Risk Factors For Renal Failure Research Articles

Human omentin-1 reduces vascular insulin resistance and hypertension in Otsuka Long-Evans Tokushima Fatty rats.

Hypertension is one of the major risk factors for renal failure and cardiovascular diseases, and is caused by various abnormalities including the contractility of blood vessels. Otsuka Long-Evans Tokushima Fatty (OLETF) rats, which mimic human type 2 diabetes, are frequently used to study obesity-induced insulin resistance (IR) and hypertension. Human omentin-1 is one of the recently identified adipocytokines. We previously demonstrated that human omentin-1 not only caused vasodilation in rat isolated blood vessels, but also prevented inflammatory responses, a possible mechanism relating IR, in human vascular endothelial cells. Taken together, we hypothesized that human omentin-1 may reduce obesity-induced IR and hypertension in OLETF rats. OLETF rats were intraperitoneally administered with human omentin-1 for 7days. Human omentin-1 had no influence on overweight, hyperglycemia, urinary glucose extraction, hyperinsulinemia, and systemic IR in OLETF rats. Human omentin-1 decreased systolic blood pressure in OLETF rats. The measurement of isometric contraction revealed that human omentin-1 had no influence on the agonist-induced contractile and relaxant responses in isolated thoracic aorta from OLETF rats. However, the relaxant response mediated by human insulin was converted into the contractile response in thoracic aorta from OLETF rats, which was prevented by human omentin-1. The Western blotting revealed that human omentin-1 improved the decrease in endothelial nitric oxide synthase activation in isolated thoracic aorta from OLETF rats. In summary, we for the first time revealed that human omentin-1 partly reduces vascular IR and thereby inhibits hypertension in OLETF rats.

Associated risk factors of renal failure among patients attending Hemodialysis center at Al-Thwara Authority Hospital in IBB city, Yemen: A cross sectional study

Background: Chronic renal failure is a major public health problem. Identifying individual’s risk factors are important to prevent infection of chronic renal failure. Objective: this study aimed to highlight the risk factors associated with chronic renal failure for patients attending hemodialysis center at Al-Thwara Authority Hospital in Ibb city, Yemen. Methods: the study is hospital-based cross sectional study. A total 100 patients collected randomly from hemodialysis centre at Al-Thwara Authority Hospital in Ibb, Yemen. Socio-demographic data, behavioral factors, medical history determined using a standardized questionnaire and analyzed by using IBM SPSS version 22 and Microsoft Excel. Results: the mean age of patients was 45.75 years, and most of them were in the range of 38-46 years. Males were 60% and 40% were females. Married subjects represented 86% and 38% of patients had primary education. Of the 100 respondents, 83% drink tap water, 86%Khat chewers, 75% consume soft drinks, 51% smokers, 48% had urinary tract infections and 30% urinary stones. Participants who used non-steroidal anti-inflammatory drugs represent 29% of the sample, 18% had heart disease and 14% of patients had pervious malaria infection. About 46% of the patients were hypertensive before their infection with renal failure, and 16% diabetics. There is association between gender of patients and heart diseases and malaria infection. Statistics correlation between age of patients and Khat chewing and smoking was estimated. Conclusion: this study suggests that, khat chewing, consumption of tap water, soft drinks and smoking increase the risk of chronic renal failure among Yemenis.

