Risk Factor For Renal Complications Research Articles

Primary aldosteronism with mild autonomous cortisol secretion increases renal complication risk.

In primary aldosteronism (PA), renal impairment has been identified as an important comorbidity. Excess cortisol production also may lead to renal damage; thus, concomitant mild autonomous cortisol secretion (MACS) may predispose PA patients to renal disorders. However, there is limited evidence to support this claim. Therefore, this study aimed to determine whether the concurrence of MACS and PA increases the risk of renal complications. This study is a retrospective cross-sectional study. A total of 1310 patients with PA were stratified into two groups according to 1 mg dexamethasone suppression test (DST) results (cut-off post-DST serum cortisol 1.8 µg/dL): MACS (n = 340) and non-MACS (n = 970). The prevalence of renal complications was compared between the group. We also performed multiple logistic regression analysis to determine factors that increase the risk for renal complications. The prevalence of lowered estimated glomerular filtration rate (eGFR) and proteinuria was nearly twice higher in the MACS group than in the non-MACS group. Not only plasma aldosterone concentration (PAC) but also the presence of MACS was selected as independent factors that were associated with the two renal outcomes. The risk of lower eGFR or proteinuria in patients who had MACS and higher levels PAC was several folds higher than in those who had an absence of MACS and lower levels of PAC. MACS is an independent risk factor for renal complications in patients with PA, and MACS concomitant with higher aldosterone secretion in PA patients causes an increase in the risk of developing renal complications.

Renal Complications and Duration of Diabetes: An International Comparison in Persons with Type 1 Diabetes.

IntroductionRenal complications are both a marker of previous suboptimal glycaemic control and a major risk factor for cardiovascular disease in persons with type 1 diabetes (T1D). The aim of the study was to evaluate the prevalence of renal complications in persons with T1D in four geographical regions.MethodsNationwide registry data from Austria/Germany, Sweden and the US were used to estimate the prevalence of renal complications from January 2016 until September 2018. Chronic kidney disease (CKD) and albuminuria in the study population and each registry were analysed by diabetes duration. Risk factors for renal complications were described by registry.ResultsIn the total cohort of 78.926 adults with T1D, mean age was 44.4 ± 18.43 years and mean diabetes duration was 21.6 ± 22 years. Mean estimated glomerular filtration rate (eGFR) was 94.0 ± 31.45 ml/min, 13.0% had microalbuminuria and 3.9% had macroalbuminuria. Mean age, diabetes duration, use of insulin pumps and continuous glucose monitoring, as well as presence of albuminuria, varied between registries. Albuminuria was present in approximately 10% of persons with diabetes duration < 20 years and impaired renal function (eGFR < 60 ml/min) was present in 17%. In persons with diabetes duration > 40 years, approximately one-third had albuminuria and 25% had impaired renal function.ConclusionsThis analysis used three nationwide registries of persons with T1D. Despite recent use of more effective diabetes therapies, a substantial proportion of persons with T1D have renal complications at < 20 years after diagnosis. Efficient glucose-lowering and renal-protective strategies are needed in persons with T1D.

Complications of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy: An evaluation of 100 cases

To evaluate the perioperative outcomes and complications of patients with peritoneal carcinomatosis who underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC). This retrospective study included 100 patients operated on between 2016 and 2020. Patients' characteristics, including age, comorbidities, chemotherapy history, treatment failures, cancer type, histology, platinum sensitivity, and perioperative complications, were documented. Perioperative complications were classified according to the Clavien-Dindo classification. Median age was 58years and median follow-up time was 16months. Eighty-six (86%) patients had ovarian cancer; 11 (11%) experienced grade III-IV complications, and the only relevant factor was the presence of multiple metastasis (P=0.031). Seven patients (7%) had surgical-site infection; in multivariant analyses, only ostomy formation was found as an independent risk factor for surgical-site infection (odds ratio [OR] 14.01; 95% confidence interval [CI] 1.36-143.52; P=0.024). Fifteen (15%) patients experienced elevated serum creatinine after surgery and the median time to creatinine elevation was 5days postoperatively (range 3-15days). In multivariant analyses, only age of of 58years or more was found as a significant factor for the elevation of serum creatinine (OR 6.96; 95% CI 1.42-32.81; P=0.014). Our results showed that the presence of multiple metastases increased the risk of grade III-IV complications and age of 58years or more was the leading risk factor for renal complications. However, we could not find a relation between postoperative complications and oncologic outcomes. HIPEC seems to be a safe approach in experienced hands.

