Functional Renal Failure Research Articles

The prognostic utility of troponin T levels in patients undergoing PCI during initial hospitalisation for STEMI

Abstract The prognostic utility of presentation or "peak" high-sensitivity troponin T (hsTnT) levels following ST-segment elevation myocardial infarction (STEMI) has been previously reported, but hsTnT, unlike other bio-markers of myocyte damage, have a 2nd or ‘plateau-phase’ of release which lasts over a week. We have reported correlations between plateau-phase hsTnT levels, and cardiac MRI determined infarct size, though whether these levels are more highly associated with late mortality than "peak" (or highest) levels, needs clarification. Methods Hence we determined late mortality and the combination of cardiovascular death, myocardial infarction and cerebrovascular accident [CD/MI/CVA] among patients with STEMI, and an HsTnT level >36 hours after symptom onset (plateau phase), who underwent percutaneous coronary intervention (PCI), either primary or pharmaco-invasive, during initial hospitalisation between October 2003 and December 2021. HsTnT levels and other potential prognostic factors were determined. Results Amongst 1955 patients, 119 patients (6%) had died by 2 years and 192 (10%) patients experienced CD/MI/Stroke. The highest quartile of plateau phase hsTnT levels (³ 3786 ng/L ng/L), were more highly associated with 2-year mortality, than the highest quartile of "peak" hsTnT levels (³ 7687 ng/L ng/L). The Figure shows Peak and plateau hs-TnT levels in quartile groups were assessed by rank test to obtain p-values. Patients lost to follow-up or with less than 2-years of follow up were considered censored. Peak quartile 1; hs-TnT £ 1611 ng/L, peak quartile 2; hs-TnT 1612 – 3900 ng/L, peak quartile 3; hs-TnT 3901 – 7686 ng/L; peak quartile 4; hs-TnT ³ 7687 ng/L. Plateau quartile 1; hs-TnT £ 1060 ng/L, plateau quartile 2; hs-TnT 1061 – 2135 ng/L; plateau quartile 3; hs-cTnT 2136 – 3785 ng/L. Log rank mortality analyses are shown in the Figure. Peak quartile 1; hs-TnT <1611 ng/L, peak quartile 2; hs-TnT 1612 – 3900 ng/L, peak quartile 3; hs-TnT 3901 – 7686 ng/L; peak quartile 4; hs-TnT ³ 7687 ng/L. Plateau quartile 1; hs-TnT £ 1060 ng/L, plateau quartile 2; hs-TnT 1061 – 2135 ng/L; plateau quartile 3; hs-cTnT 2136 – 3785 ng/L, plateau quartile 4; hs-TnT >3786 ng/L. Multivariate Cox regression analysis incorporating age, sex, smoking status, hypertension, renal function, cardiogenic shock and heart failure hospitalisation found plateau hs-TnT levels (HR, 3.564; 95% CI, 1.674 – 7.590; P = 0.001) were an independent predictor of all-cause mortality at 2-years post-STEMI, whereas peak hs-cTnT levels (HR, 1.965; 95% CI, 0.959 – 4.025; P = 0.065) were not. Conclusions Plateau phase hsTnT levels were of prognostic significance in STEMI patients treated with PCI. Thus, measurement of plateau hs-cTnT levels following STEMI could be an accurate, inexpensive method of long-term prognostic risk stratification.

Hypocalcaemia in pregnant and lactating goats (distribution, etiology, diagnostic methods)

The article presents the results of studies on the prevalence, etiology, and methods of diagnosing hypocalcemia in pregnant and lactating goats of Zaanen, Alpine, Nubian, and Lamancha dairy breeds of 1–4 years of age, with a productivity of 750–1050 kg per lactation. Subclinical hypocalcemia was diagnosed in 45,3 % of goats, including 44,0 % of lactating goats (75–90 and 120–140 days of gestation) and 46,3 % of lactating animals (0–2; 15–25 and 50–60 days after lambing). Clinically expressed hypocalcaemia was diagnosed in 5,2 % of goats in the first 24–48 hours after lambing. The following clinical signs characterized the subclinical course of hypocalcemia: a) slight depression of the general condition; b) decreased body weight (BCS 1,5–2,0); c) decreased appetite; d) incisor shakiness; e) hypotension of the foregut; f) unsteady gait; g) muscle tremors; h) lactation and isolated cases of mastitis and metritis in lactating goats in the first days after lambing. It has been established that the leading causes of hypocalcemia in goats are, first of all, violations of the feeding regime and diet structure during pregnancy and lactation. The role of the nutritional factor lies in the unbalanced and insufficient feeding of animals, in particular, the deficiency of macro- (Ca, P and their ratio, Mg), microelements (Zn, Cu, I), a pronounced deficiency of vitamins A and D, as well as the lack of motivation and insufficient natural insolation of animals. In addition, goats' diets often noted a lack of metabolic energy, dry matter, crude fat, and a deficiency of readily fermentable sugar and starch carbohydrates. In the studied goats with liver pathology and functional renal failure (hepatorenal syndrome), the development of secondary hypocalcaemia was diagnosed.

