Serum Creatinine Research Articles

EGFR Evalutation among the Hypothyroid Patients Attending at a Tertiary Center of Chattogram

Background: Hypothyroidism is a prevalent endocrine illness that affects people all over the world. The modulation of renal hemodynamics and basal metabolic rate is disrupted in hypothyroidism. The kidney is generally involved in thyroid hormone metabolism, breakdown and excretion. Chronic renal hypoperfusion affects the hypothalamic pituitary-thyroid axis, resulting in low circulating thyroid hormone levels, changed peripheral hormone metabolism, decreased tissue thyroid hormone content and altered thyroid iodine storage. Recent research has linked an increased risk of hypothyroidism to a decreased estimated Glomerular Filtration Rate (eGFR). The purpose of the study is to determine the association between eGFR with hypothyroidism in a tertiary care hospital of Chattogram. Materials and methods: A cross-sectional study was done during July 2022 to June 2023 including 100 diagnosed hypothyroidism cases attending in Chittagong Medical College Hospital. Serum Thyroid Stimulating Hormone (TSH) serum free thyroxine (FT4) serum creatinine, and blood urea were measured. The estimated glomerular filtration rate (eGFR) were determined. The result were analysed using SPSS version 25. Results: The mean age was 42.76±10.18 years with 93% female. Most of the patients (92%) were in a subclinical hypothyroid state and 8% were in an overt hypothyroid state. The mean ±SD serum creatinine levels and urea levels were 0.8±0.2mg/dl and 25.4±6.5 mg/dl, respectively. The mean eGFR was 75.36±7.54 ml/min/1.73 m2. There was a significant decrease in mean eGFR in the < 60 ml/min/1.73m2 group among the study population. There was a significant association between decreased eGFR and hypothyroidism. Serum TSH had significantly shown a negative correlation with eGFR. Serum TSH level had a significant positive correlation with serum creatinine (r=0.56, p<0.05) and serum urea (r=0.25, p<0.05). There was a significant eGFR difference between subclinical hypothyroidism and overt hypothyroidism. Conclusion: It can be concluded from this study that the hypothyroidism was significantly correlated with decreased eGFR. IAHS Medical Journal Vol 7(1), June 2024; 86-90

Clinical characteristics and prognosis of steroid-resistant nephrotic syndrome in children: a multi-center retrospective study

Abstract Background This study investigated the factors influencing the prognosis of children with steroid-resistant nephrotic syndrome (SRNS) in patients from the Guangxi region. Methods We retrospectively analyzed clinical and pathological data of 279 patients with SRNS from six tertiary hospitals in Guangxi. Clinical data were compared between initial (I-SRNS) and secondary (S-SRNS) steroid resistance subgroups and Cox regression analysis was used to determine risk factors for chronic kidney disease (CKD) and CKD stage 5 (CKD5) in patients with SRNS. Results The median age of onset was 54 months. Thirty-three patients had extra-kidney manifestations. Fifty-two, 24, 57, 33, and 41 patients had hypertension, acute kidney injury, vitamin D deficiency, high intraocular pressure, and dwarfism, respectively. One hundred eighty-two and 92 patients had I-SRNS and S-SRNS, respectively. There were significant differences in sex, ethnicity, family history, incidence of hematuria, clinical classification, efficacy of immune agents, and prognosis between groups (P < 0.05). Among the 279 cases of SRNS, 239 had normal kidney function, 37 developed CKD, and 16 had CKD5. An increase in serum creatinine level (HR = 1.003) was significantly associated with CKD in children with SRNS, and effective immunosuppressant therapy decreased the CKD risk (HR = 0.168). Patients with increased serum creatinine levels (HR = 1.003) and acute kidney injury (HR = 4.829) were more likely to progress to CKD5. Conclusions Children with S-SRNS showed a higher response to immunosuppressants than those with I-SRNS. Effective immunosuppressant therapy was found to protect against CKD, whereas increased acute kidney injury was an independent risk factor for CKD5.

Vancomycin combined with piperacillin/tazobactam increases the risk of acute kidney injury compared with vancomycin plus other anti-pseudomonal beta-lactams: a systematic review and network meta-analysis

