Urea-creatinine Ratio Research Articles

Distinct phenotyping of critical patients with demand-capacity imbalance initiating acute renal replacement therapy by consensus clustering

BackgroundCertain patient subpopulations requiring dialysis initiation show varied survival rates and chances of ending renal replacement therapy (RRT). Consensus clustering can help identify these subgroups and their dialysis outcomes. MethodsThe study included patients who were over 18 years old with urine output above 400 ml per day and an estimated glomerular filtration rate over 15 ml/min/1.73 m2. They underwent acute RRT because of systemic demand-capacity imbalance. Using consensus clustering with 33 clinical variables and urea:creatinine ratio (UCR) to the variables to investigate the catabolic demand. Endpoints were all-cause mortality and being dialysis-free at 180-day follow-up after RRT initiation. ResultsOf 946 patients (mean 63 ± 17 years and 649 men, 68.6 %) three distinct phenotypes were identified. 509 (53.8%) patients died and 364 (38.5%) patients were weaned off dialysis. Cluster 2 showed better survival (60.23% vs. 53.18% [cluster 1] vs. 45.85% [cluster 3], P < 0.01) and higher possibility to be weaned off RRT (45.24% vs. 38.44% [cluster 1] vs. 31.62% [cluster 3], P < 0.01). High UCR had increased mortality (59.16% vs. 47.75%, P < 0.01) and a lower weaning rates (33.27%; 45.72%, P < .01). UCR with the clustering phenotype improved risk stratification. ConclusionsAmong critical patients undergoing RRT due to systemic demand-capacity imbalance, more than half of the patients died. We identified distinct phenotypes in demand-capacity imbalance in a heterogeneous cohort of patients initializing RRT. Additionally, we found that pre-dialysis UCR as a novel predictor for mortality and the likelihood of being dialysis-free.

Weak association between urea-creatinine ratio and c-reactive protein with nutritional risk in hospitalized patients with COVID-19: A cross-sectional study

BackgroundCOVID-19 is a systemic infection with a significant impact on nutrition risk and the hematopoietic system. The neutrophil-lymphocyte ratio (NLR) may have prognostic value in determining severe cases of COVID-19 and the urea-creatinine ratio (UCR) is currently being studied as a potential biomarker of catabolism associated with critical illness. The aim was to assess the association between the NLR, UCR and C-reactive protein (CRP) with nutritional risk in hospitalized patients with COVID-19. MethodsThis is a retrospective cross-sectional study that assessed 589 hospitalized patients with COVID-19, 18 years of age or older, of both sexes. Nutritional risk was assessed by Nutritional Risk Screening (NRS, 2002) and NLR by neutrophils divided by lymphocyte count. The UCR was calculated by the ratio between urea and creatinine and quantified by the calorimetric biochemical method and CRP by the immunoturbidimetric method. Differences between groups were applied by the Mann-Whitney U test and the automated binary regression test. ResultsOf the 589 patients, 87.4% were at nutritional risk. When evaluating patients admitted to the ICU, 91.9% were at nutritional risk. Patients with NRS ≥3 are older, with lower body mass and BMI, higher NLR and UCR and lower CRP values. However, 73% of patients admitted to the ward were at nutritional risk, and only age differed between groups, being higher in patients with NRS ≥3. Logistic regression showed a weak association between nutritional risk in NRS and UCR (Model 1) (OR=0.96, p=0.003) and NRS with CRP (Model 1) (OR=1.01, p<0.001) in patients in the ICU. On the other hand, the logistic regression in ward patients found association only for CRP in both models (Model 1, OR=1.01, p=0.041) and (Model 2, OR=1.01, p=0.031). ConclusionWe found a low association between nutritional risk and UCR and CRP in patients admitted to the ICU, while in the ward patients the nutritional risk also had weak association with CRP.

Dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis assessed by bedside ultrasound and their correlation with blood urea/creatinine ratio

To investigate the dynamic changes of diaphragm and limb skeletal muscle in patients with sepsis by bedside ultrasound and their correlation with the ratio of blood urea/creatinine ratio (UCR) in 7 days after intensive care unit (ICU) admission. A prospective observational study was conducted. A total of 55 patients with sepsis admitted to ICU of General Hospital of Ningxia Medical University from June 2022 to February 2023 were selected as the research objects. General information, laboratory indicators [urea, serum creatinine (SCr), and UCR] on days 1, 4, and 7 of ICU admission, and prognostic indicators were observed. Bedside ultrasound was used to assess the dynamic changes of diaphragm morphology [including diaphragmatic excursion (DE), end-inspiratory diaphragm thickness (DTei), and end-expiratory diaphragm thickness (DTee)] on days 1, 4, and 7 of ICU admission, as well as limb skeletal muscle (quadriceps femoris) morphology [including rectus femoris-muscle layer thickness (RF-MLT), vastus intermedius-muscle layer thickness (VI-MLT), and rectus femoris-cross sectional area (RF-CSA)]. Diaphragm thickening fraction (DTF) and RF-CSA atrophy rate were calculated, and the incidence of diaphragm and limb skeletal muscle dysfunction was recorded. The correlation between ultrasound morphological parameters of diaphragm and quadriceps and UCR at each time points in 7 days after ICU admission was analyzed by Pearson correlation. A total of 55 patients with sepsis were included, of which 29 were in septic shock. As the duration of ICU admission increased, the incidence of diaphragm dysfunction in patients with sepsis increased first and then decreased (63.6%, 69.6%, and 58.6% on days 1, 4, and 7 of ICU admission, respectively), while the incidence of limb skeletal muscle dysfunction showed an increasing trend (54.3% and 62.1% on days 4 and 7 of ICU admission, respectively), with a probability of simultaneous occurrence on days 4 and 7 of ICU admission were 32.6% and 34.5%, respectively. The UCR on day 7 of ICU admission was significantly higher than that on day 1 [121.77 (95.46, 164.55) vs. 97.00 (70.26, 130.50)], and RF-CSA atrophy rate on day 7 was significantly higher than that on day 4 [%: -39.7 (-52.4, -22.1) vs. -26.5 (-40.2, -16.4)]. RF-CSA was significantly lower on day 7 compared to day 1 [cm2: 1.3 (1.0, 2.5) vs. 2.1 (1.7, 2.9)], with all differences being statistically significant (all P < 0.05). Pearson correlation analysis showed that RF-CSA on day 7 of ICU admission was negatively associated with the UCR on the same day (r = -0.407, P = 0.029). Diaphragmatic dysfunction in patients with sepsis occurred early and can be improved. Limb skeletal muscle dysfunction occurred relatively later and progresses progressively. The RF-CSA on day 7 of ICU admission may be a reliable measure of limb skeletal muscle dysfunction in patients with sepsis, can be an indicator of early identification and diagnosis of ICU-acquired weakness (ICU-AW). Continuous loss of muscle mass occurring in septic patients is mainly associated with persistent organismal catabolism, and undergoes significant changes around a week in ICU.

Association of Calf Circumference with Clinical and Biochemical Markers in Older Adults with COVID-19 Admitted at Intensive Care Unit: A Retrospective Cross-Sectional Study.

COVID-19 is an infectious disease characterized by a severe catabolic and inflammatory state, leading to loss of muscle mass. The assessment of muscle mass can be useful to identify nutritional risk and assist in early management, especially in older adults who have high nutritional risks. The aim of this study was to evaluate the association of calf circumference (CC) with clinical and biochemical markers and mortality in older adults with COVID-19 admitted to the intensive care unit (ICU). A retrospective cross-sectional study was conducted in a public hospital. CC was adjusted for body mass index (BMI), reducing 3, 7, or 12 cm for a BMI of 25-29.9, 30-39.9, and ≥40 kg/m2, respectively, and classified as reduced when <33 cm for women and <34 cm for men. Pearson's correlation between BMI and CC was performed to assess the association between variables. Regression analysis was adjusted for sex, age, and BMI variables. Cox regression was used to assess survival related to CC. A total of 208 older adults diagnosed with COVID-19 admitted to ICU were included, of which 84% (n = 176) were classified as having reduced CC. These patients were older, with lower BMI, higher nutritional risk, malnourished, and higher concentration of urea and urea-creatinine ratio (UCR) compared with the group with normal CC. There was an association between edematous patients at nutritional risk and malnourished with reduced CC in the Cox regression, either adjusted or not for confounding. CC was not associated with severity, biochemical markers, or mortality in older adults with COVID-19 admitted to the ICU, but it was associated with moderately malnourished patients assessed by subjective global assessment (SGA).

