Term Renal Function Research Articles

#1248 Sex specific associations between fat free mass and weight with mortality: sequences of regressions analyses from the UK Biobank cohort

Abstract Background and Aims There is growing evidence that muscle mass (MM) loss, observed in long term conditions (LTCs), including chronic kidney disease (CKD), is associated with mortality. This study aimed to explore the direct association between MM and mortality, having controlled for the combined influence of ageing, long term conditions (LTCs), inflammation, renal function and body weight. Furthermore, we sought to explore whether this association differed between the biological sexes. Method An observational study was conducted using the UK Biobank cohort. Adults were recruited between 2007-2010 at 22 UK centres. MM was estimated using bioimpedance defined whole body fat-free mass (BI-FFM: Tanita BC418). Primary outcome was all-cause mortality (ACM), with the cause / date of death being obtained from the NHS Information Centre (England and Wales) and NHS Central Registry (Scotland). Follow up was defined as the period between the first visit date to either date of death / the latest date for central registry downloads (December 2021). Estimated glomerular filtration rate using creatinine (eGFRCreat) or cystatin-C (eGFRcystatin-C) were calculated (CKD-EPI 2009 equation without ethnicity correction). Participants were excluded if they were on dialysis, died from SARS-CoV-2 infection or withdrew consent. Sequences of regressions analyses (SoRA), a graphical Markov modelling technique which assesses the complexity of direct and indirect pathways of association between blocks of variables which are ordered a-priori to reflect postulated directions of association, were fitted for both sexes. Results There were 500,589 participants eligible for analysis (272,623 females / 227,966 males). There were 33,755 deaths over a median follow up period of 12.58 (IQR 11.85-13.30) yrs. The male model revealed per 5 kg-higher BI-FFM (holding weight constant) was associated with lower odds of ACM in the eGFRCreat (OR 0.827, 95% CI 0.781-0.875) and eGFRCystatin-C (OR 0.425, 95% CI 0.301-0.599) sub-models, whereas a 5 kg-higher weight (holding BI-FFM constant) was associated with higher odds of ACM in the eGFRCreat (OR 1.070, 95% CI 1.027-1.115) and eGFRCystatin-C (OR 1.395, 95% CI 1.170-1.663) sub-models. In contrast, the female model revealed a 5 kg-higher BI-FFM (holding weight constant) was associated with higher odds of ACM in the eGFRCreat (OR 2.016, 95% CI 1.650-2.463) and eGFRCystatin-C (OR 1.729, 95% CI 1.391-2.151: Fig. 1) sub-models, whereas a 5 kg-higher body weight (holding BI-FFM constant) was associated with lower odds of ACM in the eGFRCystatin-C (OR 0.935, 95% CI 0.918-0.952) but not the eGFRCreat (OR 1.020, 0.970-1.072) sub-model. Conclusion Our analysis demonstrates sex-divergent associations between BI-FFM and/or body weight with ACM when estimated kidney function is accounted for. These associations suggest sex-specific explanations as to why MM loss leads to adverse outcomes in multimorbid populations and further characterises the sex-stratified nature of the “obesity paradox” in LTCs.

Short and long-term renal function changes with direct oral anticoagulants in elderly patients with atrial fibrillation

Abstract Background Atrial Fibrillation (AF) and chronic kidney disease (CKD) frequently coexist in elderly patient. Previous evidence showed that vitamin K antagonists (VKAs) may be associated with an accelerated decrease of estimated glomerular filtration rate (eGFR) compared to direct oral anticoagulants (DOACs). However, there is little evidence on DOACs in the elderly population and in real life settings; the evidence available to us comes from randomized clinical trials with younger populations. Purpose The main objective of this study was to investigate the medium to long term renal function changes in older AF patients treated with DOACs and VKAs. Methods Enrolled patients underwent 3 eGFR measurements during follow-up, and the between arms difference in eGFR lost over time was investigated by 1) the Linear Mixed Models (LMM) and 2) group-based trajectory model (GBTM) analyses. Analysis was done according to short-term (3.2 years) and long-term follow-up (6.7 years). During the study period 420 enrolled AF patients (77.0±6.0 years, 136 on VKAs and 284 on DOACs) underwent 1260 eGFR assessments. Results After a median follow-up of 4.9 years, in the whole sample eGFR decreased from 67.4±18.2 ml/min/1.73 m2 to 47.1±14.3 ml/min/1.73 m2, p<0.001. Patients on DOACs experienced a significantly lower eGFR decrease that those treated with VKAs (-21.3% vs -45.1%, p<0.001). The benefit of DOACs compared with VKAs was evident both in the short term (eGFR decline -6.6 (95% CI: -9.1 to -4.0) ml/min/1.73 m2 vs -19.9 (95% CI: -23.6 to -16.2) ml/min/1.73 m2 respectively) and in the long-term, (eGFR -13.5 (95% CI: -16.1 to -11.0) ml/min/1.73 m2 in DOACs group vs -34.2 (95% CI: -37.9 to -30.5) ml/min/1.73 m2), respectively). After stratifying our study population into 5 groups according to trajectories of renal function decline, from the first (lowest decline in eGFR) to the fifth (greatest decline in eGFR), the first trajectory consisted of 80% patients on DOACs therapy. Logistic regression showed that the group on DOACs therapy was 3.03- to 4.24-fold more likely to belong to the trajectory with less eGFR decline than the VKAs group. Conclusions In conclusion, DOACs were associated with less long term decline in renal function in elderly patients with AF compared with VKAs.

Urologic manifestations of hypotonia, ataxia, and delayed development syndrome (HADDS), a rare neurodevelopmental disorder