Abstract Objective To explore whether vancomycin plus piperacillin/tazobactam actually increases nephrotoxicity compared with other anti-pseudomonal beta-lactams (BLs). Methods PubMed, Embase, Web of Science, Cochrane, CNKI, Wanfang and VIP were searched from inception to October 2023. The primary outcomes were acute kidney injury (AKI) as defined as acute increase in serum creatinine of 0.3 mg/dL or 50% and severe Stage 2–3 AKI. Results We included 70 studies (76 638 patients). Network meta-analysis indicated that vancomycin plus piperacillin/tazobactam was associated with significantly higher AKI risk than vancomycin plus cefepime (OR 2.55, 95% CI 2–3.28), vancomycin plus meropenem (OR 2.26, 95% CI 1.71–3.02) and vancomycin plus other uncommonly used BLs (OR 2.47, 95% CI 1.87–3.29). Also, vancomycin + piperacillin/tazobactam was associated with significantly higher Stage 2–3 AKI risk than vancomycin + cefepime (OR 2.22, 95% CI 1.34–3.62), vancomycin + meropenem (OR1.96, 95% CI 1.22–3.25) and vancomycin + uncommonly used BLs (OR 2.81, 95% CI 1.66–4.91). Vancomycin plus piperacillin/tazobactam did not result in a significant difference in the incidence of receiving dialysis treatment, mortality, length of stay and time to AKI. Subgroup analyses of studies conducting propensity score matching demonstrated vancomycin + piperacillin/tazobactam was associated with significantly higher AKI rates than vancomycin + cefepime (OR 2.19, 95% CI 1.38–3.47) and vancomycin + meropenem (OR 1.38, 95% CI. 1.18–1.60). Subgroup analysis of critically ill patients and children indicated that vancomycin + piperacillin/tazobactam was associated with significantly higher AKI rates. Conclusions Vancomycin + piperacillin/tazobactam significantly increased the risk of AKI and severe Stage 2–3 AKI compared with vancomycin plus other BLs. More prospective studies are needed.

Outcomes of Community-Acquired Acute Kidney Injury

Background: Community-acquired acute kidney injury (CA-AKI) occurs outside of the hospital and is the most common form of AKI. CA-AKI is not well understood, which hinders efforts to prevent, identify, and manage CA-AKI. Objective: Examine 30-day outcomes following CA-AKI using national administrative and lab data from the Veterans Health Administration (VA). Research Design: Retrospective cohort study. Subjects: VA primary care patients with recorded outpatient serum creatinine (SCr) with observed CA-AKI (cases) and a standardized mortality ratio propensity-weighted 5% comparator sample without observed CA-AKI in 2013–2017. Measures: CA-AKI was defined as a ≥1.5-fold relative increase in outpatient SCr or inpatient SCr (≤24 h from admission) from a reference outpatient SCr ≤12 months prior. Outcomes were 30-day mortality and hospitalization and were assessed in separate weighted Cox regression models. Results: Among 220,777 CA-AKI events and 492,539 comparators without observed CA-AKI, CA-AKI was associated with a higher risk of 30-day all-cause mortality [hazard ratio (HR)=4.17, 95% CI: 3.74, 4.63] and hospitalization (HR=1.82, 95% CI: 1.74, 1.90) versus comparator. Risks increased with severity (mortality HR=3.02, 7.67, and 12.22 for AKI stages 1–3, respectively). Outpatient CA-AKI was associated with a high risk of mortality (HR=2.04, 95% CI: 1.83, 2.28) and even higher for inpatient CA-AKI, present [≤24 h from admission (HR=11.32, 95% CI: 10.16, 12.61)]. Conclusions: In a national cohort of Veterans, CA-AKI was associated with a 2-fold increased risk of hospitalization and a 3–11-fold risk of mortality. Improving identification and management is critical to mitigate adverse outcomes of CA-AKI.

Abstract 4138248: Outcomes of Patients with Radiation-Associated Cardiac Disease Undergoing Cardiothoracic Surgery: Development of a Disease Specific Risk Score

Background: Radiation-associated cardiac disease (RACD) has significant long-term mortality and morbidity, often requiring cardiac surgery(CS). Hypothesis: We sought to study factors associated with longer-term survival in RACD patients and develop a specific risk score associated with 5-year survival following CS. Methods: This was an observational cohort study of 351 patients with documented RACD (252 [72%] had mantle radiation for lymphoma at a mean of 18 years prior), who underwent CS at a tertiary care center between 1991-2018. Clinical characteristics were collected, and Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Multivariable analysis for 5-year mortality was performed using age, sex, history of lymphoma, New York Heart Association class, prior cardiac surgery, atrial fibrillation, constriction, chronic pulmonary disease, serum creatinine, left ventricular ejection fraction, right ventricular systolic pressure and valvular surgery(aortic, mitral or tricuspid). Results: Clinical characteristics are shown in Figure 1. Mean follow-up was 6.2±4.6 years&5-year mortality occurred in 123 (35%) patients (7 [2%] in-hospital deaths). Cox 5-year survival analysis results are shown in Figure 2A. A receiver operator curve analysis for 5-year mortality showed an area under curve of 0.70 (95% confidence interval 0.64-76, p<0.001). Subsequently, a 5-year risk score (0-7 points) was generated (Figure 2 A); with an increasing risk of mortality at 5 years, based on increasing risk score (Figure 2C). Cardiac reoperation was not associated with worse outcomes. Conclusion: RACD patients undergoing CTS have a high rate of 5-year mortality, despite a low baseline STS score&perioperative mortality. A novel RACD-specific risk score (incorporating higher age, abnormal renal/pulmonary, constrictive pericarditis&need for concomitant mitral valve surgery) provides good discrimination for 5-year survival&could be used for shared-decision making.

