Glomerular Filtration Rate Values Research Articles

Abstract 10108: SuPAR, Galectin-3 and ST2 Are Associated With Chronic Kidney Disease Progression in Patients With Heart Failure With Reduced Ejection Fraction

Introduction: Patients with heart failure with reduced ejection fraction (HFrEF) are at risk for both acute and progressive kidney disease. Elevated levels of the circulating soluble urokinase plasminogen activator receptor (suPAR), Galectin-3, and soluble suppression of tumorigenicity 2 (ST2) have been associated with kidney disease progression in those with CKD. However, there is little known about their predictive value for glomerular filtration rate (GFR) decline in populations with HFrEF. Methods: We aimed to determine whether these biomarkers were associated with decline in GFR and death in patients with HFrEF. We included 310 participants from the Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life in whom baseline suPAR, Galectin-3, and ST2 and repeated measures of GFR were obtained. The primary outcome was change in 2021 CKD-EPI creatinine-based GFR over 2 years. Secondary outcome was mortality. A joint cox regression model for mortality controlled for age, sex, race, NYHA class, and change in GFR and accounted for competing risks of ventricular assist device (VAD) implantation and heart transplantation. Results: Participants were followed for 2 years or until VAD, transplant, or death. Mean age was 59 years (standard error of mean 0.7) and 36% had diabetes mellitus. Median GFR was 60 ml/min/1.73m 2 with 58% NYHA Class III. Of these, 45 died, 33 received LVAD, and 25 were transplanted. Higher baseline suPAR (β coefficient -0.22 √(ml/min/1.73m 2 ); 95%CI -0.29, -0.15; P<0.001), Galectin-3 (β coefficient -0.02 √(ml/min/1.73m 2 ); 95%CI -0.04, -0.01; P=0.012), and ST2 (β coefficient -0.01 √(ml/min/1.73m 2 ); 95%CI -0.02, -0.01, -0.19; P<0.001) plasma concentrations were associated with a decline in eGFR over time in multivariable models. Only ST2 (HR 1.02 per ng/mL increase; 95%CI 1.01, 1.03; P<0.001) was associated with mortality, after controlling for longitudinal change in GFR. Conclusions: Higher baseline suPAR, Galectin-3, and ST2 were associated with GFR decline over 2 years in patients with HFrEF. ST2 was associated with a greater risk of mortality, while suPAR and Galectin-3 were not. These biomarkers may be incremental tools used to predict GFR decline in patients with advanced heart failure.

Asymptomatic Renal Function Abnormalities in Patients having Silicosis.

A number of occupational exposures are associated with various types of renal dysfunction. Several studies for many years have drawn attention to renal dysfunction and nephrotoxicity among workers exposed to silica. This study was conducted to evaluate renal dysfunction, if any, among Indian patients having silicosis and its correlation with the duration of exposure to silica dust. This study includes 52 eligible patients with a history of silica dust exposure and silicosis confirm on radiological examination by the pneumoconiosis board. Investigations like serum creatinine, urinary albumin creatinine ratio, etc. were done. The "modification of diet in renal disease" (MDRD) formula was used to calculate the glomerular filtration rate (GFR). This study showed 53.84% of patients (n = 28) having albuminuria and a mean "urinary albumin to creatinine ratio" (UACR) of 101.88 ± 128.99 mg/gm. Isolated macroalbuminuria was detected in 11.5% of patients (n = 6) while 42.3% of patients (n = 22) presented with microalbuminuria. The mean GFR was 81.94 ± 22.09 mL/min/1.73 m2 among study patients of which four (7.7%) patients had GFR value <60 mL/min/1.73 m2 . We could also identify a significant association between the duration of exposure to silica dust and UACR and GFR (p < 0.01). Albuminuria and reduced estimated GFR in patients with silica dust exposure is not uncommon and reflect early underlying renal dysfunctions. Our study suggests a simple and cost-effective screening strategy for early detection of renal dysfunction among silicosis patients that may be considered as a tool to prevent further renal damage in such patients.

The Serum Uric Acid to Serum Creatinine Ratio is an Independent Risk Factor for Diabetic Kidney Disease.

