Pre-existing Renal Disease Research Articles

Medicinal plants and renal failure: A case-control study

Medicinal plants contain many active constituents that can cause adverse effects on kidneys that are often unrecognized. The aim of our work was to study the association between the regular use of medicinal plants and the risk of chronic renal failure in hospitalized patients in four departments of Mohammed VI University Hospital. A case-control study was performed from January 2018 to December 2018. The cases were patients with a first-time diagnosis of chronic renal failure and without family history of kidney diseases or pre-existing renal disease. One control was matched to each case for age, gender, date of entry, and history of hypertension or diabetes. 208 patients were recruited. Among 104 cases, 42 patients (40.4%) regularly used medicinal plants compared to 18.3% in the group of controls (OR: 1.3; 95% CI; p<0.001). Multivariate analysis showed that the regular use of medicinal plants was significantly associated with the risk of chronic renal failure (OR: 3.05; 95% CI; p<0,001). Also a total of 52 plant species representing 29 plant families were reported in our study. Dominant plant families were represented by the Lamiaceae followed by the Apiaceae. Regular use of medicinal plants increases the risk of chronic kidney failure. Therefore, we need active measures to regulate this sector.

Slow Heart Rate Within 72 Hours After Cardiac Arrest Is Associated with Good Neurologic Outcome in Out-of-Hospital Cardiac Arrest Survivors Who Undergo Targeted Temperature Management with 33°C.

We aimed to verify whether slow heart rate (HR) is associated with neurologic outcome and the factors that can contribute to the development of bradycardia in out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management (TTM). We extracted the data of comatose adult OHCA survivors who underwent TTM between October 2015 and December 2018 from the prospective multicenter registry. Data on HR recorded every 6 hours within 72 hours after return of spontaneous circulation and calculated minimal, mean, and maximal HR and time to the lowest HR were obtained. HR <50 bpm was defined as bradycardia. The primary outcome was a 6-month neurologic outcome based on Pittsburgh-Glasgow Cerebral Performance Category Scale. Of the 814 included patients, 508 (62.4%) had poor neurologic outcome and 197 (24.2%) had bradycardia. Bradycardia (odds ratio [OR], 0.574; 95% confidence interval [CI], 0.362-0.192), minimal HR (OR, 1.023; 95% CI, 1.008-1.037), and mean HR (OR, 1.016; 95% CI, 1.002-1.030) were independently associated with poor neurologic outcome, but not maximal HR and time to the lowest HR. Preexisting arrhythmia (OR, 2.067; 95% CI, 1.037-4.118), renal disease (OR, 2.028; 95% CI, 1.153-3.567), cardiac etiology (OR, 1.526; 95% CI, 1.045-2.228), downtime (OR, 0.985; 95% CI, 0.974-0.996), and serum lactate levels (OR, 0.936; 95% CI, 0.900-0.974) were independently associated with bradycardia. Bradycardia and decreased mean and minimal HR were independently associated with good neurologic outcomes. Bradycardia was associated with preexisting arrhythmia, renal disease, cardiac etiology, shorter downtime, and lower serum lactate level.

Acute Kidney Injury in Acute Ischemic Stroke Patients in Clinical Trials.

Acute ischemic stroke patients are at risk of acute kidney injury due to volume depletion, contrast exposure, and preexisting comorbid diseases. We determined the occurrence rate and identified predictors associated with acute kidney injury in acute ischemic stroke patients. Multiple specialized ICUs within academic medical centers. Post hoc analysis of pooled data from prospective randomized clinical trials. Acute ischemic stroke patients recruited within 3 hours or within 5 hours of symptom onset. IV recombinant tissue plasminogen activator, endovascular treatment, IV albumin, or placebo. Serum creatinine levels from baseline and within day 5 or discharge were used to classify acute kidney injury classification into stages. Any increase in serum creatinine was seen in 697 (36.1%) and acute kidney injury was seen in 68 (3.5%) of 1,931 patients with acute ischemic stroke. Severity of acute kidney injury was grade I, II, and III in 3.1%, 0.4%, and 0.05% patients, respectively. Patients with albumin (5.5% compared with 2.6%; p = 0.001), preexisting hypertension (4.3% compared with 1.5%; p = 0.0041), and preexisting renal disease (9.1% compared with 3.0%; p < 0.0001) had higher risk of acute kidney injury. The risk of acute kidney injury was lower between those who either underwent CT angiography (2.0% compared with 4.7%; p = 0.0017) or endovascular treatment (1.6% compared with 4.2%; p = 0.0071). In the multivariate analysis, hypertension (odds ratio, 2.6; 95% CI, 1.2-5.6) and renal disease (odds ratio, 3.5; 95% CI, 1.9-6.5) were associated with acute kidney injury. The risk of death was significantly higher among patients with acute kidney injury (odds ratio, 2.7; 95% CI, 1.4-4.9) after adjusting for age and National Institutes of Health Stroke Scale score strata. The occurrence rate of acute kidney injury in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of acute kidney injury increased the risk of death within 3 months among acute ischemic stroke patients.