The Value of Prognostic Nutritional Index Combined with Urea-Creatinine Ratio in Assessing the Prognosis of Transplantation in Patients Undergoing Haploidentical Stem Cell Transplantation

The Value of Prognostic Nutritional Index Combined with Urea-Creatinine Ratio in Assessing the Prognosis of Transplantation in Patients Undergoing Haploidentical Stem Cell Transplantation

Urea/Creatinine Ratio's Correlation with Creatine Kinase Normalization in Pediatric COVID-19 Patients with Myositis: Evaluating Prognostic and Predictive Value.

Coronavirus disease 2019 (COVID-19) has been chiefly linked with substantial respiratory complications. However, emerging studies have brought attention to the occurrence of severe muscle inflammation (myositis) related to COVID-19, potentially leading to multi-organ failure and increased mortality. Myositis is generally characterized by heightened serum creatine kinase (CK) levels. Acute myositis is characterized by an infiltration of viruses into calf muscle fibers, which may cause a subsequent inflammatory response leading to calf muscle pain. Symptomatic and supportive management, along with explanation and reassurance, is all that is required in managing this condition. While the association between myositis and severe outcomes has been recognized in adults, it remains less understood in the pediatric population. The current retrospective study, conducted at Policlinico San Marco University Hospital in Catania, aimed to analyze clinical and laboratory factors associated with myositis in pediatric patients with SARS-CoV-2 infection. Between January 2022 and January 2023, ten pediatric patients diagnosed with myositis and SARS-CoV-2 infection were evaluated. The study highlighted clinical manifestations such as fever, calf muscle pain, and abnormal gait. Lab results showed elevated CK levels among other findings. All patients underwent treatment, with the majority recovering without complications. A notable correlation was observed between CK levels, blood urea nitrogen (BUN), and the urea/creatinine ratio (UCR). The study also discusses potential pathophysiological mechanisms behind SARS-CoV-2's impact on skeletal muscles, emphasizing an indirect inflammatory response. Our findings underscore that while myositis in children with SARS-CoV-2 infection appears to follow a benign and self-limiting trajectory, it is crucial to monitor specific markers for early intervention and management. Further research is warranted to elucidate the underlying mechanisms and improve clinical outcomes.

Evaluation of Some Parameters to Detection of Type 2 Diabetes Induced Nephropathy in the Population Sample of Al Dewaniyah Province

Background: Diabetic nephropathy (DN is a dreaded consequence of Type2 diabetes mellitus (T2D), accounting for about 40% of end-stage renal disease (ESRD). Aim: finding a predictive and tracking function of kidney failure and generalizing it as a clinical diagnostic method effective, and finding related to the development of complications of this disease with age, gender, familiar History, smoking and area of residence. Subjects: Study was conducted at a single center in Iraq from the beginning of February to the end of July 2021,The 90 individual were divided into 2 groups, of which 50 were chronic renal failure patients with T2D, and 40 were age and sex matched controls.Methods: The Insulin and HbA1C% levels was measured by using sandwich ELISA technique and a sandwich immune detection method respectively, A spectrophotometric method was applied to measure concentrations of urea, creatinine and glucose, in serum samples, then the urea-creatinine ratio and HOMA-IR were calculated mathematically. Results: There were significant elevated differences (p&lt;0.05) for all parameters in the patient group compared to healthy controls. Moreover, ANOVA test showed significant (p&lt;0.05) variation when Urea, Creatinine, Glucose, HOMA-IR and HbA1C % levels were compared between the same sex in the two subgroups, while the test showed significant (p&lt;0.05) variation for only males when Urea: Creatinine ratio and Insulin levels were compared between the same sex. Conclusion: It can be dependable on investigations of Urea, Creatinine, Urea: Creatinine ratio Glucose, Insulin, HOMA-IR and HbA1C % as good prognostic indicators for diagnosis renal failure resulting from complications of DM.

Derivation and External Validation of the Ottawa Bloodstream Infection Model for Acutely Ill Adults.