300. Continued inpatient care following elective anterior cervical discectomy and fusion increases the risk of 30-day readmissions and post-discharge complications

BACKGROUND CONTEXT With a shift toward value-based and bundled-payment models, identification of areas of cost and quality improvement will be required. Though abundant literature is present on the predictors of discharge destinations, few studies have studied the impact of discharge to an inpatient care facility (skilled-care or rehabilitation) on post-discharge outcomes following elective spine surgery. PURPOSE We sought to collate evidence using a large national multi-center surgical database to assess the clinical impact of continued post-discharged inpatient care (skilled care facility or inpatient rehabilitation unit) on 30-day complications, readmissions and mortality after elective anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING This was a retrospective study done using the 2015-2016 American College of Surgeons (ACS) – National Surgical Quality Improvement Program (NSQIP) database. PATIENT SAMPLE Current Procedural Terminology (CPT) codes for ACDF (CPT- 22551, 22552) were used to identify patients from the database. Only elective ACDFs being done for ≤3 levels were included in the study. Patients undergoing additional posterior cervical spine procedures (instrumentation, laminectomy, laminotomy, etc.) were excluded from the analysis. In addition, patients undergoing surgery for cervical fracture, malignancy and spinal deformity were also excluded. Finally data was filtered to remove for missing variables to prevent any confounding in analysis. Discharge disposition was defined as discharge to an inpatient care facility (skilled care or rehabilitation) vs home. Those patients being discharged to other destinations such as acute care hospitals, unskilled facilities and assisted living facilities were excluded from the analysis to ensure that the results are relevant to the objective of the study. OUTCOME MEASURES Thirty day postdischarge complications, reoperations, redmissions and mortality. METHODS Multivariate logistic regression analyses were used to assess for the independent impact of discharge to an inpatient care facility vs home on the odds of experiencing 30-day post-discharge complications, readmissions, reoperations and mortality, while controlling for preoperative, intraoperative and predischarge clinical factors and patient characteristics. RESULTS A total of 15,624 patients were finally included for analysis. A total of 459 (2.9%) patients were discharged to an inpatient care (skilled care or rehabilitation) facility. Age of ≥65 years, Black or African-American race, partially dependent or totally dependent functional health status, a LOS ≥3 days, a total operative time>150 mins, ASA grade>II and inpatient surgery were significant predictors for a discharge to skilled care/rehabilitation facility. Following adjustment for predischarge clinical characteristics, discharge to an inpatient care facility was an independent significant risk factor for renal complications (OR 8.22 [95% CI 1.84-36.7]; p=0.006) and 30-day readmissions (OR 1.63 [95% CI 1.09-2.42]; p=0.016). CONCLUSIONS Discharge to inpatient care facilities following elective ACDF is associated with higher odds of renal complications and 30-day readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimize the risk of complications. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Discharge to skilled-care or rehabilitation following elective anterior cervical discectomy and fusion increases the risk of 30-day re-admissions and post-discharge complications.

With a shift toward value-based and bundled-payment models, identification of areas of cost and quality improvement will be required. Though abundant literature is present on the predictors of discharge destinations, few studies have studied the impact of discharge to a skilled-care or rehabilitation facility on post-discharge outcomes following elective spine surgery. The 2015-2016 ACS-NSQIP database was queried using Current Procedural Terminology (CPT) codes 22551 and 22552 to retrieve records of patients undergoing ACDF (≤3 levels). Patients who had concurrent posterior cervical spine procedures and surgery for malignancy and spinal deformity were excluded. A total of 15,624 patients were finally included for analysis, 459 (2.9%) patients were discharged to a skilled care or rehabilitation facility. Age of ≥65 years, Black or African-American race, partially dependent or totally dependent functional health status, a LOS ≥3 days, a total operative time >150 min, ASA grade > II and inpatient surgery were significant predictors for a discharge to skilled care/rehabilitation facility. Following adjustment for pre-discharge clinical characteristics, discharge to skilled care or rehabilitation was an independent significant risk factor for renal complications (OR =8.22; 95% CI, 1.84-36.7; P=0.006) and 30-day readmissions (OR =1.63; 95% CI, 1.09-2.42; P=0.016). Discharge to skilled-care or rehabilitation facilities following elective ACDF is associated with higher odds of renal complications and 30-day readmissions. These results stress the importance of careful patient selection prior to discharge to inpatient care facilities to minimize the risk of complications.

Prevalence and determinants of microalbuminuria in children suffering from sickle cell anemia in steady state.