Endoplasmic Reticulum Stress-Mediated Cell Death in Renal Fibrosis.

The endoplasmic reticulum (ER) is indispensable for maintaining normal life activities. Dysregulation of the ER function results in the accumulation of harmful proteins and lipids and the disruption of intracellular signaling pathways, leading to cellular dysfunction and eventual death. Protein misfolding within the ER disrupts its delicate balance, resulting in the accumulation of misfolded or unfolded proteins, a condition known as endoplasmic reticulum stress (ERS). Renal fibrosis, characterized by the aberrant proliferation of fibrotic tissue in the renal interstitium, stands as a grave consequence of numerous kidney disorders, precipitating a gradual decline in renal function. Renal fibrosis is a serious complication of many kidney conditions and is characterized by the overgrowth of fibrotic tissue in the glomerular and tubular interstitium, leading to the progressive failure of renal function. Studies have shown that, during the onset and progression of kidney disease, ERS causes various problems in the kidneys, a process that can lead to kidney fibrosis. This article elucidates the underlying intracellular signaling pathways modulated by ERS, delineating its role in triggering diverse forms of cell death. Additionally, it comprehensively explores a spectrum of potential pharmacological agents and molecular interventions aimed at mitigating ERS, thereby charting novel research avenues and therapeutic advancements in the management of renal fibrosis.

Safety of Contrast Agents Administration in Patients with Type 2 Diabetes Mellitus During Metformin Intake

Metformin is a sugar-lowering drug that is actively used in long-term therapy of type 2 diabetes mellitus (DM2). The safety of metformin for different groups of DM2 patients is currently well studied. However, the drug is contraindicated for patients with severe renal impairment and should be used with caution in cases of moderate renal impairment. Since contrast agents as well as metformin are excreted by kidneys, patients with reduced renal function taking metformin require special attention due to the risk of lactic acidosis, a life-threatening condition resulting from functional renal failure and accumulation of metformin in tissues. Numerous studies have shown that the risk of lactic acidosis is relatively low and in most cases is not associated with metformin therapy per se, but rather with comorbidities. Initial versions of clinical recommendations related to the use of contrast agents strictly limited the use of metformin before and after examination, but as data on lactate acidosis and possible causes of this condition expanded, the recommendations gradually became less strict. For emergency contrast studies, they are currently unchanged, but data are gradually accumulating on the safety of continuing metformin in these clinical situations. There is no consensus among contrast manufacturers on whether and in what regimen metformin should be interrupted during contrast studies as well as on a number of other related issues. The best strategy for clinicians is to check the instructions for each specific drug before use.