Abstract 4128377: Association between Mean Platelet Volume (MPV) and coronary artery disease: An analysis of NHANEs 2017-2020

Background: Recent data showed that mean platelet volume (MPV) is linked to mortality after myocardial infarction and restenosis following coronary angioplasty. However, its association with coronary artery disease (CAD) remains unclear. Therefore, we aim to investigate the association between MPV and CAD using a nationwide database. Methods: We analyzed retrospective cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2017-2020, including participants aged 18 years and older. The data on MPV were classified into three groups: below the 10th percentile (P10), between the 10th and 90th percentiles (P10 to P90), and above the 90th percentile (P90). Univariable and multivariable logistic regression models were utilized to identify the association between MPV and CAD. Results: A total of 12,156 patients with MPV results were identified. Their mean age was 37 ± 24 years, with females constituting 51.0% of the population. The racial distribution was primarily White at 33.8%, Black at 25.7%, Mexican American at 13.2%, Asian at 10.7%, and other races at 16.6%. The participants were categorized into three MPV groups: below P10 (11.2%), P10 to P90 (77.3%), and above P90 (11.5%), with median MPV values of 6.8, 8, and 9.7 fL, respectively. In a univariable analysis using participants with MPV in the P10 to P90 as a reference, those with MPV above the 90th percentile had a significantly higher risk of CAD, with an OR of 1.39 (P90-MPV: 95% CI 1.05, 1.83; P=0.021). No significant association was found between participants with MPV below the 10th percentile and risk of CAD (P10-MPV: OR 0.91, 95% CI 0.59, 1.41; P=0.684). After adjusting for age, gender, smoking status, blood pressure (SBP >130 vs <130 mmHg), type 2 diabetes, urine albumin creatinine levels, serum creatinine, heart failure, and stroke history, the association between those with MPV above P90 and increased CAD risk remained significant (P90-MPV aOR 1.65; 95% CI 1.16, 2.34; P=0.005). Gender and race did not modify this effect. Conclusion: Our findings indicate that high MPV (above the 90th percentile) is positively associated with the risk of CAD in the general population. Further longitudinal cohort studies are necessary to explore this relationship and its clinical implications thoroughly.

The Coexistence of Klebsiella pneumoniae and Candida albicans Enhanced Biofilm Thickness but Induced Less Severe Neutrophil Responses and Less Inflammation in Pneumonia Mice Than K. pneumoniae Alone

Due to the possible coexistence of Klebsiella pneumoniae (KP) and Candida albicans (CA), strains of KP and CA with biofilm production properties clinically isolated from patients were tested. The production of biofilms from the combined organisms (KP+CA) was higher than the biofilms from each organism alone, as indicated by crystal violet and z-stack immunofluorescence. In parallel, the bacterial abundance in KP + CA was similar to KP, but the fungal abundance was higher than CA (culture method), implying that CA grows better in the presence of KP. Proteomic analysis was performed to compare KP + CA biofilm to KP biofilm alone. With isolated mouse neutrophils (thioglycolate induction), KP + CA biofilms induced less prominent responses than KP biofilms, as determined by (i) neutrophilic supernatant cytokines (ELISA) and (ii) neutrophil extracellular traps (NETs), using immunofluorescent images (neutrophil elastase, myeloperoxidase, and citrullinated histone 3), peptidyl arginine deiminase 4 (PAD4) expression, and cell-free DNA. Likewise, intratracheal KP + CA in C57BL/6 mice induces less severe pneumonia than KP alone, as indicated by organ injury (serum creatinine and alanine transaminase) (colorimetric assays), cytokines (ELISA), bronchoalveolar lavage fluid parameters (bacterial culture and neutrophil abundances using a hemocytometer), histology score (H&E stains), and NETs (immunofluorescence on the lung tissue). In conclusion, the biofilm biomass of KP + CA was mostly produced from CA with less potent neutrophil activation and less severe pneumonia than KP alone. Hence, fungi in the respiratory tract might benefit the host in some situations, despite the well-known adverse effects of fungi.