BackgroundSickle cell anemia (SCA) is considered a major risk factor for renal complications. The main goal of this study was to determine the frequency of macroalbuminuria and microalbuminuria in Congolese children <18 years of age suffering from Sickle cell anemia and to identify associated factors.MethodsThe cross-sectional study was completed in 150 hemoglobin-SS children (77 boys and 73 girls). Microalbuminuria was defined by a urine albumin:creatinine ratio of 30–299 mg/g.ResultsThe mean age of this group was 8.8 ± 4.3 years (range 2–18). Microalbuminuria was found in 27 children (18%). In multivariate logistic regression, only age emerged as a determinant of microalbuminuria odds ratio 1.11 (95% confidence interval 1.00–1.22); P = 0.042].ConclusionsIn our series, only age was a major determinant of the occurrence of microalbuminuria. These results confirm the need for early screening of microalbuminuria in Congolese children suffering from Sickle cell anemia in a context where access to renal and bone marrow transplant is nonexistent.

Predictors of renal dysfunction after endovascular and open repair of abdominal aortic aneurysms

ObjectiveRenal complications after repair of abdominal aortic aneurysms (AAAs) have been associated with increased morbidity and mortality. However, limited data have assessed risk factors for renal complications in the endovascular era. This study aimed to identify predictors of renal complications after endovascular AAA repair (EVAR) and open repair. MethodsPatients who underwent EVAR or open repair of a nonruptured infrarenal AAA between 2011 and 2013 were identified in the National Surgical Quality Improvement Project Targeted Vascular module. Patients on hemodialysis preoperatively were excluded. Renal complications were defined as new postoperative dialysis or creatinine increase >2 mg/dL. Patient demographics, comorbidities, glomerular filtration rate (GFR), operative details, and outcomes were compared using univariate analysis between those with and without renal complications. Multivariable logistic regression was used to identify independent predictors of renal complications. ResultsWe identified 4503 patients who underwent elective repair of an infrarenal AAA (EVAR: 3869, open repair: 634). Renal complication occurred in 1% of patients after EVAR and in 5% of patients after open repair. There were no differences in comorbidities between patients with and without renal complications. A preoperative GFR <60 mL/min/1.73m2 occurred more frequently among patients with renal complications (EVAR: 81% vs 37%, P < .01; open: 60% vs 34%, P < .01). The 30-day mortality was also significantly increased (EVAR: 55% vs 1%, P < .01; open: 30% vs 4%, P < .01). After adjustment, renal complications were strongly associated with 30-day mortality (odds ratio [OR], 38.3; 95% confidence interval [CI], 20.4-71.9). Independent predictors of renal complications included GFR <60 mL/min/1.73m2 (OR, 4.6; 95% CI, 2.4-8.7), open repair (OR, 2.6; 95% CI, 1.3-5.3), transfusion (OR, 6.1; 95% CI, 3.0-12.6), and prolonged operative time (OR, 3.0; 95% CI, 1.6-5.6). ConclusionsPredictors of renal complications include elevated baseline GFR, open approach, transfusion, and prolonged operative time. Given the dramatic increase in mortality associated with renal complications, care should be taken to use renal protective strategies, achieve meticulous hemostasis to limit transfusions, and to use an endovascular approach when technically feasible.

Monitoring for proteinuria in patients with type 2 diabetes mellitus

ObjectiveThe UK National Institute for Health and Care Excellence (NICE) guideline on diabetes recommends at least annual monitoring of patients with type 2 diabetes mellitus (T2DM) for proteinuria. To date,...

Assessment of long-term renal complications in extremely low birth weight children

We assessed the long-term renal complications in a regional cohort of extremely low birth weight (ELBW) children born in 2002–2004. The study group, comprising 78 children born as ELBW infants (88% of the available cohort), was evaluated with measurement of serum cystatin C, urinary albumin excretion, renal ultrasound, and 24-h ambulatory blood pressure measurements. The control group included 38 children born full-term selected from one general practice in the district. Study patients were evaluated at a mean age of 6.7 years, and had a median birthweight of 890 g (25th–75th percentile: 760–950 g) and a median gestational age of 27 weeks (25th–75th percentile: 26–29 weeks). Mean serum cystatin C levels were significantly higher (0.64 vs. 0.59 mg/l; p = 0.01) in the ELBW group. Hypertension was diagnosed in 8/78 ELBW and 2/38 of the control children (p = 0.5). Microalbuminuria (>20 mg/g of creatinine) was detected only in five ELBW children (p = 0.17). The mean renal volume was significantly lower in the ELBW group (absolute kidney volume 81 ml vs. 113 ml; p < 0.001, relative kidney volume 85 vs. 97%; p < 0.001). Abnormally small kidneys (<2/3 of predicted size) were detected in 19 ELBW and four control children (p = 0.08). Multivariate logistic regression revealed that the only independent risk factor for renal complications was weight gained during neonatal hospitalization (odds ratio: 0.67; 95% confidence interval: 0.39–0.94). Serum cystatin C and kidney volume are significantly lower in school-age ELBW children. It is important to include systematic renal evaluation in the follow-up programs of ELBW infants.