#472 Cardiorenal relations in patients with chronic heart failure

Abstract Background and Aims To study the functional state of the kidneys and cardiorenal relationships in patients with chronic heart failure, depending on the representation of components of metabolic syndrome Method To achieve the objectives, 227 male patients with chronic heart failure (CHF) of ischemic origin of functional class II-III according to NYHA, aged 40-60 years with a history of myocardial infarction of 6 months, were examined up to 5 years. Depending on the presence of MS components, 3 groups of patients were identified: group I (n=80), patients without MS (CHF FC II—42, CHF FC III—38 patients); Group II (n=77) patients with various combinations of dyslipidemia (HDL-C <1.03 mmol/l; LDL-C >3.0 mmol/l) with abdominal obesity (AO), hypertension and hypertriglyceridemia (HTG) (CHF FC II—40, CHF FC III—37 patients); Group III (n=75) patients with various combinations of dyslipoproteinemia (DLP) and type 2 diabetes mellitus (DM2) with AO, hypertension and hypertriglyceridemia (CHF) (CHF FC II—36, CHF FC III—39 patients). When diagnosing MS, the International Diabetes Federation diagnostic criteria for MS were used (IDF, 2009). The study of the functional state of the kidneys included determination of the level of serum creatinine, urinary albumin excretion (determination of microalbuminuria (MAU ≥300 mg/l) in a single morning urine using indicator strips (Biosensor AN, Russia), glomerular filtration rate (GFR), calculated by the formula GFR EPI, which takes into account race, sex, age, serum creatinine. To calculate GFR using the CKD-EPI formula, you can use special applications for mobile devices (QxMDCalculator). Results When studying the parameters of the functional state of the kidneys in patients with group 1 CHF, 20 patients (25%) out of 80 were diagnosed with MAU. Serum creatinine clearance in this group was 89.0 ± 8.49 μmol/L, and the GFR level was 88.58 ± 8.36 ml/min. With the development of MS in group II patients, 41 out of 77 patients had MAU (53.2%). A decrease in GFR by 19.3% (P<0.01) was also found with an increase in serum creatinine levels by 22.7% (P<0.01), in contrast to the data from group I of the study. Further analysis of the parameters of renal function in CHF group III revealed a significant decrease in GFR (by 29.8%; P<0.001) with a significant increase in blood creatinine levels (by 31.8%; P<0.001) in relation to the data of group I. Also in group III of patients with CHF and MS (+DM2), microalbuminuria was detected in 47 patients (74.6%) out of 75. When comparing indicators of renal function between study groups II and III, there was a significant difference in the level of blood creatinine clearance and glomerular filtration rate by 21.3% and 20.1% (P<0.005), respectively. According to the classification of CKD, in group I of patients with CHF, stage I CKD was detected in 39.3%, in group II in 28.6% and in group III in 19.4%. CKD stage II was detected in group I in 46.4%, in group II in 50% of patients. 46.9% had CKD stage II of the disease in group III of the study. Also, in group II, 21.4% and group III, 43.7% were diagnosed with stage III CKD. V In group I, 35% had a high risk, 53.6% had a moderate and 14.3% had a low combined risk of developing cardiovascular complications in cardiorenal syndrome. Conclusion Thus, MS in patients with CHF aggravates renal dysfunction, which developed as one of the main pathogenetic links of CHF. It has been established that as MS progresses (addition of type 2 diabetes to other components of MS), the phenomena of functional renal failure increase. Violation of the functional state of the kidneys, the severity and nature of this dysfunction depends on the presence and nature of the representation of MS components.

Management of immunosuppressive therapy after functional renal graft failure: results of a practice survey of French-speaking nephrologists

The management of patients with kidney transplant failure (KTF) remains a complex process involving multiple stakeholders. A working group of the Transplantation Commission of the French-speaking Society of Nephrology, Dialysis and Transplantation (SFNDT) conducted a survey on the management of immunosuppressants (IS) after KTF among nephrologists at transplant centres and general nephrologists in France, Switzerland and Belgium between March and June 2023. We analysed 232 replies from 58 nephrologists at transplant centres and 174 general nephrologists, aged 43.6 (+10.6) years. In the first three months following KTF, nephrologists reported discontinuing antimetabolite, calcineurin inhibitor (CNI) and corticosteroid treatment in 83%, 39.9% and 25.8% of cases respectively. Conversely, some nephrologists reported that they were continuing to use CNI (14%) and corticosteroids (19.1%) on a long-term basis. The patient’s comorbidities associated with the discontinuation of IS treatment are cancer and opportunistic infections as KT’s complications and presence of diabetes mellitus at KTF, whereas humoral rejection encourages the IS to be maintained. Transplantectomy is proposed by nephrologists most often for graft intolerance syndrome (86.5%), more rarely to discontinue IS (17.6%) or in the absence of plans of new transplantation (9.3%). In multivariate analyses, the presence of a protocol in the centre facilitated the management of IS by the general nephrologists. The management of IS after AFG by French-speaking nephrologists is heterogeneous. Specific prospective studies are needed to establish new best practice recommendations, based on more robust evidence, which could encourage better adherence by nephrologists.

Impact of Type 1 Diabetes on Renal Parameters in Children Aged One to 17 at the Mother and Child University Hospital in N'Djamena, Chad.