Predictors for Severe COVID-19 Infection

BackgroundCOVID-19 is a pandemic disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Predictors for severe COVID-19 infection have not been well defined. Determination of risk factors for severe infection would enable identifying patients who may benefit from aggressive supportive care and early intervention.MethodsWe conducted a retrospective observational study of 197 patients with confirmed COVID-19 infection admitted to a tertiary academic medical center.ResultsOf 197 hospitalized patients, the mean (SD) age of the cohort was 60.6 (16.2) years, 103 (52.3%) were male and 156 (82.1%) were black. Severe COVID-19 infection was noted in 74 (37.6%) patients, requiring intubation. Patients aged above 60 were significantly more likely to have severe infection. Patients with severe infection were significantly more likely to have diabetes, renal disease, chronic pulmonary disease and had significantly higher white blood cell counts, lower lymphocyte counts, and increased C-reactive protein (CRP) compared to patients with non-severe infection. In multivariable logistic regression analysis, risk factors for severe infection included pre-existing renal disease (odds ratio [OR], 7.4; 95% CI 2.5-22.0), oxygen requirement at hospitalization (OR, 2.9; 95% CI, 1.3-6.7), acute renal injury (OR, 2.7; 95% CI 1.3-5.6) and initial CRP (OR,1.006; 95% CI, 1.001-1.01). Race, age and socioeconomic status were not identified as independent predictors.ConclusionsAcute or pre-existing renal disease, supplemental oxygen at the time of hospitalization and initial CRP were independent predictors for the development of severe COVID-19 infections. Every 1 unit increase in CRP increased the risk of severe disease by 0.06%.

Real-world analysis of peptide receptor radionuclide therapy (PRRT) in the treatment of neuroendocrine tumors.

e16701 Background: PRRT received FDA approval in 2018 for treatment of somatostatin receptor positive gastroenteropancreatic neuroendocrine tumors (GEPNETs) based on NETTER-1 trial data that included only small bowel grade 1 and 2 neuroendocrine tumors. We present real-world data of PRRT outcomes and implementation from a large tertiary treatment center following approval. Methods: Patients treated with PRRT at University of Iowa between Jan 2018 - July 2019 were included in this retrospective study. Patient and tumor characteristics, cumulative dose and cycles of Lu 177 PRRT administered, treatment course, treatment-related toxicity and responses were reviewed, and 1-year progression-free and overall survival rates were calculated. Results: 67 patients received PRRT, of which 61 completed at least 2 doses. Primary tumor sites included small bowel (64.1%), pancreas (20.3%), and lung (9.4%). 43 (64%) had grade 2 NET; 5 had grade 3 (7.4%). 44 (65.6%) completed 4 cycles of PRRT per FDA approval while 10 received 3 cycles (14.9%). Median duration of follow up was 11.7 months. 53 patients received at least 2 doses and at least one imaging procedure post-PRRT. No complete responses were noted. 9 patients were found to have disease progression at last follow up. 1-year progression-free survival was 78% (95% CI 64-88%). 1-year overall survival was 88% (95% CI 75-94%). Of 23 patients who received fewer than 4 cycles, PRRT was discontinued in 4 (5.9%) due to myelosuppression, specifically thrombocytopenia grade 2 and above. 9 patients discontinued therapy due to change in clinical status or progression per treating physician, 2 experienced carcinoid crisis and 2 had renal function deterioration (preexisting renal disease). 5 patients had previously received PRRT with either Y90 or Lu 177 prior to FDA approval and were retreated in our cohort. 5 patients had preexisting renal disease, including one patient on peritoneal dialysis. Conclusions: We noted a higher rate of treatment discontinuation after 3 cycles, possibly due to heavy pretreatment or treatment of patients with advanced disease, not uncommon after a new therapy is approved and implemented into practice. Discontinuation due to myelosuppression or renal dysfunction was minimal, consistent with NETTER-1 data. Our cohort is unique as it included patients who had received prior PRRT as well as others with preexisting renal dysfunction. Despite this, treatment-related toxicity in our cohort was not significantly higher.

Acute kidney injury in critically ill children and 5-year hypertension.

To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5years post-discharge. Two-center retrospective cohort study of children (≤ 18years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included. Patients who could not be merged with the provincial database, did not survive admission, underwent cardiac surgery, had pre-existing renal disease associated with hypertension or a prior diagnosis of hypertension were excluded. AKI defined using the Kidney Disease: Improving Global Outcomes (KDIGO) definition. Using diagnostic codes and medications from administrative data, novel pediatric-specific hypertension definitions were designed. Both the evaluation of the prevalence of hypertension diagnosis and the association between AKI and hypertension occurred. Nineteen hundred and seventy eight patients were included (median age at admission [interquartile range] 4.3years [1.1-11.8], 44% female, 325 (16.4%) developed AKI). Of these patients, 130 (7%) had a hypertension diagnosis 5years after discharge. Patients with AKI had a higher prevalence of hypertension diagnosis [non-AKI: 84/1653 (5.1%) vs. AKI: 46/325 (14.2%), p < .001]. Children with AKI had a higher adjusted risk of hypertension diagnosis (hazard ratio [95% confidence interval] 2.19 [1.47-3.26]). Children admitted to the ICU have a high prevalence of hypertension post-discharge and children with AKI have over two times higher risk of hypertension compared to those with no AKI.

