Receiving Renal Replacement Therapy Research Articles

A Chinese patent medicine's long-term efficacy on non-dialysis patients with CKD stages 3-5: a retrospective cohort study.

Chinese patent medicine is commonly used in China as an important treatment mechanism to thwart the progression of chronic kidney disease (CKD) stages 3-5, among which Niaoduqing granules are a representative Chinese patent medicine; however, its long-term efficacy on CKD prognosis remains unclear. Patients were grouped according to Niaoduqing granule prescription duration (non-Niaoduqing granule (non-NDQ) group vs Niaoduqing granule (NDQ) group). Serum creatinine (SCr) variation was compared using a generalized linear mixed model (GLMM). Multivariate Cox regression models were constructed, adjusting for confounding factors, to explore the risk of composite outcomes (receiving renal replacement therapy (RRT) or having an estimated glomerular filtration rate (eGFR)<5mL/min/1.73 m2, ≥50% decline in the eGFR from the baseline, and doubling of SCr) in individuals consuming Niaoduqing granules. A total of 1,271 patients were included, with a median follow-up duration of 29.71 (12.10, 56.07) months. The mean SCr Z-scores for the non-NDQ group and NDQ group were -0.175 and 0.153, respectively, at baseline (p = 0.015). The coefficients of the NDQ group from visit 1 to visit 5 were -0.207 (95% CI: -0.346, -0.068, p = 0.004), -0.214 (95% CI: 0.389, -0.039, p = 0.017), -0.324 (95% CI: 0.538, -0.109, p = 0.003), -0.502 (95% CI: 0.761, -0.243, p = 0.000), and -0.252 (95% CI: 0.569, 0.065, p = 0.119), respectively. The survival probability was significantly higher in the NDQ group (p = 0.0039). Taking Niaoduqing granules was a significant protective factor for thwarting disease progression (model 1: HR 0.654 (95% CI 0.489-0.875, p = 0.004); model 2: HR 0.646 (95% CI 0.476, 0.877, p = 0.005); and model 3: HR 0.602 (95% CI 0.442, 0.820, p = 0.001)). The long-term use of Niaoduqing granules improved SCr variation and lowered the risk of CKD progression by 39.8%.

Cardiogenic shock and chronic kidney disease: Dangerous liaisons

BackgroundChronic kidney disease (CKD) is one of the leading causes of death worldwide, closely interrelated with cardiovascular diseases, ultimately leading to the failure of both organs – the so-called “cardiorenal syndrome”. Despite this burden, data related to cardiogenic shock outcomes in CKD patients are scarce. MethodsFRENSHOCK (NCT02703038) was a prospective registry involving 772 patients with cardiogenic shock from 49 centres. One-year outcomes (rehospitalization, death, heart transplantation, ventricular assist device) were analysed according to history of CKD at admission and were adjusted on independent predictive factors. ResultsCKD was present in 164 of 771 patients (21.3%) with cardiogenic shock; these patients were older (72.7 vs. 63.9years) and had more comorbidities than those without CKD. CKD was associated with a higher rate of all-cause mortality at 1month (36.6% vs. 23.2%; hazard ratio 1.39, 95% confidence interval 1.01–1.9; P=0.04) and 1year (62.8% vs. 40.5%, hazard ratio 1.39, 95% confidence interval 1.09–1.77; P<0.01). Patients with CKD were less likely to be treated with norepinephrine/epinephrine or undergo invasive ventilation or receive mechanical circulatory support, but were more likely to receive renal replacement therapy (RRT). RRT was associated with a higher risk of all-cause death at 1month and 1year regardless of baseline CKD status. ConclusionsCardiogenic shock and CKD are frequent “cross-talking” conditions with limited therapeutic options, resulting in higher rates of death at 1month and 1year. RRT is a strong predictor of death, regardless of preexisting CKD. Multidisciplinary teams involving cardiac and kidney physicians are required to provide integrated care for patients with failure of both organs.

Results in Kidney Transplant Recipients from Living Donors 75 Years of Age or Older

The increasing age of patients receiving renal replacement therapy (RRT) in Turkey, coupled with a shortage of kidney donors, has led to longer waiting times for transplants and an escalation in mortality rates. This retrospective study aims to assess the effect of accepting kidneys from elderly donors (≥70 years) on transplant outcomes, given the rising number of elderly patients in the population. A total of 1400 patients were transplanted with kidneys from donors over 50 years old, with patient and graft survival as primary endpoints. Our results demonstrated that the most significant risk factors for graft function were recipient age >65 years, male gender, and presence of type 2 diabetes. Moreover, kidneys from donors aged 75 and overachieved a half-life of 5 years. These findings suggest that donor age does not necessarily correlate with graft failure and that transplantation from elderly donors could help alleviate the organ shortage. Further research is needed to substantiate these conclusions.

[Pituitary disorders in patients with end-stage chronic renal failure].