Background Diabetes is a metabolic disease caused by a defect in the secretion of insulin or its misuse.It is a major public health problem worldwide. While type 2 diabetes generally affects people of advanced age, type 1 diabetes generally occurs in people of younger ages and its prevalence is increasingly high among children in Chad. When it is poorly managed, it can be accompanied by several functional complicationsincluding renal failure. In order to have an overview of the incidence of this complication in children suffering from type 1 diabetesand to contribute to its better follow-up, a study was conducted at the Mother and Child University Hospital in N'Djamena whose objective was to assess the impact of type 1 diabetes on renal parameters in children aged one to 17 years. Methodology A cross-sectional study was conducted from April to June 2023 at the Mother and Child University Hospital Center in N'Djamena on 61 children with type 1 diabetes aged one to 17 years.A questionnaire sheet was submitted to the parents of the participants and the data from this sheet were analyzed while biochemical parameters were evaluated using standard commercial kit methods, the IONIX SFRI automated ion analyzer, HemoCue HbA1c501® hemoglobinometer, and spectrophotometer (BioSystems). Results Participants were ranked according to glycemic control and duration of diabetes discovery. 73.61% of the children showed alterations in renal parameters, some of which increased and others decreased; 86.9% had poor glycemic control, whichis associated with alterations in renal parameters in study participants.Multiple logistic regression showed hypercreatinemia, hyperuremia, hyperglycemia, hyperhemoglobinemia, hyperchloremia, hyponatremia, hypokalemia, hyperglycemia, hyperketonuria, hyperproteinuria, and decreased glomerular filtration rate (GFR). Conclusion It appears from this study that type 1 diabetes through glycemic control and the duration of discovery has an increasing impact on certain renal parameters and a decrease in others, leading to impaired renal function.

Suspension of Sonchus arvensis L Leaves Ethanolic Extract Affects Blood Creatinine and Urea Levels in Streptozotocin-Induced Wistar Male Rats

The study focused on analyzing the secondary metabolites present in the ethanol extract of Sonchus arvensis L. leaves (SALEE) and their impact on creatinine and urea levels when administered in suspension form at different doses. Phytochemical screening of SALEE identified alkaloids, flavonoids, phenols, saponins, and tannins. In the experiment, twenty-five white male rats were divided into five groups: a healthy control group (Group I), a negative control group (Group II), and three test groups (Groups III, IV, and V) receiving SALEE at doses of 200, 300, and 400 mg/kg BW, respectively. After inducing diabetes with streptozotocin and a 21-day follow-up period, creatinine and urea levels were assessed. The results demonstrated that SALEE administration significantly reduced creatinine levels and increased urea levels. Notably, the 200 mg/kg BW dose of SALEE exhibited a consistent and long-term effect. It was observed that blood urea levels fluctuated even in healthy and negative control groups during the 21-day observation period. In the group receiving the highest dose of SALEE (400 mg/kg BW), blood urea levels increased significantly on days 14 and 21, indicating a potential increase in the rats' appetite rather than renal function failure. Overall, the findings suggest that SALEE has promising potential to regulate creatinine and urea levels in the blood of individuals with diabetes, highlighting its potential for therapeutic and supplemental use.

Correlation between neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with proteinuria in different stages of chronic kidney disease

Abstract Background Chronic kidney disease (CKD) is a progressive failure of renal function with ongoing systemic inflammation. Inflammatory markers such as neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and proteinuria were documented as independent predictors of CKD progression. Although proteinuria estimated by the protein to creatinine ratio (UPCR) is generally employed to screen the disease progression of CKD, the correlation of NLR and PLR with different stages of CKD is yet to be studied. Consequently, this study strived to find the stage-wise correlation between NLR and PLR with proteinuria in CKD patients. Methods Eighty-five CKD patients with proteinuria who visited the Nephrology Clinic at Teaching Hospital Jaffna, Sri Lanka, were randomly selected and categorized as stages II to IV based on the estimated glomerular filtration rate (e-GFR). Blood samples were collected and subjected to investigate patients’ NLR and PLR. Furthermore, urine protein and creatinine were measured and UPCR was calculated. Participants’ demographic, clinical, and laboratory data were obtained from patients’ clinical registry. Spearman’s rank correlation and receiver operative characteristic (ROC) curve analysis was done, and the p value < 0.05 was considered statistically significant. Results Amongst the total participants, males were predominant (58.8%), with a mean age of 58.1. Severity analysis based on the e-GFR revealed that 17.64%, 18.82%, 29.41%, and 34.11% of CKD patients were in stages II, IIIA, IIIB, and IV, respectively. Stage-wise correlation and ROC curve analysis indicated that NLR and PLR were positively correlated with UPCR in stages IIIA, IIIB, and IV of CKD with more than 80% predictive sensitivity and specificity. Conclusion NLR and PLR can be used as novel predictive markers for monitoring the severity of CKD; however, further large-scale cohort studies of NLR and PLR with serial monitoring and multiple closely spaced measurements are recommended to develop these markers into clinically acceptable markers for CKD progression.