Stillbirth is associated with increased risk of long-term maternal renal disease: a nationwide cohort study

BackgroundStillbirth is a devastating adverse pregnancy outcome that may occur without any obvious reason or may occur in the context of fetal growth restriction, preeclampsia, or other obstetric complications. There is increasing evidence that women who experience stillbirths are at greater risk of long-term cardiovascular disease, but little is known about their risk of chronic kidney disease and end-stage renal disease. We conducted the largest study to date to investigate the subsequent risk of maternal chronic kidney disease and end-stage renal disease following stillbirth.ObjectiveTo identify whether pregnancy complicated by stillbirth is associated with subsequent risk of maternal chronic kidney disease and end-stage renal disease, independent of underlying medical or obstetric comorbidities.Study Design/MethodsWe conducted a population-based cohort study using nationwide data from the Swedish Medical Birth Register, National Patient Register, and Swedish Renal Register. We included all women who had live births and stillbirths from 1973 to 2012, with follow-up to 2013. Women with preexisting renal disease were excluded. Cox proportional hazard regression models were used to estimate adjusted hazard ratios and 95% confidence intervals for associations between stillbirth and maternal chronic kidney disease and end-stage renal disease respectively. We controlled for maternal age, year of delivery, country of origin, parity, body mass index, smoking, gestational diabetes, preeclampsia, and small for gestational age deliveries. Women who had a history of medical comorbidities, which may predispose to renal disease (prepregnancy cardiovascular disease, hypertension, diabetes, lupus, systemic sclerosis, hemoglobinopathy, or coagulopathy), were excluded from the main analysis and examined separately.ResultsThere were 1,941,057 unique women who had 3,755,444 singleton pregnancies, followed up over 42,313,758 person-years. The median follow-up time was 20.7 years (interquartile range, 9.9–30.0 years). 13,032 women (0.7%) had at least 1 stillbirth. Women who had experienced at least 1 stillbirth had a greater risk of developing chronic kidney disease (adjusted hazard ratio, 1.26; 95% confidence interval, 1.09–1.45) and end-stage renal disease (adjusted hazard ratio, 2.25; 95% confidence interval, 1.55–3.25) compared with women who only had live births. These associations persisted after removing all stillbirths that occurred in the context of preeclampsia, and small for gestational age or congenital malformations (for chronic kidney disease, adjusted hazard ratio, 1.33; 95% confidence interval, 1.13–1.57; for end-stage renal disease, adjusted hazard ratio, 2.95; 95% confidence interval, CI 1.86–4.68). There was no significant association observed between stillbirth and either chronic kidney disease or end-stage renal disease in women who had preexisting medical comorbidities (chronic kidney disease, adjusted hazard ratio, 1.13; 95% confidence interval, 0.73–1.75 or end-stage renal disease, adjusted hazard ratio, 1.49; 95% confidence interval, 0.78–2.85).ConclusionWomen who have a history of stillbirth may be at increased risk of chronic kidney disease and end-stage renal disease compared with women who have only had live births. This association persists independently of preeclampsia, and small for gestational age, maternal smoking, obesity, and medical comorbidities. Further research is required to determine whether affected women would benefit from closer surveillance and follow-up for future renal disease.

Abstract 132: Acute Kidney Injury in Acute Ischemic Stroke Patients: Pooled Analysis of ALIAS I and II and IMS III Trials

