Recurrent acute kidney injury in elderly patients is common and associated with 1-year mortality

Background

Acute kidney injury (AKI) is common among elderly patients after a first hospitalized AKI. Patients who recover are at risk for recurrence, but recurrent geriatric AKI is not well-studied.

Methods

This was a retrospective, 12-month cohort study using data from the National Clinical Research Center for Geriatric Diseases. Recurrent AKI was defined as a new spontaneous rise of?≥?0.3 mg/dl (≥?26.5 µmol/L) within 48 h or a 50% increase in serum creatinine (Scr) from the baseline within 7 days after the previous AKI episode. The outcome measured was 12-month mortality.

Results

Among 1711 study patients, 652 developed AKI. Of the 429 AKI survivors in whom recovery could be assessed, 314 patients recovered to their baseline renal function, and 115 patients developed chronic kidney disease (CKD). Of the group that recovered renal function, 90 patients (28.7%) subsequently developed recurrent AKI, while 224 (71.3%) did not. Of the 429 survivors with AKI, 103 patients (24.0%) died within 12 months. Multivariate logistic regression analysis revealed that recurrent AKI was significantly associated with coronary disease (odds ratio [OR?=?2.008; 95% confidence interval [CI] 1.024–3.938; P?=?0.042), a need for mechanical ventilation (OR?=?2.265; 95% CI 1.267–4.051; P?=?0.006) and high blood urea nitrogen levels (OR?=?1.036; 95% CI 1.002–1.072; P?=?0.040) at the first AKI event. Kaplan–Meier curves showed the 12-month survival of patients with non-recurrent AKI was better than that of patients with CKD, and survival of patients with recurrent AKI was worse than that of patients with CKD (log rank P?<?0.001). In the multivariate Cox regression analysis, mortality at 12 month was higher in the patient with recurrent AKI as compared with those with a single episode (HR?=?3.375; 95% CI 2.241–5.083; P?<?0.001).

Conclusion

Recurrent AKI is common among elderly patients who recovered their renal function post-AKI and is associated with significantly higher 12-month mortality compared with CKD patients.

     

Effects of the diagnostic window and duration of acute kidney injury on 1-year mortality in elderly patients: a single-center retrospective study

Background

We evaluated the prognostic impact of AKI duration on the 1-year mortality rate in elderly patients diagnosed based on the 48-hour and 7-day changes in serum creatinine (Scr) levels recommended by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines.

Methods

This retrospective study was conducted from 2007 to 2018 on elderly patients in the Geriatric Department of the Chinese PLA General Hospital. Based on the two diagnostic criteria in the KDIGO guidelines, the patients were divided into a 48-hour diagnostic window and a 7-day diagnostic window group, and into transient AKI (lasting 1–2 days) and persistent AKI (lasting 3–6 days, and?≥?7 days) based on the time at which the Scr level returned to the baseline value. The primary outcome was the 1-year mortality rate after AKI.

Results

In total, 688 patients were enrolled, including 367 (53.3%) with a 48-hour and 321 (46.7%) with a 7-day diagnostic window. Of the 688 patients, in the 48-hour window group, 12.0% had transient AKI, 31.1% had lasting 3–6 days, and 56.9% had lasting?≥?7 days; in the 7-day window group, 5.3% had transient AKI, 24.0% had lasting 3–6 days, and 70.7% had lasting?≥?7 days. Overall, 332 patients (33.6%) died within 1 year, including 189 (51.5%) in the 48-hour and 143 (44.5%) in the 7-day diagnostic window group. After adjusting for multiple covariates, AKI duration was associated with a significantly higher 1-year mortality rate (3–6 days: HR?=?3.535; 95% CI?=?1.685–7.417, P?=?0.001;?≥?7 days: HR?=?2.400; 95% CI?=?1.152–5.001, P?=?0.019) in the 48-hour diagnostic window group, but it did not differ in the 7-day diagnostic window group (P?=?0.452).

Conclusions

Persistent AKI was common in elderly hospitalized patients, accounting for 88% and 95% of patients with 48-hour and 7-day diagnostic windows, respectively. Moreover, AKI duration was associated with different clinical outcomes depending on the diagnostic window. Further studies should focus on the mechanism underlying the relationship of AKI outcomes with diagnostic criteria.