Abstract 4118122: Effect of Beta Blockers on Exercise Capacity, Diastolic Function, and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction

Introduction: In recent landmark HFpEF trials, 75-80% of patients are taking beta blockers (BB) without clear evidence of clinical or symptomatic benefit. Patients with HFpEF commonly have comorbidities that have been classically managed with BB (AF, CAD, HTN), though the utility of this medication class for these conditions is being reconsidered. It remains unclear what impact BB use, in patients with HFpEF, has on exercise capacity, diastolic function, and quality of life. Hypothesis: We hypothesized that BB use is associated with worse exercise capacity, diastolic function, and quality of life in HFpEF patients. Methods: This retrospective cohort study was completed using deidentified patient data from the INDIE-HFpEF and RELAX clinical trials (two trials of HFpEF patients). Patients were divided into two groups based on BB use at trial enrollment. The primary outcomes were exercise capacity, diastolic function, and quality of life at baseline evaluation. A multivariate logistic regression model was used to assess for statistically significant differences after controlling for potentially confounding variables including age, sex, BMI, AF, prior MI, COPD, DM, HTN, serum creatinine, and NYHA functional class. Results: A total of 320 patients were included in this analysis, with 230 on BB (72%). Baseline demographics are shown in Table 1. Patients studied were older (68 years old), white (90%), obese (average BMI 34 kg/m 2 ) individuals with an average LVEF of 61%. Outcomes and multivariate linear regression results are shown in Table 2. After controlling for potential confounding variables, there were no differences in baseline exercise capacity [peak VO2 (mL/kg/min): 12.1 vs 13.2, P=0.233], diastolic function [average E/e’: 14 vs 12, P=0.125; LAVI (mL/m 2 ): 42 vs 37, P = 0.665; peak TR velocity (m/s): 2.8 vs 2.7, P = 0.165; PASP (mmHg): 41 vs 36, P = 0.357], quality of life [KCCQ: 54 vs 58, P = 0.206; MLHFQ 43 vs 46, P = 0.762], or NT-proBNP (633 vs 342; pg/mL, P = 0.208) in HFpEF patients on BB compared to those not on BB. Conclusion: There was no association with BB use and worse exercise capacity, diastolic function, or quality of life in HFpEF patients. This may be due to heterogenous treatment effects, with differing impact of BB based upon the underlying pathophysiology of unique HFpEF phenotypes. To definitively determine the impact of BB use in patients with HFpEF, both on clinical outcomes and symptoms, randomized controlled trials are necessary.

Abstract 4115634: Potential Role for Circadian Disruption in Acute Kidney Injury-driven Cardiovascular Disease

Background/Hypothesis: Circadian disruption and AKI, even if kidney function recovers, are linked to an increased risk of CVD and death. We explored the hypothesis that AKI was associated with CVD through circadian disruption. Approach: Sixteen ~25-week-old PER2::Luciferase (a real-time reporter of circadian rhythm) C57BL/6J male mice had micro-clamps applied to both renal pedicles for ~26 minutes to produce a recoverable AKI. Three animals underwent a sham procedure. Three animals had to be euthanized all others had serum creatinine (Scr) measured on day 2. Twelve weeks after surgery, all animals (n=13) were euthanized. Results: The sham group's day 2 Scr (n=3; mean 0.10 [range 0.08 - 0.15]) was unchanged from baseline (0.11 [0.07 - 0.18]). Based on the day 2 Scr, 3 mice were classified as having mild/moderate AKI (Scr increased ≤ 3-fold) (0.16 [0.08 - 0.20]) and 7 as having severe AKI (Scr increased > 3-fold) (0.98 [0.26 - 1.93]). By 12 weeks post-AKI, the Scr (0.16 [0.1 - 0.2 mg/dl]) of all animals returned to a level statistically similar to baseline. Immunohistochemistry demonstrated that 6 of 7 mice with severe AKI had atherosclerotic-like lesions in the aortic root (A), sinus, or coronaries (B): 4 mice had lesions averaging 9,754.7 µm 2 and 2 mice had coronary artery lumen narrowing averaging 56.2%. Similar lesions were found in 1 of 3 mice with mild/moderate AKI, but no lesions were found in the sham animals (C). The lesions had CD45+ cells on their surface and in the adventitia (A inset), but were devoid of CD68+ and SMC alpha-actin+ cells. In the neointima, SMC alpha-actin+ cells predominated (B inset). Mouse liver, lung, adrenal gland, renal cortex, outer and inner medulla were collected at 15:00 and analyzed for 5 days by Lumicycle. Circadian rhythms were evaluated with JTK_CYCLE. No apparent AKI-dependent differences were observed in the liver, lung, adrenal, or renal outer medulla. However, the amplitude of renal inner medulla rhythms decreased with AKI (P = 0.008), while the amplitude of renal cortex increased with AKI (P = 0.01, E&F). Conclusions: This is the first report of an AKI model resulting in atherosclerosis-like lesions in wild-type mice without the need for a high-fat diet, genetic manipulation, or further provocation. The lesions were associated with a disruption of the intrarenal circadian rhythms. We will discuss the implications of this research as well as the metabolic consequences of the circadian disruption.