#2777 RISK FACTORS ASSOCIATED WITH OUTCOMES IN PATIENTS WITH HENOCH - SCHӧNLEIN PURPURA NEPHRITIS

Abstract Background and Aims Henoch - Schӧnlein purpura (HSP) is an immuno-mediated small-vessel vasculitis that manifests as non—thrombocytopenic purpura, arthritis or arthralgia, abdominal pain and/or kidney involvement. HSP nephritis can presented is micro- or macroscopic hematuria, proteinuria, nephrotic or nephritic syndrome, as well as acute renal failure. The aim of the study is to identify risk factors associated with unfavorable outcomes in patients with HSP nephritis. Method This retrospective study enrolled 68 patients with HSP nephritis. Renal and extra-renal symptoms were analyzed. A diagnosis of HSP nephritis was made when hematuria and/or proteinuria, and/or renal failure was associated with a palpable purpuric eruption or abdominal or joint pains (at least two of these three clinical signs) and predominant mesangial IgA immune deposits, confirmed by renal biopsy. The patients were subdivided into five classes according to the renal manifestation at onset of disease: 1) micro- or macroscopic hematuria; 2) mild proteinuria (<1 g/L) ± hematuria; 3) acute nephritic syndrome, defined as moderate proteinuria, hematuria, increased serum creatinine and/or hypertension; 4) nephrotic syndrome; 5) mixed nephritic-nephrotic syndrome. Results Of 68 patients with HSP nephritis, diagnosed by kidney biopsy, 41 (60,29%) were male and 27 (39,71%) - female. Age of onset was between 18 and 66 years (mean 37,28 ± 9,34). Duration of follow-up was between 2 and 28 years. 29 patients had histories of infection preceding presentation. At onset all patients had palpable purpura and urinary abnormalities (only hematuria - in 16,18%; mild proteinuria ± hematuria – in 44,12%; moderate or severe proteinuria and hematuria – in 39,70%). Arthralgias were present in 49 patients (72,06%), gastrointestinal involvement – in 32 patients (47,05%). Renal function was impaired in 26,47% of patients, and 51,47% were hypertensive. Mesangial hypercellularity lesions were found in most patients (97,06%), endocapillary proliferation – in 20,58%, segmental sclerosis – in 32,35%, tubular atrophy/interstitial fibrosis – in 38,23%. Corticosteroids and cyclophosphamide were prescribed in patients who presented with severe clinical and histological features and/or rapidly progressing renal disease. During follow-up classical extra-renal organ diseases were seen in 55,88% of patients, and hematuria and/or proteinuria – in 77,94%. At final review 26,47% had progression of renal failure. Risk factors for renal failure were moderate or severe proteinuria during follow-up (p<0,001), renal impairment at presentation (p<0,001), hypertension at presentation and during follow up (p<0,05), crescents, interstitial fibrosis and tubular atrophy (p<0,001). No significant difference in renal outcome was observed between patients who had relapses in extra-renal organs versus in those who did not. Conclusion Our results indicated that lower GFR, nephrotic syndrome, nephritic-nephrotic syndrome and crescentic nephritis were risk factors for unfavorable outcomes.

Burden, socio-demographic and other risk factors associated with haemodialysis in North-west Nigeria: A retrospective multicentre analysis.

Kidney diseases requiring haemodialysis are becoming an emerging public health problem. This study aimed to determine the burden, socio-demographic and other risk factors associated with haemodialysis in Northwest Nigeria. The study was a retrospective multicentre review of secondary data from the dialysis centres of public hospitals in northwestern Nigeria. Risk factors for renal failure were examined in 1329 patients who were enrolled for haemodialysis between 2019 and 2022 in the four public dialysis centres in Kano and Jigawa state. Data were analysed using IBM SPSS Statistics for Windows, version 22.0, with statistical significance set at P ≤ 0.05. The minimum age of the patients was 2 years and the maximum was 100 years with a median of 48 (interquartile range = 31, 60) years. Chronic kidney disease (CKD) was found amongst more than two-thirds 998 (75.1%) of the patients. Up to 51 (3.8%), 62 (4.7%) and 10 (0.8%) were seropositive for HIV, hepatitis B and hepatitis C, respectively. Acute kidney injury (AKI) was significantly higher (67.9%, P < 0.001) amongst patients with post-partum haemorrhage (PPH), and were 24 times more likely to develop AKI when compared with those with no PPH (adjusted odds ratio [aOR] =24, 95% confidence interval [CI] = [13.5-44.5]). CKD was significantly higher amongst patients with hypertension (HTN) (84.9%, P < 0.001), and were 3.2 times more likely to develop CKD compared with non-hypertensives (aOR = 3.2, 95% CI = [2.4-4.1]). Acute on CKD (AOCCKD) was significantly higher amongst patients with chronic glomerulonephritis (CGN) (28.1%, P < 0.001), and were three times more likely to develop AOCCKD than those without CGN (aOR = 3, 95% CI = [2.1-4.2]). PPH was the major reason for AKI related haemodialysis while diabetes and HTN were the major causes of CKD-requiring haemodialysis. CGN was more amongst patients who had dialysis due to acute exacerbation of CKD. The government and relevant stakeholders should ensure a favourable policy for the screening and management of patients.