Disorders in the kidneys lead to disturbance of homeostasis. As the glomerular filtration rate decreases, the metabolism of numerous biologically active substances, including pituitary hormones, decreases. The article presents an overview of pituitary dysfunction in patients with chronic kidney disease (CKD) and discusses the possible reasons of the pathogenetic mechanisms. Particular focus is being given to the assessment of changes in the concentration of pituitary hormones in patients with end-stage chronic kidney disease (CKD) and discusses the pathogenetic mechanisms of their formation. Particular attention is paid to the assessment of changes in the concentration of pituitary hormones in patients receiving renal replacement therapy (RRT). CKD leads to an increase in the level of prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Concentrations of growth hormone (GH), isulin-like growth factor-1 (IGF-1), thyroid-stimulating hormone (TSH), adrenocorticotropic hormone (ACTH) and vasopressin may remain within normal values or increase in this group of patients. RRT does not reduce the levels of prolactin, LH, FSH, while the concentration of growth hormone, IGF-1, TSH tends to normalize. The content of ACTH and vasopressin may remain unchanged or decrease. Kidney transplantation in most cases corrects hormonal disorders. Correction of hormonal changes can improve the clinical outcome and quality of life of patients with end stage CKD.

Comparison of lung ultrasonography, transthoracic echocardiography and clinical findings in assessing volume status in patients receiving renal replacement therapy

While transthoracic echocardiography and clinical findings are used to assess body volume status, lung ultrasonography (LUS), which is a non-invasive method, has also been used in assessing hypervolemia in recent years. This study aims to compare LUS, transthoracic echocardiography (TTE) and clinical findings in the assessment of body volume status in patients receiving renal replacement therapy (RRT). The study included 99 subjects who received RRT and were followed-up in our hospital. The patients were randomly selected from kidney transplant patients and those who had been receiving peritoneal dialysis (PD) or hemodialysis (HD) for at least the past three months. In addition, a control group consisting of 52 healthy subjects was also enrolled. LUS and TTE were simultaneously performed (within 24 hours). The mean left atrial (LA) diameter was 37.8±2.7 mm, 37.9±3.4 mm, 38.6±3.5 mm and 29.0±4.4 mm in patients who received PD, kidney transplantation, HD and in the control group, respectively. There was a moderate positive correlation between the total number of B-lines and LA diameter (mm) in the combined group consisting of the patient and control groups (p=0.0001, r=0.286). In this study, the number of B-lines on LUS has been found to be higher in patients receiving renal replacement therapy due to the effect of hypervolemia compared to the control group. However, there was no statistically significant difference in terms of the number of B-lines and LA diameter in echocardiography.

Prospective Study of Ultrasound Markers of Organ Congestion in Critically Ill Patients With Acute Kidney Injury

Organ congestion may be a mediator of adverse outcomes in critically ill patients with severe acute kidney injury (AKI). The presence of abnormal venous Doppler waveforms could identify patients with clinically significant organ congestion who may benefit from a decongestive strategy. This prospective multicenter cohort study enrolled patients with severe AKI defined as Kidney Disease: Improving Global Outcomes stage 2 or higher. Patients were not eligible if they received renal replacement therapy (RRT) for more than 72 hours at the time of screening. Participants underwent serial Doppler ultrasound examinations of the portal, hepatic and intrarenal veins during the week following enrolment. We calculated the venous excess ultrasound (VExUS) score based on these data. The primary outcome studied was major adverse kidney events at 30 days (MAKE30) defined as death, RRT dependence, or a persistent decrease in kidney function. A total of 125 patients were included for whom 291 ultrasound assessments were performed. Severely abnormal venous waveforms were documented in 14.4% of portal vein assessments, 6.5% of intrarenal venous assessments, and 14.4% of hepatic vein assessments. The individual ultrasound markers were not associated with MAKE30. The VExUS score (grade 0-1: reference; grade 2: adjusted hazard ratio [aHR]: 4.03, confidence interval [CI]: 1.81-8.99; grade 3: aHR: 2.70, CI: 1.10-6.65; P= 0.03), as well as severely abnormal portal, hepatic and intrarenal vein Doppler were each independently associated with mortality. Although not significantly associated with MAKE30, venous Doppler abnormalities suggestive of venous congestion were associated with higher mortality in critically ill patients with severe AKI.

[Construction of anomogram for predicting the prognosis of patients with sepsis-associated acute kidney injury].