A retrospective study was designed to evaluate whether the serum uric acid to serum creatinine ratio (SUA/SCr) can be used as an indicator of diabetic kidney disease (DKD) and macroangiopathy in patients with type 2 diabetes mellitus (T2DM). We screened 2227 patients diagnosed with T2DM, and 450 patients were finally included. They were assigned to three groups based on the tertile of SUA/SCr (Group Tertile 1, Tertile 2, Tertile 3). Demographic information and biochemical parameters were collected from Electronic Patient Record (EPR). The estimated glomerular filtration rate (eGFR) values were lowest in Group Tertile 1 and highest in Group Tertile 3 (P < 0.05). There was no significant difference in urinary albumin creatinine ratio (UACR) among the three groups (P > 0.05). Partial correlation analyses revealed that SUA/SCr levels were significantly and positively correlated with eGFR, SUA, body mass index, gamma-glutamyl transpeptidase, alanine transaminase, triglycerides, C-peptide, high-density lipoprotein cholesterol and fatty liver, while they were negatively correlated with SCr, blood urea nitrogen, cystatin-c, age, male sex, DM duration and hypertension history (P < 0.05). Logistic regression analysis revealed that SUA/SCr was an independent risk factor for eGFR < 60 mL/min/1.73 m² (P < 0.05). The ROC curve showed that the cutoff value of SUA/SCr for the identification of eGFR < 60 mL/min/1.73 m² was 3.434. In patients with normal UACR, SUA/SCr levels of patients with eGFR < 60 mL/min/1.73 m² were lower than those with eGFR ≥ 60 mL/min/1.73 m² (P < 0.05). Regression analysis did not show SUA/SCr associate to macrovascular disease after adjusting for confounding factors. SUA/SCr is an independent risk factor for DKD in patients with T2DM and may be helpful for identifying normoalbuminuric DKD.

Acute Kidney Injury in Patients with Non-Valvular Atrial Fibrillation Treated with Rivaroxaban or Warfarin: A Population-Based Study from the United Kingdom.

To compare the risk of acute kidney injury (AKI) among users of rivaroxaban vs warfarin. We identified two cohorts of patients with non-valvular atrial fibrillation (NVAF) who initiated rivaroxaban (15/20 mg/day, N = 6436) or warfarin (N = 7129) excluding those without estimated glomerular filtration rate values recorded in the year before oral anticoagulant (OAC) initiation and those with a history of end-stage renal disease or AKI. We used two methods to define AKI during follow-up (mean 2.5 years): coded entries (method A) and the Aberdeen AKI phenotyping algorithm (method B) using recorded renal function laboratory values during the study period to identify a sudden renal deterioration event. Cox regression was used to calculate hazard ratios (HRs) for AKI with rivaroxaban vs warfarin use, adjusted for confounders. The number of identified incident AKI cases was 249 (method A) and 723 (method B). Of the latter, 104 (14.4%) were also identified by method A. After adjusting for age, sex, baseline renal function and comorbidity, HRs (95% CIs) for AKI were 1.19 (0.92-1.54; p=0.18) using method A and 0.80 (0.68-0.93; p<0.01) using method B. Estimates stratified by baseline level of chronic kidney disease were largely consistent with the main estimates. Our results support a beneficial effect of rivaroxaban over warfarin in terms of AKI occurrence in patients with NVAF. More research into how best to define AKI using primary care records would be valuable for future studies.

Polymorphisms in glucose homeostasis genes are associated with cardiovascular and renal parameters in patients with diabetic nephropathy

Background Diabetic nephropathy (DN) has become the major cause of end-stage kidney disease and is associated to an extremely high cardiovascular (CV) risk. Methods We screened 318 DN patients for 23 SNPs in four glucose transporters (SLC2A1, SLC2A2, SLC5A1 and SLC5A2) and in KCNJ11 and ABCC8, which participate in insulin secretion. Regression models were utilised to identify associations with renal parameters, atherosclerosis measurements and CV events. In addition, 506 individuals with normal renal function were also genotyped as a control group. Results In the patient’s cohort, common carotid intima media thickness values were higher in carriers of ABCC8 rs3758953 and rs2188966 vs. non-carriers [0.78(0.25) vs. 0.72(0.22) mm, p < 0.05 and 0.79(0.26) vs. 0.72(0.22) mm, p < 0.05], respectively. Furthermore, ABCC8 rs1799859 was linked to presence of plaque in these patients [1.89(1.03-3.46), p < 0.05]. Two variants, SLC2A2 rs8192675 and SLC5A2 rs9924771, were associated with better [OR = 0.49 (0.30-0.81), p < 0.01] and worse [OR = 1.92 (1.15-3.21), p < 0.05] CV event-free survival, respectively. With regard to renal variables, rs841848 and rs710218 in SLC2A1, as well as rs3813008 in SLC5A2, significantly altered estimated glomerular filtration rate values [carriers vs. non-carriers: 30.41(22.57) vs. 28.25(20.10), p < 0.05; 28.95(21.11) vs. 29.52(21.66), p < 0.05 and 32.03(18.06) vs. 28.14(23.06) ml/min/1.73 m2, p < 0.05]. In addition, ABCC8 rs3758947 was associated with higher albumin-to-creatinine ratios [193.5(1139.91) vs. 160(652.90) mg/g, p < 0.05]. The epistasis analysis of SNP-pairs interactions showed that ABCC8 rs3758947 interacted with several SNPs in SLC2A2 to significantly affect CV events (p < 0.01). No SNPs were associated with DN risk. Conclusions Polymorphisms in genes determining glucose homeostasis may play a relevant role in renal parameters and CV-related outcomes of DN patients.