S-41-5: NEW INSIGHTS INTO THE OPTIMAL ANTIHYPERTENSIVE THERAPY IN CKD PATIENTS

Chronic kidney disease (CKD) is defined as continuous existence of reduced renal function, estimated glomerular filtration rate (eGFR) &lt; 60 mL/min/1.73m2, and/or proteinuria including microalbuminuria. CKD patients are not only prone to progress to renal failure but also at high risk for developing cardiovascular diseases (CVD) as the concept of cardio-renal syndrome is assumed. As the cause of CKD, diabetic kidney disease and nephrosclerosis are dominating and their progression is promoted by aging and lifestyle-related diseases (LSD) such as hypertension and diabetes. Therefore, in order to maximally prevent renal failure and CVD in CKD patients, aggressive intervention achieving strict control of LSD starting at its earliest stage is important. Renal function is generally evaluated by eGFR, however, the fundamental aspect of renal function is renal blood flow or renal plasma flow (RPF), and the decrease of RPF is compensated by the increase in filtration fraction yielding the maintenance of GFR value. Accordingly, if eGFR is less than 60, it should be recognized that the extent of renal injury is not mild but moderate or worse. However, the measurement of RPF requires laborious and invasive procedure. Albuminuria may reflect the increase in glomerular capillary pressure (glomerular hypertension) elicited by reduced nephron number but the urinary albumin excretion is highly variable and is not necessarily parallel to the degree of renal injury. Among LSD, hypertension plays a pivotal role as the risk factor for renal failure and CVD, and the strict blood pressure control targeting &lt; 130/80mmHg is recommended in the guidelines. As antihypertensive agents, renin-angiotensin system inhibitors such as ARB and ACE inhibitors are preferred because of dilating the efferent arterioles resulting in the alleviation of glomerular hypertension and the reduction in albuminuria. Calcium channel blockers have advantage in preserving RPF and GFR by dilating the afferent arterioles. In addition, recent randomized controlled trials have demonstrated that sodium-glucose cotransporter 2 inhibitors retard the GFR decrease in diabetic and non-diabetic CKD patients. Angiotensin receptor neprilysin inhibitor, now used for hypertension, has also been shown to reduce the risks of GFR decrease and worsening of renal function in heart failure patients. Nonsteroidal mineralocorticoid receptor antagonists are expected to provide renoprotective effects such as albuminuria reduction with affordable risk of hyperkalemia. Thus, in future strategy of antihypertensive therapy for CKD aiming maximum renal and cardiovascular protection, practical evaluation of renal injuries at early stages and incorporation of drugs with new evidence are the key issues.

Oxidative Stress and Mitochondrial Dysfunction in Chronic Kidney Disease

The kidney contains many mitochondria that generate ATP to provide energy for cellular processes. Oxidative stress injury can be caused by impaired mitochondria with excessive levels of reactive oxygen species. Accumulating evidence has indicated a relationship between oxidative stress and kidney diseases, and revealed new insights into mitochondria-targeted therapeutics for renal injury. Improving mitochondrial homeostasis, increasing mitochondrial biogenesis, and balancing mitochondrial turnover has the potential to protect renal function against oxidative stress. Although there are some reviews that addressed this issue, the articles summarizing the relationship between mitochondria-targeted effects and the risk factors of renal failure are still few. In this review, we integrate recent studies on oxidative stress and mitochondrial function in kidney diseases, especially chronic kidney disease. We organized the causes and risk factors of oxidative stress in the kidneys based in their mitochondria-targeted effects. This review also listed the possible candidates for clinical therapeutics of kidney diseases by modulating mitochondrial function.

A study on thyroid, lipid profile and eGFR, protein-creatinine ratio, on assessing risk factor for renal failure

Aim: To assess the risk factors for renal dysfunction in a heterogeneous population. To determine the age and sex wise distribution of eGFR and Urinary spot Protein- Creatinine ratio (UPCR) in a heterogeneous population. To estimate the lipid profile and thyroid profile and assess their role as risk factor in renal dysfunction. Introduction: Chronic Kidney Disease (CKD), is a major health problem in India. As per the Kidney Diseases Improving Global Outcomes (KDIGO) 2012, CKD is defined1 as abnormalities of kidney structure or function present for more than three months. Thyroid hormones were also found to influence GFR, tubular secretion and absorption.16,17One study has shown that normal to high levels of Thyroid Stimulating Hormone (TSH) and normal to low levels of free triiodothyronine (FT3) were associated with increased risk of CKD in euthyroid subjects.18 It is also said that high level of serum free thyroxine (FT4) was associated with increased risk of CKD rather than TSH and FT3.There was also associated rapid decline in eGFR.19Many studies have found that hypothyroidism is associated with dyslipidemia and renal dysfunction.