Background: Acute ischemic stroke patients are at risk of acute kidney injury (AKI) due to volume depletion, contrast exposure and pre-existing co-morbid diseases. We determined the incidence and identified predictors associated with AKI in acute ischemic stroke patients. Methods: Data from the Albumin in Acute Ischemic Stroke trial (ALIAS) - I and II and Interventional Management of Stroke (IMS) - III clinical trials were pooled and analyzed in which acute ischemic stroke patients were randomized into either IV albumin, placebo, endovascular or IV thrombolytic treatment groups. Serum creatinine levels from baseline and within day 5 or discharge along with the demographic and comorbidity information was collected. AKI classification was used to ascertain severity of renal dysfunction and based on increase in serum creatinine levels from baseline, stage 1 ≥ 0.3 mg/dl (≥ 26.4umol/L) or (&gt;1.5 to 2-fold), stage 2 (&gt;2 to 3-fold) and stage 3 (&gt;3-fold) were identified. We analyzed the relationship between AKI and mortality at 3 months post randomization. Results: A total of 1931 acute ischemic stroke patients (mean age 66± 13 (SD) years; 1024 were men) were analyzed. Any increase in serum creatinine was seen in 691 (35.8%, 95% CI 30%-40%) and AKI was seen in 68 (3.5%, 95% CI 3%-4%) of 1931 patients. Severity of AKI was grade I, II, III in 2.1 %, 0.4%, and 0.1% patients, respectively. The risk of AKI was not higher between those who either underwent CT angiography (2% compared with 4.2%, RR 0.5, 95% CI 0.3-0.8, p=0.02) or endovascular treatment (1.9% compared with 4.1%, RR 0.4, 95% CI 0.2-0.8, p=0.0096). Patients with preexisting hypertension (4.3% compared to 1.5%, RR 2.8, 95% CI 1.3-5.7, p=0.006) and preexisting renal disease (9.1% compared to 3.0%, RR 3.1, 95% CI 1.8-5.3, p=0.006) had higher risk of AKI. Mortality at 3 months was significantly higher among patients with AKI (27% compared with 15%, RR 1.8, 95% CI 1.2-2.7, p=0.0083). Conclusions: The incidence of AKI in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of AKI increased mortality at 3 months among acute ischemic stroke patients.

Abstract WMP100: Excessive Blood Pressure Reduction Increases the Risk of Acute Kidney Injury After Intracerebral Hemorrhage

Background: Elevated blood pressure (BP) in the first 24 hours of admission of acute intracerebral hemorrhage (ICH) has been the focus of intensive therapeutic investigation, although early intensive BP lowering addresses a concern about development of acute kidney injury (AKI). However, it is unclear as to the effect of BP measure including the absolute BP reduction and increased BP variability on AKI in patients with acute ICH. Methods: We retrieved data of consecutive patients with acute ICH from our prospective stroke registry between July 2015 and August 2017. We excluded patients with preexisting end-stage renal disease or in-hospital death within 24 hours. The primary outcome was AKI within 7days after admission defined using the AKI Network criteria. We recorded BP on emergency department arrival and for every 1 hour from 1 to 24 hours after admission (25 measurements). We measured mean systolic BP (SBP) and maximum minus minimum SBP within both 12 hours and 24 hours, and also quantified SBP variabilities (SBPV) including standard deviation, coefficient of variation, successive variation, and average real variability. Results: Among 361 patients with ICH (age 72.7±12.8, male 55%, non-lobar 76%), 31 (9%) developed AKI. For all SBP measure, the 12-hour SBP reduction was associated with the increased risk of AKI in multivariable analysis (odds ratio [per10 mmHg increase] 1.30; 95% CI 1.10-1.35). There was no significant association between the SBP variability and risk of AKI. The area under the receiver operating characteristic curve of the 12-hour SBP reduction for predicting AKI was 0.75. The association between the 12-hour SBP reduction and AKI was not modified by preexisting chronic kidney disease (interaction P=0.40). Conclusion: Early BP reduction in the first 12 hours of admission contributed to the risk of AKI in acute ICH. This may have clinical implication to avoid excess absolute BP reduction in patients with acute ICH.

Thirty-day outcomes among intensive care unit patients with septic shock with versus without preadmission chronic renal disease

Background: Considerable research indicates that experiencing acute kidney injury (AKI) during hospitalization from sepsis increases patients' risk of death, but few data exist on whether preexisting renal disease, irrespective of the need for dialysis, also increases mortality. Objectives: The objectives of this study were to identify if preexisting renal disease alters outcomes in patients admitted to a Saudi Arabian, tertiary-care intensive care unit (ICU) for septic shock. Materials and Methods: All patients ≥14 years old admitted to the ICU for septic shock from December 2015 to January 2017 were enrolled prospectively and followed for a minimum of 30 days or until death or hospital discharge. Patients with versus without preexisting renal disease were compared regarding demographic and baseline clinical characteristics, details of their infection and treatment, and outcomes. Results: Among 161 patients (mean age: 61.6; male:female = 1:1), 33 had some documented, preexisting renal disease, among whom 17 required regular dialysis. Among the 128 without preexisting renal disease, 66 (52%) died in hospital, versus 11 of 17 (65%) and 9 of 16 (56%) with kidney disease requiring and not requiring dialysis, respectively. Both the presence of renal dysfunction and the development of new-onset AKI were borderline linked to increased, inhospital mortality (P = 0.051 and 0.080, respectively). However, the presence of preexisting renal disease, with or without the need for dialysis, was nonsignificantly (P = 0.58) linked to increased, inhospital mortality. Conclusions: In our sample of 161 patients with septic shock, the presence of preexisting renal disease was not associated with increased mortality, but new-onset AKI and the presence of renal dysfunction in the ICU both were associated with increased mortality.

The impact of COVID-19 in diabetic kidney disease and chronic kidney disease: A population-based study.