Evaluation of urinary tract infections in a two-year follow-up after renal transplantation: A single center experience

Introduction:After renal transplantation, urinary tract infection (UTI) is observed in 23-75% of cases. In this study, we aimed to investigate the incidence of UTIs after renal transplantation, the causative pathogens and the predisposing factors that increase the risk. Methodology: Patients who underwent renal transplantation in our hospital between 2016-2017 were included in the study. Results: Twenty-five patients who underwent kidney transplantation were included in the study. UTI was detected in 12 patients (48%). One patient had neurogenic bladder, three had nephrolithiasis and one had vesicoureteral reflux. 8 of the patients had at least two UTI attacks. In total 38 UTI attacks; There were 7 (18.4%) nitrite positivity. UTI was detected in 15 (39.5%) patients during the first 3 months after transplantation. While 7 (18.4%) of the urine cultures were gram positive and 27 (71.1%) were gram negative bacteria, 4 (10.5%) were found as contamination. Escherichia coli (34.2%) was the most common causative agent, followed by Klebsiella pneumoniae (21.1%), Enterococcus faecium (18.4%), Pseudomonas aeruginosa (5.3%) and other gram negative (%). 10.5) uropathogens were found to be followed. When compared with basal and UTI GFR (glomerular filtration rate) levels, the GFR values detected during UTI were decreased significantly (p = 0.00). The most frequently preferred antibiotics in UTI treatment were ertapenem 42.1%, levofloxacin 10.5%, seftriaxon 10.5% and fosfomycin 10.5%. Discussion: Improperly treated UTI negatively affects the outcome of transplantation and increases mortality. Therefore, risk factors, antibiotic resistance and empirical treatments should be reviewed and treatment success should be increased.

Mean estimated GFR values in children 2-12 years admitted in a tertiary care centre using schwartz formula

GFR (Glomerular filtration rate) is the amount of blood filtered by the kidney’s glomerulus into the Bowman ’s capsule per unit of time. Schwartz equation is the length based calculation of estimated GFR (e GFR). Pottel’s equation is length independent one. The aim of the study is to find out the mean eGFR values in different age groups using the height dependent Schwartz formula in children 2-12 years. Secondary objective is to find out the relationship between eGFR and birth weight, gestational age, family history of renal disease and past history of urinary tract infection and to compare eGFR calculated by height dependent Schwartz formula and height independent Pottel’s equation700 children in the age group 2 to 12 years were included in the study. After obtaining written informed consent from the child’s guardian, pessronal details and serum creatinine values were collected. Height was measured using a stadiometer. Estimated GFR values were calculated using Schwartz formula and results were statistically analysed.Where GFR values by Schwartz formula were compared with inulin based GFR as in referenced study, it was found out that in certain ages there was statistically significant difference. Among the determinants studied, there was a weak positive correlation between gestational age and eGFR. eGFR by Schwartz formula was also compared with eGFR based on height independent Pottel’s equation and was found that there was statistically significant difference between absolute values, but they show a positive correlation1: There was no statistically significant correlation between birth weight, family history of renal disease and past history of urinary tract infection with eGFR; 2: There was a weak positive correlation between gestational age at birth and eGFR; 3: When eGFR by Schwartz formula was compared with eGFR by Pottel’s equation, there was a positive correlation between the two, though the absolute values differed significantly; 4: Normative data of this study can be used for predicting eGFR in children 2-12 years.

Liver fat content assessed by conventional B-mode ultrasound and metabolic profile in non-diabetic patients: Implications for clinical practice.

Several studies have demonstrated a positive correlation between severe hepatic steatosis and metabolic alterations; however, few studies have addressed the potential association between different grades of steatosis and clinical patterns in a non-diabetic population. We conducted a cross-sectional study of 223 non-diabetic individuals. The severity of steatosis was assessed using B-mode ultrasound. We analyzed lipid and glucose profiles according to the severity of hepatic steatosis. Estimated glomerular filtration rate (eGFR) values were also recorded to investigate the potential impact of steatosis on kidney function. Patients with steatosis were found to have higher insulinemia and mean values of fasting plasma glucose compared to patients without steatosis. A significant decrease in high-density lipoprotein level was observed only in patients with severe or moderate steatosis. All grades of steatosis were associated with increased triglyceride levels, which were more significant in severe steatosis. Subgroup analysis by body mass index demonstrated a significant difference between lean patients with steatosis and lean patients without steatosis for triglycerides (p = 0.002) and high-density lipoprotein levels (p = 0.019). Finally, patients diagnosed with steatosis demonstrated a higher prevalence of estimated glomerular filtration rate < 90 ml/min. The degree of steatosis diagnosed at ultrasound may predict glucose or lipid metabolism disorders and a decline in kidney function in a non-diabetic population.