Early B-cell factor 3 (EBF3) is a transcription factor involved in neuronal differentiation and maturation. Pathogenic variants are associated with hypotonia, ataxia, and delayed development syndrome (HADDS) (MIM#617330). Urologic manifestations are common and may have implications regarding long term renal function. To review all known patients with pathogenic variants of the EBF3 gene resulting in HADDS with urologic manifestations. We hypothesize a high rate of bladder dysfunction secondary to the EBF3 variant's impact on relaxation of the urinary sphincter leading to detrusor sphincter dyssynergia (DSD). The PubMed database was queried for publications of the EBF3 mutation between January 2017 and January 2023. Search terms were "EBF3 mutation OR HADDS AND urology OR phenotype". Retrospective analysis of HADDS patients cared for in our institution was performed. Demographic and clinical information was collected. We identified 52 patients (33F:19M) through literature (28F:18M) and retrospective review (5F:1M). There was a high prevalence of genitourinary physical exam abnormalities, history of urinary tract infection, vesicoureteral reflux (VUR), and diagnosis of neurogenic bladder. Within the literature review cohort, 67% had a urologic diagnosis. Females were disproportionately affected with urologic manifestations. In our cohort, four of six children were diagnosed with VUR and severe voiding dysfunction consistent with neurogenic bladder (67%). These children were managed with a vesicostomy. Five children had bowel dysfunction requiring therapy. Urodynamics suggested a high prevalence of external sphincter dyssynergia. Less severe forms of DSD were felt to be implicated in the abnormal voiding parameters in children who presented later in life based on non-invasive flow studies. There is significant variability in the phenotypic presentation of patients with HADDS. While EBF3 plays a clear role in neurodevelopment, it also impacts muscle development and may impact muscle relaxation. The location of the genetic variant may impact the degree of DSD, with more severe forms leading to earlier presentations. Initial work-up should include a renal ultrasound (RUS) and post void residual (PVR). Consideration can be given to obtaining a VCUG, DMSA scan or urodynamic studies. Yearly screening should be pursued with an RUS and PVR in those with an initial unremarkable work-up given the variable timing and severity of presentation. Urologic manifestations of HADDS include high rates of bladder dysfunction secondary to DSD, vesicoureteral reflux, urinary tract infection, and cryptorchidism. These patients are at risk of renal deterioration if urinary abnormalities are not properly diagnosed and managed.

SP3.9 The role of urinary biomarkers in predicting post operative kidney function

Abstract Aims Post-operative Acute Kidney Injury (AKI) has implications on recovery, conferring a significant risk of morbidity and mortality. A previous study of 488 major abdominal surgery patients demonstrated that urinary biomarkers could predict peri-operative AKI. The aim of this follow-up study was to assess the biomarkers (NGAL, KIM-1, DKK-3 and IGFBP-7*TIMP-2) for their ability to predict long-term changes in renal function. Methods Predictive ability for long term renal function derangement was assessed by classifying the participants change in their ‘CKD’ stage from the pre-operative status, determined by the measured eGFR at follow up as per the KDIGO criteria (at least 6 months from their operation). Biomarker performance was assessed utilising AUROC analysis. Biomarkers were also interrogated for their ability to predict mortality at one year. Results Follow up measurement of renal function was obtained in 446 of 488 patients. 40 patients died within 1 year of their operation. Median time of follow up renal function measurement was 398 days post operatively (IQR: 366 – 490 days). 169 patients developed an increase in their CKD stage. No biomarker showed good predictive ability for such a rise – all displayed AUC values of <0.6. Similarly, AUC values for the prediction of mortality within one year were low, with all AUC values <0.65. Discussion This study has determined that urinary AKI biomarkers are poor predictors for long term derangement in renal function and mortality at one year in the surgical patient. Such evidence suggests that biomarkers are best suited to detect changes in the immediate post operative period.

MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP70-03 THE ROLE OF CIRCUMCISION IN PREVENTING URINARY TRACT INFECTIONS IN CHILDREN WITH ANTENATAL HYDRONEPHROSIS: SYSTEMATIC REVIEW AND META-ANALYSIS Justin Chan, Adree Khondker, Min Joon Lee, Jin Kyu Kim, Michael Chua, Joana Dos Santos, Natasha Brownrigg, Juliane Richter, Armando Lorenzo, and Mandy Rickard Justin ChanJustin Chan More articles by this author , Adree KhondkerAdree Khondker More articles by this author , Min Joon LeeMin Joon Lee More articles by this author , Jin Kyu KimJin Kyu Kim More articles by this author , Michael ChuaMichael Chua More articles by this author , Joana Dos SantosJoana Dos Santos More articles by this author , Natasha BrownriggNatasha Brownrigg More articles by this author , Juliane RichterJuliane Richter More articles by this author , Armando LorenzoArmando Lorenzo More articles by this author , and Mandy RickardMandy Rickard More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Circumcision has been reported to reduce the risk of urinary tract infection (UTI) in boys with congenital urinary tract anomalies, a diverse group of conditions that includes hydronephrosis. Our aim was to specifically compare the rates of UTIs in circumcised vs. uncircumcised boys with antenatal hydronephrosis by conducting a systematic review and meta-analysis. METHODS: A comprehensive search was performed until December 2021. Comparative studies were evaluated according to Cochrane collaboration recommendations. Assessed measures included UTIs, continuous antibiotic prophylaxis (CAP) use, renal function, development of cortical scarring, as well as circumcision complications. Odds ratios (OR) and mean difference with 95% confidence interval (CI) were extrapolated from available data. Random-effects meta-analysis were performed, and confounders were assessed with subgroup analysis. RESULTS: Sixteen studies describing 7,503 boys with antenatal hydronephrosis were identified, including 4,116 boys who were uncircumcised and 3,387 boys who were circumcised. The median follow-up time was 24.0 months (range: 6.0 - 152.4 months). Uncircumcised and circumcised boys were found to have UTI rates of 19.1% and 6.1%, respectively. This translates to a number needed to treat (NNT) of 8. Overall effect estimates demonstrate that circumcised boys have a significantly reduced odds of developing any UTI [OR 0.23, 95% CI 0.17, 0.31; p<0.001]. Furthermore, there was a significantly reduced odds of developing UTI on CAP [OR 0.18, 95% CI 0.11, 0.32; p<0.001]. When stratifying by etiology of antenatal hydronephrosis, circumcision reduced the odds of UTI in boys with vesicoureteral reflux [OR 0.24, 95% CI 0.12, 0.47; p<0.00001], or posterior urethral valve [OR 0.29, 95% CI 0.13, 0.64; p=0.002]. Long term renal function, development of renal scarring, and postoperative complications were not consistently reported, which prohibited pooling. Most studies had moderate risk of bias. CONCLUSIONS: Current evidence suggests that circumcision reduces the frequency of UTIs in boys with antenatal hydronephrosis. Based on these findings, circumcision should be considered in boys with antenatal hydronephrosis to prevent the risk of developing UTI. Further research is warranted to individualize the prophylactic role of circumcision for patients with different etiologies and grade of hydronephrosis. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1003 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Chan More articles by this author Adree Khondker More articles by this author Min Joon Lee More articles by this author Jin Kyu Kim More articles by this author Michael Chua More articles by this author Joana Dos Santos More articles by this author Natasha Brownrigg More articles by this author Juliane Richter More articles by this author Armando Lorenzo More articles by this author Mandy Rickard More articles by this author Expand All Advertisement PDF downloadLoading ...