To explore the risk factors for poor prognosis in sepsis-associated acute kidney injury (SA-AKI) and establish a nomogram predictive model. The clinical data of patients with SA-AKI admitted to the department of critical care medicine of Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to September 2022 were retrospectively analyzed, including demographic information, worst values of blood cell counts and biochemical indicators within 24 hours of SA-AKI diagnosis, whether the patient received renal replacement therapy (RRT), mechanical ventilation, vasopressor therapy during hospitalization, acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), fibrinogen-to-albumin ratio (FAR) within 24 hours of diagnosis, acute kidney injury (AKI) staging, total length of hospital stay, length of intensive care unit (ICU) stay, and others. According to the 28-day outcome, the patients were divided into survival group and death group, and the indicators between the two groups were compared. Univariate and multivariate Logistic regression analyses were used to screen for risk factors associated with mortality in SA-AKI patients. A nomogram predictive model for SA-AKI prognosis was constructed based on the identified risk factors. Receiver operator characteristic curve (ROC curve) and calibration plots were generated to evaluate the predictive value of the nomogram model for SA-AKI prognosis. A total of 113 SA-AKI patients were included, with 67 in the survival group and 46 in the death group. The 28-day mortality among SA-AKI patients was 40.7%. The comparison between the two groups showed that there were statistically significant differences in age ≥ 65 years, AKI stage, mechanical ventilation, vasopressors, RRT, length of ICU stay, and laboratory indicators cystatin C (Cys C), fibrinogen (Fib), and FAR. Multivariate Logistic regression analysis showed that age ≥ 65 years [odds ratio (OR) = 7.967, 95% confidence interval (95%CI) was 1.803-35.203, P = 0.006], cystatin C (OR = 7.202, 95%CI was 1.756-29.534, P = 0.006), FAR (OR = 2.444, 95%CI was 1.506-3.968, P < 0.001), and RRT (OR = 7.639, 95%CI was 1.391-41.951, P = 0.019) were independent risk factors for mortality in SA-AKI patients. ROC curve analysis showed that the area under the ROC curve (AUC) for age ≥ 65 years, cystatin C, FAR, and RRT in predicting SA-AKI patient mortality were 0.713, 0.856, 0.911, and 0.701, respectively. A nomogram predictive model for SA-AKI patient prognosis was constructed based on age ≥ 65 years, cystatin C, FAR, and RRT, with an AUC of 0.967 (95%CI was 0.932-1.000) according to ROC curve analysis. The calibration plot indicated good consistency between predicted and actual probabilities. Age ≥ 65 years, cystatin C, FAR, and RRT are independent risk factors for mortality in SA-AKI patients. The nomogram predictive model based on these four factors can accurately predict SA-AKI patient prognosis, helping physicians adjust treatment strategies in a timely manner and improve patient outcomes.

Effects of comorbid chronic kidney disease on mortality in idiopathic pulmonary fibrosis patients and influence of pirfenidone

Chronic kidney disease (CKD) is a comorbidity in idiopathic pulmonary fibrosis (IPF), and managing IPF with CKD is challenging due to limited options for antifibrotic therapy. The aim of this study was to examine the prevalence of CKD and prescription status of pirfenidone in IPF patients and to analyze its impact on mortality. Data from the Korean National Health Insurance Service (NHIS) database between October 2015 and September 2021 were used. IPF and CKD were defined based on both International Classification of Diseases 10th Revision (ICD-10) codes and Rare Intractable Disease (RID) codes. The risk of mortality was assessed based on accompanying CKD with or without antifibrotic therapy. Among 5038 patients with IPF, 8.4% had comorbid CKD and 83.3% with CKD did not receive renal replacement therapy (RRT). Patients with IPF and CKD were older, predominantly male, and had more frequent comorbidities such as cardiovascular disease and diabetes mellitus than subjects without CKD. Pirfenidone was prescribed to 105 (24.6%) of 426 CKD patients, and 89.5% of them did not receive RRT. Pirfenidone was also prescribed to 775 (16.8%) of 4612 IPF patients without CKD. Significant difference was not found in all-cause mortality between the IPF patients with or without CKD regardless of pirfenidone treatment. The use of antifibrotics in IPF patients with CKD is limited due to CKD severity; however, evidence is lacking. Mortality did not increase with accompanying CKD regardless of antifibrotic use. Further research on IPF and CKD is needed.

Association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury receiving renal replacement therapy: a retrospective observational cohort study based on MIMIC-IV database

ObjectiveTo investigate the association between furosemide administration and clinical outcomes in patients with sepsis-associated acute kidney injury (SAKI) receiving renal replacement therapy (RRT).DesignA retrospective observational cohort study.SettingThe data were collected...

The relationship of KDIGO classification and incidence &amp; mortality of acute kidney injury in sepsis patients in intensive care unit: A retrospective cohort study