Global warming, renal function and heart failure: a 20-year follow-up study

Abstract Background There is a growing concern about the possible effects of global warming on human health. In HF outpatients, renal function significantly worsens during summer. More specific analyses on the impact of increasing temperatures on body homeostasis are lacking. Purpose We investigated the relationship between the trend of temperatures from 2002 to 2021 and renal function in heart failure (HF) outpatients. Methods All creatinine and estimated glomerular filtration rate (eGFR) values of HF outpatients followed at one tertiary hospital in a Mediterranean area of Spain were retrieved from electronic health records. eGFR was calculated through the CKD-EPI formula. Temperature data from the local municipality were derived from the Meteocat service; as temperatures from the years 2004–2005 were not available, these years were not analysed. Summer was defined as the timespan from June to September included. We calculated average values of creatinine and eGFR during summer and the rest of the same year, considering each patient and each year. Similarly, we averaged temperature values during summer and the rest of the same year. Results We derived 6,307 couples of average creatinine/eGFR values in summer and in the rest of the year from 2,194 patients. Across all the years (2002–2003 and 2006–2021), creatinine was slightly higher in summer than in the rest of the year (1.26 vs. 1.21 mg/dL, p&amp;lt;0.001), and eGFR was lower (65 vs. 67 mL/min/1.73 m2, p&amp;lt;0.001). Temperatures in summer and the rest of the year increased gradually, albeit not linearly, from 2002 to 2021 (Figure 1). The absolute (Δ) and percent changes (Δ%) in median temperatures between summer and the rest of the year increased across years (r=0.149, p=0.001 and r=0.144, p=0.002, respectively), as well as Δ and Δ% of the monthly median of maximal temperatures (r=0.119, p&amp;lt;0.001 and r=0.052, p&amp;lt;0.001, respectively) (Figure 1). The Δ and Δ% temperatures between summer and the rest of the year displayed several significant correlations with Δ and Δ% creatinine and eGFR after adjusting for several variables including age, sex, HF therapies, and creatinine outside of summer (Figure 2). Conclusions Over a 20-year timespan there has been an increase in 1) temperatures in summer and in the rest of the year, and 2) the temperature excursion between summer and the rest of the year. Changes in temperatures between summer and the rest of the year correlated with the magnitude of the decrease in renal function during summer, likely because of worse dehydration with higher temperatures. Therefore, the progressive rise in temperature may have detrimental effects on renal function during summer in HF outpatients. Funding Acknowledgement Type of funding sources: None.

A Deep Learning Approach for the Estimation of Glomerular Filtration Rate.

An accurate estimation of glomerular filtration rate (GFR) is clinically crucial for kidney disease diagnosis and predicting the prognosis of chronic kidney disease (CKD). Machine learning methodologies such as deep neural networks provide a potential avenue for increasing accuracy in GFR estimation. We developed a novel deep learning architecture, a deep and shallow neural network, to estimate GFR (dlGFR for short) and examined its comparative performance with estimated GFR from Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations. The dlGFR model jointly trains a shallow learning model and a deep neural network to enable both linear transformation from input features to a log GFR target, and non-linear feature embedding for stage of kidney function classification. We validate the proposed methods on the data from multiple studies obtained from the NIDDK Central Database Repository. The deep learning model predicted values of GFR within 30% of measured GFR with 88.3% accuracy, compared to the 87.1% and 84.7% of the accuracy achieved by CKD-EPI and MDRD equations (p = 0.051 and p &lt; 0.001, respectively). Our results suggest that deep learning methods are superior to equations resulting from traditional statistical methods in estimating glomerular filtration rate. Based on these results, an end-to-end predication system has been deployed to facilitate use of the proposed dlGFR algorithm.

Performance of Creatinine- and Cystatin C-Based Equations for Glomerular Filtration Rate Estimation in HIV-1-Infected Individuals Receiving Dolutegravir + Tenofovir Disoproxil Fumarate + Lamivudine as Initial Antiretroviral Therapy: A Retrospective Observational Study.