Prognostic Nutritional Index as a Predictor of Diabetic Nephropathy Progression.

Malnutrition and immunologic derangement were not uncommon in patients with chronic kidney disease (CKD). However, the long-term effects of prognostic nutritional index (PNI), an immunonutrition indictor, on renal outcomes in patients with diabetic nephropathy (DN) and type 2 diabetes mellitus (T2DM) are unknown. In this retrospective cohort study, 475 patients with T2DM and biopsy-confirmed DN from West China Hospital between January 2010 and September 2019 were evaluated. PNI was evaluated as serum albumin (g/L) + 5 × lymphocyte count (109/L). The study endpoint was defined as progression to end-stage renal disease (ESRD). The Cox regression analysis was performed to investigate the risk factors of renal failure in DN patients. A total of 321 eligible individuals were finally included in this study. The patients with higher PNI had a higher eGFR and lower proteinuria at baseline. Correlation analysis indicated PNI was positively related eGFR (r = 0.325, p < 0.001), and negatively correlated with proteinuria (r = −0.68, p < 0.001), glomerular lesion (r = −0.412, p < 0.001) and interstitial fibrosis and tubular atrophy (r = −0.282, p < 0.001). During a median follow-up of 30 months (16–50 months), the outcome event occurred in 164(51.09%) of all the patients. After multivariable adjustment, each SD (per-SD) increment of PNI at baseline was associated with a lower incidence of ESRD (hazard ratio, 0.705, 95% CI, 0.523–0.952, p = 0.023), while the hypoalbuminemia and anemia were not. For the prediction of ESRD, the area under curves (AUC) evaluated with time-dependent receiver operating characteristics were 0.79 at 1 year, 0.78 at 2 years, and 0.74 at 3 years, respectively, and the addition of PNI could significantly improve the predictive ability of the model incorporating traditional risk factors. In summary, PNI correlated with eGFR and glomerular injury and was an independent predictor for DN progression in patients with T2DM. Thus, it may facilitate the risk stratification of DN patients and contribute to targeted management.

Preventive effect of 20 mEq and 8 mEq magnesium supplementation on cisplatin-induced nephrotoxicity: a propensity score–matched analysis

The protective effect of magnesium (Mg) supplementation against cisplatin (CDDP)-induced nephrotoxicity has been widely described; however, the optimal dose of Mg supplementation is unclear. The aim of this study was to investigate whether 20mEq of Mg supplementation is more effective than 8mEqMg in preventing CDDP-induced nephrotoxicity, as well as the associated risk factors, in cancer patients treated with CDDP-based chemotherapy. Pooled data of 272 patients receiving 20mEq or 8mEqMg supplementation to CDDP-based chemotherapy from a multicenter, retrospective, observational study were compared using propensity score matching. Separate multivariate logistic regression analyses were used to identify the risk factors for renal failure induced by each treatment dose. There was no significant difference in the incidence of nephrotoxicity between the 8mEq and 20mEq groups (P = 0.926). There was also no significant difference in the severity of nephrotoxicity, elevated serum creatinine levels, and decreased estimated creatinine clearance levels between the two groups. Cardiac disease and albumin levels were identified as independent risk factors for CDDP-induced nephrotoxicity. We did not find an advantage of 20mEq over 8mEqMg supplementation in terms of a preventive effect against CDDP-induced nephrotoxicity. The optimal dose of Mg supplementation for the prevention of CDDP-induced nephrotoxicity remains unknown, and further studies are warranted.