     

High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents

Background

Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.

Aim

The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.

Methods

Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.

Results

The patients’age was 49.2?±?12 years. Baseline serum creatinine was 3.76?±?1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97); p?=?0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35); p?=?0.001].

Conclusion

Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.

     

The effect of renal artery-only or renal artery–vein clamping during partial nephrectomy on short and long-term functional results: Is clamping technique important?

Purpose

To evaluate the effect of artery-only (AO) and artery–vein (AV) clamping during partial nephrectomy (PN) on short- and long-term renal function outcome.

Methods

Medical records of 154 patients in the AO group and 192 patients in the AV group who underwent open and minimally invasive (laparoscopic/robotic) PN between January 2011 and January 2018 were retrospectively assessed. Preoperative patient and tumor-specific characteristics in addition to perioperative factors and renal function outcomes were compared. The change in the estimated glomerular filtration rate (eGFR) from postoperative 1–3 days, 12 and 24 months after surgery was calculated. Acute kidney injury (AKI) was defined a as a?>?25% reduction in eGFR.

Results

There were no statistically significant differences between the clamping techniques in terms of postoperative 1–3 days, 12 and 24 months eGFR change percentage and risk of progression to chronic kidney disease (CKD). No significant difference in short- and long-term renal functions was found between the minimally invasive or open AO and AV clamping subgroups at any time point. In multivariate analysis, the R.E.N.A.L score (AO group p?=?0.026, AV group p?<?0.001) and preoperative eGFR (AO group p?<?0.001, AV group p?=?0.010) were strong predictors of the acute kidney injury in both groups. Older age (AO group p?=?0.045, AV group p?=?0.010) and preoperative eGFR (AO group p?=?0.008, AV group p?=?0.002) were significantly associated with CKD progression at 2-year follow-up in both groups.

Conclusion

AV clamping does not adversely affect postoperative renal function compared to AO clamping. Preoperative patient- and tumor-related factors are more important for renal function regardless of the clamping technique.

     

Could urinary kidney injury molecule-1 be a good marker in subclinical acute kidney injury in mild to moderate COVID-19 infection?

Purpose

To evaluate urinary kidney injury molecule-1 (uKIM-1), which is a proximal tubule injury biomarker in subclinical acute kidney injury (AKI) that may occur in COVID-19 infection.

Methods

The study included proteinuric (n?=?30) and non-proteinuric (n?=?30) patients diagnosed with mild/moderate COVID-19 infection between March and September 2020 and healthy individuals as a control group (n?=?20). The uKIM-1, serum creatinine, cystatin C, spot urine protein, creatinine, and albumin levels of the patients were evaluated again after an average of 21 days.

Results

The median (interquartile range) uKIM-1 level at the time of presentation was 246 (141–347) pg/mL in the proteinuric group, 83 (29–217) pg/mL in the non-proteinuric group, and 55 (21–123) pg/mL in the control group and significantly high in the proteinuric group than the others (p?<?0.001). Creatinine and cystatin C were significantly higher in the proteinuric group than in the group without proteinuria, but none of the patients met the KDIGO-AKI criteria. uKIM-1 had a positive correlation with PCR, non-albumin proteinuria, creatinine, cystatin C, CRP, fibrinogen, LDH, and ferritin, and a negative correlation with eGFR and albumin (p?<?0.05). In the multivariate regression analysis, non-albumin proteinuria (p?=?0.048) and BUN (p?=?0.034) were identified as independent factors predicting a high uKIM-1 level. After 21?±?4 days, proteinuria regressed to normal levels in 20 (67%) patients in the proteinuric group. In addition, the uKIM-1 level, albuminuria, non-albumin proteinuria, and CRP significantly decreased.

Conclusions

Our findings support that the kidney is one of the target organs of the COVID-19 and it may cause proximal tubule injury even in patients that do not present with AKI or critical/severe COVID-19 infection.

