Etelcalcetide controls secondary hyperparathyroidism and raises sclerostin levels in hemodialysis patients previously uncontrolled with cinacalcet

IntroductionThere is scarce clinical experience with etelcalcetide in patients with secondary hyperparathyroidism uncontrolled with cinacalcet. The effect of etelcalcetide on serum sclerostin levels remains to be clarified.Materials and methodsProspective cohort study in prevalent hemodialysis patients with uncontrolled sHPT under cinacalcet for at least 3 months, mean parathyroid hormone (PTH) > 800 pg/mL and calcium (Ca) > 8.3 mg/dL. Etelcalcetide 5 mg IV/HD was initiated after cinacalcet washout. Levels of PTH, Ca, and phosphorus (Pi) followed monthly for 6 months. Plasma sclerostin levels measured before etelcalcetide treatment and after 6 months.ResultsThirty-four patients were enrolled, 19 (55.9%) male gender. Mean age 60.7 (± 12.3) years; median time on HD 82.5 (7–296) months and median cinacalcet dose was 180 mg/week (Interquartile Range: 180–270).Serum Ca, Pi and PTH levels showed a significant reduction after etelcalcetide treatment from 8.8 mg/dL, 5.4 mg/dL and 1005 pg/mL to 8.1 mg/dL (p = 0.08), 4.9 mg/dL (p = 0.01) and 702 pg/mL (p < 0.001), respectively. Median etelcalcetide dose remained at 5 mg/HD. Plasma sclerostin concentration increased from 35.66 pmol/L (IQR11.94–54.58) to 71.05 pmol/L (IQR54.43–84.91) (p < 0.0001).ConclusionEtelcalcetide improved sHPT control in this group of patients, previously under cinacalcet treatment, and significantly increased plasma sclerostin concentration. The impact of etelcalcetide treatment on sclerostin levels is a novel finding.     

危重患者急性肾损伤危险因素分析

目的研究外科重症监护室及综合性重症监护室危重患者发生急性肾损伤(AKI)的危险因素。方法回顾性分析四川大学华西医院外科及综合性重症监护病房2009年10月至12月所有的住院患者,筛选资料完整且符合标准的病例共273例,分别进行单因素和多因素分析。结果外科及综合性重症监护室危重患者AKI发生率为27.1%,病死率45.2%。AKI的独立危险因素为糖尿病(X1)(P=0.006)、慢性肝病(X2)(P=0.047)、非手术治疗(X3)(P=0.013)、基础肌酐值>120μmol/L(X4)(P=0.006)、脓毒血症(X5)(P<0.001)、肾毒性药物应用(X6)(P=0.004)。Logistic回归模型:Logistic P=-3.556+1.132X1+1.121X2-0.884X3+0.980X4+1.645X5+2.246X6。结论外科及综合性重症监护室危重患者一旦发生AKI,其病死率明显增加,外科及综合性重症监护室发生AKI的主要危险因素为糖尿病、有慢性肝病、脓毒血症,基础肌酐值>120μmol/L及肾毒性药物应用者。手术治疗为AKI保护因素。     

维持性血液滤过治疗心脏手术后急性肾损伤

目的探讨持续性血液滤过（CVVH）对心脏手术后急性肾损伤（acute kidney injury，AKI）的治疗作用。方法回顾性分析12例心脏手术后AKI患者采用CVVH治疗的临床资料。结果11例存活，1例死亡。存活患者心率及平均动脉压在CVVH过程中波动于正常范围，血肌酐、尿素氮、血钾水平在治疗后显著下降，肾功能均恢复正常。结论CVVH是救治心脏手术后AKI患者的有效手段，此结果仍需扩大样本进一步研究。     

Cardiometabolic effects of direct-acting antivirals in patients with hepatitis C

Hepatitis C virus (HCV) has long been associated with several extrahepatic manifestations, including increased cardiovascular risk. The emergence of direct-acting antivirals (DAAs) has allowed us to evaluate the potential reversal of these manifestations after successful treatment. Therefore, many studies have provided significant takeaways regarding the positive effect of DAAs therapy on insulin resistance, type 2 diabetes mellitus, cardiovascular disease and atherosclerosis. In contrast, studies have shown detrimental effects on lipid metabolism and indeterminate results regarding renal function and uric acid metabolism. Nevertheless, as more and more patients achieve sustained virological response, the effects of HCV eradication on cardiometabolic processes will be extensively studied, allowing more reliable conclusions on the extent of extrahepatic outcomes.     