Dolutegravir (DTG) may inhibit organic cation transporter-2 in renal tubules and elevate serum creatinine levels without true renal function deterioration. There are scarce data on the glomerular filtration rate (GFR) equations in Chinese HIV patients with DTG/TDF/3 TC. This retrospective study was to evaluate the changes in creatinine- and cystatin C-based estimated GFR values among Chinese adult HIV patients with initial highly active antiretroviral therapy (HAART) with DTG/TDF/3 TC for 48 weeks. Retrospective analysis of Chinese adult HIV patients who received initial HAART with DTG/TDF/3 TC between January 2016 and May 2021. We compared the changes in creatinine-based and cystatin C-based estimated GFR before and 48 weeks after HAART to determine the optimal tool for renal function estimation. Ninety-five patients [91.58% men; median age, 34 years (interquartile range, 29-44 years)] were enrolled. The median baseline CD4+ cell count was 185 cells/µL [interquartile range, 53-303 cells/µL] and the median baseline viral load was 148,000 copies/mL [interquartile range, 26,800-596,000 copies/mL]. The estimated GFR at 4, 12, and 24 weeks was significantly different than at baseline (P < 0.05) using all 4 equations. Only the GFR estimated using the CKD-EPIcreat and CKD-EPIcys equations was significantly different at 48 weeks of treatment (P < 0.05). The modification of diet in renal disease-based decline of GFR incidence at 4, 12, 24, and 48 weeks of treatment (21.5%, 24.21%, 33.68% and 38.95%, respectively) was higher than that calculated using the other 3 GFR equations. The modification of diet in renal disease equation may not be optimal for Chinese HIV-1-infected adults receiving DTG + TDF + 3 TC as the initial antiviral therapy. Clinicians must carefully choose the GFR equation for patients with HIV/hepatitis B virus coinfection.

LABORATORY AND CLINICAL FEATURES OF TUMOR LYSIS SYNDROME IN CHILDREN WITH HIGH-GRADE NON-HODGKIN LYMPHOMA AND EVALUATION LONG-TERM RENAL FUNCTIONS IN SURVIVORS

Tumor lysis syndrome (TLS) describes biochemical and clinical abnormalities resulting from spontaneous or treatment-induced necrosis of rapidly proliferating tumors such as Burkitt's lymphoma (BL). TLS can lead to complications like acute kidney injury (AKI) which can be fatal. In patients who had AKI in childhood, the frequency of kidney problems increases in later ages. Therefore, there is a need to examine long term kidney functions in patients with TLS. The purpose of our study is to investigate the laboratory and clinical features of tumor lysis syndrome in childhood non-Hodgkin lymphomas (NHL) and to reveal its impact on long term kidney function in survivors. Our study was a single center retrospective study. 107 patients (0-18 years of age) admitted to our hospital between 1998-2020 years with a diagnosis of NHL and who received chemotherapy were included in the study. Clinical and laboratory characteristics of the patients at the time of diagnosis and within 14 days from the start of chemotherapy were examined. The presence of TLS and its laboratory and clinical features were examined according to the Cairo-Bishop criteria. The relationship between TLS and age, gender, histopathological subgroup, tumor stage, lactate dehydrogenase (LDH) level at presentation, bone marrow and kidney involvement were investigated. The presence of AKI was determined according to the Kidney Disease: Improving Global outcomes criteria. Long-term renal functions of the patients were investigated. 80.3% of the patients with a median age of 9.8 years were male. The most common histopathological subgroup was BL (77.5%), while the majority of patients (76.7%) had advanced disease. Clinical TLS (CTLS) was observed in 12.1% of the cases, and isolated laboratory TLS (LTLS) was observed in 18.7%. Hyperhydration±alkalinization and allopurinol were used in first-line treatment and prophylaxis. A significant correlation was found between young age, advanced stage, high lactate dehydrogenase level at presentation and LTLS. Bone marrow involvement was found to be significantly higher in the group with CTLS. AKI was observed in 12.1% of the patients. Out of a total of 103 patients whose treatment was completed, 93 (90.3%) patients survived and 10 deaths were observed. No death due to TLS was observed. The mean survival time was 215.55±7.502 months. After an average of 6.9 years, when the glomerular filtration rate values of the patients at the first admission and at the last admission were compared, a mean decrease of 10 mL/min/1.73 m2 was detected. However, it was not found to be statistically significant. In our study, lower age, advanced stage, high LDH level at presentation were found to be risk factors for TLS. Long-term renal function loss was not detected in the survivors, for whom early and careful prophylaxis/treatment approaches were applied for TLS. The survivors are still being followed up.