Clinical Significance of Apela in Acute Cardiorenal Insuffiency of Chronic Heart Failure

Introduction: Apela has a wide range of biological effects on the cardiovascular system, but the changes and significance of endogenous Apela in patients with chronic heart failure (CHF) and acute deterioration of cardiac and renal function are unclear. Methods: A total of 69 patients with stable CHF combined with well-preserved renal function were enrolled and followed for 12 months. The effects of Apela on human renal glomerular endothelial cells (hRGEC), human glomerular mesangial cells (hMC), and human renal tubular epithelial cells (HK-2) were observed. Results: Serum Apela concentration was positively correlated with NYHA class (r = 0.711) and N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration (r = 0.303) but negatively correlated with left ventricular ejection fraction (LVEF) (r = −0.374) and 6-min walk distance (r = −0.860) in patients with stable CHF. Twenty-one patients experiencing deterioration of renal and cardiac function were diagnosed with cardiorenal syndrome (CRS) during the follow-up period. In addition, the serum Apela, as well as the difference in Apela between stable and worsening phases (ΔApela), was correlated with the estimated glomerular filtration rate (eGFR) and ΔeGFR in patients with CRS. Apela significantly inhibited the upregulated expression of MCP-1 and TNF-α induced by angiotensin II (AngII) in hRGEC, hMC, and HK-2 cells. Apela inhibited the adhesion of THP-1 cells to hRGEC and promoted the tubular formation of hRGEC. Moreover, Apela enhanced the expression of MMP-9 in hMC but inhibited the upregulated expression of α-SMA and vimentin in HK-2 cells by AngII. Conclusion: This study suggests that the level of Apela can be used to diagnose heart failure and assess the severity of cardiac dysfunction in patients with stable CHF, and its dynamic changes can be used to evaluate the damage to renal function in patients with CRS. Apela plays multiple protective effects on renal cells, highlighting its clinical application prospect in the prevention and treatment of CRS.

Diagnosis and treatment of hepatorenal syndrome; a systematic review

Hepatorenal syndrome (HRS) is a severe form of functional renal failure associated with reduced renal blood flow, predominantly affecting patients with ascites and cirrhosis, showcasing normal kidney histology. This complication of advanced liver disease is marked by a grim prognosis, with survival typically spanning weeks or months. Diagnosis hinges on a blend of clinical and laboratory criteria, given the absence of definitive biomarkers. This systematic study sought to formulate guidelines for HRS diagnosis and treatment. Data, drawn from PubMed/Medline, Scopus databases, and Embase, encompassed English-language articles from 2010 to 2023, adhering to PRISMA guidelines. Among 457 studies, seven met eligibility criteria, employing surveys and national database analyses as prevalent methods. Current care standards involved albumin and terlipressin treatment, with continuous intravenous terlipressin administration proving equally effective and better-tolerated than boluses. Despite its 40-50% success rate, predictors included serum bilirubin and creatinine levels, blood pressure, and systemic inflammatory response syndrome presence. Liver transplant stands as the sole curative avenue, while alternative therapies like dopamine, noradrenaline, renal and liver replacement therapy, and transjugular intrahepatic portosystemic shunt are under evaluation. Ongoing research into advanced remedies is imperative, given current treatment limitations. Considerations such as antibiotic prophylaxis in severe cirrhosis with low protein ascitic fluid levels and volume expansion with albumin during spontaneous bacterial peritonitis and high-volume paracentesis further underscore the multifaceted approach required in managing HRS. This study advocates for continuous exploration of innovative therapies and emphasizes the pivotal role of liver transplant consideration for eligible patients.

How might Low Carb and Ketogenic Diets affect the Progression of Chronic Kidney Disease?

Background: Obesity, an ever-increasing cause for deaths in the American population, often leads to complications such as Type II Diabetes Mellitus. Both obesity and diabetes predispose to renal disease, which can be ameliorated by treatment of both disorders. Ketogenic and Low Carb diets (KD/LCD) can lower blood sugar of T2DM patients and accelerate weight loss. Diet is a potential factor in slowing the rate of decline in kidney function. Yet, high diet acid loads, as from keto acid, may promote renal damage. Here, we evaluate existing studies on the benefits or harms of KD/LCD on factors associated with renal disease progression. 
 Methods: Reviews and analysis of existing studies on chronic kidney disease and Ketogenic diets. We analyzed eGFR, the measure of the rate of change in decline of renal function to infer the effects of Ketogenic and Low Carb diets.
 Results: Nine of the 22 papers reviewed were analyzed. Studies included from 18 to 1797 participants and included healthy subjects, those with diabetes and /or obesity, and those with normal renal function or moderate kidney failure (eGRF ranged from 94 ± 12 mL/min/ to 40 ml/min/1.73m2). Study duration ranged from 5 weeks to 6 years. Several studies demonstrated improvements, including decreases in serum creatinine, urinary albumin, weight loss, and eGFR.
 Conclusions: Renal function improved in shorter studies of diabetics who demonstrated weight loss. Longer studies or those in nondiabetics demonstrated no change in renal function.

