 2020-2023. IV contrast risk was calculated using eGFR (CKD-EPI 2021) and classified as high risk (HR: eGFR &amp;lt; 30 mL/min/1.73 m2), moderate risk (MR: eGFR 30-59) and low risk (LR: eGFR &amp;gt;=60) as per the Royal Australian and New Zealand College of Radiologists 2018 guidelines, using the Beckman-based eGFR as the gold standard. Results 132 paired samples patients were available for analysis (61% male, average age 69 y (23-98), 70% Chinese, eGFR (iStat) 3-143, eGFR (Beckman) 3-121 mL/min/1.73 m2). The proportions of Beckman-based eGFR HR:MR:LR cases were 53:39:40. The prevalence of HR/MR cases was 70%. The diagnostic performance of the iSTAT-based eGFR to accurately identify HR/MR patients was: sensitivity 93.5%, specificity 95%, PPV 97.7%, NPV 86.4%, accuracy 93.9%. For different Beckman-derived eGFR categories, the mean difference in eGFR (iSTAT - Beckman), 95% lower limit of agreement (LOA) and upper LOA was: &amp;lt;30 mL/min/1.73 m2: -1.0, -3.2, -1.1; 30-60 mL/min/1.73 m2: 0.9, -13.3, 15.1; &amp;gt;60 mL/min/1.73 m2: 1.6, -16.8, 20.1. Linear regression fit (Passing-Bablok): CKD-EPI Beckman = 1.193 + 0.9773 CKD-EPI iSTAT. Correlation coefficient was 0.981. Kappa for the 3 categories of risk classification was 0.814. Conclusions The iSTAT creatinine assay could reliably identify patients at medium/high risk of acute kidney injury following intravenous contrast administration. Performance was best for low and high risk patients with 100% of high risk patients being correctly identified. It is a useful screening test but differences in eGFR of up to 20 mL/min/1.73 m2 may be seen between the Beckman and iSTAT eGFR values at higher levels, meaning numeric eGFR results are not interchangeable.

Assessing the Inhibitory Potential of Pregnenolone Sulfate on Pentraxin 3 in Diabetic Kidney Disease: A Molecular Docking and Simulation Study.

Diabetic Kidney Disease (DKD), a frequent consequence of diabetes, has substantial implications for both morbidity and mortality rates, prompting the exploration of new metabolic biomarkers due to limitations in current methods like creatinine and albumin measurements. Pentraxin 3 (PTX3) shows promise for assessing renal inflammation in DKD. This study investigates how DKD metabolites could influence PTX3 expression through molecular docking, ADMET profiling, and dynamic simulation. Network and pathway analyses were conducted to explore metabolite interactions with DKD genes and their contributions to DKD pathogenesis. Thirty-three DKD-associated metabolites were screened, using pentoxifylline (PEN) as a reference. The pharmacokinetic properties of these compounds were evaluated through molecular docking and ADMET profiling. Molecular dynamics simulations over 200 ns assessed the stability of PTX3 (apo), the PRE-PTX3 complex, and PEN-PTX3 across multiple parameters. Cytoscape identified 1082 nodes and 1381 edges linking metabolites with DKD genes. KEGG pathway analysis underscored PTX3's role in inflammation. Molecular docking revealed pregnenolone sulfate (PRE) with the highest binding affinity (-6.25 kcal/mol), followed by hydrocortisone (-6.03 kcal/mol) and 2-arachidonoylglycerol (-5.92 kcal/mol), compared to PEN (-5.35 kcal/mol). ADMET profiling selected PRE for dynamic simulation alongside PEN. Analysis of RMSD, RMSF, RG, SASA, H-bond, PCA, FEL, and MM-PBSA indicated stable complex behavior over time. Our findings suggest that increasing PRE levels could be beneficial in managing DKD, potentially through isolating PRE from fungal sources, synthesizing it as dietary supplements, or enhancing endogenous PRE synthesis within the body.