Background:The spectrum of pre-existing renal disease is known as a risk factor for severe COVID-19 outcomes. However, little is known about the impact of COVID-19 on patients with diabetic nephropathy in comparison to patients with chronic kidney disease.Methods:We used the Mexican Open Registry of COVID-19 patients 11 to analyze anonymized records of those who had symptoms related to COVID-19 to analyze the rates of SARS-CoV-2 infection, development of COVID-19 pneumonia, admission, intubation, Intensive Care Unit admission and mortality. Robust Poisson regression was used to relate sex and age to each of the six outcomes and find adjusted prevalences and adjusted prevalence ratios. Also, binomial regression models were performed for those outcomes that had significant results to generate probability plots to perform a fine analysis of the results obtained along age as a continuous variable.Results:The adjusted prevalence analysis revealed that that there was an 87.9% higher probability of developing COVID-19 pneumonia in patients with diabetic nephropathy, a 5% higher probability of being admitted, a 101.7% higher probability of intubation and a 20.8% higher probability of a fatal outcome due to COVID-19 pneumonia in comparison to CKD patients (p<0.01).Conclusions:Patients with diabetic nephropathy had nearly a twofold rate of COVID-19 pneumonia, a higher probability of admission, a twofold probability of intubation and a higher chance of death once admitted compared to patients with chronic kidney disease alone. Also, both diseases had higher COVID-19 pneumonia rates, intubation rates and case-fatality rates compared to the overall population.

Colchicine-induced pancreatitis in an elderly patient with renal impairment: A case report

Colchicine is widely used in the treatment of acute gout. It has a narrow therapeutic window and can be extremely toxic in vulnerable older patients especially those with renal impairment. The most common side effects are gastrointestinal related, such as nausea, vomiting, diarrhea and abdominal pain. Colchicine-induced acute pancreatitis is very rare especially within therapeutic dose range. We report an atypical presentation of acute pancreatitis caused by a therapeutic dose of colchicine in an elderly patient with preexisting chronic renal disease.

Understanding the Impact of Fenestrated Aortic Repair on Medium and Long-term Renal Function; A UK Tertiary Centre Experience

Introduction: Renal function, its decline and the presence of acute kidney injury (AKI) is associated with poor cardiovascular outcomes and it maybe a common phenomenon in standard Endovascular Aneurysm repair (EVAR). Data is conflicting as to the impact of Fenestrated EVAR on renal function. This study aimed understand the impact of FEVAR on renal function at a UK tertiary centre. Methods: A prospectively populated database of FEVAR's performed between 2010 and 2018 were analysed. Creatinine, reciprocal of creatinine (as per the ASTRAD Trial) and eGFR (calculated by the CKD-EPI and MDRD formulae) were assessed. Regression analysis was performed to identify correlation variables. Results: 133 patients treated with FEVAR were included. Median follow-up was 22 months with a mean AAA diameter of 6.4(1.1) cm and a baseline eGFR of 68.9mL/min/1.73m2. A statistically significant 14% decline was noted at day 3 but this improved over study follow-up with an overall small decline of 10% in renal function at 22months. 5-year follow-up demonstrated a return to baseline in a subset of 60 long-term follow patients. A higher Pre-operative serum creatinine and lower haemoglobin significantly correlated with a decline in both short and long-term renal function. Independently, a larger the AAA diameter predicted a poorer the Day 3 renal function and the longer the duration of procedure the greater the decline in long-term renal function. A baseline Serum Creatinine of 94 mmolL-1 or higher predicted a AKI stage 1 at Day 3. Additionally, those at risk of developing a high Serum Creatinine (>130mmolL-1) were predicted by a baseline Serum Creatinine of 125 mmolL-1 or higher. Conclusion: Reassuringly FEVAR is associated with only a small decline in renal function. An increasing length of procedure (perhaps a surrogate for contrast volume) and size of the AAA leads to a higher post-procedural creatinine. Pre-operative renal function is important and optimization may improve renal function outcomes in the short-term. Comparisons of pre-existing renal artery disease and renal function is underway. Disclosure: Nothing to disclose

Elective Splenectomy in Immune Thrombocytopenic Purpura: An Analysis of National Inpatient Sample (NIS) Database between Years 2006 and 2014