高容量血液滤过治疗心脏手术后急性肾损伤的疗效观察

目的:观察高容量血液滤过(high volume hemofiltration,HVHF)对心脏外科手术后急性肾损伤(acutekidneyinjury,AKI)患者的治疗作用,以及HVHF用于不同程度AKI患者对预后的影响。方法:25例心脏手术后AKI患者,男性16例,女性9例,平均年龄15~80(56.4±16.80)岁。根据患者开始HVHF时血肌酐(SCr)及尿量水平分为三组:组Ⅰ(AKIⅠ期,n=6),SCr增长≥0.3mg/dl(≥26.4μmol/L)或增长超过基础值的150%~200%(1.5~2倍),或尿量<0.5ml/(kg.h)持续超过6h;组Ⅱ(AKIⅡ期,n=6),SCr增长超过基础值的200%~300%(2~3倍),或尿量<0.5(ml/kg.h)持续超过12h;组Ⅲ(AKIⅢ期,n=7),SCr增长超过基础值的300%(3倍)[或SCr≥4.0mg/dl(≥354μmo/L),并急性升高≥0.5mg/dl(44μmol/L)],尿量<0.3ml/(kg.h)持续24h,或无尿12h。血管通路采用中心静脉置管,血流量200~250ml/min,置换液流速4000ml/h,前稀释输入。滤器为AV600(聚砜膜,1.6m2)。低分子肝素联合枸橼酸抗凝。每30min记录血压、心率、体温等生命体征,观察患者神经精神系统体征的变化。HVHF前和治疗后每24h,留取标本查血常规、肝肾功能、电解质、血气分析等。以APACHEⅡ评分判断患者整体病情的变化。结果:患者总死亡率为57.9%,组Ⅰ(AKIⅠ期)患者死亡率低于组Ⅲ(AKIⅢ期)(50%vs71.4%)。组Ⅰ患者较组Ⅲ更为危重,其体外循环断流时间[(244.2±170.46)vs(154.3±73.58)分]和主动脉夹闭时间[(93.2±43.21)vs(82±59.59)分]均长于组Ⅲ,且术后接受主动脉球囊反搏(IABP)者明显多于组Ⅲ(66.7%vs28.6%)。HVHF治疗12h后患者高热状态明显改善(P<0.05),心率及平均动脉压在HVHF过程中波动于正常范围,SCr及尿素氮水平在治疗24h后显著下降(P<0.05),存活患者肾功能均恢复正常。APACHEⅡ评分经治疗后明显改善(P<0.05 vs after 60h)。结论:本研究发现HVHF是救治心脏手术后AKI患者的有效手段,在AKIⅠ期开始HVHF治疗,患者存活率明显提高。此结果仍需扩大样本进一步研究。     

Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study

BackgroundSerum cystatin C concentration is associated with cardiovascular disease. However, the relationship between cystatin C and acute aortic dissection (AAD) remains unclear. In the current study, we aim to evaluate the predictive value of cystatin C in the occurrence of acute kidney injury (AKI) and the prognosis of AAD patients.MethodsThe patients with AAD admitted to our hospital from November 2019 through January 2022 were consecutively included in the retrospective cohort study. A complete blood cell count, serum biochemistry tests, including cystatin C and creatinine, in-hospital mortality and the incidence of AKI were recorded. All the patients were categorized into four groups according to the quartile of their serum cystatin C levels. Multivariate logistic and Cox regression analyses were conducted to determine the independent risk factors for the incidence of AKI and the prognosis of AAD patients, respectively. Kaplan-Meier analyses and log-rank tests were used to evaluate differences in survival. Receiver operating characteristic (ROC) curves were used to assess the predictive value of cystatin C for short-term mortality and the incidence of AKI in AAD patients.ResultsA total of 357 patients were included in this study. The results showed that the higher the concentration of cystatin C, the higher the level of serum creatinine and the higher the incidence of AKI. Mortality was significantly higher in the group with serum cystatin C levels >1.18 mg/L. Type A AAD, white blood cell count >10×10⁹/L, platelet count <100×10⁹/L, and serum cystatin C concentration >1.18 mg/L [adjusted hazards ratio (HR) =2.405, 95% confidence interval (CI), 1.029–4.063, P=0.041] were independent risk factors for in-hospital mortality. Cystatin C levels >1.18 mg/L remained an independent predictor of AKI in AAD after adjusting for the confounding [odds ratio (OR) 76.489, 95% CI, 25.586–228.660]. The areas under the ROC curves of cystatin C in predicting the mortality and incidence of AKI in AAD patients were 0.655 (95% CI, 0.551–0.760) and 0.807 (95% CI, 0.758–0.856), respectively.ConclusionsIn sum, serum cystatin C concentration is a potential predictor of short-term mortality and the incidence of AKI in AAD patients.     