“Recurrent Papillary Necrosis and Nephrocalcinosis Induced by Nonsteroidal Anti-Inflammatory Drugs for Gouty Arthritis Associated with Congenital Chloride-Losing Diarrhea: A Major Risk for Kidney Loss”

Congenital chloride-losing diarrhea (CCLD) is a rare genetic disorder due to autosomal recessive mutation in the SLC26A3 gene on chromosome 7. It is characterized with chronic watery diarrhea with high fecal chloride (Cl: >90 mmol/L), low potassium (K), and metabolic alkalosis with low urinary Cl and K. The overall long-term prognosis is favorable with optimal life-long salt and K supplementation. In this case report, we describe a man with progressive renal failure and small kidneys that showed nephrocalcinosis and papillary necrosis. His disease was diagnosed since birth and was confirmed by our tests. He was incompliant with therapy and had developed gout. The latter complication of his disease has led to excessive NSAID use over the past years. Reinstitution of diet, drug therapy, and allopurinol had stabilized his renal disease for 1 year of follow-up. In conclusion, excessive analgesic use is a risk factor for renal failure in CCLD.

Clinical Characteristics and Prognosis of Renal Thrombotic Microangiopathy in Lupus Nephritis

Introduction. LN is an important complication affecting the prognosis of SLE. We retrospectively analysed the influence of thrombotic microangiopathy (TMA) on LN, identified risk factors of TMA in LN and renal failure in LN-TMA, and evaluated the availability of plasmapheresis. Methods. After balancing epidemiological characteristics and pathological types between groups, 127 patients (LN-TMA:42, LN:85) were included. After consulting medical records and followup data, we used the corresponding statistical methods, such as chi-squared test and Student’s t-test, to compare differences in various aspects and explore the correlation among factors. Results. LN-TMA patients had significantly higher blood urea nitrogen (13.2 mmol/L vs. 7.5 mmol/L, P < .001), systolic and diastolic blood pressures (both P < .01), serum creatinine (157.75 μmol/L vs. 79.00 μmol/L, P < .001), lactic dehydrogenase (P < .05), renal activity index (8.00 vs. 2.00; P < .001), SLE disease activity index score (13.8 ± 3.4 vs. 10.88 ± 6.0; P < .01), and pleurisy (P < .01) and lower haemoglobin (84.4 ± 20.14 vs. 99.38 ± 23.45 g/L, P < .05), platelets (87 vs. 155 ×109/L, P < .001), estimated glomerular filtration rate (39.24 vs. 97.40 mL/min/ 1.73m2, P < .05), and 3- and 5-year renal survival rates (P < .001 and P < .01, respectively) than non- TMA patients. Infection and TMA (P < 0.01) were independent risk factors for LN-TMA and renal failure, respectively. There was no obvious effect of plasmapheresis. Conclusion. TMA is an independent risk factor for renal failure in LN. As TMA affects the severity and prognosis of LN, identifying specific diagnostic indicators and effective treatment for LN is necessary.

Evaluation of Aflatoxin B1 and Patulinin Blood of Iraqi Renal Failure patients

Objectives: The current study aimed to investigate and evaluatethe Aflatoxin B1 and Patulin in bloodsamples of patients with Renal Failure.Method: Hundred fifty blood samples collected from patients with Renal Failure were included in thisstudy. The agerange of patients was 1-61 years. Toxin extraction from the samples was done by Thin LayerChromatography technique (TLC).Results: There were 100 from 150 samples of blood containedAflatoxinB1and Patulin. The highestpercentage blood samples contamination with Aflatoxin B1 was (18.181 %) at age group (11-30) years andPatulin was (20 %) that collected from persons at age group (11-20) years,the percentage of blood samplesthat contamination withAflatoxin B1 and Patulin that collected from the female was (52.727 % and 53.33%).Conclusion: Persons in Najaf province high exposure to mycotoxins from foods (apples,pear and peach)that present in local markets, that are contaminated with mycotoxins. This suggests that these mycotoxinsmay be a risk factor of renal failure.

Renal Failure among Women of Reproductive Age in Burundi: Estimating the Prevalence and Associated Factors Using Population-Based Data.