Knowing the probability that patients have a bloodstream infection (BSI) could influence the ordering of blood cultures and interpretation of their preliminary results. Many previous BSI probability models have limited applicability and accuracy. This study used currently recommended modeling techniques and a large sample to derive and validate the Ottawa BSI Model. At a tertiary care teaching hospital, we retrieved a random sample of 4180 adults having blood cultures in our emergency department or during the initial 48h of the encounter. Variable selection was based on clinical experience and a systematic review of previous model performance. Model performance was measured in a temporal external validation group of 4680 patients. A total of 327 derivation patients had a BSI (8.0%). BSI risk increased with increased number of culture sets (2 sets: adjusted odds ratio [aOR] 1.52 [1.10-2.11]; 3 sets: 1.99 [0.86-4.58]); with indwelling catheter (aOR 2.07 [1.34-3.20); with increasing temperature, heart rate, and neutrophil-lymphocyte ratio; and with decreasing systolic blood pressure, platelet count, urea-creatinine ratio, and estimated glomerular filtration rate. In the temporal external validation group, model discrimination was good (c-statistic 0.71 [0.69-0.74]) and calibration was very good (integrated calibration index .016 [.010-.024]). Exclusion of validation patients with acute SARS-CoV-2 infection improved discrimination slightly (c-statistic 0.73 [0.69-0.76]). The Ottawa BSI Model uses commonly available data to return an expected BSI probability for acutely ill patients. However, it cannot exclude BSI and its complexity requires computational assistance to use.

PS-C13-11: EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Object: Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Methods: 413 patients with hypertension who were hospitalized in the Hypertension Center of Lanzhou University Second Hospital from January 2015 to June 2021 were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia. Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators. After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed. Results: Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated. Conclusion: There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.

Evaluation of Levels of Urea and Creatinine, Comorbidity and Socioeconomic Status in Diabetic Patients

Nephropathy occurs in 10±40% of patients who have Type I (insulin-dependent) diabetes mellitus [1±3]. The development of diabetic nephropathy cannot be explained by poor glycaemic control alone. Objectives: To determine the frequency, association of diabetes with gender, correlation of diabetes duration with urea and creatinine, co morbidity, socioeconomic status renal disease in diabetic patients. Methods: The study was carried out in Mayo Hospital. A total of 100 patients were included in this study from 1st November 2019 to 31st January 2020. Blood samples were collected from diabetic people for chemical analysis to determine the protein and Urea Creatinine Ratio (UCR). RFTs was done to calculate the urea/creatinine values and their ratios. Statistical analysis was performed by using SPSS software version 13. Results: The ratio of male and female diabetic patients was 60:40. Mean age of male diabetic patients was 53.67 years and of female diabetic patients was 50.42 years. Frequency of renal diseases in diabetic patients was 55%. A significant p-value was obtained from the correlation of duration of diabetes (yrs) with urea and creatinine (mg%). Frequency of co-morbidity in all diabetic patients was measured and the highest frequency was of heart diseases. Conclusions: We conclude that diabetes is the single main and leading cause of renal diseases. It is clear that diabetic kidney disease is becoming a problem in Pakistan. As long as the duration of diabetes increases there will be more chances of renal disease so the proper diagnose at time and management is very necessary.

Serum Interleukin-26 is a Potential Biomarker for the Differential Diagnosis of Neurosyphilis and Syphilis at Other Stages

BackgroundInterleukin-26 (IL-26) is an atypical proinflammatory cytokine due to its binding to circulating double-stranded DNA and direct antibacterial activity. Although IL-26 has been confirmed to be involved in the pathophysiology of cancer, chronic inflammatory diseases and infections, the diagnostic and prognostic values of IL-26 levels in syphilis patients are not clear. This study aimed to investigate IL-26 levels in different stages of syphilis progression.MethodsA total of 30 healthy controls and 166 patients with syphilis at different stages of disease progression were enrolled. Serum IL-26 levels were quantified in accordance with the protocols of RayBio® Human Interleukin-26 Enzyme Linked Immunosorbent Assay (ELISA) kits. Clinical laboratory diagnostic parameters and blood analysis data were detected and collected according to clinical medical laboratory standards.ResultsThe levels of serum IL-26 were significantly higher in neurosyphilis patients than in healthy subjects (6.87 (4.36, 12.14) and 1.67 (0.09, 4.89) pg/μL, respectively; ****p < 0.0001), latent syphilis (1.48 (0.40, 2.05) pg/μL, ****p < 0.0001), seroresistant syphilis (0.81 (0.20, 2.91) pg/μL, ****p < 0.0001) and secondary syphilis (1.66 (0.41, 4.25) pg/μL, ****p < 0.0001) with data presented as the median with interquartile range. The concentration of serum IL-26 was most sensitive to serum low-density lipoprotein concentration (r = −0.438, **p = 0.004) in latent syphilis, urine epithelial cells (r = 0.459, **p = 0.003) in seroresistant syphilis, and serum creatinine levels (r = 0.463, **p = 0.004) and urea creatinine ratio levels (r = 0.500, **p = 0.008) in secondary syphilis patients. There was no significant correlation with the concentration of IL-26 and toluidine red unheated serum test (TRUST) titers in each type of syphilis patient.ConclusionCirculating IL-26 in serum displays diagnostic potential in the progression of neurosyphilis and warrants further evaluation in clinical trials.