     

The Potential of Semaglutide Once-Weekly in Patients Without Type 2 Diabetes with Weight Regain or Insufficient Weight Loss After Bariatric Surgery—a Retrospective Analysis

Purpose

About 20–25% of patients experience weight regain (WR) or insufficient weight loss (IWL) after bariatric metabolic surgery (BS). Therefore, we aimed to retrospectively assess the effectiveness of adjunct treatment with the GLP-1 receptor agonist semaglutide in non-diabetic patients with WR or IWL after BS.

Materials and Methods

Post-bariatric patients without type 2 diabetes (T2D) with WR or IWL (n?=?44) were included in the analysis. The primary endpoint was weight loss 3 and 6 months after initiation of adjunct treatment. Secondary endpoints included change in BMI, HbA1c, lipid profile, hs-CRP, and liver enzymes.

Results

Patients started semaglutide 64.7?±?47.6 months (mean?±?SD) after BS. At initiation of semaglutide, WR after post-bariatric weight nadir was 12.3?±?14.4% (mean?±?SD). Total weight loss during semaglutide treatment was???6.0?±?4.3% (mean?±?SD, p?<?0.001) after 3 months (3.2 months, IQR 3.0–3.5, n?=?38) and???10.3?±?5.5% (mean?±?SD, p?<?0.001) after 6 months (5.8 months, IQR 5.8–6.4, n?=?20). At 3 months, categorical weight loss was?>?5% in 61% of patients,?>?10% in 16% of patients, and?>?15% in 2% of patients. Triglycerides (OR?=?0.99; p?<?0.05), ALT (OR?=?0.87; p?=?0.05), and AST (OR?=?0.89; p?<?0.05) at baseline were negatively associated with weight loss of at least 5% at 3 months’ follow-up (p?<?0.05).

Conclusion

Treatment options to manage post-bariatric excess weight (regain) are scarce. Our results imply a clear benefit of adjunct treatment with semaglutide in post-bariatric patients. However, these results need to be confirmed in a prospective randomized controlled trial to close the gap between lifestyle intervention and revision surgery in patients with IWL or WR after BS.

Graphical abstract

     

Racial Differences in Bariatric Surgical Approach: a Cross-Sectional National Inpatient Sample Analysis

Purpose

Although racial inequalities in referral and access to bariatric surgical care have been well reported, racial difference in the selection of surgical techniques is understudied. This study examined factors associated with the utilization of the two main bariatric surgical techniques: laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).

Materials and Methods

The National Inpatient Sample database was queried for patients who underwent elective LSG or LRYGB for the treatment of severe obesity. Chi-square tests and multivariable logistic regression assessed associations of surgical approach with patient and facility characteristics. Sensitivity analyses examined the following body mass index (BMI) subgroups:?<?40.0 kg/m², 40.0–44.9 kg/m², 45.0–49.9 kg/m², and?≥?50.0 kg/m².

Results

Within the final cohort (N?=?86,053), 73.0% (N?=?62,779) underwent LSG, and 27.0% (N?=?23,274) underwent LRYGB. Patients with BMI 45.0–49.9 kg/m² (OR?=?0.85) and BMI?≥?50.0 kg/m² (OR?=?0.80) were less likely to undergo LSG than patients with BMI 40.0–45.0 kg/m² (all p?<?0.001). However, Black (OR?=?1.74) and White Hispanic patients (OR?=?1.30) were more likely to undergo LSG than White non-Hispanic patients (all p?<?0.005). In the BMI?≥?50.0 kg/m² group, Black patients were still more likely to undergo LSG compared to White non-Hispanic patients (OR?=?1.69, p?<?0.001), while Asians/Pacific Islanders were less likely to receive LSG than White non-Hispanic patients (OR?=?0.41, p?<?0.05).

Conclusion

In this observational study, we identified racial differences in the selection of common bariatric surgical approaches across various BMI categories. Future investigations are warranted to study and to promote awareness of the racial/ethnic influence in attitudes on obesity, weight loss, financial support, and surgical risks during bariatric discussions with minorities.

Graphical abstract

     

One Anastomosis Gastric Bypass for Revision of Restrictive Procedures: Mid-Term Outcomes and Analysis of Possible Outcome Predictors

Purpose

Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors.

