P0695ANALYSIS OF HOSPITALIZATION EVENTS IN NON-DIALYSIS CKD PATIENTS

Abstract Background and Aims Data are limited about rates and causes of hospitalization in patients with Chronic Kidney Disease (CKD) during maintenance period. In the present study, we investigate the amount, characteristics and trends of hospital admissions in a large cohort of pre-dialysis CKD patients followed within the Emilia-Romagna Region (Italy) PIRP project. Method Patients who were enrolled in the PIRP project in the period 1.4.2004-31.12.2018 constitute the study population. The PIRP database contains clinical and laboratory data collected at each follow-up visit. Hospitalization data regarding admissions occurred during patients’ follow-up in PIRP were obtained from the regional hospital discharges database through unique individual linkage. Day-hospital admissions and hospitalizations aimed at arteriovenous fistula creation and peritoneal catheter placement were excluded. Results In almost 15 years of observation, 27,886 patients were enrolled in PIRP, mostly males (65,3%) with baseline median age of 75 years and baseline median eGFR=32.3 mL/min/1.73m2. Among them, 19,288 (69.2%) generated 72,432 hospitalizations during their follow-up in the project. The number of hospitalizations per person/year was 1.06 overall, increasing from 0.38 for stage CKD 1 to 1.93 for stage CKD 5 (Fig.1). The median length of stay was 9 days. Overall, cardio-vascular diseases were the main cause of hospitalization (30.0% of admissions), with renal diseases, tumors and respiratory diseases each accounting for over 10% of admissions, although the distribution of causes of hospitalization varies according to CKD stage (Fig.2). About one fifth of patients had one or more hospitalizations for acute kidney injury. The trend analysis revealed a steadily decreasing hospitalization rate for patients that were on CKD stage 4 and 5 at baseline, a constant hospitalization trend over time for patients who began their follow-up in stages 1 to 3a, while hospitalization rate of patients in CKD 3b stage declined after 9 years (Fig 3). Conclusion The study broadens our knowledge on the hospitalizations “consumption” by the population with CKD in the non-dialysis phase. It confirms that patients with CKD represent a vulnerable population, needing about 1 hospitalization / year / patient. The trend towards a reduction in hospitalizations during the follow-up period could be traced back to the specific care model, which encourages a more frequent management of patients in the Nephrology clinics.

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MO444MACROPHAGE DENSITIES CORRELATE WITH LONG-TERM FUNCTION IN PAUCI-IMMUNE AND MEMBRANOUS GLOMERULONEPHRITIS AS WELL AS IN HYPERTENSIVE NEPHROPATHY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab090.006 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Maren Bettina Pfenning ◽

Jessica Schmitz ◽

Kevin Schulte ◽

Carsten Hafer ◽

Abedalrazag Ahmad Khalifa ◽

...

Keyword(s):