Background/Aim: Acute kidney injury (AKI) is a common and serious complication associated with morbidity and mortality in patients with sepsis. This study aimed to determine the severity of AKI according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria and evaluate its relationship with mortality in patients who were followed up in the intensive care unit (ICU) due to sepsis and developed AKI. Methods: We retrospectively analyzed patients diagnosed with sepsis and followed up in the ICU, including all patients with AKI. The severity of AKI was determined for all patients using the KDIGO criteria. The patients were divided into four groups: Stage 1, Stage 2, Stage 3, and without AKI. Patients with missing data, COVID-19 patients, patients with chronic kidney insufficiency, and kidney transplant patients were excluded. Results: A total of 1,177 sepsis patients were included in the study, of whom 52.4% were male (n=617). The median age of the study group was 78 years (Q1-Q3: 68-85 years). It was determined that 57.9% of the patients (n=681) developed AKI at any stage. According to the KDIGO criteria, the rates of patients in Stage 1, Stage 2, and Stage 3 developing AKI were 23.9%, 16.2%, and 17.8%, respectively. The incidence of hypertension (HT) and diabetes mellitus (DM), which are comorbidities, increased as the patients’ KDIGO stage increased (P&lt;0.001). Conclusion: AKI occurred in 57.9% of sepsis patients in the ICU, and 30.4% received renal replacement therapy (RRT). It was determined that mortality increased as the KDIGO stage of our patients increased.

#3459 GLUCOSE-LOWERING THERAPIES IN END STAGE RENAL DISEASE: HOW CAN WE PREDICT THE RISK OF HYPOGLYCAEMIA?

Abstract Background and Aims Diabetes is a common co-morbidity in patients with end stage renal disease (ESRD) receiving renal replacement therapy (RRT). Glucose-lowering therapies (GLT) such as sulphonylureas and insulin are commonly used treatments in diabetes but increase the risk of hypoglycaemia. Dialysis is also a risk factor for hypoglycaemia due to reduced drug clearance, decreased gluconeogenesis and glucose loss into the dialysate. Guidelines suggest an HbA1c target of 58 mmol/mol for patients with ESRD receiving glucose lowering therapies, given that tight HbA1c control has not been shown to improve cardiovascular risk, and HbA1c under 58mmol/mol will incur risk of hypoglycaemia in a potentially vulnerable population. We evaluated the clinical and demographic features associated with HbA1c &amp;lt;58 mmol/mol in an ESRD cohort aiming to define characteristics that predict the need for closer glycaemic monitoring. Method We performed a retrospective observational study of patients receiving RRT and treated with GLT attending a single centre nephrology unit using data collected from a clinically used electronic database. Patients with HbA1c &amp;lt;58 mmol/mol in the last 12 months were identified. Clinical, biochemical and demographic factors were compared between groups. Deprivation was measured using the Scottish Index of Multiple Deprivation (SIMD), whereby 1 represented the most deprived areas within Glasgow, while 5 represented the most affluent. Between group characteristics were analysed using Pearson's Chi-squared test or Wilcoxon test, and logistic regression was used to evaluate factors contributing to hypoglycaemia. Results We identified 607 patients, 51.6% of whom had an HbA1c below 58 mmol/mol. 298 patients were on haemodialysis, 14 on peritoneal dialysis and 291 had a kidney transplant. Patients with HbA1c&amp;lt;58 mmol/mol were older, (58±16.8 vs 60±15 years, p = 0.004) but there was no difference in duration of diabetes (9.1±10.2 vs 8.3±12.3 years, p = 0.42) or ESRD vintage (4.6±6.9 vs 4.1±7.5 years, p = 0.44). There was a higher proportion of type 2 diabetes in the group with HbA1c &amp;lt;58 mmol/mol(26 vs 36%, p = 0.04). There was no association between HbA1c and SIMD (p = 0.46) nor gender (p = 0.55). In logistic regression, increasing age (OR 1.19, 95% CI 1.03, 1.38) and ESRD vintage (OR 1.03, 95% CI 1.01, 1.06) increase the likelihood of tight glycaemic control. Transplantation reduced the risk (OR 0.64, 95% CI 0.44, 0.93). There was no association between type of GLT and risk of tight glycaemic control. Subgroup analyses of the haemodialysis and transplant populations was also performed with broadly similar findings. In patients on haemodialysis, increasing age and ESRD increased the risk of HbA1c &amp;lt;58 mmol/mol. In patients with a kidney transplant, there was no association between current estimated glomerular filtration rate and HbA1c &amp;lt;58 mmol/mol. Conclusion Tight glycaemic control is very common in patients with ESRD on GLT. We found signals that patients with type 2 diabetes, receiving haemodialysis, increasing age, and ESRD vintage, increased risk of tight glycaemic control and hypoglycaemia. Transplantation was a substantial protective factor. In patients with a kidney transplant, no trend was found in eGFR and HbA1c. This is a huge concern and suggests HbA1c checks need to be included as part of regular renal profile monitoring every 3 months. More regular follow-up with the Diabetes team may also be useful in this patient group. Continuous glucose monitoring (CGM) devices have revolutionised diabetes care by allowing easy access to data such as time in range and trends in blood sugar throughout the day, thus making it easier to optimise treatment. These devices also provide the patient with a warning when they are approaching hypoglycaemia. This study provides an argument that existing indications for CGM do not match risk factors for tight glycaemic control in ESRD. Hypoglycaemia is difficult to predict in ESRD patients and access to CGM should be widened.