EFFECT OF HYPOKALEMIA ON LEFT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: Analyzing the changes of left ventricular structure and function in essential hypertension patients with hypokalemia, we want to provide an evidence for clinical diagnosis and treatment of early heart damage caused by hypertension and hypokalemia. Design and method: 413 patients with hypertension were selected, including 270 cases of essential hypertension and 143 cases of essential hypertension with hypokalemia.Collect patient general information, biochemistry, urine routine, office blood pressure, 24 h ambulatory blood pressure, left atrial diameter, left ventricular end diastolic diameter, left ventricular end systolic diameter, ventricular septal thickness, left ventricular posterior wall thickness and other indicators.After propensity score matching, 108 cases in the essential hypertension group and the essential hypertension with hypokalemia group were each, and statistical analysis was performed. Results: Albumin, and urea-creatinine ratio levels of the essential hypertension with hypokalemia group were significantly reduced, and the ratios of sodium ions and sodium potassium were lower than those of the primary hypertension group. Correlation analysis shows that the left ventricular mass index was positively correlated with and the course of hypertension, systolic blood pressure, diastolic blood pressure, mean arterial pressure, creatinine, sodium-to-potassium ratio, mean systolic blood pressure during the day, mean diastolic blood pressure during the day, mean systolic blood pressure at night, mean night diastolic blood pressure. Multiple linear regression analysis showed that the left ventricular mass index was independently positively correlated with systolic blood pressure, hypertension course, creatinine, sodium-to-potassium ratio, night systolic blood pressure, 24 h average systolic blood pressure, and 24 h systolic blood pressure load rate; potassium ion, low density Lipoprotein, angiotensin II and left ventricular mass index are independently and negatively correlated. Conclusions: There are more obvious ventricular structural changes in essential hypertension patients with hypokalemia; serum potassium ion concentration and sodium-to-potassium ratio are independent risk factors for left ventricular mass index in essential hypertension patients with hypokalemia.

Correlation between Urea Creatinine Ratio (UCR) and lipid profile in COVID-19 patients

Background: SARS-CoV-2, as the leading cause of COVID-19 disease, can cause kidney disorders characterized by the presence of hematuria, increased creatinine, and other kidney pathological conditions. Since a 24-hour urine examination as the gold standard for urea examination has several weaknesses, it is necessary to carry out an alternative examination method especially, the Urea Creatinine Ratio (UCR). This study evaluates the correlation between UCR and lipid profile in COVID-19 patients.Methods: A descriptive-analytical design with a cross-sectional approach is applied. COVID-19 patients with positive PCR were examined for UCR, Total Cholesterol, Triglycerides, HDL, and LDL. The assessment was based on clinical chemistry analysis using an automatic analyzer. We perform a normality test using Shapiro-Wilk. The Pearson correlation test is used to see a correlation between variables. The study was conducted at Siloam Hospital in April-August 2021. Data were analyzed using SPSS version 20 for Windows.Results: There was no significant difference between UCR and the other variables based on the statistical analysis test (p&gt;0.05). There was no significant correlation between UCR and cholesterol total (p= 0.230), UCR and Triglyceride (p= 0.680, UCR and HDL (p=0.970) and UCR and LDL (p= 0.190). Conclusion: There is no significant correlation between UCR and lipid profile in COVID-19 patients

Effect of intermittent or continuous feeding and amino acid concentration on urea-to-creatinine ratio in critical illness.