Association of Preoperative Renal-Resistive Index With Long-term Renal and Cardiovascular Outcomes After Cardiac Surgery

ObjectiveTo investigate the association of elevated preoperative renal resistive index (RRI) with persistent renal dysfunction, major adverse kidney events (MAKE) and major adverse cardiovascular events (MACE) after cardiac surgery. DesignObservational cohort study. SettingUniversity hospital. ParticipantsNinety-six adult patients undergoing cardiac surgery. InterventionsRRI measurement the day before surgery. Measurements and Main ResultsFifty-eight patients (60%) had elevated RRI ≥0.70. Five years after surgery, persistent renal dysfunction (sustained decline in estimated glomerular filtration rate ≥25%) had occurred in 25 patients (26%), MAKE (persistent renal dysfunction, renal replacement therapy, or death) in 34 (35%), and MACE (myocardial infarction, unstable angina, decompensated heart failure, stroke, or cardiovascular death) in 28 (29%). RRI was higher in patients who developed persistent renal dysfunction (median, 0.78 [interquartile range, 0.74-0.82] vs. 0.70 [0.66-0.77], p = 0.001), MAKE (0.77 [0.72-0.81] vs. 0.68 [0.65-0.76], p = 0.002), and MACE (0.77 [0.72-0.81] vs. 0.70 [0.66-0.77], p = 0.006). Patients with elevated RRI had a significantly higher cumulative incidence of all long-term outcomes. After adjustment for baseline renal function and heart failure, elevated RRI was associated with persistent renal dysfunction (hazard ratio [HR], 5.82 [95% confidence interval, 1.71-19.9]), MAKE (HR, 4.21 [1.59-11.1]), and MACE (HR, 2.81 [1.03-7.65]). ConclusionsElevated preoperative RRI is associated with persistent renal dysfunction, MAKE and MACE after cardiac surgery. Preoperative RRI may be used for long-term risk assessment in patients undergoing cardiac surgery.

Hepatorenal syndrome: Updates.

Hepatorenal syndrome: Updates.

Circulating mannose-binding lectin concentration in patients with stable coronary artery disease is associated with heart failure and renal function

BackgroundMannose-binding lectin (MBL) has been associated with cardiovascular disease and its complications, the progression of diabetic nephropathy, and complement-mediated renal interstitial injury. However, the relationship between plasma MBL concentration with both heart failure and renal function is unclear. In this study, we examined associations of plasma MBL with both renal function and heart failure in patients with stable coronary artery disease (CAD). MethodsWe enrolled 348 consecutive stable CAD patients and used ELISA to evaluate plasma concentrations of MBL. Renal function was classified into KDIGO G1, G2 and G3a-G4 groups according to the eGFR of ≥ 90, 60–89 and 15–59, ml/min/1.73 m2, respectively. Patients with a left ventricular ejection fraction (LVEF) ≤ 40 % were classified to have heart failure. ResultsA significant positive association was found between MBL with diabetes mellitus, current smoker, blood urea nitrogen, creatinine, and brain natriuretic peptide, and a significant negative association was found between MBL with eGFR and LVEF. KDIGO stage G3a-G4 and heart failure increased along with tertiles of MBL (p for trend < 0.05). Multivariate analysis showed that compared to the patients with a low MBL concentration, the odds ratios of having KDIGO stage G3a-G4 were 1.89 (1.01–3.55) times and 2.37 (1.25–4.59) times higher for those with medium and high MBL concentrations. Furthermore, compared to the patients with a low MBL concentration, the OR of having heart failure were 1.97 (1.01–3.93) times higher for those with high MBL concentrations. Moreover, multivariate analysis showed an independent association between plasma MBL concentration with both KDIGO stage G3a-G4 and heart failure (LVEF < 40 %). In addition, the effect of MBL on both LVEF and eGFR was confirmed by structural equation model analysis. ConclusionThere are associations between circulating MBL concentration with both heart failure and renal function in stable CAD patients, suggesting that increased plasma MBL may contribute to the pathogenesis of both chronic kidney disease and heart failure.