Materials and Methods

Single-center retrospective comparative study of revisional OAGB outcomes (2015–2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed.

Results

In all, 203 patients underwent revisional OAGB following LAGB (n?=?125), SG (n?=?64), and SRVG (n?=?14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3?±?6.6 and 42?±?11.2 kg/m² (p?=?0.64), reduced to 31.3?±?8.3 and 31.9?±?8.3 (p?=?0.64) at mid-term follow-up, respectively. Excess weight loss (EWL)?>?50% was achieved in?~?50%, with EWL of 79.4?±?20.4% (corresponding total weight loss 38.5?±?10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p?=?0.47 and p?=?0.46), respectively.

In univariable analysis, EWL?>?50% was associated with male gender (p?<?0.001), higher weight (p?<?0.001), and BMI (p?=?0.007) at primary surgery, and higher BMI at revisional OAGB (p?<?0.001). In multivariable analysis, independent predictors for EWL?>?50% were male gender (OR?=?2.8, 95% CI 1.27–6.18; p?=?0.01) and higher BMI at revisional OAGB (OR?=?1.11, 95% CI 1.03–1.19; p?=?0.006).

Conclusion

Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL?>?50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.

Graphical abstract

     

Association of angiotensin-converting enzyme insertion/deletion polymorphism with type 1 diabetic nephropathy: a meta-analysis

Objective: This study aimed to systematically evaluate the effect of an angiotensin-converting enzyme (ACE) insertion/deletion (I/D) gene polymorphism on type 1 diabetic nephropathy (DN).

Methods: Cochrane Library, Embase, PubMed, Science Direct, Web of science, Wanfang data, VIP database, China Knowledge Resource Integrated Database, and SinoMed were searched. A total of 17 case–control studies analyzing ACE I/D polymorphism and type 1 DN risk were included in the present meta-analysis.

Results: Overall, a significant increased risk was found in allele comparison (OR?=?1.16, 95% CI?=?1.05–1.28, p?=?0.04), dominant comparison (OR?=?1.56, 95% CI?=?1.14–2.15, p?=?0.006) and homozygote comparison (OR?=?1.52, 95% CI?=?1.06–2.19, p?=?0.02). In subgroup analyses according to ethnicity, the risk of type 1 DN in Asian population was increased in allele comparison (OR?=?1.98, 95% CI?=?1.15–3.42, p?=?0.01), recessive comparison (OR?=?2.48, 95% CI?=?1.51–4.10, p?=?0.0004), dominant comparison (OR?=?3.15, 95% CI?=?1.90–5.23, p?p?=?0.05). However, there was no association between the ACE I/D genetic variants and type 1 DN in Caucasian populations.

Conclusions: Our meta-analysis results indicate that the ACE I/D polymorphism may contribute to type 1 DN development, especially in the Asian groups with type 1 diabetes. The current findings need to be confirmed by future well-designed and larger sample size primary studies in populations with different ethnicities.     

Low endogenous testosterone levels are associated with the extend of lymphnodal invasion at radical prostatectomy and extended pelvic lymph node dissection

Objective

To investigate clinical factors associated to lymphnodal metastasis load in patients who underwent to radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND).

Materials and methods

Between November 2014 and December 2019, ET was measured in 617 consecutive patients not under androgen deprivation therapy who underwent RP and ePLND. Lymphnode invasion (LNI) was codified as not present (N?=?0) or with one (N?=?1) or more than one metastatic node (N?>?1). The risk of multiple pelvic lymph node metastasis (N?>?1, mPLNM) was assessed by comparing it to the other two groups (N?>?1 vs. N?=?0 and N?>?1 vs. N?=?1). Then, we assessed the association between ET and lymphnode invasion for standard predictors, such as PSA, percentage of biopsy positive cores (BPC), tumor stage greater than 1 (cT?>?1) and tumor grade group greater than two (ISUP?>?2).

Results

Overall, LNI was detected in 70 patients (11.3%) of whom 39 (6.3%) with N?=?1 and 31 (5%) with N?>?1. On multivariate analysis, ET was inversely associated with the risk of N?>?1 when compared to both N?=?0 (odds ratio, OR 0.997; CI 0.994–1; p?=?0.027) as well as with N?=?1 cases (OR 0.994; 95% CI 0.989–1.000; p?=?0.015).