Abstract 4147609: Hypoalbuminemia as predictor of poor functional status in hospitalized patients with advanced heart failure

Introduction: Timely involvement of palliative care services for patients with advanced heart failure (HF) improves symptom burden, functional status, and resource utilization. The Karnofsky Performance Scale (KPS) is an objective tool used by palliative care specialists to assess physical ability and guide palliative interventions. Patients with lower KPS have poor outcomes, however evidence linking clinical parameters such as New York Heart Association (NYHA) class, ejection fraction (EF), and albumin with KPS remains limited. Goals: To identify clinical parameters associated with poor functional status in hospitalized patients with advanced HF Methods: Individuals with acute decompensated HF admitted between 2021-2023, ineligible for advanced cardiac therapies, and referred to palliative care were included. Data collected encompassed demographic variables, clinical parameters (NYHA classification, KPS, comorbidities, EF, Brain natriuretic peptide (BNP), albumin, creatinine), and palliative care interventions (family meetings, advanced care planning discussions). Bivariate and multivariate analyses, utilizing Kruskal-Wallis and chi-square tests along with adjusted regression models, were conducted using R to compare characteristics, with a low KPS (≤40) as the primary outcome. Results: A total of 97 individuals were included, with a mean age of 68 ± 17.7 years, 32 (33.0%) were female. Hypoalbuminemia was directly associated with KPS. Patients with albumin levels ≤3 g/dL were more likely to have KPS ≤40 (OR 2.6 [CI 1.03-6.7], p=0.04). NYHA class, EF, serum creatinine, and comorbid conditions (chronic kidney disease, stroke, chronic obstructive pulmonary disease, dementia) were not significantly associated with KPS. Those with lower KPS scores had higher utilization of palliative care services for family meetings, although did not differ significantly in advanced care planning status. Conclusions: In our analysis of hospitalized patients with advanced HF, hypoalbuminemia had the highest predictive value for low functional status. Low KPS score was associated with increased utilization of palliative care services and higher rates of inpatient mortality.

Exploring the predictive value of serum lipids for short‐term prognosis in patients with acute‐on‐chronic liver failure

AbstractAimsAcute‐on‐chronic liver failure (ACLF) is defined as acute liver injury superimposed on chronic liver disease, resulting in a significantly increased short‐term mortality rate. Serum lipids are associated with the severity of liver disease and contribute to the prognostic assessment for cirrhosis and liver failure. However, the presentation of serum lipids varies in different studies, making it difficult to draw definitive conclusions. This study aimed to investigate the predictive value of serum lipids for short‐term prognosis in patients with ACLF.MethodsThis retrospective analysis was conducted using the clinical data of patients hospitalized for ACLF between January 2018 and December 2021. The collected data were subjected to Least Absolute Shrinkage and Selection Operator and logistic regression analyses to identify the independent predictors of 28‐day and 90‐day mortality. Separate regression models were developed for each identified serum lipid. These models were combined with the Model for End‐Stage Liver Disease (MELD), MELD combined with serum sodium concentration (MELD‐Na), Chronic Liver Failure Consortium Acute‐on‐chronic Liver Failure (CLIF‐C ACLF), and Chinese Group on the Study of Severe Hepatitis B‐ACLF (COSSH‐ACLF) scores to construct new models. The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC), Nagelkerke R2, Brier score, net reclassification index (NRI), and integrated discrimination improvement (IDI) to assess the prognostic ability of serum lipids.ResultsThis study included 266 patients with ACLF, of whom 25.9% (69/266) died within 28 days and 38.5% (102/265, with 1 lost to follow‐up) died within 90 days. The independent predictors of 28‐day mortality were age, the presence of overt hepatic encephalopathy at admission, high‐density lipoprotein cholesterol (HDL‐C) levels, and international normalized ratio (INR). The independent predictors of 90‐day mortality were age, albumin levels, serum creatinine levels, and INR. The comparative analysis revealed that the AUC of all other models exceeded that of HDL‐C (p < 0.001). The COSSH‐ACLF model demonstrated superior predictive ability compared with the MELD and HDL‐MELD models (p = 0.013 and 0.017, respectively). Furthermore, the HDL‐COSSH‐ACLF model exhibited a similar trend in predictive ability compared with the latter two models (p = 0.009). No significant differences were observed in the AUC performances of the other models. A comparison of NRI calculated using the cutoff values assigned by equal assignment revealed that the addition of HDL‐C improved the predictive ability of the MELD score by 4.6% (NRI = 0.0460, p = 0.036). The MELD‐Na score exhibited an 8.4% improvement (NRI = 0.0844, p = 0.047), while the COSSH‐ACLF score demonstrated a 14.4% improvement (NRI = 0.1443, p = 0.015). However, these changes did not significantly impact the capacity of the CLIF‐C ACLF score (NRI = 0.0350, p = 0.141). No significant differences were observed in the IDI comparisons between the models with different cutoff values (all p > 0.050).ConclusionsSerum HDL‐C is an independent predictor of 28‐day mortality in patients with ACLF. Although it has inferior predictive ability when considered alone, HDL‐C enhances the predictive capacity of MELD, MELD‐Na, and COSSH‐ACLF when incorporated into these models.