ELEVATED SYMPATHETIC NERVOUS ACTIVITY IS RELATED TO THE DEVELOPMENT OF RENAL INJURY IN PATIENTS WITH DIABETES AND/OR HYPERTENSION: PP.30.189

Objective: Hypertension (HT) and diabetes (DM) are known as risk factors for renal complications and end-stage renal disease (ESRD). Elevated sympathetic nervous activity (SNA) is known as its association with HT and DM, and as a cardiovascular risk factor. To evaluate the role of SNA on the development of renal injury in patients with HT or DM, we conducted this study. Methods: Plasma norepinephrine (NE), insulin, leptin, BMI, total body fat-mass and blood pressure (BP) were measured in 4 study groups according to renal function using K/DOQI. i) 290 men with stage-1 (normal renal function, HT alone=63, DM alone=43, HT+DM=41, nonHT+nonDM=143), ii) 41 men with stage-2 (HT=20, DM=7, HT+DM=9, nonHT+nonDM=5), iii) 37 men with stage-3 or 4 (HT=15, DM=7, HT+DM=8, nonHT+nonDM=7) and iv) 73 men with stage-5 (ESRD, HT=23, DM=24, HT+DM=15, nonHT+nonDM=11, follow-up average=8.4yrs). Results: Plasma NE and BP levels were significantly greater in subjects with stage-5 (ESRD)>stage-3 or 4>stage-2>stage-1 (normal renal function), but plasma insulin, leptin, BMI and fat-mass were greater in stage-1>stage-2>stage-3 or 4>stage-5. Plasma NE, insulin, BMI and fat-mass were greater in HT+DM>DM>HT>nonHT+nonDM in the groups with stage 1–4, however BP levels were greater in HT+DM>HT>DM>nonHT+nonDM. Importantly plasma NE, insulin and BP levels were higher in subjects with DM+HT than DM alone or HT alone. In ESRD patients, plasma NE, leptin, BMI and fat-mass were greater in patients with short-term hemodialysis (<1 yrs) compared to long-term (>8 yrs), although insulin did not change with the duration of hemodialysis. Plasma NE correlated with systolic BP, creatinine and GFR in all subjects especially with moderate renal injury (stage 2–4), but insulin, leptin, BMI or fat-mass did not. In multiple regression analysis, plasma NE was a significant determinant for systolic BP, creatinine and GFR in all subjects. Conclusions: Plasma NE was closely linked to the development and stage of renal injury (GFR). SNA plays an important role in renal injury and BP levels especially in diabetes and hypertension.

Clinical outcomes of octogenarians undergoing contemporary percutaneous coronary intervention

Renal complications after repair of abdominal aortic aneurysms (AAAs) have been associated with increased morbidity and mortality. However, limited data have assessed risk factors for renal complications in the endovascular era. This study aimed to identify predictors of renal complications after endovascular AAA repair (EVAR) and open repair.Patients who underwent EVAR or open repair of a nonruptured infrarenal AAA between 2011 and 2013 were identified in the National Surgical Quality Improvement Project Targeted Vascular module. Patients on hemodialysis preoperatively were excluded. Renal complications were defined as new postoperative dialysis or creatinine increase >2 mg/dL. Patient demographics, comorbidities, glomerular filtration rate (GFR), operative details, and outcomes were compared using univariate analysis between those with and without renal complications. Multivariable logistic regression was used to identify independent predictors of renal complications.We identified 4503 patients who underwent elective repair of an infrarenal AAA (EVAR: 3869, open repair: 634). Renal complication occurred in 1% of patients after EVAR and in 5% of patients after open repair. There were no differences in comorbidities between patients with and without renal complications. A preoperative GFR <60 mL/min/1.73m2 occurred more frequently among patients with renal complications (EVAR: 81% vs 37%, P < .01; open: 60% vs 34%, P < .01). The 30-day mortality was also significantly increased (EVAR: 55% vs 1%, P < .01; open: 30% vs 4%, P < .01). After adjustment, renal complications were strongly associated with 30-day mortality (odds ratio [OR], 38.3; 95% confidence interval [CI], 20.4-71.9). Independent predictors of renal complications included GFR <60 mL/min/1.73m2 (OR, 4.6; 95% CI, 2.4-8.7), open repair (OR, 2.6; 95% CI, 1.3-5.3), transfusion (OR, 6.1; 95% CI, 3.0-12.6), and prolonged operative time (OR, 3.0; 95% CI, 1.6-5.6).Predictors of renal complications include elevated baseline GFR, open approach, transfusion, and prolonged operative time. Given the dramatic increase in mortality associated with renal complications, care should be taken to use renal protective strategies, achieve meticulous hemostasis to limit transfusions, and to use an endovascular approach when technically feasible.