Acute Renal Infarction: A Single-Center Experience

Objective: The aim of this study is to evaluate the clinical characteristics and short- and midterm renal functions in patients with acute renal infarction. Methods: The medical records of the patients who were diagnosed with acute renal infarction by computed tomography in our clinic between 2012 and 2019 were retrospectively reviewed. Twenty-four patients who had follow-up data for at least 1 year were included in the study. Clinical, radiological, and laboratory findings of the patients at the time of admission and the results of serum creatinine level and glomerular filtration rate at first month and first year were recorded. Results: The mean age of the patients was 49.5 ± 20.7 years. In half of the cases, cardiac origin diseases were the underlying risk factor of acute renal infarction. Flank/abdominal pain was the most common presenting symptom. At admission, mean white blood cell count, serum lactate dehydrogenase, serum creatinine, and glomerular filtration rate values were 12 507 ± 6367/μL, 437.4 ± 261 U/L, 1.4 ± 1.9 mg/dL, and 85.3 ± 47.7 mL/min/1.73 m2, respectively. Chronic kidney disease developed in 7 patients. Conclusions: Acute renal infarction should be taken into consideration in patients with flank or abdominal pain and increased serum lactate dehydrogenase level. In addition, patients with acute renal infarction are at risk of developing chronic kidney disease.

The progress of chronic renal disease patients followed by the diagnosis of COVID-19 in ICU

Aim: The mortality and morbidity of COVID-19 disease are higher in patients with comorbidities. In this study, we staged patients with chronic renal failure hospitalized in the intensive care unit (ICU) and aimed to evaluate the process of the disease according to the stage of failure.&#x0D; Material and Method: The medical records of 249 patients followed in Ankara City Hospital MH3 ICU were reviewed retrospectively. The patients were divided into three stages according to their estimated glomerular filtration rate (e-GFR) value (stage 1: e-GFR≥90 ml/min/1.73 m², stage-2: e-GFR: 15-89 ml/min/1.73 m², stage- 3: e-GFR≤15 ml/min/1.73 m²). Data such as age, gender, comorbidity status, length of stay in the ICU, duration of mechanical ventilation, and mortality rate of the patients were recorded. Patients who were evaluated as stage-2 were also classified into 3 stages (stage-2a: e-GFR: 60-89 ml/min/1.73 m², stage-2b: e-GFR:30-59 ml/min/1.73 m², stage-2c: e-GFR: 15-29 ml/min/1.73 m²) and evaluated with the same parameters.&#x0D; Results: The mean age of all patients was 71 years. It was found that the intubation rate was higher (p=0.012) and the mortality rate was higher (p=0.003) in patients evaluated as stage-3. APACHE II and SOFA scores were higher than the other groups (p=

Relationships between squamous cell carcinoma antigen and cytokeratin 19 fragment values and renal function in oral cancer patients

Squamous cell carcinoma antigen (SCC-Ag) and cytokeratin 19 fragment (CYFRA) are used to screen and monitor oral cancer patients. However, recent studies have reported that tumour markers become elevated as renal function decreases, regardless of tumour progression. A retrospective study was performed of 423 oral cancer patients who underwent blood testing for these tumour markers and other blood analytes during a 10-year period. The values of SCC-Ag and CYFRA increased significantly with decreasing renal function (P < 0.01), and the values were abnormal at a median 2.6 ng/ml for SCC-Ag and 4.7 ng/ml for CYFRA in the group with estimated glomerular filtration rate (eGFR) values of< 30 ml/min/1.73 m2. The factors that were related to the variation in tumour markers were albumin and creatinine. The cut-off values of eGFR were 59.7 ml/min/1.73 m2 for SCC-Ag and 63.6 ml/min/1.73 m2 for CYFRA, and the cut-off age when the tumour markers might rise due to the effect of renal function were 72 years for SCC-Ag and 73 years for CYFRA. In conclusion, decreased renal function should be taken into account when evaluating tumour markers in oral cancer. In addition, tumour markers are likely to be overestimated in patients over the age of 72–73 years.