MP56-14 LONG-TERM RENAL FUNCTION IN PATIENTS UNDERGOING TRIMODAL THERAPY FOR BLADDER CANCER

You have accessJournal of UrologyCME1 Apr 2023MP56-14 LONG-TERM RENAL FUNCTION IN PATIENTS UNDERGOING TRIMODAL THERAPY FOR BLADDER CANCER Affan Zafar, Linda Nguyen, Alexandra Hunter, William Shipley, Niall Heney, Anthony Zietman, Matthew Wszolek, Jason Efstathiou, Michael Drumm, Hannah Roberts, and Adam Feldman Affan ZafarAffan Zafar More articles by this author , Linda NguyenLinda Nguyen More articles by this author , Alexandra HunterAlexandra Hunter More articles by this author , William ShipleyWilliam Shipley More articles by this author , Niall HeneyNiall Heney More articles by this author , Anthony ZietmanAnthony Zietman More articles by this author , Matthew WszolekMatthew Wszolek More articles by this author , Jason EfstathiouJason Efstathiou More articles by this author , Michael DrummMichael Drumm More articles by this author , Hannah RobertsHannah Roberts More articles by this author , and Adam FeldmanAdam Feldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Trimodal therapy (TMT) is a standard treatment option for select patients with muscle-invasive bladder cancer. The efficacy of TMT has been shown in several randomized trials; however, the long-term effect on renal function has not been investigated. Furthermore, various types of chemotherapy agents (ie. mitomycin, 5-FU, cisplatin) used during TMT are nephrotoxic. As many bladder cancer patients are elderly with significant medical comorbidities, data on long term renal function would aid in management. We sought to evaluate the change in renal function over 10 years in bladder cancer patients who have completed TMT. METHODS: The Massachusetts General Hospital’s institutional TMT database was retrospectively reviewed to obtain baseline renal function (estimated GFR) at time of muscle-invasive bladder cancer (MIBC) diagnosis. The eGFR values were calculated using the CKD-EPI creatinine equation. Interval eGFR was obtained for years 1, 3, 5, and 10 after the date of bladder cancer diagnosis. RESULTS: 287 patients undergoing TMT treatment for muscle invasive bladder cancer were reviewed. Patients were excluded due to incomplete TMT treatment or missing data, resulting in 251 eligible patients for evaluation of baseline mean eGFR. Median follow up was 4.56 years. Baseline mean eGFR was 65.67 mL/min/1.73. Mean eGFR for years 1, 3, 5, and 10 were 58.43 mL/min/1.73, 55.4 mL/min/1.73, 54.54 mL/min/1.73, and 57.3 mL/min/1.73, respectively. CONCLUSIONS: Renal function for bladder cancer patients undergoing TMT declined slightly after 1 year of follow up but remained stable for the remainder of the 10 years of follow up. Further studies are needed to identify predictors of renal decline and compare these results with the overall bladder cancer and general population. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e780 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Affan Zafar More articles by this author Linda Nguyen More articles by this author Alexandra Hunter More articles by this author William Shipley More articles by this author Niall Heney More articles by this author Anthony Zietman More articles by this author Matthew Wszolek More articles by this author Jason Efstathiou More articles by this author Michael Drumm More articles by this author Hannah Roberts More articles by this author Adam Feldman More articles by this author Expand All Advertisement PDF downloadLoading ...

MP58-13 FUNCTIONAL OUTCOMES AFTER SURGERY IN PATIENTS WITH RENAL CANCER AND TUMOR THROMBUS

MP58-13 FUNCTIONAL OUTCOMES AFTER SURGERY IN PATIENTS WITH RENAL CANCER AND TUMOR THROMBUS

MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP47-12 SINGLE LAYER CORTICAL RENORRHAPHY AS A SAFE ALTERNATIVE TO DUAL LAYER RENORRHAPHY DURING ROBOTIC PARTIAL NEPHRECTOMY Tarek El-Ghazaly, Jonathan Rosenfeld, Shilajit Kundu, Robert Nadler, and Kent Perry Tarek El-GhazalyTarek El-Ghazaly More articles by this author , Jonathan RosenfeldJonathan Rosenfeld More articles by this author , Shilajit KunduShilajit Kundu More articles by this author , Robert NadlerRobert Nadler More articles by this author , and Kent PerryKent Perry More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003293.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic partial nephrectomy (RPN) is being increasingly adopted in the management of renal masses amenable to nephron-sparing surgery. Robotic renorraphy techniques, including dual layer repairs, have carried over from laparoscopic partial nephrectomy (LPN) which was initially associated with higher bleeding and urine leak rates compared to open partial nephrectomy (OPN). Dual layer repair has been shown in previous studies to prolong warm ischemia time, while potentially leading to a higher rate of pseudoaneurysm formation and worse long term renal function parameters. Our aim is to compare single cortical robotic renorrhaphy (SCRR) to dual-layer robotic renorrhaphy (DLRR) in terms of bleeding rates secondary to pseudoaneurysm formation, urine leak rates, and long-term renal functional outcomes. METHODS: A prospectively maintained list of all RPN procedures at Northwestern Memorial Hospital from January 2018 to July 2022 was retrospectively reviewed. 247 RPNs were identified, including 71 cases with SCRR carried out, and 176 cases with DLRR. Preoperative imaging was used to calculate nephrometry scores using R.E.N.A.L. (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines, hilar) measurements. Charts of patients with a length of stay longer than 72 hours, or with any readmissions under the urology service were closely examined for bleeding or leakage complications. Other examined parameters included drain fluid-to-serum creatinine ratios, as well as short term and long term changes in glomerular filtration rates (GFR). RESULTS: Comparing SCRR to DLRR, similar nephrometry scores were seen across both groups undergoing RPN (6.6 vs 7, p=0.29), including equivalent tumor sizes (34 mm vs 30 mm, p=0.11) and nearness to the collecting system (p=0.25). No significant differences in rates of bleeding secondary to pseudoaneurysms (0.03% vs 0.02%, p=0.8), urine leak rates (0% vs 0%), or changes in GFR (p=0.25) were seen between both groups of this study. CONCLUSIONS: No significant changes in urine leakage or bleeding rates secondary to pseudoaneurysm formation or changes in renal functions were found when comparing SLRR to DLRR during RPN for masses of equivalent sizes, depth and nephrometry scores. Single layer cortical repair seems to offer a safe method of shortening renorrhaphy and warm ischemia times compared to dual layer repairs. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e648 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tarek El-Ghazaly More articles by this author Jonathan Rosenfeld More articles by this author Shilajit Kundu More articles by this author Robert Nadler More articles by this author Kent Perry More articles by this author Expand All Advertisement PDF downloadLoading ...