Kidney Diseases ◽

Laboratory Data ◽

Kidney Injury ◽

Membranous Glomerulonephritis ◽

Renal Outcome ◽

Renal Diseases ◽

Hypertensive Nephropathy ◽

And Control ◽

Control Samples

Abstract Background and Aims Macrophages and monocytes are main players in innate immunity. In renal diseases, their role is poorly understood. Our multicentric cross-sectional study aimed to study the prevalence of macrophages and monocytes in various human native kidney diseases. For this, we used precise pixel-based digital quantification of their densities in renal biopsies and correlated our findings with clinical data. Method We included 324 patients, who underwent a diagnostic renal biopsy. Additional normal kidney samples from 16 tumour nephrectomies were used as controls. According to the diagnosed diseases, we established 17 patient groups. Biopsies were stained for CD68+-macrophages using automated immunohistochemistry (Ventana Ultra) and selected groups were further subtyped for CD14+-monocytes and CD163+-M2-macrophages (67 cases, pauci-immune glomerulonephritis (PIGN), IgA-nephropathy (IgAN) and control samples). Digitized sections (Leica) were analysed using the open-source software QuPath to quantify cell densities (positively stained areas displayed as percentages of ROI) in renal cortex, medulla and extrarenal tissue, respectively. Detailed clinical and laboratory data at timepoint of biopsy were available for all patients. Additional data for follow-up were achievable in 158 cases. Results Renal disease samples presented higher mean macrophage densities compared to control cases (CD68: cortex 1.2 vs. 0.2%, p<0.001, medulla 0.8 vs. 0.04%, p<0.001; CD163: cortex 3.2 vs. 0.5%, p<0.001, medulla 2.3 vs. 0.6%, p<0.05), but CD14+-density did not differ between patients and control samples. The highest cortical CD68+-density occurred in PIGN (1.98%) and in medulla in ascending infections (1.86%). The lowest cortical CD68+-densities were measured in thin basal membrane syndrome / Alport-syndrome (0.56%) and in medulla in immunotactoid and fibrillary glomerulopathy (0.26%). Chronic kidney disease displayed lower percentages of CD68+-densities (cortex: 1.15%; medulla: 0.49%) compared to acute kidney injury (cortex: 1.84%, p<0.001; medulla: 1.08%, p<0.001) and acute on chronic kidney injury (cortex: 1.81%, p<0.001; medulla: 1.43%, p<0.001). We detected a correlation of CD68+- and CD163+-infiltration with kidney function (eGFR) in cortex and medulla at the time of biopsy (CD68: r=-0.51 for cortex, r=-0.60 for medulla; CD163: r=-0.71 for cortex, r=-0.73 for medulla; p<0.001) and follow up (CD68: r=-0.41 for cortex, r=-0.34 for medulla, p<0.001; CD163: r=-0.46 for cortex, r=-0.50 for medulla, p<0.05). Older patients (>64 years) showed a higher medullary M2-infiltration (1.81% vs. 4.34%, p<0.005). The eGFR at the time of biopsy inversely correlated (p<0.05) with cortical CD68+-density in IgAN (r=-0.39), PIGN (r=-0.53), membranous glomerulonephritis (MGN; r=-0.70), focal segmental glomerulonephritis (r=-0.63), and hypertensive nephropathy (HNP; r=-0.44). At follow-up, this correlation (p<0.05) was still present in PIGN (r=-0.43), MGN (r=-0.58), and HNP (r=-0.77). In PIGN, cortical CD163+-density and eGFR were associated (p<0.001) at timepoint of biopsy (r=-0.51) and follow-up (r=-0.51). Particularly, cANCA-vasculitis showed a strong correlation between eGFR and cortical CD68+- as well as CD163+-densities at time of biopsy (CD68: r=-0.78; CD163: r=-0.75, p<0.001) and also for follow-up (CD68: r=-0.48; CD163: r=-0.68, p<0.05). Conclusion Macrophages may promote progression of human renal diseases, whereas monocytes do not correlate with eGFR-decline. Especially, in cANCA- vasculitis CD163+- infiltration is associated with renal outcome. Additional studies are needed to investigate, whether macrophages can serve as predictive markers or therapeutical targets in native renal diseases.

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MO526REAL-WORLD EVIDENCE ON CLINICAL OUTCOMES IN NON-DIABETIC CKD

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab087.0046 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Christoph Wanner ◽

Johannes Schuchhardt ◽

Chris Bauer ◽

Stefanie Lindemann ◽

Meike Brinker ◽

...