Adverse cutaneous reactions to psychotropic drugs

IntroductionPsychotropic drugs are not devoid of side effects, especially cutaneous reactions, some of which are severe, and can jeopardize functional and life prognosis. The Aim of this study is to highlight the epidemiological and clinical features of severe cutaneous adverse reactions (SCARs) due to psychotropic drugs. Materials and methodsWe carried out a retrospective study over a period of 10years, It concerned all patients hospitalized in our dermatology department for SCARs induced by psychotropic drugs. The imputability was confirmed by the French methodology of Bégaud et al. ResultsWe identified 41 cases, of which 18 patients (43.9%) were being treated with psychotropic drugs for the first time. The most incriminated psychotropic drugs were: carbamazepine (n=16), phenobarbital (n=8), lamotrigine (n=5). Clinical forms were: drug reaction with eosinophilia and systemic symptoms syndrome (n=30), Stevens–Johnson syndrome (n=4), overlap syndrome (n=1), drug-induced vasculitis (n=4), symmetrical drug-related intertriginous and flexural exanthema syndrome (n=1), photosensitivity (n=1). Complications were as follows: hepatic cytolysis (75%), cholestasis (60%), functional renal failure (43%). Carbamazepine was statistically correlated with renal damage and cholestasis (P=0.013) and phenobarbital was associated with a risk of hepatic cytolysis (P=0.027). ConclusionCutaneous side effects to psychotropic drugs remain rare<2%. In our study, we found that rapid or recent increase in dose of anticonvulsants, or the combination of several psychotropic drugs is the most common cause of SCARs. We also found that carbamazepine was more likely to cause renal damage and cholestasis, whereas chlorpromazine was statistically correlated with hepatic cytolysis.

The AMD ANNALS: A continuous initiative for the improvement of type 2 diabetes care

AimsSince 2006, the Italian AMD (Associations of Medical Diabetologists) Annals Initiative promoted a continuous monitoring of the quality of diabetes care, that was effective in improving process, treatment and outcome indicators through a periodic assessment of standardized measures. Here, we show the 2022 AMD Annals data on type 2 diabetes (T2D). MethodsA network involving ∼1/3 of diabetes centers in Italy periodically extracts anonymous data from electronic clinical records, by a standardized software. Process, treatment and outcome indicators, and a validated score of overall care, the Q-score, were evaluated. Results295 centers provided the annual sample of 502,747 T2D patients. Overall, HbA1c value ≤7.0% was documented in 54.6% of patients, blood pressure <130/80 mmHg in 23.0%, and LDL-cholesterol levels <70 mg/dl in 34.3%, but only 5.2% were at- target for all the risk factors. As for innovative drugs, 29.0% of patients were on SGLT2-i, and 27.5% on GLP1-RAs. In particular, 59.7% were treated with either GLP1-RAs or SGLT2-i among those with established cardiovascular disease (CVD), 26.6% and 49.3% with SGLT2-i among those with impaired renal function and heart failure, respectively. Notably, only 3.2% of T2D patients showed a Q score <15, which correlates with a 80% higher risk of incident CVD events compared to scores >25. ConclusionsThe 2022 AMD Annals data show an improvement in the use of innovative drugs and in the overall quality of T2D care in everyday clinical practice. However, additional efforts are needed to reach the recommended targets for HbA1c and major CVD risk factors.

Disparities and Risk Factors for Surgical Complication in American Indians and Native Hawaiians

IntroductionAmerican Indian and Alaskan Natives (AIAN) and Native Hawaiian and Pacific Islanders (NHPI) research is limited, particularly in postoperative surgical outcomes. This study analyzes disparities in AIAN and NHPI surgical complications across all surgical types and identifies factors that contribute to postoperative complications. MethodsThis retrospective cohort study examined all surgeries from 2011 to 2020 in the National Surgical Quality Improvement Program, queried by race. Multivariable models analyzed the association of race and ethnicity and 30-day postoperative complication. Next, multivariable models were used to identify preoperative variables associated with postoperative complications, specifically in AIAN and NHPI patients. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated. ResultsAIAN patients were associated with higher odds of postoperative complication (AOR: 1.008 [CI: 1.005-1.011], P < 0.001) compared to non-Hispanic white patients. The comorbidities that were of higher incidence in AIAN patients, which also adversely contributed to postoperative complication, included dependent functional status, diabetes, congestive heart failure (CHF), open wounds, preoperative weight loss, bleeding disorders, preoperative transfusion, sepsis, hypoalbuminemia, along with an active smoking status and ASA ≥3. In NHPI patients, dependent functional status, CHF, renal failure, preoperative transfusion, open wounds, and sepsis were of higher incidence and significantly contributed to postoperative complication. ConclusionsSurgical outcome disparities exist particularly in AIAN patients. Identification of modifiable patient risk factors may benefit perioperative care for AIAN and NHPI patients, which are historically understudied racial groups.