Background Renal failure is a leading cause of morbidity and mortality in many resource-constrained settings. In developing countries, little has been known about the prevalence and predisposing factors of renal failure using population-based data. The objective of this study was to examine the prevalence and associated factors of renal failure among women of reproductive age in Burundi. Methods We used nationally representative cross-sectional data from the 2016-2017 Burundi Demographic and Health Survey (BDHS). Data on 17,269 women of reproductive age were included. The outcome variable was a renal failure as determined by the patient's report. Percentage, chi-square test, and multivariable logistic regression model were used to analyze the data. The results from the logistic regression model were presented as adjusted odds ratio (AOR) and confidence interval (95% CI). The significance level was set at p < 0.05. Results The overall prevalence of renal failure was 5.0% (95% CI: 4.4%, 5.7%). Higher-aged women were more likely to have a renal failure when compared with women aged 15–19 years. Rural dwellers were 1.65 times as likely to have a renal failure when compared with women in the urban residence (AOR = 1.65; 95% CI: 1.24, 2.20). Women who had secondary + education had a 39% reduction in the odds of renal failure when compared with women with no formal education (AOR = 0.61; 95% CI: 0.46, 0.81). Health insurance coverage accounted for a 23% reduction in the odds of renal failure when compared with women who were not covered by health insurance (AOR = 0.77; 95% CI: 0.63, 0.93). Women who had a terminated pregnancy were 1.50 times as likely to have a renal failure when compared with women with no history of terminated pregnancy (AOR = 1.50; 95% CI: 1.24, 1.82). Furthermore, women with a history of contraceptive use were 1.32 times as likely to have a renal failure when compared with women without a history of contraceptive use (AOR = 1.32; 95% CI: 1.11, 1.57). Conclusion Lack of formal education, having no health insurance coverage, and ever used anything or tried to delay or avoid getting pregnant were the modifiable risk factors of renal failure. The nonmodifiable risk factors were old age, rural residence, certain geographical regions, and having a history of pregnancy termination. Understanding the risk factors of renal failure will help to instigate early screening, detection, and prompt treatment initiation. In addition, early detection of the risk factors can help to reduce the adverse health impact including maternal death.

Pleural Effusion Is Associated with Severe Renal Dysfunction in Patients with Acute Pancreatitis.

BackgroundRenal dysfunction is a leading cause of death in patients with acute pancreatitis (AP) and often occurs later than respiratory complications. Whether respiratory complications can predict renal impairment remains unclear. The aim of this study was to investigate the association between pleural effusion and renal dysfunction in AP.Material/MethodsMedical records were reviewed from individuals who were hospitalized with AP from January 1, 2015 to December 31, 2019. The patients were divided into 2 groups, based on the presence or absence of pleural effusion on admission. Disease severity, renal function parameters, and outcomes were compared between the 2 groups.ResultsA total of 222 patients were enrolled, 25 of whom had pleural effusion on admission and 197 who did not. Patients with AP who had pleural effusion had more serious illness (higher incidences of pancreatic inflammation, pancreatic fluid collection, and moderate-to-severe AP; worse Bedside Index for Severity in Acute Pancreatitis score; and a higher modified computed tomography severity index [all P<0.05]) plus worse outcomes (higher incidences of ventilation and vasopressor use [both P<0.05]). Moreover, patients with pleural effusion had a higher level of blood urea nitrogen and lower estimated glomerular filtration rate (both P<0.05). After adjustment for potential confounders, pleural effusion was a risk factor for renal failure in patients with AP (odds ratio 6.32, 95% confidence interval 1.08–36.78, P=0.040).ConclusionsPleural effusion is associated with severe renal dysfunction in AP. Therefore, efforts should be made to improve early recognition and timely treatment of renal failure by closely monitoring renal function in patients with AP and pleural effusion on admission.

COVID-19 and acute kidney injury in the intensive care unit

Die akute Nierenschädigung („acute kidney injury“, AKI) ist eine häufige und schwere Komplikation bei COVID-19(„coronavirus disease 2019“)-Patient*innen auf der Intensivstation. Dabei zeigt sich eine enge Assoziation zwischen der Schwere des Krankheitsverlaufs von COVID-19 und dem Auftreten von Nierenversagen. Den Hauptrisikofaktor für ein nierenersatztherapiepflichtiges Nierenversagen stellt die Notwendigkeit einer invasiven Beatmung dar, wobei der Beginn des Nierenversagens häufig eng mit dem Intubationszeitpunkt assoziiert ist. Zusätzlich stellen Risikofaktoren für schwere COVID-19-Verläufe gleichzeitig Risikofaktoren für ein schweres Nierenversagen dar. AKI bei COVID-19 weist eine hohe Mortalität auf und führt bei einem Teil der Patient*innen zu anhaltender Niereninsuffizienz. Allerdings kommt es bei einem recht großen Teil der dialysepflichtigen Überlebenden zu einer Erholung der Nierenfunktion. Im Hinblick auf Vermeidung und Therapie des COVID-19-assoziierten Nierenversagens gelten bislang dieselben Empfehlungen wie für AKI anderer Ursachen (Kidney Disease: Improving Global Outcomes, KDIGO-Bundles). Bei hohem Patient*innenaufkommen und entsprechend ausgelasteten Ressourcen kann die Durchführung von extrakorporalen Nierenersatzverfahren im Kontext einer krankheitsassoziierten Hyperkoagulabilität kritisch werden. Zur Vermeidung von Triage-Situationen wurde in einzelnen Zentren die akute Peritonealdialyse als Alternative zu den extrakorporalen Verfahren eingesetzt.

Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury

BackgroundAlthough acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI.MethodsFive hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery.ResultsIn the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery.ConclusionsThese findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.

Extensive cell salvage and postoperative outcomes following thoracoabdominal and descending aortic repair

ObjectiveCell salvage (CS) reduces intraoperative blood transfusion. However, it may cause deformity of the red blood cells and loss of coagulation factors, which may lead to unwanted sequelae. Thus, we hypothesized that extensive CS would lead to adverse outcomes after descending/thoracoabdominal aortic aneurysm (D/TAAA) repair. MethodsBetween 1991 and 2017, 2012 patients undergoing D/TAAA repair were retrospectively reviewed. After we excluded patients without reported intraoperative CS amount, patients were enrolled in the study (N = 1474) and divided into 2 groups: low CS (salvaged units <40, N = 983) and high CS (salvaged units ≥40, N = 491). Analyses were performed to verify the extensive CS as the risk factor for adverse outcomes. ResultsPreoperative demographics showed that the high-CS group had a significantly greater incidence of male patients (72% vs 58%), heritable aortic disease (24% vs 17%), redo (27% vs 20%), greater glomerular filtration rate (mL/min/1.73 m2, 75 vs 66) and more extensive aneurysms (TAAA extent II-IV). The high-CS group had significantly more postoperative complications compared with the low-CS group, including respiratory failure, renal failure, cardiac complications, neurologic deficits, bleeding, and 30-day mortality. Multivariable analysis confirmed high CS was an independent risk factor for renal failure along with long bypass time, older age, and extent of repairs. There was an incremental risk of renal failure and 30-day mortality proportional to salvaged cell unit (P < .001 in both). ConclusionsIncreased salvaged cell units were associated with adverse postoperative outcomes after D/TAAA repairs. Risk of renal failure and mortality increased proportionally to the salvaged cell units.

Risk of Renal Failure Within 10 or 20 Years of Systemic Lupus Erythematosus Diagnosis.

The frequency of endstage renal disease (ESRD) from systemic lupus erythematosus (SLE) in the United States has not improved over the last few decades in large population datasets. Understanding the risk factors for renal failure in SLE could lead to earlier detection of lupus nephritis and potentially more effective treatments in those with markers of poor prognosis. The Hopkins Lupus Cohort, comprising 2528 patients was used. One hundred fifty-one patients experienced renal failure after SLE diagnosis, defined as dialysis or renal transplant. We estimated the risk of renal failure in subgroups defined by demographics, laboratory tests, and the American College of Rheumatology/Systemic Lupus International Collaborating Clinics (ACR/SLICC) classification criteria satisfied within 1 year of SLE diagnosis. The overall incidence of renal failure within 20 years of SLE diagnosis was 8.4%. The risk was much higher (20.0%) among those who experienced proteinuria within the first year of diagnosis. Demographic predictors included African American ethnicity [rate ratio (RR) 1.82, P = 0.0012] and age ≥ 40 years at SLE diagnosis (RR 0.51 vs those with diagnosis at < 30 yrs of age, P = 0.019). Among immunologic markers, low C3 was a strong predictor of renal failure (RR 2.00, P = 0.0011). Proteinuria within the first year of diagnosis of SLE is one of the most important predictors of ESRD. Our data also confirm African American ethnicity, younger age at SLE diagnosis, and low C3 as strong predictors of renal failure.