P8.062: Prevalence of Hyperkalemia (HK) Among Stable Kidney Transplant Patients

Objectives: To determine the characteristics of renal transplant patients with hyperkalemia. Evaluate the use of Renin Angiotensin Aldosterone System inhibitors (RAASi) in this population. Materials and Methods: Laboratory records of kidney transplant patients in our unit between January and December 2021 were evaluated. Clinical variables (age, time since transplant, sex, use of RAASi) and laboratory variables (kalemia, creatininemia, proteinuria) were analyzed.). Renal function was calculated using the CKD EPI formula. Only records of patients in stable conditions were considered, discarding those records during hospitalizations or clinical complications. Two groups were divided with and without records of hyperkalemia (greater than or equal to 5 mEq/l) and statistical differences between groups. A value of p <0.01 was considered significant. Results: In the evaluated period, out of 454 patients under follow-up, 438 had a record of potassium values obtained in the database, to which a total of 1349 determinations were made. Of these determinations, 138 had high values (10.23%), which corresponded to 74 patients (16.3% of the study population). Of these 74 patients, 29 (39%) had more than one elevated record. Results are resented in Figure 1. Patients with hyperkalemia presented higher creatinine values, lower glomerular filtration rate and lower red series values. The group with hyperkalemia had a significantly greater use of RAASi, mainly due to the use of Angiotensin Converting Enzyme Inhibitors (ACEi). No differences were observed between both groups regarding the use of low doses of ACEi/ARB (Angiotensin Receptor blockers). The results are shown in Figure 1. The frequency of hyperkalemia was significantly higher in the group with renal stage IV (39.34%) vs stage I-II (2.68%) of chronic kidney disease. In stages I-II of CKD, 40% of patients (60/149) are found with RAASi, while in stage IV it rises to 60% (37/61; p 0.007). About 29% of patients with RAASi in both groups were on low doses of the same. Conclusions: 16% of transplant patients presented hyperkalemia in our series, with a significant difference between those with early stages of kidney disease (2.68% in stages I and II) vs those with CKD IV (39%). Although half of the patients are nephroprotected by RAASi, 29% of them have a dose lower than the average dose. Srita Gabriela Melchior - Secretaria de la Unidad.

Retrospective assessment of the association between co-morbid disease burden and biochemical parameters in hospitalized hypertensive COVID-19 patients

Background/Aim: Hypertension (HT) was examined as a risk factor affecting the progression of the 2019 novel coronavirus disease (COVID-19). In COVID-19 patients, it can be found in many co-morbid diseases, along with hypertension. It is not clear whether the co-morbid burden of the disease affects the prognosis in hypertensive COVID-19 patients and which biochemical parameters may be indicative of this. Therefore, this study was designed to determine the effect of co-morbid disease burden on biochemical parameters in hospitalized hypertensive COVID-19 patients.&#x0D; Methods: After receiving approval from the University Ethics Committee, demographic, clinical, radiological, and laboratory data of 250 hospitalized hypertensive COVID-19 patients between May 2020 and Sept 2020 were screened. Patients with missing records and unclear history of hypertension drug use were excluded from the study. A total of 215 patients were included in the study. Patients were divided into four groups according to the co-morbidity status: (1) HT alone (Group HT0), (2) HT+ Diabetes Mellitus (DM) (Group HTDM1), (3) HT+one co-morbidity exclude DM (Group HT2), and (4) HT+at least two co-morbidities (Group HT3).&#x0D; Results: We analyzed the data of 105 female and 110 male patients. Of the 215 patients whose data were evaluated in this study, 15 patients died. Two hundred people were discharged with recovery. The mortality rate was 7%. Of the hypertension patients, 34.9% had DM, 32.6% had coronary artery disease (CAD), 30.2% had chronic obstructive pulmonary disease (COPD), 16.3% had heart failure (HF), 23.3% had chronic kidney failure (CKD), and 9.3% had cerebrovascular disease (CVD). Twenty-five percent were smokers. Urea, creatinine, direct bilirubin (DBil), and Troponin-I values were significantly higher in the Group HT3 compared to the Group HT0, Group HTDM1, and Group HT2 (P &lt; 0.001, P &lt; 0.001, P &lt; 0.001, P = 0.002 respectively). Glomerular filtration rate (GFR) and albümin levels were significantly lower in Group HT3 than in Group HT0, Group HTDM1, and Group HT2 (P &lt; 0.001 and P &lt; 0.001, respectively). The logistic regression model was statistically significant (χ2(7) = 69.088 and P &lt; 0.001); advanced age, decrease in GFR and plateletcrit (PCT) levels, and increase in D-dimer and DBil levels were observed as predictive parameters of mortality in all hospitalized COVID-19 HT patients.&#x0D; Conclusion: We determined that SARS-CoV-2 pneumonia patients with HT plus at least two co-morbidities were more serious than other patient groups in terms of organ damage and biochemical variables. In our study, we observed an increase in urea, creatinine, D-dimer, Dbil, and Troponin-I values and a decrease in GFR and albumin values as the co-morbidity burden increased in hypertensive COVID-19 patients. However, a decrease in GFR and hemogram PCT levels and an increase in D-dimer and DBil levels could be risk factors for mortality.

Risk factors for childhood chronic kidney disease: a population-based study.