We sought to determine whether peaks in essential amino acid (EAA) concentration associated with intermittent feeding may provide anabolic advantages when compared with continuous feeding regimens in critical care. We performed a secondary analysis of data from a multicenter trial of UK intensive care patients randomly assigned to intermittent or continuous feeding. A linear mixed-effects model was developed to assess differences in urea-creatinine ratio (raised values of which can be a marker of muscle wasting) between arms. To investigate metabolic phenotypes, we performed k-means urea-to-creatinine ratio trajectory clustering. Amino acid concentrations were also modeled against urea-to-creatinine ratio from day 1 to day 7. The main outcome measure was serum urea-to-creatinine ratio (millimole per millimole) from day 0 to the end of the 10-day study period. Urea-to-creatinine ratio trajectory differed between feeding regimens (coefficient -.245; P = .002). Patients receiving intermittent feeding demonstrated a flatter urea-to-creatinine ratio trajectory. With k-means analysis, the cluster with the largest proportion of continuously fed patients demonstrated the steepest rise in urea-to-creatinine ratio. Neither protein intake per se nor serum concentrations of EAA concentrations were correlated with urea-to-creatinine ratio (coefficient = .088 [P = .506] and coefficient <.001 [P = .122], respectively). Intermittent feeding can mitigate the rise in urea-to-creatinine ratio otherwise seen in those continuously fed, suggesting that catabolism may have been, to some degree, prevented.

Urea–Creatinine Ratio (UCR) After Aneurysmal Subarachnoid Hemorrhage: Association of Protein Catabolism with Complication Rate and Outcome

The urea-creatinine ratio (UCR) has been proposed as potential biomarker for critical illness-associated catabolism. Its role in the context of aneurysmal subarachnoid hemorrhage (aSAH) remains to be elucidated, which was the aim of the present study. We enrolled 66 patients with aSAH with normal renal function and 36 patients undergoing elective cardiac surgery as a control group for the effects of surgery. In patients with aSAH, the predictive or diagnostic value of early (day 0-2) and critical (day 5-7) UCRs was assessed with regard to delayed cerebral ischemia (DCI), DCI-related infarction, and clinical outcome after 12 months. Preoperatively, UCR was similar both groups. Within 2 days postoperatively, UCRs increased significantly in patients in the elective cardiac surgery group (P < 0.001) but decreased back to baseline on day 5-7 (P= 0.245), whereas UCRs in patients with aSAH increased to significantly greater levels on day 5-7 (P= 0.028). Greater early or critical UCRs were associated with poor clinical outcomes (P= 0.015) or DCI (P= 0.011), DCI-related infarction (P= 0.006), and poor clinical outcomes (P<0.001) respectively. In multivariate analysis, there was an independent association between greater early UCRs and poor clinical outcomes (P= 0.026). In this exploratory study of UCR in the context of aSAH, greater early values were predictive for a poor clinical outcome after 12 months, whereas greater critical values were associated with DCI, DCI-related infarctions, and poor clinical outcomes. The clinical implications as well as the pathophysiologic relevance of protein catabolism should be explored further in the context of aSAH.