Risk Factors for Renal Failure after Continuous-Flow Left Ventricular Assist Device Implantation

Renal failure after continuous-flow Left ventricular assist device (CF-LVAD) implantation increases the risk of death. Although CF-LVAD improve hemodynamic status and affect renal function, there was no study which analyzed the relationship of hemodynamics and renal function after CF-LVAD implantation. Then, we investigated that risk factors for renal failure (RF) in the chronic phase after CF-LVAD implantation using postoperative hemodynamic data. Between October 2005 and August 2018, 191 consecutive patients underwent CF-LVAD implantation at Osaka University Hospital. Of these, 76 who recorded postoperative right heart catheterization were included (mean age, 42 ± 13 years; 38% were women). We used 5 different types of CF-LVADs (HeartMate II: 50%, DuraHeart:13%, Jarvik2000:13%, EVAHEART:16%, HeartWare:8%. Preoperative and postoperative RF was defined that estimated glomerular filtration rate (eGFR) < 60mL/min/1.73m2 at preoperative and postoperative 1 year, respectively. We analyzed the course of renal function after CF-LVAD implantation and the risk factors for RF in the chronic phase. Two weeks after implantation, the mean eGFR was improved from 70 (47-90) to 101 (73-131) mL/min/1.73 m2. However, the renal function showed gradual decline and eGFR was 70 (60-93) mL/min/1.73 m2 at postoperative 1year. There were 17(22%) patients who developed RF at postoperative 1year. Multivariate analysis revealed that preoperative RF (OR, 10.2; 1.66-63.2; p = 0.006) and postoperative higher level of systemic vascular resistance index (SVRI) (OR, 1.19; 1.00-1.42; p = 0.020) were risk factors for RF in the chronic phase. On the other hand, among patients with preoperative low cardiac index (CI < 2.2 L/min/m2), preoperative RF was not risk factor for postoperative RF. Renal function improved immediately after CF-LVAD implantation, however, gradually decrease to the baseline after the transient improvement. Patients with preoperative RF significantly related to postoperative RF significantly, which was particularly noticeable in patients with preoperative CI was maintained. Elevated SVRI, which can be related to peripheral circulatory failure, was significant risk factor for postoperative RF and thus adequate management of elevated SVRI has the possibility to maintain postoperative renal function for CF-LVAD patients.

Abstract MP74: Association of Albuminuria With Incident Atrial Fibrillation: The Multi-ethnic Study of Atherosclerosis (MESA)

Background: Atrial fibrillation (AF) shares risk factors with atherosclerotic cardiovascular disease (CVD). Albuminuria (AU) is an established risk factor for renal failure and CVD. Endothelial dysfunction, inflammation and hemostasis underlie the pathogenesis of AU. However, the association of AU with incident AF and its effect modifiers are not fully understood. Purpose: To assess the association of AU with incident AF and to identify its effect modifiers. Methods: We studied MESA participants, free of clinical CVD and AF at baseline, with urine samples at exam 1. Participants were followed for incident AF ascertained by follow up visit ECGs, hospital discharge diagnoses or Medicare claims data. Participants were compared by the presence or absence of AU (albumin-creatine ratio of ≥30). Kaplan-Meier curves were used to estimate the cumulative rate of incident AF and log-rank test to evaluate statistical significance. Hazard ratio (HR) and 95% confidence interval (CI) were computed by Cox proportional hazard models. Final adjusted model included CHARGE-AF risk score covariates with socioeconomic variables, current alcohol use, renal function, and lipid lowering medication use. Results: A total of 6376 participants were analyzed (median age 62 years, male 47.4%, White race 38.8%, mean BMI 28.3 ± 5.5). During median follow-up of 13.9 years, there were a total of 924 AF events. Participants with AU had a higher incidence of AF than those without AU at 10 years (23.9% vs 10.4%, p &lt; 0.05, Figure 1A ). In fully adjusted model, AU was significantly associated with incident AF [HR 1.53 (95% CI 1.27 - 1.85, p &lt; 0.01). Low high-density lipoprotein cholesterol (&lt; 40 mg/dL) and high triglyceride (≥ 150 mg/dL) augmented the association between AU and incident AF (p-interaction &lt; 0.05 for all, Figure 1B ). Conclusion: AU was significantly associated with incident AF after adjusting for conventional risk factors in a multi-racial prospective cohort. Lipid markers were identified as effect modifiers in the association of AU with AF.