Conclusions

In clinical PCa, the risk of mPLNM was increased by low ET levels. As ET decreased, patients had an increased likelihood of mPLNM. Because of the inverse association between ET and mPLNM, higher ET levels were protective against aggressive disease. The influence of locally advanced PCa with high metastatic load on ET levels needs to be explored by controlled trials.

     

Outcomes of acute kidney injury patients with and without cancer

Abstract

Incidence of AKI in hospitalized patients with cancer is increasing, but there have been few studies on AKI in patients with cancer. We conducted a retrospective cohort study in a South Korean tertiary care hospital. A total of 2211 consecutive patients (without cancer 61.5%; with cancer 38.5%) were included over a 140-month period. Predictors of all-cause death were examined using the Kaplan–Meier method and the Cox proportional hazards model. The main contributing factors of AKI were sepsis (31.1%) and ischemia (52.7%). AKI was multifactorial in 78% of patients with cancer and in 71% of patients without cancer. Hospital mortality rates were higher in patients with cancer (42.8%) than in patients without cancer (22.5%) (p?=?0.014). In multivariate analyses, diabetes mellitus (DM) and cancer diagnosis were associated with hospital mortality. Cancer diagnosis was independently associated with mortality [odds ratio?=?3.010 (95% confidence interval, 2.340–3.873), p?=?0.001]. Kaplan–Meier analysis revealed that subjects with DM and cancer (n?=?146) had lower survival rates than subjects with DM and without cancer (n?=?687) (log rank test, p?=?0.001). The presence of DM and cancer was independently associated with mortality in AKI patients both with and without cancer. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.     

Preoperative serum cystatin C combined with dipstick proteinuria predicts acute kidney injury after cardiac surgery

Background: Acute kidney injury (AKI) is common following cardiac surgery and is associated with poor outcomes. However, the detection of those preoperative patients who will develop AKI is still difficult. In this study, we compared serum cystatin C combined with dipstick proteinuria as early markers to predict AKI available before surgery. Methods: We prospectively followed 616 patients undergoing cardiac surgery and identified 179 that developed AKI, defined as an increase in serum creatinine (SCr) of ≥?0.3?mg/dL or ≥?50% increase in creatinine level. Preoperative values for cystatin C were categorized into quartiles. We defined proteinuria, measured with a dipstick, as mild (trace to 1+) or heavy (2?+?to 4+). Univariate as well as multivariate regression was performed. Cystatin C combined with dipstick proteinuria before surgery was assessed for its' predictive value of AKI using receiver operating characteristic (ROC) curves. Results: The final cohort consisted of 616 patients aged 60.7?±?13.2 years, and baseline SCr was 75.8?±?26.4?μmol/L, estimated glomerular filtration rate (eGFR) 96.3?±?29.0?mL/min/1.73?m² and cystatin C 1.05?±?0.33?mg/L. Patients in higher cystatin C quartiles were older (p?p?=?0.021), hyperuricemia (p?p?p?=?0.002). Those with heavy proteinuria were more often to have diabetes mellitus (p?=?0.010), hyperuricemia (p?=?0.043), worse cardiac function (p?p?p?p?p?p?p?p?Conclusion: These data suggest that preoperative serum cystatin C combined with dipstick proteinuria may improve prediction of AKI among patients undergoing cardiac surgery.     

Undertreatment of Gallbladder Cancer: A Nationwide Analysis

Background

Gallbladder cancer has a high mortality rate and an increasing incidence. The current National Comprehensive Cancer Network (NCCN) guidelines recommend resection for all T1b and higher-stage cancers. This study aimed to evaluate re-resection rates and the associated survival impact for patients with gallbladder cancer.

Methods

Patients with gallbladder adenocarcinoma who underwent resection were identified from the National Cancer Database (2004–2015). Re-resection was defined as definitive surgery within 180 days after the first operation. Propensity scores were created for the odds of a patient having a re-resection. Patients were matched 1:2. Survival analyses were performed using the Kaplan–Meier and Cox proportional hazard methods.