Hemodiyaliz Tedavisi Almakta Olan Son Dönem Böbrek Yetmezliği Olan Hastalarda Spondiloartropati sıklığı

Objectives: Destructive spondyloarthropathy (dSpA) occurs due to inflammatory destruction of axial joints due to beta2-microglobulin (beta2-M) accumulation in patients with end-stage renal disease (ESRD) receiving renal replacement therapy (RRT). This study aimed to investigate the frequency of dSpA in ESRD patients receiving RRT, by the diagnostic criteria sets of inflammatory back pain (IBP) and inflammatory classical SpA.&#x0D; Methods: A total of 140 patients were included. The data of the demographic informations, laboratory tests, clinical findings, HLA allele subgroups were collected. Sacroiliac and lateral feet X-rays and if necessary sacroiliac tomography were taken in patients with dSpA related pain. dSpA was investigated according to the Amor and ESSG criteria sets. &#x0D; Results: Fifty two patients were women (37%). The mean age was 51 ± 15 years. IBP and sacroiliitis were detected in 22 and 28 of the patients, respectively. There was a significant difference according to sacroiliitis and IBP in terms of CRP (p=0.028, p=0.043). dSpA were detected in 21 (15%) patients. Presence of HLA-A1 and duration of HD were determined as independent risk factors for dSpA. &#x0D; Conclusions: In the diagnosis of dSpA, the character and inflammatory origin of the pain and inflammatory markers should be investigated in addition to the radiological criteria.

Associations of continuous anionic gap detection with the mortality in critically ill patients receiving renal replacement therapy

PurposeTo investigate the associations of anion gap (AG) levels before and 1-day after hemodialysis as well as anion gap changes with the mortality in critically ill patients receiving renal replacement therapy (RRT).MethodsTotally, 637 patients from MIMIC-III were included in this cohort study. The associations between AG (T0), AG (T1), or ∆AG [AG (T0) − AG (T1)], and the risk of 30-day or 1-year mortality were examined by Cox restricted cubic spline regression models. Univariate and multivariate Cox proportional-hazards model was applied to assess the associations between AG (T0), AG (T1), ∆AG with 30-day and 1-year mortality, respectively.ResultsThe median follow-up time was 18.60 (8.53, 38.16) days and 263 (41.3%) patients were survived. There was a linear relationship between AG (T0), AG (T1) or ∆AG and the risk of 30-day or 1-year mortality, respectively. The risk of 30-day mortality was higher in AG (T0) > 21 group (HR = 1.723, 95% CI 1.263–2.350), and AG (T1) > 22.3 group (HR = 2.011, 95% CI 1.417–2.853), while lower in AG > 0 group (HR = 0.664, 95% CI 0.486–0.907). The risk of 1-year mortality was increased in AG (T0) > 21 group (HR = 1.666, 95% CI 1.310–2.119), and AG (T1) > 22.3 group (HR = 1.546, 95% CI 1.159–2.064), while decreased in AG > 0 group (HR = 0.765, 95% CI 0.596–0.981). Patients with AG (T0) ≤ 21 had higher 30-day and 1-year survival probability than those with AG (T0) > 21.ConclusionAG before and after dialysis as well as the changes of AG were important factors associated with the risk of 30-day and 1-year mortality in critically ill patients receiving RRT.

The structure of mineral and bone disorders in patients with сhronic kidney disease of the 5th dialysis stage, taking into account the presence or absence of a diagnosis of type 1 diabetes mellitus

BACKGROUND: In patients with end-stage CKD, receiving renal replacement therapy (RRT) with programmed hemodialysis (HD), the severity of complications is associated with metabolic disturbances: accumulation of uremic toxins, nephrogenic anemia, secondary hyperparathyroidism (SHPT), extraskeletal calcification, impaired clearance and rhythm of hormone secretion.AIM: To evaluate the main biochemical and hormonal parameters, and manifestations of mineral bone disease (MBD) in patients receiving RRT with HD, before and after hemodialysis, taking into account the presence or absence of diabetes mellitus.MATERIALS AND METHODS: We divided all patients receiving RRT with HD in two groups: #1 (n=24) — patients with DM, #2 (n=16) — patients without DM. All of them had their blood analyzed before and immediately after the HD. Data analysis was performed with the Statistica 13 (StatSoft, USA). A prognostically significant model was considered at p&lt;0.05.RESULTS: The level of iPTH, both at baseline and after HD, was lower in group #1 (p&lt;0.001). The level of alkaline phosphatase (AP) was significantly higher in group #2 (p=0.012). In both groups before HD, a high incidence of hypocalcemia was detected (according to albumin-corrected calcium in group #1 in 58.3%, in group #2 in 43.7% of cases, p = 0.366) and hyperphosphatemia (in 66.7% and in 43 .7% of cases, respectively, p=0.151). Hypocalcemia after HD in group #1 persisted in 14%, in group #2 — in 20% of cases (p&gt;0.05); hyperphosphatemia in group #1 was completely leveled, in group #2 it persisted in 7% of cases (p=0.417). Prior to the HD session, group #1 had significantly higher levels of RAGE, glucagon, immunoreactive insulin (IRI), cortisol, and glucose than after the HD session (p&lt;0.05). In group #2, after HD, the levels of glucagon, IRI and cortisol significantly decreased (p&lt;0.05), and the level of 3-nitrotyrosine (3-HT) increased significantly (p=0.026). In group #1, fibrocalcinosis of the heart valves according to ECHO and calcification of the arteries of the lower extremities according to ultrasonic doplerography were more common than in group #2 (42% vs 25%, p&lt;0.001 and 75% vs 37.5%, p=0.018, respectively). (χ2)). Compression fractures occurred with the same frequency in both groups (60%). A decrease in bone mineral density (BMD) to the level of osteopenia was noted more often in group #1 (50% vs 18.8%), and osteoporosis was more common in group #2 (68.8% vs 33.3%) (p&lt;0.001, χ2).CONCLUSION: The low level of PTH in group #1 may reflect the effect of diabetes on calcium-phosphorus metabolism. Patients with DM have an increased risk of renal osteodystrophy with a low bone turnover because of a number of metabolic factors inherent in diabetes. At the same time, the dynamics of phosphorus and calcium indicators during the HD procedure were similar.

