338. Multicenter Evaluation of Superinfection Occurrence and Impact on Clinical Outcomes in Patients with COVID-19

Abstract Background The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spread globally throughout late 2019. During this pandemic, concern for bacterial and fungal superinfections has been present during the treatment of these patients. Methods Hospitalized, adult patients with laboratory confirmed and symptomatic COVID-19 disease admitted between March 12, 2020 and May 31, 2020 were eligible for inclusion in this study. Data was obtained from electronic medical records and the hospital system’s clinical surveillance program including demographics, comorbidities, hospitalization dates, laboratory values, mechanical ventilation, positive blood and respiratory cultures, treatment administration for COVID-19 as defined by the system’s fluid treatment algorithm, and discharge disposition. Outcomes of this analysis include overall bacterial and fungal superinfection occurrence rate within 28 days of admission, patient characteristics that correlate with a higher risk of a superinfection, and the effect on 28-day mortality. Patient Population Flow diagram of patient inclusion. Results A total of 404 patients were included in the study analyses of which 56 (13.9%) had a documented superinfection within 28-days from admission. The most common superinfection organisms observed were Staphylococcus spp. (36.9%), Candida spp. (16.7%), and Klebsiella spp. (13.1%). Mortality was significantly higher in patients with superinfections (12.1% vs 5.8%, p < 0.001). To best assess characteristics that place patients at a higher risk of superinfection, a backwards, stepwise, multivariable logistic regression was performed. Black ethnicity, chronic kidney disease, intensive care unit (ICU) upon admission, lymphocytopenia, and receipt of tocilizumab were found to more likely have a superinfection within 28-days from admission. Baseline Characteristics Comparison and analysis of baseline characteristics in patients with or without superinfection present. 28-day Mortality Day-28 mortality comparison in patients with or without superinfection. Mortality was observed in 7/58 patients with a superinfection versus 20/346 patients without superinfection present (p < 0.001). Multivariable analysis results for increased superinfection risk. All baseline characteristics with univariate analysis resulting in a p value of < 0.2 were included in the backwards, stepwise logistic regression model. Conclusion In conclusion, our retrospective cohort study reports a superinfection rate of 13.9%. Presence of a superinfection significantly increases the likelihood of mortality within 28-days from admission. Characteristics that have a significant correlation to increased risk of superinfections include Black ethnicity, chronic kidney disease, ICU upon admission, and receipt of tocilizumab. Disclosures Kevin W. Garey, Pharm.D., M.S., FASHP, Summit Therapeutics (Research Grant or Support)

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Eculizumab discontinuation in children and adults with atypical haemolytic uremic syndrome: a prospective multicentric study

Blood ◽

10.1182/blood.2020009280 ◽

2020 ◽

Author(s):

Fadi Fakhouri ◽

Marc Fila ◽

Aurelie Hummel ◽

David Ribes ◽

Anne-Laure Sellier-Leclerc ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Rare Variants ◽

Multivariable Analysis ◽

Disease Stage ◽

Multicentric Study ◽

Haemolytic Uremic Syndrome ◽

Increased Risk ◽

Uremic Syndrome ◽

Complement Gene

The optimal duration of eculizumab treatment in patients with atypical haemolytic uremic syndrome (aHUS) remains poorly defined. We conducted a prospective national multicentric open-label study in order to assess eculizumab discontinuation in children and adults with aHUS. Fifty-five patients (including 19 children) discontinued eculizumab (mean duration of treatment, 16.5 months). Twenty-eight (51%) patients had complement gene rare variants, mostly in MCP (n= 12, 22%), CFH (n= 6, 11%) and CFI (n=6, 10%) genes. At eculizumab discontinuation, 17 (30%) and 4 (7%) patients had chronic kidney disease stage 3 and 4, respectively. During follow-up, 13 (23%) patients (6 children and 7 adults) experienced aHUS relapse. In multivariable analysis, female gender and the presence of a rare complement gene variant were associated with an increased risk of aHUS relapse, whereas requirement for dialysis during previous episodes of acute aHUS was not. In addition, an increased soluble C5b-9 plasma level at eculizumab discontinuation was associated with a higher risk of aHUS relapse in all patients and in the subset of carriers of complement gene rare variants, in log rank test and in multivariable analysis. Among the 13 relapsing patients, who were all restarted on eculizumab, 11 regained their baseline renal function and two had a worsening of their pre-existing chronic kidney disease, including one patient who progressed to end-stage renal disease. A strategy of eculizumab discontinuation in aHUS patients based on complement genetics is reasonable and safe. It improves the management and quality of life of a sizeable proportion of aHUS patients while reducing the cost of treatment. Trail registration number: NCT02574403.