Results

The study identified 6175 patients, and 466 of these patients (7.6%) underwent re-resection. Re-resection was associated with younger median age (65 vs 72 years; p?<?0.0001), private insurance (41.6% vs 27.1%; p?<?0.0001), academic centers (50.4% vs 29.7%; p?<?0.0001), and treatment location in the Northeast (22.8% vs 20.4%; p?=?0.0011). Compared with no re-resection, re-resection was associated with pT stage (pT2: 47.6% vs 42.8%; p?=?0.0139) and pN stage (pN1-2: 28.1% vs 20.7%; p?<?0.0001), negative margins on final pathology (90.1% vs 72.6%; p?<?0.0001), and receipt of chemotherapy (53.7% vs 35.8%; p?<?0.0001). The patients who underwent re-resection demonstrated significantly longer overall survival (OS) than the patients who did not undergo re-resection (median OS, 44.0 vs 23.0 months; p?<?0.0001). After propensity score-matching, re-resection remained associated with superior survival (median OS, 44.0 vs 31.0 months; p?=?0.0004).

Conclusions

Re-resection for gallbladder cancer is associated with improved survival but remains underused, particularly for early-stage disease.

     

Biochemical Markers and Obstructive Sleep Apnea Risk in Individuals After Long-Term Bariatric Surgery

Background

Individuals who have undergone long-term bariatric surgery may be at increased obstructive sleep apnea (OSA) risk. The purpose of this study was to estimate the frequency of OSA risk and its associations, via biochemical markers, in patients who have undergone long-term bariatric surgery.

Methods

This cross-sectional study evaluated patients after 5 years or more post Roux-en-Y gastric bypass. Biochemical markers, anthropometrics, and OSA risk, via the STOP-Bang score screening tool, were evaluated. Independent Student t, Pearson’s chi-squared, or correlation tests were applied, according to total OSA risk score groups or its isolated components.

Results

Among the 77 patients evaluated (88.3% female; body mass index?=?32.7?±?5.8 kg/ m²; postoperative time?=?9.9?±?3.1 years), 36 were at risk for OSA. OSA risk score was positively correlated to high-sensitivity C-reactive protein levels (r²?=?0.270; p?=?0.025), triglycerides (r²?=?0.338, p?=?0.004), total cholesterol (r²?=?0,262; p?=?0,028), and HbA1c (r²?=?0.332; p?=?0.005). Compared to each counterpart, basal insulin and triglycerides were higher among those who self-reported witnessed apnea (12.8?±?6.5 vs 8.1?±?3.8, p?=?0.013; 136.4?±?41.1 vs 88.5?±?34.8, p?=?0.001, respectively), while levels of total cholesterol and LDL-C were higher in participants who reported tiredness (183.9?±?27.0 vs 164.8?±?33.4, p?=?0.005; 105.9?±?24.4 vs 92.0?±?26.6, p?=?0.018). Participants with snoring also had higher levels of triglycerides (107?±?41.1 vs 83.7?±?33.9, p?=?0.010).

Conclusions

OSA risk was highly prevalent among patients who had undergone long-term bariatric surgery, as noted via increased STOP-Bang scores, as were isolated components related to inflammatory markers and lipid and glycemic profile.

Graphical Abstract

     

Correlation analysis of low-level serum uric acid and cardiovascular events in patients on peritoneal dialysis

Background

The impact of serum uric acid (SUA) on development of cardiovascular disease (CVD) in patients undergoing peritoneal dialysis (PD) remains controversial, especially the impact of hypouricemia (HUA) on CVD. The aim of our study was to investigate the influence of low-level SUA on cardiovascular (CV) events in PD patients.

Methods

A retrospective cohort study was conducted.728 PD patients from February 1, 2010 to May 31, 2019 were enrolled. All demographic and laboratory data were collected at baseline and 6 months after PD treatment. The study cohort was divided into four groups according to SUA level (μmol/L) after 6 months of PD: Group1 (<?360), Group2 (360–420), Group3 (420–480), Group4 (≥?480). The clinical characteristics of each group were analyzed. With Group2 as reference, logistic regression analysis was performed to investigate the correlation between SUA levels and risk of CV events in patients undergoing PD. Use Kaplan–Meier method to generate CV events risk graph.