Posterior Urethral Valve: Factors Affecting the Renal Outcome

Background: Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male children with associated sequlae. Different factors, such as age at presentation, initial and nadir serum creatinine, renal parenchymal echogenicity on initial USG, vesicoureteric reflux (VUR) , recurrent UTI, bladder dysfunction and the presence or absence of pop-off mechanism like VURD have significant impact on ultimate renal outcome. The main aim of the study was to observe the effects of different prognostic factors like age of presentation and preoperative VUR of the PUV respondents on postoperative long term renal outcome as well as changes of renal function status on the basis of initial and postoperative serum creatinine level in our settings. Material Methods: This was a quasi-experimental study and conducted in the Department of Pediatric urology of Bangladesh Shishu Hospital and Institute, Dhaka. We enrolled 58 male children of different ages having posterior urethral valve, who were admitted in the pediatric urology department from July,2018 to Dec,2021. Results: Total 58 patients included in our study. Among all patients 53.4% were aged between 1 month to 1 year, 39.7% of them were more than 1 year old and 6.9% of them were neonates. Among 31 respondents, 32.3 % had poor renal function 35.5 % of them also had moderately impaired renal function. Again, out of 23 respondents, 30.4% had poor renal function 6% had moderately impaired renal function. The relation between age category and postoperative renal function status (On the basis of postoperative eGFR) of the posterior urethral valve respondents were statistically not significant. Patients who had no VUR, 66.7% of them had normal renal function, 25% had moderately impaired renal function and 8.3% had poor renal function. Respondents who had bilateral VUR, 55% of them had poor renal function and 35% had moderately impaired renal function. Among respondents who had unilateral VUR, 28.6% of them had poor renal function and 28.6% had moderately impaired renal function but 42.9% had normal renal function. The relation between preoperative VCUG findings and postoperative long term renal function status of the PUV patients were statistically significant. 7 (100%) respondents who had preoperative abnormal renal function, more than 71.4% of them had returned to normal renal function after operative procedure. But abnormal renal function was present in 2 (28.6%) patients during follow up. In our study we found 29.3% of our patients had poor renal outcome and 29.3% patients had moderately impaired renal function within the mean follow up period of 19.33±12.38 months (ranges from 9months to 4 years). Conclusion: Our research highlights the significance of age at presentation, despite its statistically negligible effect on long-term renal outcomes. However, among the children with PUV following valve ablation and with a long-term follow-up, beginning serum creatinine and the presence of various types of VUR on initial VCUG had a significant effect (p.05) on postoperative renal function on the basis of serum creatinine.

Natural course and determinants of short-term kidney function decline in hereditary transthyretin amyloidosis: a French observational study

Data regarding renal involvement in patients with hereditary transthyretin (ATTRv) amyloidosis are scarce and the natural course of chronic kidney disease (CKD) in this population remains unclear. This observational study, including adult patients diagnosed with ATTRv amyloidosis at the French Reference Centre for Cardiac Amyloidosis, investigated renal function outcome and its determinants. Multivariable logistic regression models identified factors associated with CKD at baseline. Determinants of the change in estimated glomerular filtration rate (eGFR) over 24 months of follow-up were assessed with a multivariable linear mixed-effects model. In total, 232 patients (78 women [34%], mean age: 64 years) with ATTRv amyloidosis were classified on the basis of their TTR variants: ATTRV122I (37%), ATTRV30M (29%), and other variants (34%). Median baseline eGFR was 78 ml/min/1.73 m2. Seventy-two patients (31%) had an eGFR below 60 ml/min/1.73m2 and 27/137 patients (20%) had significant proteinuria (urine protein/creatinine ratio ≥30 mg/mmol). Renal biopsy, performed in four cases, found typical Congo red-positive and TTR-labelled amyloid deposits in all cases. Older age (OR 1.07, p < .001) and a prior history of hypertension (OR 2.09, p = .04) were associated with a higher prevalence of CKD at baseline, whereas higher left ventricular global longitudinal strain (LVGLS) (OR 0.83, p < .001) was associated with a lower prevalence. The estimated change in eGFR was −7.12 [−9.61, −4.63] and −8.21 [−10.81, −5.60] ml/min/1.73 m2 after 12 and 24 months of follow-up, respectively. eGFR decline was independently associated with older age ((67–74], coefficient= −14.35 mL/min/1.73 m2, p < .01, >74, coefficient = −22.93 mL/min/1.73 m2, p < .001, versus <56), ATTRV122I (coefficient = −17.17 mL/min/1.73m2, p < .01, versus ATTRV30M) and LVGLS (coefficient = 1.22, p < .01). These data suggest that CKD is a common finding in patients with ATTRv amyloidosis, and that eGFR decline is rapid during the first year of evaluation. Older age, lower LVGLS and ATTRV122I were associated with a worse renal outcome. Further studies are now needed to evaluate effects of new targeted therapies on long term renal function.