RELATIONSHIPS BETWEEN CLINICAL RENAL PARAMETERS AND OSAS

SESSION TITLE: Sleep Disorders Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To assess the possible relationships between OSA and renal outcomes analysis. In OSAS, the sleep fragmentation and repetitive episodes of hypoxia/reoxygenation increase sympathetic activity, endothelial dysfunction, oxidative stress, lipid dysregulation and, systemic inflammation with direct effect on renal function. METHODS: We conducted a follow-up prospective study of 55 outpatients (mean aged 52.58±5.17 years) diagnosed with OSA and 26 healthy controls (mean aged 51.19±5.51 years), unselected for the presence of kidney disease. Demographic, anthropometric (weight, height), smoking history, blood pressure, plasma lipid profile: triglycerides (TG), total cholesterol (TC), Low Density Lipoprotein cholesterol (LDLc), High Density Lipoprotein cholesterol (HDLc), blood albumin and glycemia were assessed. Kidney function was determined by serum creatinine and urea, urine Albumin Excretion Rate (AER), Urinary Protein Excretion Estimation (UPEE), urinary Albumin/Creatinine Ratio (ACR), Urea/Creatinine Ratio (UCR), and creatinine clearance, as an estimate of Glomerular Filtration Rate (eGFR), calculated according to the Cockcroft and Gault and Modification of Diet in Renal Disease equation formulas. All subjects underwent cardiorespiratory poligraphy with VitalNight plus Sleep Diagnosis System according to the American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events, version 2.6 recommendations. Before testing, all participants were asked to complete the Epworth Sleepiness Scale (ESS) questionnaire. Statistical analysis included Spearman correlations tests, t test and one-way ANOVA test. RESULTS: In OSAS patients versus control, we found UPEE (p=0.04), ACR (p=0.0008), creatinine clearance (p=0.01), blood albumin (p= 0.01), TC (p=0.006), TG/albumin ratio (p= 0.0003) were significantly higher, meanwhile eGFR (p=0.01) and HDLc (p=0.04) were lower. In OSAS group, correlations are as follows: Apnea/Hypopnea Index (AHI) and TG/HDLc ratio (r=0.27;p=0.04), AHI and HDLc (r=-0.37;p=0.003); Oxygen Desaturation Index (ODI) and creatinine clearance (r=-0.29;p=0.02), ODI and UCR (r=0.37;p=0.004); eGFR and apneas number (r=0.30;p=0.02), the longest duration of oxygen saturation (minutes) (SpO2)£88% (r=-0.25;p=0.05); UPEE and glycemia (r=-0.40;p=0.002), UPEE and LDLc (r=0.41;p=0.001); TG and ACR (r=0.36;p=0.006), TG and AER (r=0.38;p=0.004). CONCLUSIONS: In OSAS patients, eGFR, UPEE, ACR may have predictive value of early stage kidney disease and, should consider screening in patients with OSA. CLINICAL IMPLICATIONS: A better understanding of pathophysiological mechanisms in this association may improve the role of treatment with continous positive airway pressure (CPAP) and reconsider the antioxidants that could attenuate intermittent hypoxia related to kidney disease. DISCLOSURES: No relevant relationships by Mihaela Gloria Martius, source=Web Response no disclosure on file for Roxana Maria Nemeș; No relevant relationships by Ancuta Petrovan, source=Web Response no disclosure on file for Carmen Monica Pop; No relevant relationships by Ligia Puiu, source=Web Response no disclosure on file for Emilia Tabacu

CALIPER paediatric reference intervals for the urea creatinine ratio in healthy children & adolescents

BackgroundThe urea creatinine ratio (UCR) is important in the clinical assessment of several medical conditions, including acute kidney injury and gastrointestinal bleeding. However, accurate and robust paediatric reference intervals (RIs) for this ratio have not been well established. Here, we determined age- and sex-specific discrete and continuous RIs for UCR in the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) cohort of healthy children and adolescents for the first time. MethodsUCR was calculated for approximately 1030 CALIPER participants using retrospective urea and creatinine (both Jaffe and enzymatic methods) normative data. Partitions were determined using the Harris & Boyd statistical method. Discrete RIs were established in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Continuous RIs were established using nonparametric quantile regression. ResultsSeveral age- and sex-specific partitions were necessary to capture dynamic physiological trends associated with this ratio throughout childhood and adolescence, highlighting the benefit of continuous RI establishment. Established UCR RIs also demonstrated marked differences between Jaffe and enzymatic assay methods. ConclusionOur results clearly demonstrate the critical need for RI stratification by important covariates such as age, sex, and creatinine assay methodology for paediatric UCR test result interpretation. These data contribute to our understanding of normative UCR values in childhood and adolescence and can be expected to improve paediatric test result interpretation in clinical laboratories that report this ratio.

Protein to Maximize Whole-Body Anabolism in Resistance-trained Females after Exercise.

Current athlete-specific protein recommendations are based almost exclusively on research in males. Using the minimally invasive indicator amino acid oxidation technique, we determined the daily protein intake that maximizes whole-body protein synthesis (PS) and net protein balance (NB) after exercise in strength-trained females. Eight resistance-trained females (23 ± 3.5 yr, 67.0 ± 7.7 kg, 163.3 ± 3.7 cm, 24.4% ± 6.9% body fat; mean ± SD) completed a 2-d controlled diet during the luteal phase before performing an acute bout of whole-body resistance exercise. During recovery, participants consumed eight hourly meals providing a randomized test protein intake (0.2-2.9 g·kg·d) as crystalline amino acids modeled after egg protein, with constant phenylalanine (30.5 mg·kg·d) and excess tyrosine (40.0 mg·kg·d) intakes. Steady-state whole-body phenylalanine rate of appearance (Ra), oxidation (Ox; the reciprocal of PS), and NB (PS - Ra) were determined from oral [C] phenylalanine ingestion. Total protein oxidation was estimated from the urinary urea-creatinine ratio (U/Cr). A mixed model biphase linear regression revealed a break point (i.e., estimated average requirement) of 1.49 ± 0.44 g·kg·d (mean ± 95% confidence interval) in Ox (r = 0.64) and 1.53 ± 0.32 g·kg·d in NB (r = 0.65), indicating a saturation in whole-body anabolism. U/Cr increased linearly with protein intake (r = 0.56, P < 0.01). Findings from this investigation indicate that the safe protein intake (upper 95% confidence interval) to maximize anabolism and minimize protein oxidation for strength-trained females during the early ~8-h postexercise recovery period is at the upper end of the recommendations of the American College of Sports Medicine for athletes (i.e., 1.2-2.0 g·kg·d).