Abstract 4147623: PORTAL VEIN PULSATILITY INDEX, INDEPENDENT OF INFERIOR VENA CAVA DILATATION, PREDICTS ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE HEART FAILURE

Background: The VExUS score is a useful tool for assessing systemic venous congestion that has shown the ability to predict acute kidney injury (AKI) in various populations (post cardiac surgical, CKD&ACS patients). Among the variables included in VExUS, inferior vena cava diameter (IVCD) is of particular importance, as the finding of a non-dilated IVCD (<20 mm) assigns a VExUS score of 0 (indicating no venous congestion). However, multiple factors in addition to congestion status may affect the IVCD, which may result in an errouneous assessment of congestion. Previous studies have suggested that portal vein pulsatility index (PVPI) and renal vein doppler are associated with volume status; however, no previous studies have assessed the PVPI, independently of IVCD, in the prediction of AKI. Hypothesis: We hypothezise that PVPI may predict AKI independently of the IVCD in patients with AHF. Methods: A prospective, single-center study was conducted, including patients admitted to the emergency room from July 2023 to January 2024 with the diagnosis of AHF, and in whom VExUS evaluation was performed during the first 8 hours of admission. For the analysis of the primary endpoint, patients were divided into four groups based on the presence or absence of a dilated inferior vena cava (cutoff <20 mm) and a PVPI ≥30%. We calculated the differences in time to the development of AKI for each group using survival analysis, Log-rank test and depicted the results using Kaplan-Meier curves. All statistical analyses were conducted using STATA v14.1. Results: A total sample of 189 patients was available for analysis (Figure 1). The mean age was 58.3 years (45.7–70.9), and the proportion of men was 73.6% (137), 5.9% patients had CKD stage IV (n = 11) and 18.8% CHF (n = 35). The median of serum creatinine at admission was 1.1 mg/dL (0.8 – 1.56) and NT-proBNP 4422 (1266 – 10783). Conclusion: PVPI, independent of dilatation of IVC, is a predictor of AKI in patients with AHF.

Abstract 4117397: SGLT2i And Cardio-Renal Outcomes In Type 2 Diabetes Mellitus: A Systematic Review And Meta Analysis.

Background: Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function. Aim: This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. Methods: A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). Results: We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p<0.00001), and their composites outcomes. Furthermore, renal outcomes with SGLT2i significantly improve Urinary Albumin-to-Creatinine Ratio (RR1.10 [95%CI 1.03–1.18]p=0.004), Improvement of the decline of the eGFR (RR1.08 [95%CI 1.04–1.11] p<0.00001) and progression of albuminuria (RR 0.69[95%CI 0.66–0.72]p<0.00001). Slower Doubling of serum creatinine (RR 0.71 [95% CI 0.61–0.82] p<0.00001), end-stage kidney disease (RR 0.66 [95% CI 0.53–0.83] p=0.0003). Reduced Acute Kidney Injury (RR 0.72 [95% CI 0.58–0.89] p=0.002) and renal impairment (RR 0.57 [95% CI 0.34–0.95] p=0.03). Regarding death from renal causes, we identified a 46% relative reduction in the risk in SGLT2i group, although was not statistically significant (RR 0.54 [95% CI: 0.23, 1.27] p=0.16). The observed heterogeneity across studies calls for careful application of these results to individual patients. Conclusion: SGLT2i confers notable advantages in managing cardiorenal complications in T2DM, demonstrating a reduction in cardiovascular mortality and heart failure hospitalizations and offering a nephroprotective effect.

Evaluation of Gender-Specific Variation in Lead-induced Nephrotoxicity in Wistar Rats