Background: Over the years, splenectomy has dropped out of favor as a treatment option for Immune Thrombocytopenic Purpura (ITP) and is now considered only for patients who have failed multiple lines of therapy. One of the major concerns is surgical morbidity. We aim to study in-hospital outcomes following elective splenectomy in this population Methods: This is a retrospective cohort analysis of NIS database (years 2006 to 2014). Patients ≥18 years of age, who had an elective admission associated with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) procedure code for splenectomy were included in the study. Our cohort of interest was patients with ITP who underwent elective splenectomy (ITP ES). ICD-9-CM diagnosis codes were used to identify patients with ITP. All other patients who underwent elective splenectomy were labeled as non-ITP ES. Utilization of intensive care services was identified by procedure codes associated with vasopressor use, cardiopulmonary resuscitation, mechanical ventilation and initiation of dialysis in the absence of pre-existing end stage renal disease. Primary outcome was inpatient mortality and secondary outcome was length of stay (LOS). Associated factors were analyzed using multivariate logistic regression analysis. A p-value &lt;0.05 was considered significant. We used STATA for statistical analysis. Results: A total of 102,698 admissions for elective splenectomies (ES) in adults were identified between the years 2006 and 2014,of which 11.36% (n= 11,668) were ITP ES. Inpatient mortality and mean LOS for all patients undergoing ES was 2.53% and 8.51 days respectively. Inpatient mortality and mean LOS in the ITP ES cohort was 0.86% and 4.37 days respectively. In the entire cohort of ES, inpatient mortality was lower in those with ITP versus non-ITP (OR 0.36, p&lt;0.001). Also females had lower mortality when compared to men (OR 0.50, p&lt;0.001). Inpatient mortality was higher with increasing age (OR 1.03, p&lt;0.001) and Charlson Comorbidity Index (CCI) ≥3 vs 0 (OR 1.54, p &lt;0.001). Mean length of stay was lower in those with ITP vs non ITP by 3.3 days (p&lt;0.001). Within the ITP-ES cohort, mortality was higher with increasing age (OR 1.12, p &lt;0.001), CCI ≥3 vs 0 (OR 18.39, p&lt; 0.0001) and CCI 2 vs 0 (OR 8.61, p 0.008). Inpatient mortality was lower in teaching hospitals compared to non-teaching hospitals with a trend towards significance (OR 0.35, p 0.05). Gender, insurance status, income quartile, geographic region and hospital size did not affect odds of inpatient mortality in this cohort. Length of stay (LOS) in ITP ES cohort had positive correlation with age (coefficient 0.038, p&lt;0.001), income quartile 51-75th vs 0-25th percentile (coefficient 0.81, p 0.03), CCI ≥3 vs 0 (coefficient 3.29, p&lt;0.001), CCI 2 vs 0 (coefficient 2.11, p&lt;0.001), CCI 1 vs 0 (coefficient 0.86, p&lt;0.001). There was no association of gender, insurance status and geographic region with LOS within this cohort. Conclusion: Inpatient mortality and length of stay in admissions for elective splenectomy was significantly lower in ITP patients compared to non ITP patients. Also, in ITP patients undergoing elective splenectomy, older age and a charlson comorbidity index of 2 or above were associated with higher odds of dying in the same admission.These findings from real world data have practical implications for clinicians and patients, as they weigh the pros and cons of splenectomy as a treatment option for ITP. Table Disclosures Donthireddy: Viracta: Other: PI for Clinical Trial.

Impact of Acute Kidney Injury Following Diagnosis of Aggressive Lymphoma or Acute Leukemia on Long-Term Kidney Outcomes

Acute kidney injury (AKI) is common in those with newly diagnosed hematologic malignancies. Precipitants of AKI in this population may include tumor lysis syndrome, hypotension and other insults associated with acute illness. In a general population, AKI not only leads to short-term consequences like fluid, electrolyte and acid-base abnormalities, but each episode has been linked to worse long-term outcomes, including chronic kidney disease, cardiovascular events and death. In patients with malignancies, loss of kidney function may be additionally detrimental, as this can jeopardize eligibility for full dose or first line chemotherapy, transplantation or enrollment in clinical trials. The purpose of this study is to determine the impact of AKI on long-term loss of kidney function in patients newly diagnosed with aggressive lymphomas or acute leukemia. We performed a population-based cohort study using data from the Rochester Epidemiology Project (REP). The REP is a medical-record linkage system that integrates data for patients across multiple medical care providers in Olmsted County, MN and surrounding areas to facilitate long-term follow-up. Adults admitted to the hospital between 2005 and 2017 following a new diagnosis of acute leukemia or aggressive lymphoma were evaluated for the exposure of AKI. AKI was defined by the KDIGO serum creatinine (SCr) criterion (Stage 1: 1.5-fold increase from baseline or 0.3mg/dL increase in 48-hours; Stage 2: 2-fold increase from baseline; Stage 3: 3-fold increase from baseline, increase in SCr to &gt;4mg/dL, or initiation of renal replacement therapy). Only the first episode of hospitalization was included. Cox proportional hazards regression was used to compare the primary outcome of loss of kidney function within 12 months of hospitalization [defined as ≥30% decline from baseline estimated glomerular filtration rate (eGFR)] in those with and without AKI. A subgroup analysis was performed in patients with a baseline eGFR &lt;60 mL/min/1.73m2. eGFR calculations used the Chronic Kidney Disease Epidemiology Collaborative equation. Outcome evaluation began 90-days after hospitalization to establish chronicity and was defined only by outpatient SCr values. Within the REP cohort, 1,085 patients were hospitalized following a new diagnosis of acute leukemia or lymphoma who consented to the use of their medical records for research. Sixteen patients with pre-existing end-stage renal disease were excluded, leaving 1,069 included patients for analysis. The majority were white (n=1,002; 93.7%) males (n=624; 58.4%) with a mean (SD) age of 64 (18) years. Mean baseline SCr was 1.0 (0.4) mg/dL with a corresponding eGFR of 80 (27) ml/min/1.73m2. A total of 355 patients (33.2%) experienced AKI during the index hospitalization, most commonly a maximum stage of I (n=231; 21.6%). Stages II and III AKI occurred in 42 (3.9%) and 59 (5.5%) patients, respectively. Cumulative incidence of ≥30% loss of baseline eGFR in the 12 months following hospitalization was 67.9% (95% CI 56.8%-76.1%) for those with any AKI and 38.8% (95% CI 31.8%-45.1%) for those without AKI during the index hospitalization. Patients diagnosed with any stage AKI were more likely to experience this outcome compared to those without AKI (HR 2.6, 95% CI 2.2-3.5, p&lt;0.001) in unadjusted analysis. Amongst those with a baseline eGFR ≤60 ml/min, no significant difference in the outcome was noted (HR 1.7, 95% CI 0.83-3.35, p=0.15). Patients with AKI during initial hospitalization following a new diagnosis of acute leukemia or aggressive lymphoma were significantly more likely to experience ≥30% loss of baseline eGFR in the 12 months following diagnosis. This highlights a critical need to identify interventions which prevent AKI and optimize renal recovery so as to decrease overall morbidity and preserve eligibility for desirable treatment options. Disclosures Barreto: FAST Biomedical, Inc: Consultancy. Leung:Prothena: Membership on an entity's Board of Directors or advisory committees; Takeda: Research Funding; Omeros: Research Funding; Aduro: Membership on an entity's Board of Directors or advisory committees.