The population-based prevalence and risk factors of childhood chronic kidney disease (CKD) are not well-defined. We ascertained childhood CKD epidemiology and perinatal risk factors, based on a large computerized medical record database that covers most of southern Israel's population. Pre- and post-natal records of 79,374 eligible children (with at least one serum creatinine test) born during 2001-2015 were analyzed. "Ever-CKD" was defined as ≥ 2 estimated glomerular filtration rate (eGFR) values < 60ml/min/1.73 m2 beyond age 2years, more than 3months apart. The last CKD status was determined on March 2019. Of 82 (0.1%) patients with ever-CKD, 35 (42.7%) had their first abnormal eGFR identified already at age 2years. In multiple logistic regression analysis, congenital anomalies of kidney and urinary tract (CAKUT)-related diagnoses, glomerulopathy, maternal oligohydramnios, small for gestational age, prematurity (under 34weeks), post-term delivery, and small for gestational age at birth were significant risk factors for ever-CKD (odds ratio (95% confidence interval): 44.34(26.43-74.39), 64.60(32.42-128.70), 5.54(3.01-10.19), 2.02(1.25-3.28), 4.45(2.13-9.28), 2.96(1.28-6.86 and 2.02(1.25-3.28), respectively). Seventy children with ever-CKD (85.4%) had a depressed eGFR (< 90ml/min/1.73 m2) on the last assessment (current-CKD), yielding a prevalence of 882/million. CKD is more prevalent among children in southern Israel than previously reported, even after excluding those with aborted-CKD. Prenatal conditions increase the risk to develop CKD in childhood. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

Comparison of the 2013 and 2019 Nationwide Surveys on the Management of Chronic Kidney Disease by General Practitioners in Japan.

In 2019, the Japan Physicians Association conducted a second nationwide survey on the management of chronic kidney disease (CKD) among the Japanese general practitioners (GPs). We aimed to clarify the changes in the state of CKD medical care by GPs since the 2013 survey. The 2013 and 2019 surveys included 2214 and 601 GPs, respectively, who voluntarily participated. The two surveys were compared, using propensity score matching to balance the background of the responded GPs. For the medical care of CKD, the frequency of urine or blood examination, use of estimated glomerular filtration rate (eGFR) value for CKD management, and continuous use of renin-angiotensin system inhibitors for their reno-protective effects were significantly higher in 2019 than in 2013 (all: p < 0.001). The medical cooperation in CKD management, the utilization of the clinical path for CKD management and the measurement of the eGFR during the medical health checkup were significantly increased in 2019, compared to those in 2013. More GPs felt dissatisfied with the components of CKD treatment by nephrologists (p < 0.001). The two surveys confirmed improvements in the level of medical care for CKD and a strengthening in cooperation. However, the dissatisfaction with the consultation with nephrologists did not necessarily improve.

A Comparison of the Renal Function between GFR from Tc-99m DTPA Renography and Serum Creatinine, Serum BUN, eGFR by CKD-EPI Equation, and 24-Hour Urine Creatinine Clearance in Thai Living Related Kidney Donors

Background: There are many methods used to estimate renal function in routine clinical practice. Good correlation between glomerular filtration rate (GFR) by Tc-99m DTPA renal scan and inulin clearance is the gold standard method of determining GFR. Objective: The aim of the present study was to evaluate renal function by GFR by Tc-99m DTPA renography and compare it between serum creatinine (Cr), serum blood urea nitrogen (BUN), estimated GFR (eGFR) by Chronic Kidney Disease Epidemiology Collaboration equation (CKDEPI equation), and 24-hour urine creatinine clearance in Thai living related kidney donors. The secondary aim was to investigate whether age or body mass index (BMI) would have a significant effect to the evaluation of GFR from Tc-99m DTPA renography. Materials and Methods: The present study was a retrospective study that included potential living kidney donors who underwent Tc-99m DTPA renal scan and renogram at Siriraj Hospital (Bangkok, Thailand) to evaluate renal function between January 2011 and January 2018. All included patients had complete GFR data from Tc-99m DTPA renography, serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance. Age, gender, and BMI data were also collected. Results: One hundred twenty cases were included. There were 72 females and 48 males, and the mean age was 36.72±10.22 years with a range of 19 to 58 years. Significant correlation was observed between GFR from Tc-99m DTPA renography and serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance. In contrast, gender and BMI revealed no significance with GFR from Tc-99m DTPA renography. Significant negative correlation was found between GFR from Tc-99m DTPA renography and age. Conclusion: The results of the present study revealed that serum Cr, serum BUN, eGFR by CKD-EPI equation, and 24-hour urine creatinine clearance were reliable methods for evaluating GFR. Older age significantly correlated with reduction of the GFR value from Tc-99m DTPA renography. Keywords: GFR; Renal function; Glomerular filtration rate; Tc-99m DTPA renography; Serum creatinine; BUN; CKD-EPI equation; Urine 24 hours creatinine clearance