P13 Finding an answer for an adolescent with back pain

Case report - IntroductionThis is the case of an adolescent referred to rheumatology following 5 years of back pain. After years of trying a number of treatments without much success, the cause was found to be a previously undiagnosed urological pathology. The case highlights awareness of non-rheumatological causes and incidental findings which can redirect a patient towards more appropriate treatment and reduce the potential for long-term adverse health issues and anxiety.Case report - Case descriptionB was referred age 16 to rheumatology with a 5-year history of lower back pain. She had previously seen paediatricians with symptoms initially attributed to constipation due to intermittent straining and hard stool. However, constipation remedies had not relieved the pain which progressed gradually to a more persistent dull ache with impact on daily activities. Various analgesics (including paracetamol and non-steroidal anti-inflammatories), exercises and acupuncture had not helped. There was no history of recurrent urinary tract infections or symptom correlation with fluid intake, menstruation or bowel habit. No inflammatory features or connective tissue disease symptoms were noted and family history was unremarkable Clinical examination was normal apart from mild tenderness in the lumbar region.Rheumatoid factor was borderline positive (15 iu/mL) with the rest of blood tests normal including renal function, inflammatory markers (CRP, ESR), anti CCP and ANA. She had minimal microscopic haematuria without proteinuria. MRI spine in 2015 was normal. In view of her young age and symptoms affecting daily activities, STIR sequence spinal MRI was requested. This excluded any new or old inflammatory changes but incidentally identified a dilated left pelvi-calyceal system.Renal ultrasound confirmed a grossly hydronephrotic left kidney with hydroureter and minimal renal tissue suggesting longstanding obstruction. No calculi were seen. The patient was referred to urologists. Further investigations (including MRI abdomen) confirmed similar findings and a distal ureteric stricture. A MAG 3 renogram showed a normal right kidney but only 12% functioning of the left kidney. Urologists have advised surgery (removal of left kidney and ureter) which may relieve symptoms or a conservative non-surgical approach (continue analgesia, physiotherapy and monitoring). The patient and her family are relieved to have a possible cause identified and are considering the surgical option due to ongoing flank discomfort. Case report - DiscussionThis was an interesting finding of hydroureter and hydronephrosis causing longstanding back pain presenting to rheumatologists. Until completion of the spondyloarthropathy protocol MRI (STIR images), aetiology had been unclear. Hydronephrosis and hydroureter has no specific age or racial predilection. Signs and symptoms may depend on whether obstruction is acute/chronic. Chronic cases may be asymptomatic or present as a dull discomfort (like this case). Some cases may only present in adulthood with pain precipitated by fluid intake. Blood tests may show impaired kidney function. Post-mortem studies suggest 50% of people have at least one renal abnormality (e.g., renal cysts, duplex ureters) with autopsy series incidence of hydronephrosis reported as 3.1%. Causes include anatomical abnormalities such as vesico-ureteric reflux, urethral strictures (usually present in childhood), calculi, benign prostatic hyperplasia, or intrapelvic neoplasms, pregnancy and infections (e.g., TB). Sudden onset unilateral renomegaly was reported in one case of primary Sjogren’s with lymphocytic interstitial nephritis and positive Sjogren’s autoantibodies. Our patient has no clinical or serological evidence of connective tissue disease.Minor pelvi-calyceal distension can occur as a normal finding in well-hydrated patients and pregnancy. However, significant hydronephrosis requires assessment to determine cause as it may affect long term renal function. Imaging via computed tomography, ultrasound and urograms can help guide further management.In this case the preceding cause and duration of pathology is unknown. Sterile, giant hydronephrosis treatment options include observation and ureteric stent or nephrostomy in patients unfit for surgery. Nephrectomy is advised for pain and recurrent infection in a non-functioning kidney. Complications may include bowel perforation, vascular injury and urine leakage. Both open and minimally invasive procedures have good reported outcomes. The COVID-19 pandemic and exams have affected timing of any elective procedures and the patient understands surgery may or may not offer complete symptom resolution.Case report - Key learning pointsNon-inflammatory causes of back pain should always be considered in cases of persistent back pain, particularly in young people to ascertain if there is a treatable causeHydronephrosis cases can be asymptomatic or present with vague, intermittent, non-specific abdominal symptoms with normal physical examination with or without haematuria. This can cause diagnostic uncertainty and delay referral to urology and appropriate renal investigations Assessment of renal function (including MAG 3 renogram) is important to guide further managementSurgical interventions (pyeloplasty/nephrectomy) may ease symptoms long term but there is no guarantee of a successful outcome and operative risks need to be considered tooLeft undiagnosed, potentially this patient could have had further disruption to daily activities and both physical and mental well being

Renal Outcomes One Year After Metabolic Bariatric Surgery: A Clinical Audit

Introduction: Obesity increases the risk of incident chronic kidney disease (CKD), being one of the strongest risk factors for new-onset CKD even in the metabolically normal obese. Weight loss has been shown to reduce renal hyperfiltration and proteinuria. Metabolic Bariatric Surgery (MBS) remains an effective treatment for obesity and its metabolic related complications. However, literature on its impact on long term renal function remains limited. Methods: This was an observational retrospective study in a tertiary centre in Singapore. MBS cases performed at the centre between 2008 and 2019 were included. The primary outcome measure was estimated Glomerular Filtration Rate (eGFR), calculated using the CKD Epidemiology Collaboration equation, and albuminuria (defined as urine Albumin-Creatinine Ratio (uACR) >3.5 mg/mmol) at baseline and at one-year post surgery. Results: 557 patients were included. Baseline parameters are as follows: mean age 41.7 ±10.1 years; female 65.4%; ethnic composition: Chinese (35.2%), Malay (33.0%), Indian (26.9%); BMI 42.5 ±7.9 kg/m²; glycaemic status: Diabetes Mellitus (34.5%), Pre-diabetes (13.5%), Non-diabetic (52.1%); Hypertensive status: Hypertension (55.2%), Pre-Hypertension (1.9%), Normotensive (42.9%). Median eGFR was 110.9 (92.4 - 121.5) mL/min/1.73 m² and median uACR was 1.00 (0.40 - 3.55) mg/mmol. At one-year post surgery, patients achieved statistically significant reductions in mean BMI (-11.3 ±4.2 kg/m2), systolic BP (-3.24 ±19.3 mmHg), diastolic BP (-5.23 ±13.8 mmHg), fasting glucose (-1.95 ±2.89 mmol/L) and improvement in HDL (0.29 ±0.26 mmol/L). In addition, statistically significant reductions in the proportion of patients on anti-hypertensive (48.8% to 14.4%), anti-diabetic (34.1% to 12.7%) and lipid-lowering medications (37.8% to 20.4%) were seen. In particular, ACE-inhibitor and/or angiotensin receptor blocker (32.9% to 9.2%, p< 0.001) usage was reduced. At one-year post surgery, median eGFR increased by 1.66 mL/min/1.73 m² (p<0.001). Further stratification by glycemic status showed significant increases in GFR in patients without diabetes or pre-diabetes. There was a decrease in median uACR (0.30 mg/mmol, p=0.001) at one-year post surgery; this remained statistically significant in patients with diabetes and pre-diabetes. 12.9% of patients had improvements in CKD staging. The proportion of patients with albuminuria decreased from 24.8% at baseline to 1.89% one-year post surgery (p<0.001). Conclusions: Metabolic bariatric surgery had a positive impact on renal function as shown by the improvement in eGFR in the non-diabetic group, and the reduction in albuminuria in the diabetes and pre-diabetes group at one-year post surgery. More adequately powered, longer-term data is required to investigate the durability of this impact.