Development of a Visual pH Measurement Method Using a Wedge-shaped Microspace with pH-dependent Swelling Hydrogel Microparticles and Its Application to Creatinine Measurement

Development of a Visual pH Measurement Method Using a Wedge-shaped Microspace with pH-dependent Swelling Hydrogel Microparticles and Its Application to Creatinine Measurement

Impact of Adoption of European Kidney Consortium Equation (EKFC) on CKD Prevalence and CKD Staging in Older Irish Adults

Abstract Background The Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation tends to overestimate glomerular filtration rate (GFR) and has limitation in younger and older age groups, while the European Kidney Function Consortium (EKFC) full-age spectrum (FAS) correct for these problems and provide better performance in estimating GFR. We compared the 2017 EKFC- FAS(Scr-CysC) equation with 2012 CKD-EPI(Scr-CysC) for estimating CKD prevalence and staging in a national representative sample of older Irish adults. Methods We utilised data from The Irish Longitudinal Study on Ageing (2009-2011), for participants aged 50 to 79 years with complete measurement of serum creatinine (Scr) and Cystatin-C (CysC). Using 2017 EKFC- FAS(Scr-CysC) and 2012 CKD-EPI(Scr-CysC), equations eGFR was calculated. CKD was defined as eGFR below 60 ml/min/1.73 m². Median eGFR, CKD prevalence, concordance correlation coefficient (CCC), and impact of EKFC equation on GFR category reclassification was examined. Results A total of 5,092 participants (53.3% women), median age 61 years were included. CKD prevalence varied significantly from 10.8% (9.9% – 11.8%) using 2021 CKD-EPI (Scr -CysC) to 16.7 % (15.5-17.9%) with the 2017 EKFC- FAS(Scr-CysC) equation. The corresponding numbers of CKD increased from 114,867 to 176,439 individuals respectively. The median eGFR for 2021 CKD-EPI (Scr -CysC) was 82.1 ml/min/1.73m2 and 2017 EKFC- FAS(Scr-CysC) was 74.5 ml/min/1.73m2, P&amp;lt;0.001). The net reclassification was 23.1 % based on 2017 EKFC- FAS (Scr-CysC) equation compared to CKD-EPI 2012 (Scr -CysC) and was towards more worsening CKD stage. The CCC between 2012 CKD-EPI(Scr-CysC) and 2017 EKFC- FAS(Scr-CysC) was 0.88 (95% CI, 0.88-0.89). Conclusion CKD prevalence varies according to eGFR equation with substantially higher numbers of CKD predicted by the European Kidney Function Consortium than CKD-EPI equations. This has direct implications on healthcare planning, resource allocation, and rates of referral to specialist nephrology services in Ireland.

Low estimated glomerular filtration rate and proteinuria among adult diabetic patients in a tertiary hospital in Eastern Uganda - a cross-sectional study

BackgroundChronic kidney disease (CKD) is one of the most common complications of diabetes mellitus (DM). Diabetes mellitus contributes to about 66% of CKD cases globally. CKD results in increased morbidity and mortality and advanced stages often require kidney replacement therapy that is unaffordable for the majority of the patients. Developing countries have scanty data regarding CKD burden in diabetic patients.ObjectivesThis study aimed at determining the prevalence of low estimated glomerular filtration rate (eGFR) and proteinuria and associated clinical and socio-demographic factors among adult diabetic patients attending the diabetic clinic of Mbale Regional Referral Hospital (MRRH).MethodsA cross-sectional study was conducted at the adult diabetic clinic of MRRH in Eastern Uganda. A total of 374 adult diabetic patients were enrolled. A urine sample for urine albumin creatinine ratio (UACR) determination and a venous blood sample for measurement of serum creatinine were obtained from each participant. The eGFR was determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and CKD was staged according to the Kidney Disease Improving Global Outcomes (KDIGO) classification.ResultsA total of 318 (85%) participants had an eGFR of ≤ 60 mL/min/1.73m2, UACR of ≥ 30g/g, or both. Only 6.1% were aware. Age, duration of DM, hypertension, and dyslipidemia were associated with low eGFR and proteinuria.ConclusionThere is a high prevalence of low eGFR and proteinuria among DM patients, 85% of the participants had these markers of CKD and the majority of them were undiagnosed. Over half of the DM patients had an eGFR consistent with advanced CKD. Strengthening routine screening for CKD biomarkers and equipping DM clinics with more diagnostic resources is recommended.

Effect of age, sex, and chronic kidney disease on urinary creatinine excretion in Japanese patients.