Keyword(s):

Clinical Outcomes ◽

Kidney Failure ◽

Time Course ◽

Kidney Injury ◽

Incidence Rates ◽

Real World Evidence ◽

Ckd Stage ◽

The Us ◽

Egfr Decline

Abstract Background and Aims Chronic kidney disease (CKD) represents a global public health problem, with significant morbidity and mortality due to cardiovascular disease during CKD progression and due to kidney failure. Although non-diabetic CKD accounts for up to 70% of the global CKD burden, its clinical consequences are poorly understood, and data are needed to help identify individuals at high risk of adverse outcomes. This analysis uses real-world evidence to provide insights into clinical characteristics, care and outcomes in individuals with non-diabetic CKD in routine clinical practice. Method Individual-level data from the US administrative claims database, Optum Clinformatics Data Mart, from January 1, 2008 to December 31, 2018 were analysed. Adults with non-diabetic CKD stage 3 or 4 and ≥365 days continuous insurance coverage were included and followed until insurance disenrollment, end of data availability or death. Individuals with diabetes mellitus, CKD stage 5 or end-stage kidney disease (ESKD) prior to the index date, or who experienced kidney failure (acute or unspecified), kidney transplant or dialysis in the baseline period, were excluded from the analysis. Study outcomes, captured in the database, were defined using common clinical coding systems. Primary outcomes were hospitalisation for heart failure (HHF), a kidney composite of ESKD/kidney failure/need for dialysis, and worsening of CKD stage from baseline. Individual CKD stage was assigned based on estimated glomerular filtration rate (eGFR) values (priority) or the respective International Classification of Diseases code at index and during follow-up. Further prespecified kidney outcomes included individual components of the kidney composite, acute kidney injury, and absolute and relative change in eGFR from baseline. Event-based outcomes were assessed by time-to-first-event analysis. Summary statistics for time-course analysis of metric outcomes were generated on a quarterly basis. Results In total, 504,924 of 64 million individuals in the Optum Clinformatics Data Mart satisfied the selection criteria. Over a median follow-up of 744 (interquartile range 328–1432) days, the incidence rates of primary outcomes of HHF, the kidney composite and worsening of CKD stage from baseline were 3.95, 10.33 and 4.38 events/100 patient-years (PY), respectively. The incidence rates of the components of the kidney composite outcome, namely ESKD/need for dialysis, kidney failure (acute and unspecified) and need for dialysis were 1.78, 9.53 and 0.49 events/100 PY, respectively. Kidney failure events were driven mainly by acute kidney injury, with an incidence of 8.61 events/100 PY. In individuals with at least one available eGFR value at baseline and one value during follow-up (n=295,174), the incidence rates of relative decreases in eGFR of ≥30%, ≥40% and ≥57% from baseline were 1.98, 0.97 and 0.30 events/100 PY, respectively; in this cohort, more rapid eGFR decline was associated with increased risk of HHF and the kidney composite outcome. In individuals with a baseline eGFR value and at least one follow-up eGFR value and an available urine albumin-to-creatinine ratio (n=25,824), time-course analysis of eGFR showed that eGFR decline mostly occurred in individuals with moderately-to-severely increased albuminuria (≥30 mg/g). Conclusion This analysis generates real-world evidence on clinical outcomes in a cohort of individuals with non-diabetic CKD treated in routine clinical practice in the US. Despite known limitations of claims databases (e.g. low availability of some laboratory data, limited individual follow-up time and tactical coding), individuals with moderate-to-severe non-diabetic CKD are shown to be at high risk of serious clinical outcomes. This highlights the high unmet medical need, and urgency for new treatments and targeted interventions for patients with non-diabetic CKD.

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Acute Kidney Injury in Primary Care: A Review of Patient Follow-Up, Mortality, and Hospital Admissions following the Introduction of an AKI Alert System

Nephron ◽

10.1159/000509855 ◽

2020 ◽

Vol 144 (10) ◽

pp. 498-505

Author(s):

Anna L. Barton ◽

Sam B.M. Williams ◽

Stephen J. Dickinson ◽

Rob G. Parry ◽

Adam Pollard

Keyword(s):

Primary Care ◽

Acute Kidney Injury ◽

Hospital Admissions ◽

Kidney Injury ◽

Alert System

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MO377HOW THE ITALIAN COVID-19 LOCKDOWN AFFECTED NEFROLOGICAL ACTIVITY IN A LOMBARD CENTER

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0031 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Paolo Albrizio ◽