The kidney is sensitive to heavy metals because of its intensive metabolic activity and multiple functions namely those of excretion and pollutants concentration. The study aimed to evaluate the gender-specific variation in lead-induced nephrotoxicity in Wistar rats. 10 male and 10 female Wistar rats (180-220g) were each divided into 2 groups (n=5 each): Control (M), Lead alone (M), Control (F), Lead alone (F). Male and female rats of the experimental groups were administered a daily dose of 100 mg/kg/bw of lead acetate dispersed in distilled water for 21 days. All rats were anesthetized and sacrificed 24 hours after the last administration. Blood samples were collected via cardiac puncture for biochemical analysis, kidney tissues were harvested, homogenized, and analyzed for antioxidant enzymes (superoxide dismutase, catalase, glutathione peroxidase) and lipid peroxidation (measured by malondialdehyde levels). Results indicated a significantly (p<0.01) lower weight gain in the lead-only female (F) group compared to the lead-only male (M) group. Lead acetate exposure caused oxidative damage, evidenced by significantly reduced antioxidant enzyme levels and increased lipid peroxidation in both male and female groups, with the effects being more pronounced in females (p<0.05). Serum creatinine and Urea levels in the lead alone (M) and lead alone (F) group were increased when compared to their respective control groups (p<0.05) however serum creatinine was significantly (p<0.001) higher in lead alone (F) than lead alone (M). The electrolyte function increased significantly in this study (p<0.05) when compared with their control groups. Sodium ion in lead alone (F) increased significantly (p<0.01) when compared to lead alone (M). The study concludes that lead exposure induced nephrotoxicity in both male and female rats, but more significantly pronounced in females than the males. This increased severity may have been mediated by the higher lead-induced oxidative stress observed in the female rats compared to males.

Correlation between Fundus Damage and Renal Function Deterioration in Chronic Kidney Disease Patients

Introduction: This study aimed to explore the correlation between the extent of fundus damage and the severity strategies for chronic kidney disease (CKD). Methods: We collected data from 118 CKD patients, including general information, renal function indicators, and fundoscopic examination results. The stages of CKD and degrees of fundus lesions were graded. SPSS 25.0 software facilitated the analysis of correlations using Kendall's tau-b correlation analysis and ordinal regression analysis. Results: Statistically significant differences were observed among multiple CKD stages in the distribution of age, systolic blood pressure, diastolic blood pressure, hemoglobin, total cholesterol, homocysteine, cystatin C, serum creatinine, blood urea, eGFR, 24-hour urine protein, urine microalbumin, urine microalbumin/urine creatinine, and blood β2 microglobulin, complement C3. Notably, the levels of cytokeratin 19 fragment and transforming growth factor β significantly increased in all CKD stages. Kendall's tau-b correlation analysis revealed a significant positive correlation between CKD stage and fundus lesion grade. Ordinal regression analysis indicated that sex differences, total cholesterol levels, and hemoglobin levels were significant predictors of fundus lesion risk. Compared with patients at stage 5 CKD, the risk of fundus damage significantly lower in patients in stage 2 and stage 3, further demonstrating a positive correlation between renal function deterioration and increased risk of fundus damage. Conclusions: Routine fundus screening and early intervention for fundus lesions are vital for assessing CKD deterioration, providing new directions for future related research.

Scleroderma Renal Crisis and Musculoskeletal Corticosteroid Injections

Background/Objective Inflammatory arthritis frequently affects patients with systemic sclerosis (SSc) but musculoskeletal corticosteroid (MSKC) injections are often avoided due to concerns of scleroderma renal crisis (SRC). This study investigated the incidence of SRC following MSKC injections. Methods In a 136-SSc cohort, 46 subjects underwent a total of 330 MSKC injections each receiving a significant dosage of triamcinolone acetonide (mean, 95.2 ± 44.2 mg per injection session). Blood pressure (BP), serum creatinine and glucose, urine protein, and complications were retrospectively reviewed before and after injection. Results MSKC and control subjects were similar in age (MSKC: 58.9 ± 12.1 vs. 55.5 ± 14.9 years), female (MSKC: 97.8% [45/46] vs. 89.9% [81/90]), antinuclear antibody (MSKC: 71.7% [33/46] vs. 81.1% [73/90]), anti-centromere antibody (MSKC: 47.8% [22/46] vs. 37.8% [34/90]), anti-topoisomerase antibody (MSKC: 26.1% [12/46] vs. 26.7% [24/90]), and anti–RNA polymerase III antibody (MSKC: 17.4.1% [8/46] vs. 24.4% [22/90]) (all p > 0.05). Pre- and post-MSKC demonstrated nonsignificant changes in systolic BP (pre: 127 ± 22 vs. post: 127 ± 21 mm Hg, p = 1.0), diastolic BP (pre: 71 ± 13 vs. post: 71 ± 11 mm Hg, p = 1.0), creatinine (pre: 0.78 ± 0.56 vs. post: 0.76 ± 0.20 mg/dL, p = 0.64), glucose (pre: 100 ± 21 vs. post: 99 ± 24 mg/dL, p = 0.67), and urine protein-creatinine ratio (pre: 0.14 ± 0.12 vs. post: 0.12 ± 0.11 mg/mg, p = 0.41). One case of SRC with mortality occurred in the controls and none in the MSKC group. No infections, hematologic abnormalities, or tendon rupture were noted. Conclusion MSKC injections in established SSc are generally safe with low incidences of SRC and complications. However, it is still prudent to monitor high-risk individuals and recent-onset SSc post–MSKC injection.