Urinary creatinine levels are used to estimate the excretion rates of certain analytes from the respective analyte-to-creatinine ratios. We clarified the influence of age and sex on estimated daily urinary creatinine excretion (eUCrE) based on the urinary creatinine level and daily urine volume. All inpatients aged ≥ 18years who attended the Kochi Medical School Hospital with serum and urinary creatinine measurement results were enrolled. Serum and urinary creatinine concentrations were extracted from the database and fluctuations with sex and age were investigated. The eUCrE was calculated for patients with early morning spot urine protein excretion (UPE), and daily urine volume was measured on the same day. Overall, 643 participants (322 men, 321 women) were enrolled. The eUCrE levels of men and women aged 18 - 64 and 18 - 44years, respectively, significantly exceeded 1g/day. Those of women aged 65-74 and ≥ 75years were significantly lower than 1g/day. Each age group was further categorised into Groups A (patients with eGFR ≥ 30mL/min/1.73 m2 and UPE < 0.5g/gCr), B (eGFR ≥ 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr), and C (eGFR < 30mL/min/1.73 m2 and UPE ≥ 0.5g/gCr). The eUCrE levels were the highest in Group A, followed by Groups B and C. This study revealed age-, sex-, and renal function-related biases in adjusted values using urinary biomarkers, including proteinuria and creatinine ratio.

The Impact of Age and Body Composition on the Agreement between Estimated and Measured GFR in Heart Transplant Recipients

Plain Language SummaryAssessing kidney function in heart transplant recipients is paramount to adjust immunosuppressive, antibacterial, and antiviral therapy. An estimate of the kidney function from plasma creatinine measurements is less expensive and time-consuming than a direct measure of kidney function but may be inaccurate in heart transplant recipients. We compared estimated and measured kidney function in 150 heart transplanted patients with a total of 723 kidney function measurements. We find that the kidney function improved the first year after transplantation, which was not detected by the estimate of the kidney function. One year after transplantation, the estimate of the kidney function was, on average, accurate and not affected by body composition, but for the individual patient the estimate was very imprecise, especially in younger patients. The results suggest that kidney function in heart transplanted patients should be measured and not estimated, especially during the first year following transplantation and in younger patients.

Impact of Baseline Renal Insufficiency on Piflufolastat F-18 Performance and Investigation of Changes in Renal Function Following Piflufolastat F-18 Administration: Results From the OSPREY Trial

IntroductionPiflufolastat F-18, a prostate-specific membrane antigen (PSMA)-targeted radiopharmaceutical, is predominantly eliminated via urinary excretion, and the kidneys have one of the highest absorbed doses. Therefore, this subgroup analysis aimed to investigate the impact of piflufolastat F-18 on renal function and its diagnostic performance in patients stratified by baseline renal function. Patients and MethodsThe OSPREY clinical trial enrolled 2 cohorts: A—high-risk patients undergoing radical prostatectomy with pelvic lymphadenectomy, and B—patients with suspected recurrent/metastatic prostate cancer on conventional imaging. Baseline estimated glomerular filtration rates were calculated, and patients were stratified by baseline chronic kidney disease (CKD) stage. Changes in serum creatinine within 28 days postdose and diagnostic performance of piflufolastat F-18 were assessed for each CKD stage group in both cohorts. Results385 patients (cohort A, n = 268; cohort B, n = 117) underwent piflufolastat F-18-PET/CT. Baseline and postpiflufolastat F-18 median creatinine levels (mg/dL) were similar for patients in cohort A (0.95 [n = 264] vs. 0.95 [n = 252], respectively) and cohort B (0.93 [n = 116] vs. 0.96 [n = 84], respectively). Among 332 men (cohort A, n = 249; cohort B, n = 83) with baseline and postpiflufolastat creatinine measurements, there were minimal changes in creatinine across all baseline CKD stage groups (median change ranged from -0.02 to 0.023 in groups with >1 patient). The diagnostic performance of piflufolastat F-18 showed no meaningful differences when stratified by baseline CKD stage. ConclusionPiflufolastat F-18 appears to be safe and effective for imaging prostate cancer, including men with mild/moderate renal insufficiency.