Utility of Urinary Neutrophil Gelatinase Associated Lipocalin (NGAL) in Decompensated Cirrhosis.

Background and Aims:Renal failure occurring in the setting of cirrhosis increases mortality by more than threefold. Serum creatinine, the conventional marker for renal dysfunction has inherent limitations in identifying and categorizing renal dysfunction in patients with chronic liver disease (CLD). Neutrophil gelatinase associated lipocalin (NGAL) is a novel biomarker which gets upregulated as early as 2-6 hours following the insult to renal tubules. In this study, we aim to check the utility of uNGAL to identify the different phenotypes of renal dysfunction in patients with CLD. We also intend to assess the utility of NGAL to predict 90-day transplant-free survival in patients with CLD.Methods:A total number of 120 adult patients, with cirrhosis of liver were recruited. Those with pre-existing renal parenchymal disease, receiving nephrotoxic medications, spontaneous bacterial peritonitis, septic shock, proteinuria, hematuria, urinary tract infection and anuria were excluded. Urine samples for NGAL was measured at admission and at 48 hours thereafter. Patients were followed up for 90 days post admission.Results:Among the study population, 16 patients (13.3%) had normal kidney function, 43 (35.8%) had prerenal azotemia and 54 (45%) had Hepatorenal Syndrome (HRS - AKI) and 7 (5.8%) had acute tubular necrosis (ATN). Urinary NGAL (uNGAL) levels were considerably lower in patients with normal kidney function and prerenal azotemia. An uNGAL level of 124 ng/ml on admission could distinguish severe forms of renal injury, with a sensitivity of 86% and specificity of 84%. The non survivors had higher uNGAL levels at admission [209.6 ng/ml (118.7-376.8) vs. 123 (33.6-344.3); P = 0.013].The receiver operated curves for uNGAL and serum creatinine at admission did not show any significant difference for predicting 90 day mortality (AUC for uNGAL: 0.632 vs 0.580 for serum creatinine; difference in AUC 0.053, P value 0.17).Conclusion:uNGAL levels are elevated in patients with HRS-AKI and ATN. A higher uNGAL level at admission was suggestive of severe renal dysfunction. An elevated uNGAL on admission is associated with inferior survival. However, uNGAL is not superior to serum creatinine in predicting 90-day mortality.