Results

728 patients were enrolled in this study, including 403 (55.4%) males and 325 (44.6%) females, with an average age of 48.66?±?13.98 years; of which 158 (21.7%) patients developed CV events. Multivariate COX regression showed that after adjusting for multiple clinical factors, Group1 (HR?=?1.92, 95% CI 1.17–3.15, P?=?0.01), Group3 (HR?=?1.89, 95% CI 1.13–3.15, P?=?0.015), and Group4 (HR?=?2.38, 95% CI 1.35–4.19, P?=?0.003) are all independent risk factors for developing CV events. The Kaplan–Meier risk curve of CV events showed that the risk of CV events in the Group1, Group3 and Group4 were significantly higher (Log-Rank?=?12.67; P?=?0.005). Restricted cubic spline (RCS) showed that SUA level is non-linearly associated with the risk of CV events, showing an U-shaped curve (\(\chi_{4}^{2}\)=13.3 P?=?0.01).

Conclusions

Our study suggested that patients with SUA level less than 360 μmol/L also exhibited the higher risk for developing CV events, an U-shaped association between SUA level and risk of CV events in patients undergoing PD. Both SUA levels below 360 μmol/L and above 420 μmol/L were found to be significant risk factors for developing CV events in patients undergoing long-term PD.

     

Opioid usage differs significantly following ureteroscopy and shockwave lithotripsy,while development of long-term usage is positively correlated with total days’ supply and total MME supplied

Purpose

This study evaluated possible predictors of long-term opioid usage among patients with ureteric stones who received ureteroscopy (URS) or shockwave lithotripsy (SWL). We also assessed opioid usage characteristics of URS and SWL recipients.

Materials and methods

This retrospective study used IQVIA PharMetrics^® Plus for Academics administrative claims database from years 2006–2020 to identify patients with a diagnosis of kidney or ureteral stones who were treated with either SWL or URS. We performed unadjusted bivariate analyses to compare opioid use characteristics of URS and SWL recipients, and performed logistic regression to determine demographic and clinical factors associated with becoming a long-term opioid user.

Results

The study population consisted of opioid naive individuals having a diagnosis of a kidney stone who underwent URS (N?=?9407) or SWL (N?=?4894). About 6.7% (N?=?964) of study subjects were long-term opioid users. Unadjusted bivariate associations showed that compared to non-long-term opioid users, long-term opioid users had significantly greater total days’ supply, total morphine milliequivalents (MME) supplied, and claims per month. A similar trend was observed for URS (vs. SWL) recipients. However, compared to SWL recipients, URS recipients had 14.3% (1.2–25.6%; p?=?0.034) lower odds of becoming long-term users. Total days’ supply (OR: 1.041 (95% CI 1.030–1.052; p?<?0.001) and total MME supplied (OR 1.001 (95% CI 1.000–1.001; p?<?0.001) were significantly associated with long-term usage.

Conclusion

Higher total days’ supply and total MME supplied as well as SWL were identified as risk factors for becoming long-term opioid users.

     

Acute kidney injury in peripheral arterial surgery patients: a cohort study

Abstract

Purpose: The aim of the study was to evaluate the prevalence of acute kidney injury (AKI) in a cohort of surgically treated patients with peripheral artery disease (PAD) and its association with the short-term and long-term outcome. Materials and methods: We conducted a retrospective cohort study on all the consecutive PAD inpatients in 2008. Data on the patients’ demographic characteristics, medical history, treatment, outcome and laboratory tests measurements were retrieved from the medical records. Results: We analyzed 166 patients (71.6% males, mean age 63.2 years?±?SD 10.7 years) and found an AKI prevalence of 12.7%. The AKI patients’ group had more chronic kidney disease (CKD) (23.8% vs. 6.2%, p?=?0.005), diabetes mellitus (DM) (61.9% vs. 33.1%, p?=?0.011) and a higher length of hospital stay (19.48 vs. 15.42 days, p?=?0.047). At one year, the mortality was 33.3% in the AKI group compared to 1.3% in non-AKI group, with a strong association between AKI and death (OR?=?35.7; 95%CI?=?6.7 to 189) and AKI and major cardiovascular events (OR?=?29.1; 95% CI?=?6.8 to 123.4). There was no significant difference in terms of age, cardiovascular disease and medication between the two groups. Conclusions: AKI was associated with a poorer one-year outcome after the surgery of PAD patients. In our study, the presence of previous chronic kidney disease and type 2 diabetes increased the incidence of acute kidney injury after surgery.     