White paper on mitigating risk factors for acute kidney injury in TAVR: A protocol to decrease TAVR-associated AKI

Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) portends a poor prognosis. In the TVT registry, AKI after TAVR occurred in 10% of the patients. The etiology of AKI after TAVR is multifactorial but contrast volume remains one of the few modifiable risk factors. As patients referred for TAVR have multiple touch points within a siloed healthcare system, there remains an unmet clinical need of a well-defined clinical pathway to minimize the risk of AKI from the time of referral for TAVR to the completion of the procedure. This white paper aims to provide such a clinical pathway.     

Impact of Obstructive Sleep Apnea on Gestational Diabetes Mellitus

IntroductionObstructive sleep apnea (OSA) increases the risk of type 2 diabetes, and hyperinsulinemia. Pregnancy increases the risk of OSA; however, the relationship between OSA and gestational diabetes mellitus (GDM) is unclear. We aimed (1) to evaluate OSA prevalence in GDM patients; (2) to assess the association between OSA and GDM; and (3) to determine the relationships between sleep parameters with insulin resistance (IR).MethodsA total of 177 consecutive women (89 with GDM, 88 controls) in the third trimester of pregnancy underwent a hospital polysomnography. OSA was defined when the apnea-hypopnea index (AHI) was ≥5 h^?1.ResultsPatients with GDM had higher pregestational body mass index (BMI) and neck circumference than controls, but no differences in snoring or OSA-symptoms, or AHI (3.2 ± 6.0 vs. 1.9 ± 2.7 h^?1, p = .069). OSA prevalence was not significantly different in both groups. We did not identify OSA as a GDM risk factor in the crude analysis 1.65 (95%CI: 0.73–3.77; p = .232). Multiple regression showed that total sleep time (TST), TST spent with oxygen saturation< 90% (T90), and maximum duration of respiratory events as independent factors related with homeostasis model assessment of IR, while T90 was the only independent determinant of quantitative insulin sensitivity check index.ConclusionOSA prevalence during the third trimester of pregnancy was not significantly different in patients with GDM than without GDM, and no associations between OSA and GDM determinants were found. We identified T90 and obstructive respiratory events length positive-related to IR, while TST showed an inverse relationship with IR in pregnant women.     

Serum 25-hydroxyvitamin D level is negatively associated with serum phosphorus level among stage 3a-5 chronic kidney disease patients

Background

Serum 25-hydroxyvitamin D (25(OH)D) negatively correlates with serum phosphorus level of stage 3a-5 chronic kidney disease (CKD) patients. So far, no explanation has been provided for this negative association.

Statin therapy may protect against acute kidney injury in patients hospitalized for interstitial SARS-CoV2 pneumonia

Background and aimsCOVID-19-associated acute kidney injury (AKI) represents an independent risk factor for all-cause in-hospital death in patients with COVID-19. Chronic statin therapy use is highly prevalent in individuals at risk for severe COVID-19. Our aim is to assess whether patients under treatment with statins have a lower risk of AKI and in-hospital mortality during hospitalization for interstitial SARS-CoV2 pneumonia.Methods and resultsOur study is a prospective observational study on 269 consecutive patients admitted for COVID-19 pneumonia at the Internal Medicine Unit of IRCCS Sant'Orsola Hospital in Bologna, Italy. We compared the clinical characteristics between patients receiving statin therapy (n = 65) and patients not treated with statins and we assessed if chronic statin use was associated with a reduced risk for AKI, all-cause mortality, admission to ICU, and disease severity. Statin use was associated with a significant reduction in the risk of developing AKI (OR 0.47, IC 0.23 to 0.95, p 0.036) after adjustment for age, sex, BMI, hypertension, diabetes, and chronic kidney disease (CKD). Additionally, statin use was associated with reduced C-reactive protein (CRP) levels (p 0.048) at hospital admission. No significant impact in risk of all-cause mortality (HR 1.98, IC 0.71 to 5.50, p 0.191) and ICU admission (HR 0.93, IC 0.52 to 1.65, p 0.801) was observed with statin use, after adjustment for age, sex, BMI, hypertension, diabetes, and CKD.ConclusionThe present study shows a potential beneficial effect of statins in COVID-19-associated AKI. Furthermore, patients treated with statins before hospital admission for COVID-19 may have lower systemic inflammation levels.     