Silvano Costa ◽

Annalisa Foschi ◽

Ivo Angelo Antonio Milani ◽

Stefano Rindi ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

First Aid ◽

The Other ◽

Renal Diseases ◽

Significant Difference

Abstract Background and Aims Italy and Lombard hospitals particularly, were hard affected by Covid-19 pandemic, mostly during spring and autumn, seasons characterized by two lockdown periods which were however, partly different as rules. During first lockdown in fact, by hospital decision, all ambulatorial activity was closed, including nephrological one. This did not happen during second lockdown period. How the different choices about hospital activity affected nephrological patients is the aim of this study. Method we evaluated all nephrological advices requested by first aid units of our 3 hospitals, all located in Lombardy, to our Nephrology Unit, splitting out data in 3 periods (I lockdown, summer and II lockdown) and comparing with 2019. Data collected were: number of advices requested by day, age, sex, previous regular nephrological follow-up, Covid-19 diagnosis, nephrological diagnosis after nephrological advice and outcome. Results as shown in table 1, during I lockdown period, with hospital decision of suspending our nephrological ambulatorial activity, we suffered an incremented rate of patients approaching local first aid units compared to 2019 same period with an increased rate of acute kidney injury, mostly for dehydration, and with a higher rate of patients requiring hospitalization. All these differences resulted statistically significant vs 2019 same period (figure 1). On the other side, no statically significant difference was found during the other two examined periods, including the II lockdown, while all our ambulatories were fully operating. Conclusion Covid-19 pandemic affected also the nephrological population with an increased rate of first aid units’ accesses, acute kidney injury events and hospitalization comparing to 2019. However, these differences were detectable only during the I lockdown period characterized by the suspension of all ambulatorial activity, including our Unit. The absence of statistically significant differences during summer and primarily during II lockdown period demonstrates the importance of nephrological ambulatorial activity in management of renal diseases and in prevention of acute events.

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The Role of Nephrologist in the Intensive Care Unit

Blood Purification ◽

10.1159/000452318 ◽

2016 ◽

Vol 43 (1-3) ◽

pp. 78-81 ◽

Cited By ~ 4

Author(s):

Zoltán H. Endre

Keyword(s):

Chronic Kidney Disease ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Renal Diseases ◽

Continuing Care ◽

Electrolyte Disorders

Participation by nephrologists is needed in most intensive care units, even when such units are ‘closed'. This participation should assist with diagnosis and management of intrinsic and complex renal diseases such as vasculitis, complex metabolic and electrolyte disorders including hyponatremia, and acute kidney injury (AKI) with and without underlying chronic kidney disease (CKD). Early nephrologist involvement will also facilitate transition to continuing care and follow-up after an episode of AKI, but may also assist in avoiding dialysis where treatment is futile. Management of AKI by intensivists should be in partnership with nephrologists to oversight and hopefully to minimize progression to CKD.

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Seasonality of acute kidney injury in a tertiary hospital academic center: an observational cohort study

Environmental Health ◽

10.1186/s12940-021-00691-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Gianmarco Lombardi ◽

Giovanni Gambaro ◽

Nicoletta Pertica ◽

Alessandro Naticchia ◽

Matteo Bargagli ◽

...

Keyword(s):