Association between proteinuria and mineral metabolism disorders in chronic kidney disease: the Japan chronic kidney disease database extension (J-CKD-DB-Ex)

Chronic kidney disease-mineral and bone disorder (CKD-MBD) are recognized as a systemic disease affecting the prognosis of patients with CKD. Proper management of CKD-MBD is important to improve the prognosis of patients with CKD. Although proteinuria is recognized as a poor prognostic factor in these patients, few reports have examined its association with CKD-MBD. We examined the association between proteinuria and CKD-MBD using data from the Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex). Among the patients registered in the J-CKD-DB-Ex, 30,977 with CKD stages G2–G5 who had serum creatinine, albumin, calcium, and phosphate concentrations measured at least once and urinalysis performed were included. The patients were divided into four groups (negative, 1+, 2+, and 3+) according to the degree of proteinuria. The association between proteinuria and CKD-MBD was examined by a logistic regression analysis. In a model adjusted for age, sex, diabetes, and the estimated glomerular filtration rate (eGFR), the odds ratio of the 3 + group compared with the negative group significantly increased to 2.67 (95% confidence interval, 2.29–3.13) for hyperphosphatemia, 2.68 (1.94–3.71) for hypocalcemia, and 1.56 (1.24–1.98) for hypomagnesemia. Proteinuria is associated with hyperphosphatemia, hypocalcemia, and hypomagnesemia in patients with CKD independently of eGFR.

Can Novel Biomarkers Effectively Predict Acute Kidney Injury in Liver or Kidney Transplant Recipients?

Acute kidney injury (AKI) constitutes a common complication associated with liver or kidney transplantation, which may significantly impact the graft condition and perioperative mortality. Current AKI diagnostic criteria based on serum creatinine (sCr) and urine output alterations are widely utilized in routine clinical practice. However, the diagnostic value of sCr may be limited by various confounding factors, including age, sex, reduced or increased muscle mass, and pre-existing chronic kidney disease (CKD). Furthermore, sCr is rather a late indicator of AKI, as its concentration tends to increase only when the severity of the injury is enough to decrease the estimated glomerular filtration rate (eGFR). Recent expertise highlights the need for novel biomarkers in post-transplantation AKI diagnosis, prediction of event-associated mortality, or evaluation of indications for renal replacement treatment (RRT). Over the last decade, the diagnostic performance of various AKI biomarkers has been assessed, among which some showed the potential to outperform sCr in AKI diagnosis. Identifying susceptible individuals, early diagnosis, and prompt intervention are crucial for successful transplantation, undisturbed graft function in long-term follow-up, and decreased mortality. However, the research on AKI biomarkers in transplantation still needs to be explored. The field lacks consistent results, rigorous study designs, and external validation. Considering the rapidly growing prevalence of CKD and cirrhosis that are associated with the transplantation at their end-stage, as well as the existing knowledge gap, the aim of this article was to provide the most up-to-date review of the studies on novel biomarkers in the diagnosis of post-transplantation AKI.

Association between blood lead levels and serum creatinine: a cross-sectional study

Association between blood lead levels and serum creatinine: a cross-sectional study

Association of Oral Tobacco-Free Nicotine Delivery Product with Acute Renal Tubular Necrosis

Usage of novel non-tobacco oral nicotine delivery products (ONDPs) has been increasing among adolescents in the United States. It is presumed that they are less toxic than their tobacco-containing counterparts, but that has not been examined in controlled studies. Most of the studies have focused on non-renal manifestations of tobacco consumption via different means. The renal manifestations of non-tobacco ONDPs are not very well known, especially in immunocompromised patients. A 19-year-old male transplant recipient presented with flank pain and a few days’ history of intake of ZYNR pouches. Immunosuppression was with tacrolimus, mycophenolate, and steroids. Baseline serum creatinine was 1.1–1.3 mg/dL. Laboratory evaluation showed elevated C-reactive protein, increased serum creatinine and blood urea nitrogen, leukocytosis, neutrophilia, and increased lactate dehydrogenase (LDH). Infectious disease work-up was negative. A kidney transplant biopsy showed severe acute tubular injury/necrosis (ATN) without evidence of rejection. Donor-specific antibodies were negative. Other etiologies of hemolysis were negative. He did not require renal replacement therapy. Kidney function and LDH improved gradually. The most recent follow-up eight months after presentation showed a serum creatinine level of 2.6 mg/dL with stable electrolytes, with eGFR of 35 mL/min/1.73 m2. Here, we describe a 19-year-old adolescent with a kidney transplant who sustained ATN leading to advanced chronic disease apparently following the usage of non-tobacco ONDP. Further larger studies are needed to study ATN as a possible renal manifestation of these next-generation products to raise awareness among the public.