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

BackgroundAcute kidney injury (AKI) is one of the most common complications after cardiac surgery. While current guidelines indicate that surgical ablation does not increase the risk of renal failure, recent studies have produced conflicting results. This study was conducted to evaluate the incidence of AKI after maze procedure in patients with rheumatic mitral valve disease and atrial fibrillation, and to elucidate risk factors associated with postoperative AKI.MethodsBetween 2011 and 2020, 203 patients with rheumatic mitral valve disease and atrial fibrillation (61.4±8.7 years, male:female =67:136) who underwent concomitant maze procedure and mitral valve replacement were retrospectively reviewed. Other combined procedures included aortic valve operations (n=64, 31.5%) and tricuspid valve procedures (n=149, 73.4%). The AKI was defined as an increase of serum creatinine level by 1.5 times after surgery based on the RIFLE (Risk, Injury, Failure, Loss, and End stage) criteria. A multivariable logistic regression analysis was performed to evaluate risk factors associated with postoperative AKI.ResultsPostoperative AKI developed in 76 patients (37.4%). The multivariable analysis demonstrated that age [odds ratio (OR), 95% confidence interval (CI): 1.065, 1.025–1.107; P=0.001], cardiopulmonary bypass (CPB) time (1.007, 1.002–1.013; P=0.009) and nadir hematocrit during CPB (0.854, 0.740–0.985; P=0.031) were associated with postoperative AKI.ConclusionsPostoperative AKI occurred in more than one thirds of patients with rheumatic mitral valve disease and atrial fibrillation who underwent combined mitral valve replacement and maze procedure. Optimization of CPB management might be needed to prevent postoperative AKI after maze procedure.     

尿胰岛素生长因子结合蛋白7在急性肾损伤中的诊断价值及意义

【摘要】目的：探讨尿胰岛素生长因子结合蛋白7（insulin-like growth factor-binding protein 7,IGFBP7）在急性肾损伤（acute kidney injury ,AKI）早期临床诊断中的意义。方法：入选我院符合纳入标准患者80例,其中AKI组50例,慢性肾脏病（chronic kidney diseases,CKD）对照组30例,正常对照组30例,检测并比较各组患者确诊当时或24小时内尿IGFBP7、血清胱抑素C(sCysC）水平;运用受试者工作特征(ROC)曲线及曲线下面积(AUC)评价2种生物标志物检测对AKI早期诊断的意义。结果：（1）与正常组和CKD组相比,AKI组的尿IGFBP7水平显著升高（P<0.05）;随AKI各期进展,尿IGFBP7水平逐渐升高,各期之间有显著差异（P<0.05）;（2）较正常组,AKI组血清sCysC水平显著升高（P<0.05）;较CKD组稍升高（P>0.05）;AKI组随疾病进展血清sCysC水平逐渐升高,各期之间差异显著（P<0.05）;（3）AKI患者中,尿IGFBP7水平与血清sCysC水平成正相关（r=0.782,P<0.05）;尿IGFBP7水平与血清SCr水平成正相关（r=0.884,P<0.05）;（4）尿IGFBP7水平、血清sCysC水平诊断AKI的AUC分别为0.889、0.877。结论：尿IGFBP7水平在AKI诊断中具有良好的敏感性。     

不同病原菌致血流感染相关急性肾损伤的危险因素分析

目的:研究不同病原菌所致血流感染患者中急性肾损伤(acute kidney injury,AKI)的发生率、危险因素和预后.方法:2018年1月1日至12月31日我院血流感染患者,选取最常见的4种病原体肺炎克雷伯菌、大肠埃希菌、凝固酶阴性葡萄球菌和金黄色葡萄球菌共计348例患者纳入本研究.收集患者基本资料、住院期间生化...     