Acute Kidney Injury ◽

Air Temperature ◽

Hospital Admissions ◽

Seasonal Pattern ◽

Laboratory Data ◽

Kidney Injury ◽

Weather Conditions ◽

Winter Period ◽

Humidity Level ◽

Increased Risk

Abstract Background The aim of our study was to describe seasonal trends of acute kidney injury (AKI) and its relationship with weather conditions in a hospitalized population. Methods We retrospectively collected demographic (age, sex), clinical (ICD-9-CM codes of diagnosis discharge) and laboratory data (creatinine values) from the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of all patients ≥18 years with at least two values available for creatinine. The outcome of interest was AKI development, defined according to creatinine kinetics criteria. The exposures of interest were the months and seasons of the year; air temperature and humidity level were also evaluated. Log-binomial regression models adjusted for age, sex, eGFR, comorbidities, Charlson/Deyo index score, year of hospitalization were used to estimate risk ratios (RR) and 95% confidential intervals (CI). Results A total of 64,610 patients met the inclusion criteria. AKI occurred in 2864 (4.4%) hospital admissions. After full adjustment, winter period was associated with increased risk of AKI (RR 1.16, 95% CI 1.05, 1.29, p=0.003). Lower air temperature and higher humidity level were associated with risk of AKI, however in multivariable-adjusted models only higher humidity level showed a significant and independent association. Conclusions AKI is one of the most common complications of hospitalized populations with a defined seasonal pattern and a significant increase in incidence during wintertime; weather conditions, particularly higher humidity level, are independent predictors of AKI and could partially justify the observed seasonal variations.

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HOSPITAL MORBIDITYINPATIENTS WITH CHRONICKIDNEYDISEASE STAGE UD

Ukrainian Journal of Nephrology and Dialysis ◽

10.31450/ukrjnd.4(44).2014.02 ◽

2014 ◽

pp. 31-40 ◽

Cited By ~ 1

Author(s):

І. Shifris ◽

V. Krot ◽

Y. Gonchar ◽

E. Krasyuk ◽

I. Dudar

Keyword(s):

Peritoneal Dialysis ◽

Bacterial Infections ◽

Hospitalization Rate ◽

Patient Treatment ◽

Ckd Stage ◽

Common Causes ◽

Duration Of Hospitalization ◽

Gender Characteristics ◽

Hospital Morbidity

According to opinion of European researchers the expenses, associated with in–patient treatment, constitutes the significant part of health service expenditure in population of patients on renal replacement therapy (RRT). Only in few studies the hospitalization levels were compared for population ofpatients on hemodialysis (HD) and peritoneal dialysis (PD). Aim. The aim of this study was analysis the hospital morbidity pattern in patients with CKD stage 5D on HD and PD. Materials and methods. It was performed the retrospective (for period 01 Jan to 31 Dec 2013) analysis of hospitalization structure and rate for patients, were treated by RRT. All hospitalization admissions were assessed in view of modality and duration of RRT, demographic/gender characteristics, and renal affection type. In 2013 the RRT treatment were provided to 351 patients, including the 296 on HD and 55 on PD. Results. Overall 173 cases of hospitalization were recorded, including 142 (82,08%) primary and 31 (17,92%) readmissions. Irrespective of RRT modality the three most common causes of hospitalization were cardiovascular diseases (CVD), bacterial infections, and anemia. 41 hospitalization was caused by RRT initiation (28 HD and 13 PD), the most of patients aged 45 years and older. The hospitalization rate in PD patients with was significantly higher than in patients on HD: 70,9±6,1% vs. 34,8±2,8%, respectively;p<0,0001. The duration of hospitalization was significantly higher by HD– than PD patients (30,09±17.21 vs. 21.82±10.56, respectively; p=0,0007). Conclusions. During follow–up, at least one hospitalization had more than 40%patients with CKD stage 5D. In HD patients the most common causes of hospitalization were bacterial infections, CVD and anemia. Anemia, CVD and bacterial infections were the most frequent causes hospitalization in PD patients.

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Hydroxyurea Treatment of Young Children with Sickle Cell Anemia: Safety and Efficacy of Continued Treatment – the BABY HUG Follow-up Study

Blood ◽

10.1182/blood.v118.21.7.7 ◽

2011 ◽

Vol 118 (21) ◽

pp. 7-7 ◽

Cited By ~ 1

Author(s):

Zora R. Rogers ◽

Billie Fish ◽

Zhaoyu Luo ◽

Rathi V. Iyer ◽

Courtney D. Thornburg ◽

...