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Evaluation of medication adherence and predictors of sub-optimal adherence among pre-dialysis patients with chronic kidney disease

Medicine Access Point of Care ◽

10.1177/2399202620954089 ◽

2020 ◽

Vol 4 ◽

pp. 239920262095408

Author(s):

Roland Nnaemeka Okoro ◽

Ibrahim Ummate ◽

John David Ohieku ◽

Sani Ibn Yakubu ◽

Maxwell Ogochukwu Adibe ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Logistic Regression ◽

Medication Adherence ◽

Kidney Disease ◽

Univariate Analysis ◽

Binary Logistic Regression ◽

Regression Analyses ◽

Dialysis Patients ◽

Improve Medication Adherence ◽

Significant Independent Predictor

Background: Multiple medications are required to effectively manage chronic kidney disease (CKD) and associated complications, posing the risk of poor medication adherence. Objectives: To measure medication adherence levels and to investigate the potential predictors of sub-optimal medication adherence in pre-dialysis patients with CKD. Methods: A prospective study was conducted in the medical and nephrology outpatients’ clinics in Maiduguri. Non-dialysis patients with CKD stages 1–4 aged 18 years and above were recruited through their physicians. The level of medication adherence was determined using Morisky Medication Adherence Scale. Descriptive statistics were used to summarize patients’ background characteristics. Multivariate binary logistic regression analyses were performed to investigate the significantly potential predictors of sub-optimal medication adherence at a p < 0.05. Results: There were 107 participants (48.6%) who had high medication adherence, while 97 (44.1%), and 16 (7.3%) of them had moderate adherence, and low adherence, respectively. The univariate analysis revealed that medication adherence level differed significantly with the number of medications taken daily by patients ( p < 0.05). Multivariate logistic regression analyses did not reveal a significant independent predictor of sub-optimal medication adherence. Conclusion: A majority of the participants reported sub-optimal medication adherence. The independent variables considered did not significantly predict sub-optimal medication adherence in the study population. Nevertheless, the study findings highlight the importance of clinical pharmacists’ CKD management supportive care to help improve medication adherence.

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Association of Serum Phosphate with Low Handgrip Strength in Patients with Advanced Chronic Kidney Disease

Nutrients ◽

10.3390/nu13103605 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3605

Author(s):

Ping-Huang Tsai ◽

Hsiu-Chien Yang ◽

Chin Lin ◽

Chih-Chien Sung ◽

Pauling Chu ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Gait Speed ◽

Handgrip Strength ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Serum Phosphate ◽

Advanced Chronic Kidney Disease ◽

Progressive Decline ◽

Appendicular Skeletal Muscle

Muscle wasting and hyperphosphatemia are becoming increasingly prevalent in patients who exhibit a progressive decline in kidney function. However, the association between serum phosphate (Pi) level and sarcopenia in advanced chronic kidney disease (CKD) patients remains unclear. We compared the serum Pi levels between advanced CKD patients with (n = 51) and those without sarcopenia indicators (n = 83). Low appendicular skeletal muscle mass index (ASMI), low handgrip strength, and low gait speed were defined per the standards of the Asian Working Group for Sarcopenia. Mean serum Pi level was significantly higher in advanced CKD patients with sarcopenia indicators than those without sarcopenia indicators (3.88 ± 0.86 vs. 3.54 ± 0.73 mg/dL; p = 0.016). Univariate analysis indicated that serum Pi was negatively correlated with ASMI, handgrip strength, and gait speed. Multivariable analysis revealed that serum Pi was significantly associated with handgrip strength (standardized β = −0.168; p = 0.022) and this association persisted even after adjustments for potential confounders. The optimal serum Pi cutoff for predicting low handgrip strength was 3.65 mg/dL, with a sensitivity of 82.1% and specificity of 56.6%. In summary, low handgrip strength is common in advanced CKD patients and serum Pi level is negatively associated with handgrip strength.