Mild increases in plasma creatinine after intermediate to high-risk abdominal surgery are associated with long-term renal injury

BackgroundThe potential relationship between a mild acute kidney injury (AKI) observed in the immediate postoperative period after major surgery and its effect on long term renal function remains poorly defined. According to the “Kidney Disease: Improving Global Outcomes” (KDIGO) classification, a mild injury corresponds to a KIDIGO stage 1, characterized by an increase in creatinine of at least 0.3 mg/dl within a 48-h window or 1.5 to 1.9 times the baseline level within the first week post-surgery. We tested the hypothesis that patients who underwent intermediate-to high-risk abdominal surgery and developed mild AKI in the following days would be at an increased risk of long-term renal injury compared to patients with no postoperative AKI.MethodsAll consecutive adult patients with a plasma creatinine value ≤1.5 mg/dl who underwent intermediate-to high-risk abdominal surgery between 2014 and 2019 and who had at least three recorded creatinine measurements (before surgery, during the first seven postoperative days, and at long-term follow up [6 months-2 years]) were included. AKI was defined using a “modified” (without urine output criteria) KDIGO classification as mild (stage 1 characterised by an increase in creatinine of > 0.3 mg/dl within 48-h or 1.5–1.9 times baseline) or moderate-to-severe (stage 2–3 characterised by increase in creatinine 2 to 3 times baseline or to ≥4.0 mg/dl). The exposure (postoperative kidney injury) and outcome (long-term renal injury) were defined and staged according to the same KDIGO initiative criteria. Development of long-term renal injury was compared in patients with and without postoperative AKI.ResultsAmong the 815 patients included, 109 (13%) had postoperative AKI (81 mild and 28 moderate-to-severe). The median long-term follow-up was 360, 354 and 353 days for the three groups respectively (P = 0.2). Patients who developed mild AKI had a higher risk of long-term renal injury than those who did not (odds ratio 3.1 [95%CI 1.7–5.5]; p < 0.001). In multivariable analysis, mild postoperative AKI was independently associated with an increased risk of developing long-term renal injury (adjusted odds ratio 4.5 [95%CI 1.8–11.4]; p = 0.002).ConclusionsMild AKI after intermediate-to high-risk abdominal surgery is associated with a higher risk of long-term renal injury 1 y after surgery.

Long term renal function following selective angioembolization for iatrogenic vascular lesions after partial nephrectomy: A matched case-control study.

PurposePartial nephrectomy is associated with a 1%–2% risk of renal iatrogenic vascular lesion (IVL) that are commonly treated with selective angioembolization (SAE). The theoretical advantage of SAE is preservation of renal parenchyma by targeting only the bleeding portion of the kidney. Our study aims to assess the long-term effect of SAE on renal function, especially that this intervention requires potentially nephrotoxic contrast load injection.Materials and MethodsA retrospective review of patients undergoing partial nephrectomy between 2002 and 2018 was performed, and patients who developed IVL were identified. A 1:4 matched case-control analysis was performed. Paired t-test and χ2 test were used for continuous and categorical variables, respectively. Multivariable logistic and Cox proportional hazards regression analyses were used to identify risk factors and confounders for SAE and postoperative renal function.ResultsEighteen patients found to have an IVL after partial nephrectomy were matched with 72 control patients. IVL's were more common in patients after minimally invasive partial nephrectomy (89% vs. 70%, p=0.008) and in those with higher RENAL nephrometry scores (8.8±2.0 vs. 6.5±1.8, p<0.001). On multivariable analysis, lower RENAL scores proved to decrease the odds of requiring postoperative SAE. No significant difference in renal function outcomes was seen at 24 months of follow-up after surgery.ConclusionsSAE for the management of IVL following partial nephrectomy is a safe and efficient procedure with no significant impact on short or long-term renal function. Less complex renal tumors with lower RENAL scores are less likely to require postoperative SAE.

Methotrexate-Induced AKI: Incidence, Risk Factors and Recovery

Background: Data on short and long term renal outcomes after high dose methotrexate (HD MTX) in large adult cohorts using a standardized definition of AKI is lacking. This is a report on the incidence of AKI after HD MTX, renal outcomes when HD MTX is continued after AKI, and long term renal function in patients who survived beyond 5 years after Risk factors for AKI following HD MTX were also examined. Methods: In this single center retrospective case control study, all adult patients (>18 years) who had received HD MTX (defined as >1g/m 2 ) from 2003 – 2013 were analyzed. AKI was identified by a > 1.5x increase in baseline serum creatinine (Cr) within 4 days after HD MTX. We have collected age at first HD MTX, race, cancer, baseline and all Cr values after HD MTX, and cumulative dose (CD) of MTX. Univariable and multivariable logistic regression models were performed with AKI as the dependent variables. Overall survival for patients that had received HD MTX was presented in a Kaplan-Meier analysis. Findings: In a cohort of 865,32.1% developed AKI. Patients who developed AKI had a lower baseline Cr (0.7 ± 0.2 vs 0.9 ±0.2; p<0.001), a higher eGFR (95.1 ± 21.8 vs 90.0 ± 22.0; p<0.001) and received a higher CD (25,750 (14100 – 35000) vs 20,000 (9425 – 34,300); p<0.01). There was no statistical difference in overall survival among patients who developed AKI (p=0.13) and those who continued to receive HD MTX after AKI (p=0.32). Recovery from AKI to within 20% of baseline Cr was associated with a higher probability of survival (p<0.001). Interpretation: Despite its relatively common incidence in adult patients receiving HD MTX, AKI does not affect overall survival and should not be a barrier to further administration of chemotherapy. Funding Statement: This study was funded by NIH/NCI Cancer Center Support Grant P30 CA008748. Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by the Internal Review Board at Memorial Sloan Kettering Cancer Center, retrospective data was collected on all adult patients (>18 years) who received HD MTX from 01/01/2003 – 12/31/2013.