Risk factors for acute kidney injury in overweight patients with acute type A aortic dissection: a retrospective study

Background

To identify risk factors for acute kidney injury (AKI) in overweight patients who underwent surgery for acute type A aortic dissection (TAAD).

Methods

A retrospective study including 108 consecutive overweight patients [body mass index (BMI) ≥24] between December 2009 and April 2013 in Beijing Anzhen Hospital has been performed. AKI was defined by Acute Kidney Injury Network (AKIN) criteria, which is based on serum creatinine (sCr) or urine output.

Results

The mean age of the patients was 43.69±9.66 years. Seventy-two patients (66.7%) developed AKI during the postoperative period. A logistic regression analysis was performed to identify two independent risk factors for AKI: elevated preoperative sCr level and 72-h drainage volume. Renal replacement therapy (RRT) was required in 15 patients (13.9%). The overall postoperative mortality rate was 7.4%, 8.3% in AKI group and 5.6% in non-AKI group. There is no statistically significant difference between the two groups (P=0.32).

Conclusions

A higher incidence of AKI (66.7%) in overweight patients with acute TAAD was confirmed. The logistic regression model identified elevated preoperative sCr level and 72-h drainage volume as independent risk factors for AKI in overweight patients. We should pay more attention to prevent AKI in overweight patients with TAAD.     

Neutrophil,lymphocyte and platelet ratio as a predictor of mortality in septic-acute kidney injury patients

BackgroundAKI is frequent in critically ill patients, in whom the leading cause of AKI is sepsis. The role of intrarenal and systemic inflammation appears to be significant in the pathophysiology of septic-AKI. The neutrophils to lymphocytes and platelets (N/LP) ratio is an indirect marker of inflammation. The aim of this study was to evaluate the prognostic ability of N/LP ratio at admission in septic-AKI patients admitted to an intensive care unit (ICU).MethodsThis is a retrospective analysis of 399 septic-AKI patients admitted to the Division of Intensive Medicine of the Centro Hospitalar Universitário Lisboa Norte between January 2008 and December 2014. The Kidney Disease Improving Global Outcomes (KDIGO) classification was used to define AKI. N/LP ratio was calculated as: (Neutrophil count × 100)/(Lymphocyte count × Platelet count).ResultsFifty-two percent of patients were KDIGO stage 3, 25.8% KDIGO stage 2 and 22.3% KDIGO stage 1. A higher N/LP ratio was an independent predictor of increased risk of in-hospital mortality in septic-AKI patients regardless of KDIGO stage (31.59 ± 126.8 vs 13.66 ± 22.64, p = 0.028; unadjusted OR 1.01 (95% CI 1.00–1.02), p = 0.027; adjusted OR 1.01 (95% CI 1.00–1.02), p = 0.015). The AUC for mortality prediction in septic-AKI was of 0.565 (95% CI (0.515–0.615), p = 0.034).ConclusionsThe N/LP ratio at ICU admission was independently associated with in-hospital mortality in septic-AKI patients.     

老年人心血管手术后急性肾功能损伤预后评价的临床观察

目的 探讨急性肾功能损伤(acute kidney injury,AKI)分级系统对老年心脏手术后患者预后的预测价值. 方法 收集2006年10月至2007年1月首次行冠状动脉移植术和(或)心脏瓣膜植换术的老年患者资料,记录患者性别、年龄、手术类型、尿量、血牛化指标和临床转归等,按照AKI网络工作组(acute kidney injury network,AKIN)分级及急性生理学和慢性健康状况评价系统(APACHEⅡ)评分在术后对患者进行评分并记录最高分值. 结果 225例患者中男169例(75.1%),女56例(24.9%),平均年龄(66.7±5.0)岁.住院病死率5.8%(13例).根据AKIN分级,最终发生不同程度AKI的患者占55.6%(125例);AKIN分级1级(96例)、2级(11例)、3级(18例)患者的住院病死率分别为2.1%(2例),9.1%(1例)和50.0%(9例).病死率随AKIN分级的递增有升高趋势(P<0.01).受试者工作特征曲线下面积分析AKIN和病死率具有相关性;Logistic回归分析结果显示,随AKIN分级的递增,相对死亡危险性增加. 结论 AKI是老年人心脏手术后的常见并发症之一,可增加术后病死率.AKIN分级系统对此类患者的预后及住院死亡有良好预测价值.