Years of Potential Life Lost on Renal Replacement Therapy: Retrospective Study Cohort

Chronic kidney disease is the non-communicable disease with the highest growth in morbidity and mortality. Renal transplantation (RT) is the first option of renal replacement in end-stage kidney disease (ESKD) and dialysis is an alternative. However, there is no objective quantification of the impact of both options on a patient's overall survival. The purpose of our study is to assess the potential years of life lost by patients on renal replacement therapy. Retrospective study cohort conducted from 2008 to 2018 based on autonomic data registry. 11,551 patients included who received renal replacement therapy (RRT) in a range of age from 15 to 94 years. The mean age at the time of onset was 62.7 years, 95% confidence interval (95% CI) (62.4; 63.0). The mortality rate of RRT patients was 42.2%, 95% CI (41.5; 43.3) and the mean age at death was 72.7 years, 95% CI (72.4; 73.1). The number of patients with ESKD treated with RT was 3776, 32.7% of the total, 95% CI (31.8; 33.5). The total amount of years of potential life lost (YPLL) in the entire cohort was 77,831.3 years, 48,010.1 years in men, and 29,821.2 years in women. The mean number of YPLL per patient with RRT was 6.74 years in both sexes, 6.95 years in women, and 6.61 years in men. The mean number of potential years of life lost in dialysis patients was 9.0 years in both sexes, 8.8 years in men, and 9.2 years in women, while among kidney transplant recipients this figure decreased to 2.2 years in both men and women. End-stage chronic kidney disease in renal replacement therapy by dialysis causes an average of 9.0 years of life potentially lost for each patient on dialysis treatment, while having received a kidney transplant reduces this figure by 75.6%.

501. Interferon-gamma Release Assays for Diagnosis of Latent TB Infection in Chronic Kidney Disease and Dialysis Patients

Abstract Background Patients with chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), are at risk of developing tuberculosis (TB). Due to their relatively immunosuppresses condition, reactivation from latent TB infection (LTBI) is the core pathogenesis in these populations. However, the prevalence of LTBI among Thai CKD patients, assessed by a high sensitivity and specificity test such as interferon-gamma release assay (IGRA), has never been thoroughly explored. We aimed to investigate the prevalence and predictors for LTBI among Thai CKD patients, including ESKD individuals receiving renal replacement therapy (RRT) either by hemodialysis (HD) or peritoneal dialysis (PD). Methods All CKD patients who underwent an investigation for LTBI status at Ramathibodi hospital were prospectively recruited from September 2020 to November 2021 and retrospectively reviewed from December 2020 to November 2021. Those with positive or borderline IGRA results using T SPOT®.TB without clinical or radiological findings compatible with active TB was diagnosed with LTBI. The LTBI prevalence was determined by CKD staging and type of dialysis. Predictors for LTBI were assessed by logistic regression analysis. Results A total of 199 CKD patients were enrolled; 102 prospectively and 97 retrospectively. There were 173 evaluable patients included with a mean (SD) age of 53 (16) years, and 44% were male. Of those, 95 (55%) had ESKD and maintained on RRT. Overall, 39 (22.5%) CKD patients had LTBI with the prevalence of 25%, 12.5%, 25%, 25% and 24.2% in those with CKD stage 1, 2, 3a, 3b and ESKD, respectively (p=0.89). Among ESKD patients, those who were maintained on HD had a higher proportion of LTBI than those on PD (28.9% vs. 5.3%, p=0.03). In multivariate analysis, drinking alcohol was significantly associated with LTBI (OR 8.51; [95%CI 1.24-58.38]; p=0.029), and HD therapy was marginally associated with LTBI (OR 8.14; [95%CI 0.95-69.91]; p=0.056) among ESKD patients. Conclusion In TB endemic settings, one-fifth of patients with CKD and a quarter of ESKD patients could carry LTBI status. Alcohol consumption and HD therapy could better identify high-risk ESKD patients and potentially screen for LBTI. Disclosures All Authors: No reported disclosures.