Effects of Left Renal Vein Ligation During Open Abdominal Aortic Aneurysm Repair on Renal Function

Left renal vein (LRV) ligation is performed during open abdominal aortic aneurysm (AAA) repair to facilitate proximal anastomosis. Its impact on short, medium, and long term renal function has not been investigated in detail using appropriately validated endpoints. This was a nested case control study using data from a prospectively maintained AAA institutional dataset (tertiary centre). A total of 76 patients who underwent elective open AAA repair and had LRV ligation (1 January 2012 to 1 January 2018) were individually case matched based on age (within two years), sex, estimated glomerular filtration rate (eGFR), American Society of Anesthesiologist (ASA) score, chronic kidney disease (CKD) stage, and history of diabetes with 76 patients who had open AAA repair without LRV ligation. Renal outcomes were compared between groups, including proportion of patients developing acute kidney injury (AKI) using the Kidney Disease Improving Global Outcomes (KDIGO) criteria, proportion developing major adverse kidney events (MAKE90) at 90 days (comprising mortality and/or decrease in eGFR >25%), and absolute decrease in eGFR at latest follow up. A higher proportion of patients developed AKI and MAKE90 in the LRV ligation group (AKI: 11 patients [14.8%] vs. 2 [2.6%], p=.009; MAKE90: 6 [7.9%] vs. 1 [1.3%] p=.053, in the LRV ligation and the non-LRV ligation groups, respectively) - even though the difference in the MAKE90 endpoint was not statistically significant. Changes in eGFR were not statistically different in the LRV ligation group at 90 days (4.0±1.1mL/min/1.73m2vs. 4.4±2.1, p=.64) or by the time of latest follow up (median: 28 months; 3.7±1.6 vs. 2.6±2.0, p=.55). Ligation of the LRV is associated with increased levels of AKI and renal deterioration in the early post-operative phase using validated reporting criteria; however, long term renal function does not seem to be affected.

Impact of autologous stem cell transplantation on long term renal function and associated progression-free and overall survival in multiple myeloma

The long-term impact of Autologous hematopietic stem cell transplantation (ASCT) on renal function, and the impact of renal function on progression-free survival (PFS) and overall survival (OS) in patients with multiple myeloma are not known. We retrospectively reviewed the records of 885 patients at our institution. We used linear mixed effect models to study the change in estimated glomerular filtration rate (eGFR) and a joint model approach to assess associations between the eGFR, PFS and OS. Sensitivity analyses were conducted at days 0, 100, 180, and 365 post-SCT. eGFR post-ASCT was significantly lower than at day 0 but stabilized at approximately 80 mL/min/1.73 m2. There was no association between eGFR and PFS or OS.; However, relapsed disease and ISS stage were associated with shorter PFS and OS. This data suggests that although there is a modest decline in eGFR post-ASCT, it is not associated with an adverse impact on PFS or OS. KEY POINTS Advanced MM stage at diagnosis was associated with reduced eGFR at all stages of chronic kidney disease. eGFR was not associated with PFS or OS in any of the analyses, but disease-related factors prior to ASCT were all associated with reduced eGFR, PFS and OS. ASCT did not adversely impact kidney function and mitigated the risk of CKD on outcomes in MM.

P1676LONG TERM RENAL FUNCTIONS IN LIVING KIDNEY DONORS AND ITS RELATIONSHIP WITH TRANSFORMING GROWTH FACTOR ßETA-1GENE POLYMORPISMS

Abstract Background and Aims Renal transplantation is the optimal treatment choice for most patients with end-stage renal disease. Despite the efforts to increase cadaveric transplantation, the primary source of kidneys is still living donors. Donating a kidney is associated with lower than expected GFR especially in the presence of hypertension and proteinuria. Increased risk of ESRD and cardiovascular disease are small and controversial. TGF-β1 is an essential regulator of fibroblast phenotype and function, hence the main driver in most healthy/pathogenic fibrotic processes. TGF-β1 overexpression has been accused of poor results in chronic nephropathies. Single nucleotide polymorphisms (SNP) in the TGF-β1 gene may accelerate chronic allograft nephropathy and chronic kidney disease progression. In this study, we aimed to assess two TGF-β1 polymorphisms’ effect on long term renal function in kidney donors. Method This cross-sectional, single-center study was conducted in a tertiary referral center. Seventy-two living kidney donors who had donated between January 1999 and May 2018 were included in the study. The age, body mass index, and sex-matched control group consisted of 100 volunteers without systemic disease. GFR was calculated with CKD-EPI formula. Renal functions were compared between donors and controls. TGF-β1 gene polymorphism status of donors was evaluated with RT-PCR. Namely, +869T/C at codon 10 (rs1800470) and +915G/C at codon 25 (rs1800471) abbreviated as codon 10 SNP and 25 SNP respectively. TGF-β1 gene polymorphism effect on renal functions was assessed with a proper statistical approach. Results The study included 72 (53 female, 19 male) kidney donors, and 100 (69 female, 31 male) healthy controls. The mean age of the donor group was 50 ± 12 years, and the mean age of the control group was 47 ± 11 years.The mean creatinine levels of donors were significantly higher than the mean creatinine levels of the control group (0.96±0.2 vs. 0.72±0.2 mg/dL p &amp;lt;0.001). The mean GFR values of donors were markedly lower than the GFR values of the control group (76±20 vs. 107±22 mL/min). Regarding codon 10 SNP status, 34/18/20 donors had C/C, T/C, and T/T phenotypes. The preoperative and final GFR were similar between all groups. Regarding codon 25 SNP status, 61/6/5 donors had G/G, G/C, and C/C phenotypes. The preoperative GFR was statistically similar between all groups. The final GFR was highest for donors with G/G phenotype and lowest for those with C/C phenotypes (Table1). Donors with C/C phenotype were at 4.7 fold increased risk for GFR&amp;lt; 60 ml/min compared to those with G/G phenotype (HR:4,74 %95 CI: 1,482-15,212; p:0,009). Conclusion Kidney donation is associated with lower GFR compared to healthy individuals. The more profound decline in some cases may be explained with TGF-β1 SNP at codon 25. Our study shows C/C phenotype is associated with lower final GFR in renal transplant donors. We propose this particular finding might be useful for eligibility, especially for marginal donors after validation with studies including a higher number of participants.