Development of a simple HPLC method for the determination of urinary O-aminohippuric acid (OAH) and an establishment of OAH reference interval

Background: O-aminohippuric acid (OAH) is considered a low-abundance urinary fluorescent metabolite with the potential to be an innovative lung cancer biomarker. There is a lack of simple methods for measuring urinary OAH metabolite, and the measurement needs to be normalized by urinary creatinine, which is produced at a constant rate. Thus, the newly developed method must be able to determine urinary creatinine and OAH simultaneously in the same run. Objective: This work aimed to develop and validate a simple high-performance liquid chromatography (HPLC) method for measuring urinary OAH and to establish the reference intervals of OAH in healthy individuals. Materials and methods: We synthesized OAH standard in a simple route and optimized simple HPLC method for simultaneous measurement of creatinine and OAH in a single run. Analysis was performed on a RP-C18 column with a gradient elution system of acetonitrile - ammonium acetate buffer (pH 6.5, 100 mM). After implementing optimal conditions, the procedure was compiled according to the International Council for Harmonisation (ICH) validation parameters. The developed method was used for the establishment of reference intervals of a total of 120 random urine samples of healthy individuals. Results: The linear range of the calibration curve for creatinine and OAH were 1-1000 µg/mL and 0.1-100 µg/mL, respectively. The recoveries ranged for both metabolites were between 91.35 % and 109.12%. The relative standard deviations (RSDs) for the intra-day and inter-day results ranged from 0.11-0.66 % to 0.16-1.73 %, respectively. The limits of detection (LOD) and quantification (LOQ) were 0.258 µg/mL and 0.783 µg/mL for creatinine, while OAH was 0.045 µg/mL and 0.137 µg/mL, respectively. The method was successfully applied to establish reference intervals of OAH in healthy individuals and was defined as 0.420-2.287 mmol/mol creatinine. Conclusion: According to various validated parameters, the proposed method was proven to quantify urinary OAH and creatinine in a single run. It can also be analyzed noninvasively without additional sample processing. Reported herein is the first establishment of OAH reference intervals in healthy individuals, which may benefit the utilization of OAH as a noninvasive biomarker for lung cancer detection in the future.

P191 CO-EXISTING HYPERTENSION: AN INDEPENDENT RISK FACTOR FOR DIABETIC RETINOPATHY IN TYPE-2 DIABETES

Background and Objectives: Hypertension has plausible reason to be show the interaction due to its independent effect on retina. Epidemiological studies also provide clue that for hypertension as a possible effect modifier in the risk development of retinopathy in diabetic patients. It is worth exploring whether subgroup in diabetic population with Hypertension have different risk potential of developing retinopathy. The present study aimed to assess the association of hypertension as a risk factor for diabetic retinopathy (DR) in type 2 diabetes mellitus. Methods: A total of 977 type-2 diabetic patients recruited retrospectively in 2008 from Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) based on hospital records for determining the incidence of diabetic retinopathy (DR), who were naı̈ve type-2 diabetes during 1993. At the end of 15 year follow-up 495 patients were diagnosed as DR by retinal colour photography. Data on diabetes and lipid profile with serum creatinine, blood pressure and biophysical measures were obtained at baseline, 5, 10 and 15 years follow-up. Binary logistic regression model was used to assess the associations of co-existing hypertension with retinopathy risk adjusting for clinical, biochemical and anthropometric variables. Results: In all three follow-up points, including at baseline, mean systolic and diastolic blood pressure were found to significantly higher among patients who developed DR (P&lt;.001). Binary logistic regression model confirmed coexisting hypertension (OR 3.2; 95% CI 2.2 -4.7) as a significant risk factor of DR adjusting for possible confounders; serum creatinine (OR 21.9; 95% CI 14.0 -35.4) and glycemic control status (OR 17.2; 95% CI 9.4 -31.4). Interaction between hypertension, glycemic control and raised serum creatinine did not appear to be statistically significant (P&gt;0.05). Conclusions: Co-existing hypertension is a significant risk factor of DR irrespective of nephropathy or glycolic control status among Type 2 diabetes mellitus.

P091 PROENKEPHALIN CONCENTRATION AND ITS DETERMINANTS IN PATIENTS WITH END-STAGE KIDNEY DISEASE TREATED WITH HEMODIALYSIS AND PERITONEAL DIALYSIS