Keyword(s):

Sickle Cell ◽

Sickle Cell Anemia ◽

Hospital Admissions ◽

Controlled Trial ◽

Laboratory Data ◽

Acute Chest Syndrome ◽

Follow Up Study ◽

Hydroxyurea Treatment ◽

The Impact

Abstract Abstract 7 BABY HUG [Clinical Trials #NCT00006400], an NIH-NICHD sponsored randomized placebo-controlled trial showed that hydroxyurea (HU) administered to 9–18 month old children with sickle cell anemia (SCA) provides substantial clinical benefit. Benefits include a decrease in pain crises, acute chest syndrome events, need for transfusion and hospital admission; hematologic improvement include higher total and fetal hemoglobin concentration, larger red cell size, and lower WBC counts with toxicity limited to transient reduction in absolute neutrophil count (ANC) [Lancet 2011; 377:1663–72]. The parent or guardian of all 176 children who completed at least 18 months of randomized treatment were offered participation in an initial observational BABY HUG Follow-Up Study and 163 (93%) consented to participate. Clinical and laboratory data were collected every 6 months by structured abstraction of the medical record regarding use of clinically prescribed HU (dose escalation recommended), blood counts, clinical imaging, and sickle cell-related events. At the time of enrollment the family did not know their child's randomized study treatment assignment; 133 (82%) initially chose clinical prescription of open-label HU. Acceptance of HU has remained high through 36 months of follow-up; during each 6 month data collection period 68–75% of participants reported having taken HU. Only 2 patients have left the study (due to relocation) and more than 93% of expected data have been collected. Preliminary analyses as of May 2011, including 417 patient years (pt-yrs) of follow up, demonstrate that in comparison to participants not taking HU, children who continue to take HU have statistically lower rates of pain crises requiring emergency department (ED) visits, episodic transfusions, and hospital admissions for any reason, including acute chest syndrome or febrile illness (see table). The substantial decrease in acute chest syndrome episodes is similar to the effect demonstrated with HU use in the randomized BABY HUG trial in younger infants and consistent with published trials detailing the benefit of HU therapy in older children and adults. The decrease in the rate of admission for febrile events in HU-treated patients is also comparable to that in the randomized trial, but the reason for this benefit is uncertain. There was no difference in hospitalization rates for painful events including dactylitis. Two patients in the non-HU group had a stroke. There were no differences between groups in the frequency of a palpable spleen or rate of acute splenic sequestration crises. Through 36 months of follow up children taking HU had persistently higher hemoglobin and MCV, and lower WBC and ANC than those not taking HU. Results of these analyses including growth and development assessments will enhance our understanding of the impact of HU use in children with SCA starting at a very young age. The accruing data from the BABY HUG Follow-Up Study demonstrate a continuation of the substantial benefits of early HU therapy with no discernable additional toxicities. Ongoing follow up of this cohort is essential to fully define these benefits as children grow, and to observe for late toxicity.Event Rate per 100 pt-yrsHUNo HUp valueED visit for Pain Crisis28.853.60.004Episodic Transfusion18.334.00.010Hospital Admission (any cause)74.9133.20.001Acute Chest Syndrome (admission)9.522.30.0001Febrile Illness (admission)30.764.3<.001Pain Crisis (admission)18.630.40.102 Disclosures: Off Label Use: Hydroxyurea is not indicated for treatment of children with sickle cell disease. Use of this medication was for clinical indications and not mandated by this observational study.

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The Role of Renal Pathology in the Prognosis and Recovery of Community-Acquired Acute Kidney Injury

Nephron ◽

10.1159/000514287 ◽

2021 ◽

pp. 1-10

Author(s):