Effect of increased enteral protein intake on plasma and urinary urea concentrations in preterm infants born at

BackgroundFeeding breast milk is associated with reduced morbidity and mortality, as well as improved neurodevelopmental outcome but does not meet the high nutritional requirements of preterm infants. Both plasma and urinary urea concentrations represent amino acid oxidation and low concentrations may indicate insufficient protein supply.This study assesses the effect of different levels of enteral protein on plasma and urinary urea concentrations and determines if the urinary urea-creatinine ratio provides reliable information about the protein status of preterm infants.MethodsSixty preterm infants (birthweight < 1500 g; gestational age < 32 weeks) were enrolled in a randomized controlled trial and assigned to either a lower-protein group (median protein intake 3.7 g/kg/d) or a higher-protein group (median protein intake 4,3 g/kg/d). Half the patients in the higher-protein group received standardized supplementation with a supplement adding 1.8 g protein/100 ml milk, the other half received individual supplementation depending on the respective mother’s milk macronutrient content. Plasma urea concentration was determined in two scheduled blood samples (BS1; BS2); urinary urea and creatinine concentrations in weekly spot urine samples.ResultsThe higher-protein group showed higher plasma urea concentrations in both BS1 and BS2 and a higher urinary urea-creatinine-ratio in week 3 and 5–7 compared to the lower-protein group. In addition, a highly positive correlation between plasma urea concentrations and the urinary urea-creatinine-ratio (p < 0.0001) and between actual protein intake and plasma urea concentrations and the urinary urea-creatinine-ratio (both p < 0.0001) was shown.ConclusionsThe urinary urea-creatinine-ratio, just like plasma urea concentrations, may help to estimate actual protein supply, absorption and oxidation in preterm infants and, additionally, can be determined non-invasively. Further investigations are needed to determine reliable cut-off values of urinary urea concentrations to ensure appropriate protein intake.Trial registrationClinicaltrials.gov; NCT01773902 registered 15 January 2013, retrospectively registered.

Prognostic value of the urea:creatinine ratio in decompensated heart failure and its relationship with acute kidney damage

BackgroundWorsening renal function is associated with an adverse prognosis for patients with acute heart failure (AHF). Urea–creatinine ratio (U:Cr ratio) might be useful for measuring renal function and could help stratify patients with AHF. Material and methodsAn observational and prospective study was conducted to analyze the prognostic value of the U:Cr ratio, measured during the first 24–28h of admission, for patients hospitalised for decompensated heart failure, and its relationship with estimated glomerular filtration rate (eGFR) and acute kidney injury (AKI). ResultsThe study included 204 patients, with a mean age of 79.3 years, and a median eGFR of 55mL/min/1.73m2. In the multivariate analysis, an U:Cr ratio above the median (50) was related to the development of AKI (36.5% vs. 21.9%) and to increased mortality, both overall (OR 2.75) and by HF (OR 3.50) in long term. In combination with eGFR, the U:Cr ratio showed prognostic value in patients with normal eGFR (mortality of 4.4% for an U:Cr ratio≤50 vs. 22% for U:Cr ratio>50; p=0.01), as well as a better predictive capacity for AKI than each of them separately (AUC, 0.718; 95% CI 0.643–0.793; p>0.000). ConclusionsAn U:Cr ratio>50 is a predictor of increased long-term mortality for patients hospitalised for decompensated HF and with normal eGFR. Given the simplicity of this biomarker, its use in clinical practice should be more systematic.