PD41-04 LONG-TERM RENAL FUNCTION OUTCOMES AFTER RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN PATIENTS WITH CHRONIC KIDNEY DISEASE

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II (PD41)1 Apr 2020PD41-04 LONG-TERM RENAL FUNCTION OUTCOMES AFTER RADICAL CYSTECTOMY WITH ORTHOTOPIC NEOBLADDER IN PATIENTS WITH CHRONIC KIDNEY DISEASE Seyedeh-Sanam Ladi Seyedian*, Hamed Ahmadi, Alireza Ghoreifi, Sidney Roberts, Saum Ghodoussipour, Sumeet Bhanvadia, Hooman Djaladat, Anne Schuckman, and Siamak Daneshmand Seyedeh-Sanam Ladi Seyedian*Seyedeh-Sanam Ladi Seyedian* More articles by this author , Hamed AhmadiHamed Ahmadi More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Sidney RobertsSidney Roberts More articles by this author , Saum GhodoussipourSaum Ghodoussipour More articles by this author , Sumeet BhanvadiaSumeet Bhanvadia More articles by this author , Hooman DjaladatHooman Djaladat More articles by this author , Anne SchuckmanAnne Schuckman More articles by this author , and Siamak DaneshmandSiamak Daneshmand More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000921.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) reconstruction following radical cystectomy (RC) is generally discouraged in patients with chronic kidney disease (CKD) as it is believed that it would cause significant electrolyte disturbances and worsening renal function in the long run. This study aims to evaluate long-term renal function outcomes of bladder cancer patients with CKD who received ONB. METHODS: According to our institutional IRB approved cystectomy database from January 2003 to December 2018, 2182 patients underwent RC for bladder cancer. ONB was constructed in 1280 (59%) patients of whom 273 had preoperative glomerular filtration rate (GFR) between 45 to 60 ml per minute/1.73 m2. Sixteen patients were excluded due to lack of follow up. Renal function was recorded at various time points postoperatively. A decrease in GFR > 10 ml per minute/1.73 m2 was considered as significant GFR drop. A multivariate cox regression analysis was performed to identify predictors of significant GFR drop. RESULTS: A total of 257 patients with complete follow up were included in this study (Table 1). Median follow-up was 2 years (IQR 7 months, 5 years). Mean preoperative GFR was 53.3 ± 4.2 ml per minute/1.73 m2. At 10-year mark follow up, 132 (51.3%) patients did not have any significant GFR drop (Figure 1). GFR also remained above 45 ml per minute/1.73 m2 in 125 (49%) patients. The median time to significant GFR drop was 1 year. On multivariate analysis, risk factors associated with significant GFR drop were age (HR 1.3, 95%CI: 1.3-5; P <0.006), neoadjuvant chemotherapy (HR 1.83, 95%CI: 1.2-2.7; P= 0.002), diabetes (HR 1.6, 95%CI: 1-2.6, P=0.02) and any complication within 30 days post-operatively (HR 1.47, 95%CI: 1-2.1, P=0.04). CONCLUSIONS: A significant proportion of patients with CKD and ONB seems to have a stable long term renal function and their baseline GFR does not seem to affect their long term renal function outcome. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e822-e822 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Seyedeh-Sanam Ladi Seyedian* More articles by this author Hamed Ahmadi More articles by this author Alireza Ghoreifi More articles by this author Sidney Roberts More articles by this author Saum Ghodoussipour More articles by this author Sumeet Bhanvadia More articles by this author Hooman Djaladat More articles by this author Anne Schuckman More articles by this author Siamak Daneshmand More articles by this author Expand All Advertisement PDF downloadLoading ...

MP59-13 KIDNEY TRANSPLANT IN PATIENTS UNDER WARFARIN USE: DOES IT INCREASE THE RISKS? ANALYSIS OF OUTCOMES AND COMPLICATIONS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III (MP59)1 Apr 2020MP59-13 KIDNEY TRANSPLANT IN PATIENTS UNDER WARFARIN USE: DOES IT INCREASE THE RISKS? ANALYSIS OF OUTCOMES AND COMPLICATIONS Felipe Bernardes*, Matheus Siqueira, Gustavo Ebaid, Gustavo Messi, Renato Falci, Kleiton Yamacake, Rafael Locali, William Nahas, and Affonso Piovesan Felipe Bernardes*Felipe Bernardes* More articles by this author , Matheus SiqueiraMatheus Siqueira More articles by this author , Gustavo EbaidGustavo Ebaid More articles by this author , Gustavo MessiGustavo Messi More articles by this author , Renato FalciRenato Falci More articles by this author , Kleiton YamacakeKleiton Yamacake More articles by this author , Rafael LocaliRafael Locali More articles by this author , William NahasWilliam Nahas More articles by this author , and Affonso PiovesanAffonso Piovesan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000928.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney disease (CKD) are known to increase the risk of venous thromboembolism. Also, the prevalence of atrial fibrillation (AF) is at least 10-fold higher than in the general population. Warfarin is the most common oral anticoagulant drug used to prophylactic therapy (OAT) in these patients. When CKD patients enter a Kidney transplant (KT) waiting list, they often remain on OAT. This implies the use of reversal agents at the time of Kidney transplant surgery specially with deceased donors. In this study, we aim to determine the outcomes and complications of KT in patients using OAT at the time of surgery. METHODS: From January 2009 to September 2019 2403 kidney transplants were done in our institution. There were 15 patients with current OAT use at the time of the procedure. We reviewed each patient record to determine OAT indication, type of anticoagulant in use, INR based on prothrombin time (PT) test prior to surgery, reversal drugs employed, concomitant use of Antiplatelets drugs, and need to reintroduction of OAT after KT. Surgical complications as well as long term graft function (estimated by MDRD and creatinine) were also investigated. RESULTS: From the 15 patients, 8 were male (53,3%) and 13 (86,7%) received kidney from deceased donors. Mean age was 54,6±11,0 years. Risk factors for thrombosis were the indication for ACO in 9 (60%) including arteriovenous fistula or hemodialysis catheter thrombosis and previous graft loss due to thrombotic event. In the remaining 6 (40%) OAT indication was AF. Eight patients (53,3%) were in concomitant use of Antiplatelets. Median INR in admission test was 2,2±1,0. On 12 patients (80%) the reversion therapy was vitamin K and fresh frozen plasma. The remaining 3 (20%) had INR < 1,5, dismissing treatment. Surgical excessive bleeding requiring transfusion were observed in 7 (46,7%) patients, and there were 02 deaths related to these complications. Re-introduction of OAT was necessary in 8 (53,3%) individuals. There was no statistical difference between long term renal graft function, with a median MDRD of 57,55 and creatinine of 1,6 after 5 years. CONCLUSIONS: Oral anticoagulants use adds surgical risks for bleeding complications and death in kidney transplant recipients, independently of anticoagulant reversal therapy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e885-e886 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felipe Bernardes* More articles by this author Matheus Siqueira More articles by this author Gustavo Ebaid More articles by this author Gustavo Messi More articles by this author Renato Falci More articles by this author Kleiton Yamacake More articles by this author Rafael Locali More articles by this author William Nahas More articles by this author Affonso Piovesan More articles by this author Expand All Advertisement PDF downloadLoading ...