Predictors of end-stage renal disease after cardiac surgery

Introduction Cardiac surgery associated acute kidney injury (CSI AKI) is severe complication. Incidence in literature varies up to 30%. In 2-5% of AKI patients introducing renal replacement therapy (RRT) is necessary and they are prone to development of a terminal renal failure. Aim of this study was to analyse incidence of AKI in our institution, compare to literature and benchmark institutions and define probably perioperative variables that are manageable and could be altered in order to reduce incidence of AKI. In order to analyse perioperative factors that can cause development of end-stage renal disease (ESRD) we collected data from Croatian Institute of Public Health (CIPH) registry of chronic renal disease and connected with our data. Methods Study design: a single centre retrospective observational study. Institutional board of Clinic Magdalena as well as Ethical Board of CIPH approved the study. There were 2181 heart operation in our institution during period 2013-2017. Eligible for study (all data collected) were 1817 patients. Categorical variables were analysed using Pearson Chi-square test, continuous variables were analysed using an unpaired T-test. The p value below 0.05 was considered statistically significant. AKIN classification was used for diagnosis of AKI. Results Data was collected from 1817 patients; 303 (16,6%) patients developed some kind of AKI; stage I 258 (85%), stage II 38 (12,5%) and stage III 9 patients (2,97%). Overall mortality was 1,98% (36) and in AKI group 5,28% (16). Thirteen patients developed ESRD (0,71%), 5 of them had AKI during hospitalisation (stage I 4, and stage III 1 patient). We found age, body mass index (BMI), Euroscore II score, cerebrovascular disease, pre-existing renal disease, peripheral vascular disease, hypertension, haemoglobin (Hb), haematocrit (Htc) and C reactive protein level to be preoperative variables related to development of AKI. Intraoperative variables with statistically significant difference among groups are operating time and clamp time. As for variables related to development of ESRD we found preoperative Hb and Htc level as well as preoperative creatinine clearens (CrCl), pre-existing renal disease, diabetes mellitus, and atrial fibrillation to be statistically significant. Discussion Discussion: Our data are comparable with literature data. Interestingly both level of Hb and Htc are variables related to development of AKI as well as ESRD after cardiac surgery. It seems that preoperative correction of anaemia and intraoperative meticulous blood management, among others perioperative tactics, could lead to reduction of incidence of AKI and ESRD after cardiac surgery.

Warfarin-induced spontaneous retroperitoneal hemorrhage from the renal vein: A rare case with an uncommon etiology.

The overall rate of major bleeding in patients with atrial fibrillation receiving warfarin therapy is approximately 4%. Among these 4% patients, spontaneous retroperitoneal hemorrhage (SRH) is a rare but potentially lethal complication with a nonspecific presentation that can lead to missed or delayed diagnosis. The current literature provides little direction for diagnosis and management of such cases. Anticoagulation-related SRH is associated with a high mortality rate (approximately 20%). Despite the vague presentation, prompt diagnosis is crucial to reverse the anticoagulation and prevent further bleeding. Contrast-enhanced computed tomography (CT) of the abdomen is the imaging modality of choice in suspected cases. Patients with SRH require aggressive treatment with blood transfusions, interventional radiological procedures, percutaneous drainage or surgical evacuation of the hematoma. We report a case of warfarin-induced SRH from the renal vein in a patient who presented to our emergency department with acute, nonspecific abdominal pain and shock. We diagnosed the patient with warfarin-induced SRH on the basis of clinical suspicion and characteristic CT findings. We initially treated the patient conservatively, followed by embolization of the right renal artery during the late course of hospital stay, and he was discharged with good recovery. SRH should be considered in the differential diagnosis of abdominal pain, hypotension, and/or decreased hemoglobin levels in patients receiving anticoagulation therapy, especially in those with preexisting end-stage renal disease.

P1.06: Preserved renal function in children with intestinal failure on long-term parenteral nutrition

Introduction: Chronic treatment with parenteral nutrition (PN) has been associated with renal complications, including hypercalciuria, nephrocalcinosis, glomerular proteinuria and reduced glomerular filtration rate (GFR). Some pediatric studies reported high prevalence of proteinuria and renal complications, but evidence is scarce and mostly short-termed. Thus, our aim was to evaluate renal complications in children with intestinal failure, receiving long term treatment with PN. Methods: A cross sectional retrospective study was performed (in the period of 5.2017 until 12.2018), using electronic medical records of patients treated in our pediatric intestinal failure clinic for more than 1 year. Data was collected regarding medical background, anthropometric measurements, blood and urine tests and abdominal sonography. Results: Complete data was available for 15 children (67% males), with median age of 6 years (ranged 1.5 to 15 years). Median duration of PN treatment was 4 years (IQR 1.5–6 years). All patients had normal blood pressure for age and height. Low grade proteinuria was identified in 61% and mild albuminuria in 30% of the cohort. Hypercalciuria was present in 50% and hyperoxaluria in 46% of the patients. Only one patient had nephrocalcinosis as noted on renal sonography. Estimated glomerular filtration rate (eGFR) was normal in all but one patient, who had preexisting renal disease. Conclusions: Pediatric patients with intestinal failure can present with preserved kidney function after years of PN treatment. Among this age group, eGFR is normal in the absence of preexisting kidney disease. Despite high prevalence of hypercalciuria, nephrocalcinosis is rare. Continued monitoring of renal function, urinary protein excretion and metabolic urine parameters, and examining larger long-term cohorts are essential in order to characterize effects of prolonged PN on different kidney functions in pediatric patients.

Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease.

Renal complications and subsequent mortality in acute critically ill patients without pre-existing renal disease.