Background and Objective. Proenkephalin (PENK) has been recently shown to reflect glomerular dysfunction and predict new-onset acute kidney injury and heart failure. While previous studies investigated PENK utility in individuals with preserved renal function, PENK concentration in patients with end-stage kidney disease (ESKD) remained to be established. The study aimed to assess plasma PENK concentration in patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) and peritoneal dialysis (PD) and to investigate its correlation with heart failure. Additionally, we aimed to determine whether PENK is removed during a hemodialysis session. Methods. 88 patients with ESKD (41 females) undergoing HD (n=66, 75%) and PD (n=22, 25%) were enrolled in this cross-sectional study. Blood samples for PENK determination were collected before and at the end of the hemodialysis session in HD patients and at a single time point in PD patients. Plasma proenkephalin concentration was assessed using a sandwich ELISA immunoassay. Samples for measurement of creatinine, urea, and NT-proBNP were drawn simultaneously. Results. The median (IQR) plasma PENK concentration in the overall population was 1.492 ng/ml (1.071-4.380). Both median eGFR (5 mL/min/1.73 m2 [4-7] vs. 5 mL/min/1.73 m2 [4-8], p=0,856) and plasma PENK levels (1.368 ng/ml [1.068-4.030] vs. 1.706 ng/ml [1.211-5.858], p=0.305) did not differ significantly between HD and PD patients. In HD patients, median PENK concentration was significantly higher before than after hemodialysis (1.368 vs. 2.061; p=0.003). No correlation was found between PENK level and urea (p=0.192), eGFR (p=0.922), duration of dialysis (p=0.637), and residual urine output (p=0.784). Heart failure (p=0.961), EF (p=0.361), and NT-proBNP (p=0.949) were not associated with increased PENK concentration. Conclusions. Our study proved that PENK is not removed during hemodialysis session. PENK concentration does not reflect renal function and cardiac status in patients with ESKD. The fact that PENK is not removed by hemodialysis calls into question the usefulness of PENK as an everyday use biomarker in acute kidney injury.

Estimated glomerular filtration rate in clinical practice: Consensus positioning of the Brazilian Society of Nephrology (SBN) and Brazilian Society of Clinical Pathology and Laboratory Medicine (SBPC/ML).

Chronic kidney disease (CKD) represents one of today's main public health problems. Serum creatinine measurement and estimation of the glomerular filtration rate (GFR) are the main tools for evaluating renal function. There are several equations to estimate GFR, and CKD-EPI equation (Chronic Kidney Disease - Epidemiology) is the most recommended one. There are still some controversies regarding serum creatinine measurement and GFR estimation, since several factors can interfere in this process. An important recent change was the removal of the correction for race from the equations for estimating GFR, which overestimated kidney function, and consequently delayed the implementation of treatments such as dialysis and kidney transplantation. In this consensus document from the Brazilian Societies of Nephrology and Clinical Pathology and Laboratory Medicine, the main concepts related to the assessment of renal function are reviewed, as well as possible existing controversies and recommendations for estimating GFR in clinical practice.

Risk factors for acute kidney injury and impact of earlier anticoagulation on renal function in patients with normotensive pulmonary embolism: a retrospective cohort study

ObjectiveWe aimed to investigate the risk factors for acute kidney injury (AKI) after normotensive pulmonary embolism (PE) and the impact of anticoagulation on renal recovery.DesignMulticentred, retrospective cohort study.SettingData from four...

Colorimetric detection of serum creatinine on a miniaturized platform using hue-saturation-value space analysis

Chronic kidney disease (CKD) is a widespread condition with considerable health and economic impacts globally. However, existing methodologies for serum creatinine assessment often involve prolonged wait times and sophisticated equipment, such as spectrometers, hindering real-time diagnosis and care. Innovative solutions like point-of-care (POC) devices are emerging to address these challenges. In this context, there is a recognized need for remote, regular, automated, and low-cost analysis of serum creatinine levels, given its role as a critical parameter for CKD diagnosis and management. This study introduces a miniaturized system with integrated heater elements designed for precise serum creatinine measurement. The system operates based on the Jaffe method and accurate serum creatinine measurement within a microreservoir chip. Smartphone-based image processing using the hue-saturation-value (HSV) color space was applied to captured images of microreservoirs. The creatinine analyses were conducted in serum with a limit of detection of ~ 0.4 mg/dL and limit of quantification of ~ 1.3 mg/dL. Smartphone-based image processing employing the HSV color space outperformed spectrometric analysis for creatinine measurement conducted in serum. This pioneering technology and smartphone-based processing offer the potential for decentralized renal function testing, which could significantly contribute to improved patient care. The miniaturized system offers a low-cost alternative ($87 per device), potentially reducing healthcare expenditures (~ $0.5 per test) associated with CKD diagnosis and management. This innovation could greatly improve access to diagnosis and monitoring of CKD, especially in regions where access to sophisticated laboratory equipment is limited.