Multistate Modeling of Clinical Trajectories and Outcomes in the ICU: A Proof-of-Concept Evaluation of Acute Kidney Injury Among Critically Ill Patients With COVID-19.

To demonstrate the utility of these models in critical care, we examined acute kidney injury (AKI) development, progression, and outcomes in COVID-19 critical illness through multistate analyses. Retrospective cohort study at an urban tertiary-care academic hospital in the United States. All patients greater than or equal to 18 years in an ICU with COVID-19 in 2020, excluding patients with preexisting end-stage renal disease. Using electronic health record data, we determined AKI presence/stage in discrete 12-hour time windows and fit multistate models to determine longitudinal transitions and outcomes. Of 367 encounters, 241 (66%) experienced AKI (maximal stages: 88 stage-1, 49 stage-2, 104 stage-3 AKI [51 received renal replacement therapy (RRT), 53 did not]). Patients receiving RRT overwhelmingly received invasive mechanical ventilation (IMV) (n = 60, 95%) compared with the AKI-without-RRT (n = 98, 53%) and no-AKI groups (n = 39, 32%; p < 0.001), with similar mortality patterns (RRT: n = 36, 57%; AKI: n = 74, 40%; non-AKI: n = 23, 19%; p < 0.001). After 24 hours in the ICU, almost half the cohort had AKI (44.9%; 95% CI, 41.6-48.2%). At 7 days after stage-1 AKI, 74.0% (63.6-84.4) were AKI-free or discharged. By contrast, fewer patients experiencing stage-3 AKI were recovered (30.0% [24.1-35.8%]) or discharged (7.9% [5.2-10.7%]) after 7 days. Early AKI occurred with similar frequency in patients receiving and not receiving IMV: after 24 hours in the ICU, 20.9% of patients (18.3-23.6%) had AKI and IMV, while 23.4% (20.6-26.2%) had AKI without IMV. In a multistate analysis of critically ill patients with COVID-19, AKI occurred early and heterogeneously in the course of critical illness. Multistate methods are useful and underused in ICU care delivery science as tools for understanding trajectories, prognoses, and resource needs.

Analysis of the impact of various risk factors on short-term and long-term outcomes in patients with COVID-19 on maintenance hemodialysis

Patients receiving renal replacement therapy (RRT) in the form of maintenance hemodialysis (MHD) belong to a group of particularly high risk of infection and the course of COVID-19. The new coronavirus infection also has a great impact on long-term outcomes.Materials and methods: A retrospective observational study included 510 patients on MHD, hospitalized from April 1, 2020 to April 01, 2021. The outcome of hospitalization was chosen as the primary endpoint of the study: discharge or 28day mortality. Death within 6 months after discharge and the development of complications related to COVID-19 during this period were considered as secondary endpoints. Data collection was carried out by analyzing electronic and archival medical records. Quantitative variables: age, duration of hospitalization, days in the intensive care unit, laboratory blood parameters: the level of D-Dimer, Glucose, Interleukin-6, Procalcitonin, Lymphocytes and Platelets, CRP, CPK, CPK-MB, LDH, Fibrinogen, Ferritin. Qualitative indicators: gender, ventilator, ARDS, the presence of diabetes, the presence of obesity, the presence of complications: cardiovascular, gastrointestinal, septic, macrothrombotic, stage of pneumonia. To identify statistically significant predictors of the risk of an event, the odds ratio (OR) method was used.Results: average age 57.8±14 years, men – 59.5%, average bed day 17.6±10.6 days. In concomitant diseases, diabetes mellitus was indicated in 24% of patients, obesity was registered in 4.3% of patients. Hospital mortality (28-day) in the total cohort of follow-up was 16.05%, in total with out-ofhospital mortality of 22%. Mortality in intensive care reached 62.7%, on ventilator more than 86%, with ARDS 94.3%. No statistical significance was revealed by gender and the presence of diabetes mellitus (DM) in concomitant diseases. When comparing short-term outcomes, the age groups over 65 differed statistically. The following laboratory blood parameters showed a significant difference (P&lt;0.001): D-Dimer, Glucose, IL-6 lymphocytes, Leukocytes, Neutrophils, Platelets, LDH, Ferritin. The following odds ratios (OR) were obtained: ARDS (OR 143.78; 95% CI 33.4-616.2; p=0.0001), on ventilator (OR 57.96; 95% CI 23.1-144.5; p=0.0001), the presence of septic complications (OR 26.4; 95% CI 13.8-50; p=0.0001), the course of the disease is defined as severe (OR 25; 95% CI 12.9-48.2; p=0.0001), the course of the disease is defined as complicated (OR 11.6; 95% CI 6.8-19.7; p=0.0001), the presence of gastrointestinal complications (OR 6.5; 95% CI 2.28-18.4; p=0.0007), the presence of obesity (OR 2.57; 95% CI 1.0-6.5; p=0.039). Mortality of patients receiving two main treatment regimens T-1 and T-2 did not differ (15.8% vs 15.7%). Significant differences (p=0.0001) appeared when compared with the T-0 and T-4 schemes, in which mortality was recorded at 8.8% and 85.7%, respectively. When comparing long-term outcomes, the analysis did not reveal statistical significance by gender. The statistical difference was noted by age. Among laboratory indicators, the PCT level was higher in survivors with complications. A significant difference among all survivors and deceased (P&lt;0.001) was shown by: D-Dimer, blood glucose level, IL-6, CRP. The highest OR was calculated for the following indicators: the presence of gastrointestinal complications (OR 7.7; 95% CI 1.0-57.7; p=0.03), the initial LDH blood level of 622 units /l (OR 4.7; 95% CI 1.63-13.63; p=0.0086), the course of the disease defined as complicated (OR 4.05; 95% 1.97-8.33; p=0.003), the course of the disease is defined as severe (OR 2.4; 95% CI 1.17-5.0; p=0.03).Conclusions: gastrointestinal complications had the greatest impact on unfavorable short-term and long-term outcomes in patients on programmed hemodialysis. In relation to such laboratory markers as Ferritin, CRH, LDH, threshold values of a significant increase in the chances characteristic of dialysis patients were obtained. During the first year of the epidemic, therapy remained largely supportive and aimed at preventing complications, the main isolated treatment regimens showed no significant differences in the impact on the outcomes of COVID-19.