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Rate of uncontrolled blood pressure and its associated factors in patients with predialysis chronic kidney disease in Bali, Indonesia

Journal of Health Research ◽

10.1108/jhr-09-2019-0203 ◽

2020 ◽

Vol 34 (6) ◽

pp. 535-545

Author(s):

Ni Wayan Kesari Dharmapatni ◽

Aurawamon Sriyuktasuth ◽

Kanaungnit Pongthavornkamol

Keyword(s):

Blood Pressure ◽

Chronic Kidney Disease ◽

Logistic Regression ◽

Kidney Disease ◽

Associated Factors ◽

Univariate Analysis ◽

Multiple Logistic Regression ◽

Care Providers ◽

Uncontrolled Blood Pressure ◽

Content Type

PurposeHypertension is a key determinant for the development and progression of chronic kidney disease (CKD). The purpose of this study is to assess the rate of uncontrolled blood pressure (BP) and identify its associated factors in patients with predialysis CKD in Bali, Indonesia.Design/methodology/approachA cross-sectional study was conducted among 165 patients who attended the nephrology clinic in a central public hospital in Bali. Data were obtained by measuring BP at threshold 130/80 mmHg, as well as collected through standardized questionnaires. Univariate analysis was done using Chi-square test, and multivariate analyses were carried out using multiple logistic regression.FindingsA total of 165 patients (111 males and 54 females) with predialysis CKD participated in this study. About 64% of the participants had uncontrolled BP. In multiple logistic regression, all selected variables significantly explained 63.2% of the variance in uncontrolled BP. However, low physical activity (odds ratio [OR] = 24.287, 95% confidence interval [CI]: 3.114–189.445), unhealthy dietary pattern (OR = 10.153, 95% CI: 2.770–37.210), as well as perceived moderate stress (OR = 4.365, 95% CI: 1.024-18.609) and high stress (OR = 10.978, 95% CI: 2.602–46.312) were significantly associated with uncontrolled BP.Research limitations/implicationsThe study findings provide evidence for health care providers to improve BP control among patients with predialysis CKD.Originality/valueControlling BP among patients with predialysis CKD was poor. Lifestyle modification and stress management are keys to improving BP control.

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The Association between Serum Retinol-Binding Protein 4 Levels and Cardiovascular Events in Patients with Chronic Kidney Disease

Laboratory Medicine ◽

10.1093/labmed/lmz104 ◽

2020 ◽

Vol 51 (5) ◽

pp. 491-497 ◽

Cited By ~ 1

Author(s):

Yuhao Su ◽

Ying Huang ◽

Ying Jiang ◽

Meilan Zhu

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Binding Protein ◽

Univariate Analysis ◽

Elevated Serum ◽

Retinol Binding Protein ◽

Serum Retinol ◽

Cox Regression Analysis ◽

Retinol Binding Protein 4 ◽

Increased Risk

Abstract Objective The study aimed to assess whether serum retinol-binding protein 4 (RBP4) is associated with a risk of cardiovascular (CV) events in chronic kidney disease (CKD) patients. Methods One hundred sixty-nine patients with CKD were followed for a mean of 36 months (range, 5–39 months). Serum RBP4 and other laboratory indicators were measured at baseline. The relationship between RBP4 and the risk of CV events was evaluated by using Cox regression analysis. Results Patients with higher serum RBP4 levels had a higher rate of CV events and a higher mortality in a univariate analysis (P < 0.001). The multivariate Cox proportional hazard analysis revealed that RBP4 (hazard ratio, 2.259; 95% confidence interval, 2.067–5.489; P = 0.002) is an independent prognostic factor for CV events in patients with CKD. Kaplan-Meier analysis demonstrated that patients with RBP4 above the median value (>33.86 mg/L) had a higher rate of CV events than did patients with RBP4 at or below the median value (≤33.86 mg/L; P < 0.001). Conclusion RBP4 levels are associated with CV events in patients with CKD. Elevated serum RBP4 levels may indicate an increased risk of CV complications in CKD patients.