Jing Xu ◽

Mengna Ruan ◽

Jun Wu ◽

Linxi Huang ◽

Cheng Xue ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Biopsy ◽

De Novo ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Renal Pathology ◽

Renal Outcomes ◽

Ckd Stage ◽

Prognostic Prediction

Objectives: The determinants leading to different renal outcomes in community-acquired acute kidney injury (CA-AKI) and the influence of renal histological damage on the prognosis and recovery of CA-AKI are scarcely reported. Methods: Adult patients with CA-AKI admitted to Shanghai Changzheng Hospital with renal biopsy profiles from January 1, 2010, to December 31, 2018, were enrolled in our cohort. After 3 months of follow-up, clinical outcomes, including patient survival, dialysis requirement during hospitalization and at 3 months, CKD stage 3–5, and renal functional recovery at 3 months, were analyzed, and risk factors were identified. Results: A total of 294 patients with CA-AKI with renal pathology were identified for this cohort. Among 282 patients who survived 3 months after AKI, 59.6% completely recovered, 21.3% partially recovered, 21.3% progressed to stage 3–5 CKD without dialysis, and 17.7% maintained dialysis. Moreover, 70.4% of patients in the cohort presented with de novo intrinsic renal disease, except acute tubular necrosis or acute interstitial nephritis, on renal biopsy. In the multivariate analyses, clinical factors were more related to short-term outcomes and severity of CA-AKI, represented by mortality, in-hospital dialysis, and CRRT requirement, while pathological elements were more involved with CKD progression, including dialysis-dependent or stage 3–5 CKD, and renal function recovery at the 3-month follow-up. The detrimental influence of glomerular and arterial lesions on renal prognosis of CA-AKI was as critical as tubular and interstitial lesions. Conclusions: Clinical and pathological parameters both contribute to patient and renal outcomes after CA-AKI. The value of renal biopsy should be recognized in prognostic prediction.

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P0493EPIDEMIOLOGY OF IGA NEPHROPATHY IN THE MALTESE ISLANDS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0493 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Abigail Attard ◽

Diana Vassallo ◽

John Swayne ◽

Jesmar Buttigieg ◽

Edward Grech ◽

...

Keyword(s):

Standard Deviation ◽

Kidney Disease ◽

Observational Study ◽

Iga Nephropathy ◽

Laboratory Data ◽

Rapidly Progressive Glomerulonephritis ◽

Kidney Injury ◽

Maltese Islands ◽

History Of

Abstract Background and Aims IgA nephropathy is the most common cause of glomerular disease worldwide. Natural history and clinical progression of this condition are highly heterogenous and can vary from asymptomatic haematoproteinuria, to a rapidly progressive glomerulonephritis that results in end-stage kidney disease (ESKD). The OXFORD MEST-C score is a set of consensus criteria that have been correlated with renal outcomes independent of baseline clinical features, proteinuria and blood pressure control. This is the first observational study carried out in the Maltese Islands that aims to evaluate the epidemiology and the histopathological distribution in Malta. Method All patients with biopsy-proven IgA nephropathy between January 2013 and July 2019 in our centre were recruited into this longitudinal retrospective observational study. Baseline data at time of biopsy included demographics, laboratory data and the MEST-C score. Study end-points included death, doubling of serum creatinine and ESKD. Data was censored on 31/12/2019. Results A total of 46 patients were recorded over this 6 year period, with a median follow-up of 2.7 years (Standard deviation 1.9). The median age of our cohort at time of biopsy was 46.1 years (Standard deviation 16.1). In total, 71.7% were males, 34.8% were hypertensive and 6.5% diabetic at baseline. At time of biopsy, 89.1% had an active sediment, 54.3% had established chronic kidney disease (CKD), 17.4% presented with acute kidney injury (AKI), 13% had a history of synpharyngitic haematuria, while 4.3% had a history of Henoch–Schönlein (HSP). In our cohort, 8 patients (17.4%) had progression of CKD. 4 of them had doubling of creatinine with 3 reaching ESKD. 1 patient died. Table 1 shows the distribution of histopathological findings in our cohort: Conclusion Despite the limited study sample, short follow-up time, and absence of treatment data, our results demonstrate that the distribution of histopathological variants in our cohort is similar to that reported elsewhere in the literature1. Barbour SJ, Espino-Hernandez G, Reich HN, Coppo R, Roberts IS, Feehally J, et al. The MEST score provides earlier risk prediction in IgA nephropathy. Kidney Int. 2016 Jan;89(1):167–75.

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