Accuracy of clinicians’ ability to predict the need for renal replacement therapy: a prospective multicenter study

PurposeIdentifying patients who will receive renal replacement therapy (RRT) during intensive care unit (ICU) stay is a major challenge for intensivists. The objective of this study was to evaluate the performance of physicians in predicting the need for RRT at ICU admission and at acute kidney injury (AKI) diagnosis.MethodsProspective, multicenter study including all adult patients hospitalized in 16 ICUs in October 2020. Physician prediction was estimated at ICU admission and at AKI diagnosis, according to a visual Likert scale. Discrimination, risk stratification and benefit of physician estimation were assessed. Mixed logistic regression models of variables associated with risk of receiving RRT, with and without physician estimation, were compared.ResultsSix hundred and forty-nine patients were included, 270 (41.6%) developed AKI and 77 (11.8%) received RRT. At ICU admission and at AKI diagnosis, a model including physician prediction, the experience of the physician, SOFA score, serum creatinine and diuresis to determine need for RRT performed better than a model without physician estimation with an area under the ROC curve of 0.90 [95% CI 0.86–0.94, p < 0.008 (at ICU admission)] and 0.89 [95% CI 0.83–0.93, p = 0.0014 (at AKI diagnosis)]. In multivariate analysis, physician prediction was strongly associated with the need for RRT, independently of creatinine levels, diuresis, SOFA score and the experience of the doctor who made the prediction.ConclusionAs physicians are able to stratify patients at high risk of RRT, physician judgement should be taken into account when designing new randomized studies focusing on RRT initiation during AKI.

Predicting Mortality Using Machine Learning Algorithms in Patients Who Require Renal Replacement Therapy in the Critical Care Unit.

Background: General severity of illness scores are not well calibrated to predict mortality among patients receiving renal replacement therapy (RRT) for acute kidney injury (AKI). We developed machine learning models to make mortality prediction and compared their performance to that of the Sequential Organ Failure Assessment (SOFA) and HEpatic failure, LactatE, NorepInephrine, medical Condition, and Creatinine (HELENICC) scores. Methods: We extracted routinely collected clinical data for AKI patients requiring RRT in the MIMIC and eICU databases. The development models were trained in 80% of the pooled dataset and tested in the rest of the pooled dataset. We compared the area under the receiver operating characteristic curves (AUCs) of four machine learning models (multilayer perceptron [MLP], logistic regression, XGBoost, and random forest [RF]) to that of the SOFA, nonrenal SOFA, and HELENICC scores and assessed calibration, sensitivity, specificity, positive (PPV) and negative (NPV) predicted values, and accuracy. Results: The mortality AUC of machine learning models was highest for XGBoost (0.823; 95% confidence interval [CI], 0.791–0.854) in the testing dataset, and it had the highest accuracy (0.758). The XGBoost model showed no evidence of lack of fit with the Hosmer–Lemeshow test (p > 0.05). Conclusion: XGBoost provided the highest performance of mortality prediction for patients with AKI requiring RRT compared with previous scoring systems.