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Prevalence of Diabetes Mellitus Associated Chronic Kidney Disease in Ethnically Diverse Backgrounds in Western Sydney

10.21203/rs.3.rs-43607/v1 ◽

2020 ◽

Author(s):

Sathvik Prasad ◽

Tien-Ming Hng ◽

Glen Maberly ◽

Germaine Wong ◽

Gideon Meyerwitz-Katz

Keyword(s):

Diabetes Mellitus ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Model Building ◽

Smoking Status ◽

Univariate Analysis ◽

Ethnically Diverse ◽

Past Research ◽

Increased Risk ◽

Diverse Backgrounds

Abstract Background: Past research has demonstrated that ethnically diverse backgrounds have a greater risk of Diabetes Mellitus and/or Chronic Kidney Disease (CKD), which both contribute significantly to the disease burden placed on the Australian Healthcare system. The purpose of this study was to investigate the differences in DM associated CKD between ethnicities in Western Sydney, NSW Australia, which is known to be an ethnically diverse geographical region.Method: Using data from Blacktown and Mt Druitt Hospitals and a retrospective approach, individuals with diabetes and CKD were identified based on HbA1c and eGFR results. Using univariate analysis and past research, a logistic regression modelling was carried out on the data to identify relationships between ethnicity and DM associated CKD.Results: Out of 73,001 observations, 24,009 individuals were included in the analysis with 3,934 individuals with HbA1c consistent with diabetes and kidney function at eGFR at Stage 2 and above. 47% were female and 53% were males and the median age was 76 ± 12 years. Using a forward-method model building process, ethnicity was compared to a reference of Caucasian. The model showed that Pacific Islanders have the most risk (OR: 5.63, p < 0.001, CI: 4.78–6.65) compared to other ethnicities. Age has an 11% increased risk per year (OR: 1.11, p < 0.001, CI: 1.1–1.11), men were at a 53% greater risk (OR: 1.53, p < 0.001, CI: 1.14–1.67) and Aboriginal/Torres Strait Islanders were 76% more likely to have DM associated CKD (OR: 1.76, p < 0.001, CI: 1.33–2.32). Increased socioeconomic status resulted in a 11% decreased risk in DM associated CKD (OR: 0.82, p < 0.001, CI: 0.79–0.86) and smoking status, interestingly, also has an 18% lower risk of DM associated CKD (OR: 0.81, p = 0.005, CI: 0.71–0.92)Conclusion: The results show a clear difference in risk between ethnicities in DM associated CKD and its associated risk factors. These differences should be accounted for when considering interventions for at risk communities.

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Stroke in chronic renal failure

Orvosi Hetilap ◽

10.1556/oh.2008.28292 ◽

2008 ◽

Vol 149 (15) ◽

pp. 691-696

Author(s):

Dániel Bereczki

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Renal Disease ◽

Chronic Renal Disease ◽

Kidney Diseases ◽

Cerebrovascular Diseases ◽

Lipid Lowering ◽

Increased Risk ◽

Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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KECEMASAN PASIEN PENYAKIT GINJAL KRONIS YANG MENJALANI HEMODIALISA

Jurnal Maternitas Kebidanan ◽

10.34012/jumkep.v4i1.480 ◽

2019 ◽

Vol 4 (1) ◽

pp. 1

Author(s):

Devi Novita Damanik

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Rating Scale ◽

Femoral Vein ◽

Univariate Analysis ◽

Sampling Technique ◽

Emotional Disturbances ◽

Hamilton Anxiety Rating Scale ◽

One Year ◽

Severe Anxiety

Background: Anxiety is a condition of psychological and physiological disorders characterized by cognitive, somatic, emotional disturbances and components of behavioral sequences. Purpose: This study aims to describe the anxiety of chronic kidney disease patients undergoing hemodialysis. Methods: This study uses univariate analysis which will describe the anxiety level of chronic kidney disease patients undergoing hemodialysis. The anxiety variable was measured using the HARS (Hamilton Anxiety Rating Scale) anxiety instrument with a validity value of 0.68 dd 0.93 and a reliability value of 0.93. The population in this study were all chronic kidney disease patients who underwent hemodialysis and experienced anxiety. The sampling technique used in this study was purposive sampling technique. The sample in this study were patients with chronic kidney disease who met the requirements of the study patients, namely: Patients who underwent hemodialysis for less than one year, patients undergoing hemodialysis with femoral vein puncture, patients undergoing hemodialysis twice a week. Results: The results showed that the study respondents had a mild anxiety rate of 9 patients (56.25%), moderate anxiety as many as 8 patients (21.875%) and severe anxiety as many as 8 patients (21.875%). Conclusion: conclusions and implications for nursing practice. The results showed a high incidence of anxiety in patients undergoing hemodialysis and distributed evenly on mild, moderate and severe anxiety.

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