Urine neutrophil gelatinase associated lipocalin as an early marker of acute kidney injury in hematopoietic stem cell transplantation patients

Abstract

Acute kidney injury (AKI) is common in hematopoietic stem cell transplantation (HSCT) patients with an incidence of 21–73%. Prevention and early diagnosis reduces the frequency and severity of this complication. Predictive biomarkers are of major importance to timely diagnosis. Neutrophil gelatinase associated lipocalin (NGAL) is a widely investigated novel biomarker for early diagnosis of AKI. However, no study assessed NGAL for AKI diagnosis in HSCT patients. We performed further analyses on gathered data from our recent trial to evaluate the performance of urine NGAL (uNGAL) as an indicator of AKI in 72 allogeneic HSCT patients. AKI diagnosis and severity were assessed using Risk–Injury–Failure–Loss–End-stage renal disease and AKI Network criteria. We assessed uNGAL on days ?6, ?3, +3, +9 and +15. Time-dependant Cox regression analysis revealed a statistically significant relationship between uNGAL and AKI occurrence. (HR?=?1.04 (1.008–1.07), p?=?0.01). There was a relation between uNGAL day?+?9 to baseline ratio and incidence of AKI (unadjusted HR?=?1.047 (1.012–1.083), p?<?0.01). The area under the receiver-operating characteristic curve for day?+?9 to baseline ratio was 0.86 (0.74–0.99, p?<?0.01) and a cut-off value of 2.62 was 85% sensitive and 83% specific in predicting AKI. Our results indicated that increase in uNGAL augmented the risk of AKI and the changes of day +9 uNGAL concentrations from baseline could be of value for predicting AKI in HSCT patients. Additionally uNGAL changes preceded serum Cr raises by nearly 2 days.     

Feasibility of E-PASS score to predict postoperative complications in laparoscopic nephrectomy

Purpose

To evaluate the usefulness of E-PASS score to predict postoperative complications after laparoscopic nephrectomy.

Methods

Between 2008 and 2020, 424 patients (179 patients: simple nephrectomy, 158 patients: radical nephrectomy, 87 patients: donor nephrectomy) who underwent laparoscopic nephrectomy in our clinic, were included in the study. Patient groups separated according to the presence of postoperative complications were compared retrospectively regarding demographic, clinical, intraoperative, and postoperative data, comorbidities, and E-PASS scores (PRS, SSS, and CRS). The relationship between postoperative complications and E-PASS scores was examined.

Results

Postoperative complications occurred in 43 (10.1%) of the patients. Age, previous abdominal/retroperitoneal surgery, radical nephrectomy rate of surgeries, operation time, amount of bleeding, need for blood transfusion, rate of conversion from laparoscopic surgery to open surgery, hospitalization time, E-PASS PRS, SSS, and CRS were statistically significantly higher in the group with postoperative complications. The cutoff value of the E-PASS CRS was ? 0.2996 to predict the development of postoperative complications (AUC?=?0.706; 95% CI 0.629–0.783; p?<?0.001). According to multivariate analysis, presence of previous abdominal/retroperitoneal surgery (OR?2.977; 95% CI?1.502–5.899; p?=?0.002), laparoscopic radical nephrectomy (OR?2.518; 95% CI?1.224–5.179; p?=?0.012), conversion from laparoscopic surgery to open surgery (OR?4.869; 95% CI?1.046–22.669; p?=?0.044) and E-PASS CRS?>?? 0.2996 (OR?2.816; 95% CI?1.321–6.004; p?=?0.007) were found to be independent risk factors predicting postoperative complications.

Conclusion

The E-PASS scoring system is an effective and convenient system for predicting postoperative complications after laparoscopic nephrectomy.