Prognostic value of hyperuricemia in patients with heart failure

In patients with heart failure, hyperuricemia is often observed. The purpose of our study is to determine the relationship of serum uric acid with biochemical characteristics of heart failure and to determine its diagnostic and prognostic value for the outcome of the disease. Material and methods: the study was based on the results of the study of 117 patients with asymptomatic hyperuricemia who applied to the clinic from September 2019 to January 2022. We determined the relationship between serum uric acid and the characteristics of heart failure, using ROCK analysis we determined the sensitivity and specificity of uric acid for the outcome of heart failure. Results: Creatinine - r=0.478**, p=0.000 shows a reliable positive correlation with uric acid concentration; CRP - r=0.742**, p=0.000; BNP - r=0.599**, p=0.000, and eGFR - r=-0.184*, p=0.046 shows a reliable negative correlation; According to the degree of heart failure, the concentration of uric acid was distributed as follows: NYHAI - 5.48+0.94; NYHAII - 6.71+1.36; NYHAIII - 8.10+1.14; NYHA IV - 8.78+1.01 (F=29.24, p&lt;0.0001). sensitivity - 00.810(95%CI: 0.709-0.911); specificity - 0.814(95%CI: 0.714-0.913); predictive value of negative result 0.814(95%CI:0.714-0.913); Prognostic value of a positive result - 0.810(95%CI:0.709-0.911); Diagnostic accuracy of the test - 0.812(95%CI:0.741-0.883). Conclusions: Serum uric acid values correlate with renal function and heart failure characteristics. The value of uric acid can be used as an additional test to predict the outcome of heart failure.

A253 PRIMARY PROPHYLAXIS FOR SPONTANEOUS BACTERIAL PERITONITIS IN HOSPITALIZED CIRRHOTIC PATIENTS WITH LOW PROTEIN ASCITES AND RENAL DYSFUNCTION OR LIVER FAILURE: A RETROSPECTIVE REVIEW FROM A TERTIARY CENTRE IN BRITISH COLUMBIA

Abstract Background Spontaneous bacterial peritonitis (SBP) is a severe and often fatal infection that can occur in patients with cirrhosis and ascites. The benefits of primary prophylaxis with antibiotics for SBP have been demonstrated in patients with cirrhosis presenting with gastrointestinal (GI) bleeding; patients hospitalized for other reasons with an ascitic protein less than 10 g/L; and patients with ascitic protein less than 15 g/L with either impaired renal function (serum creatinine greater than 106 µmol/L, BUN greater than 8.9 mmol/L, or serum sodium less than or equal to 130 mEq/L) or liver failure (Child-Pugh score greater than or equal to 9 or bilirubin greater than 50 umol/L). Purpose To evaluate the rate of primary prophylaxis in patients discharged from a tertiary care hospital with low protein ascites and impaired renal function or liver failure, and subsequent episodes of SBP, hospitalizations, or deaths. Method A retrospective chart review at St. Paul’s Hospital in Vancouver, British Columbia, from November 2019 to August 2021 was conducted. Hospitalized patients with cirrhosis who had an ascitic protein less than 15 g/L and met criteria for either renal dysfunction or liver failure were included in the study. The rate of primary prophylaxis prescribed in eligible patients as well as the subsequent incidence of SBP, hospitalizations, or all-cause mortality were evaluated. Patients were followed up to 12 months after the index paracentesis. Result(s) A total of 279 patients with cirrhosis were hospitalized during the study period. 69 patients underwent a diagnostic paracentesis and 41 patients met the inclusion criteria for primary SBP prophylaxis. 28 patients were excluded with most common reasons being ascitic protein above 15 g/L (n=12), no documented ascitic protein concentration (n=9), or index paracentesis met the criteria for the diagnosis of SBP (n=5). Of the patients included, 37 (90.2%) did not receive primary prophylaxis. 8 of these patients (21.6%) developed subsequent SBP. 30 patients (81.1%) were hospitalized at least once in the following 12 months. 18 (48.6%) died during the follow-up period with 1 death attributed to SBP. 4 patients (9.76%) received primary prophylaxis and were prescribed either ciprofloxacin or trimethoprim/sulfamethoxazole. None of these patients developed SBP, however, 3 (75%) were hospitalized and died from other causes. Conclusion(s) The rate of primary prophylaxis for SBP in hospitalized patients with low protein ascites and impaired renal function or liver failure at our institution is low. The guarded prognosis in this subset of patients is also demonstrated. Further studies are needed to assess the root causes for the lack of primary prophylaxis given. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared