Abstract P358: Association of Kidney Function and Cerebral Arterial Stiffness

Background and Purpose: Chronic kidney disease (CKD) is known to have affected the systemic vasculature and its remodeling, which eventually led to the systemic arterial stiffness. However, the relationship between cerebral circulation and impaired renal function is poorly understood. To evaluate the effect of renal dysfunction to increase systemic and intracranial arterial stiffness, we assessed the relation between renal resistive index (RRI) and pulsatility index (PI) of the middle cerebral artery (MCA). Methods: We included patients with acute lacunar infarction. Demographic and clinical data were collected by retrospective chart review. Bilateral transcranial Doppler ultrasound (TCD) examination of the MCAs was performed using the ST3 Ultrasound system (Spencer Technologies) and PI were calculated. RRI was obtained through kidney Doppler sonography. Subjects with occlusion or significant stenosis of MCA, atrial fibrillation, bilaterally absent transtemporal sonographic windows were excluded. Results: Of the 283 included subjects (mean age 67.8 ± 10.2), 74 patients had renal dysfunction (glomerular filtration rate < 60ml/min/1.73m2 at admission) and 49 patients underwent kidney Doppler ultrasound within 1 year since their acute stroke. Renal dysfunction was significantly associated with higher arterial stiffness (median PI 1.12, IQR 0.85 to 1.57 vs. controls PI 0.84, IQR 0.54 to 1.22 [p<0.0001]). There was a proportional relationship between the degree of renal dysfunction and the distal vascular resistance. In multivariate adjusted regression analysis, renal function was related to high PI (p<0.001). Furthermore, there is strong correlation between RRI and PI ( r =0.65, p <0.001). Conclusions: In patients with lacunar infarction, renal impairment is an independent determinant of increased arterial stiffness in cerebral circulations. In addition, PI is significantly associated with RRI.

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1692. Retrospective Review on the Safety and Efficacy of Nitrofurantoin for the Treatment of Cystitis in the Veteran Population With or Without Renal Insufficiency

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1870 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S829-S830

Author(s):

Elwyn W Welch ◽

Shaila Sheth ◽

Chester Ashong ◽

Caroline Pham

Keyword(s):

Renal Function ◽

Renal Dysfunction ◽

Clinical Cure ◽

Clinical Cure Rate ◽

Retrospective Chart Review ◽

Outpatient Setting ◽

Secondary Outcome ◽

Cure Rate ◽

Acute Cystitis ◽

Significant Difference

Abstract Background Nitrofurantoin has been used to treat cystitis in women; however, data supporting its use in men is lacking. In addition, recent retrospective studies have challenged the manufacturer’s recommendation to avoid nitrofurantoin with creatinine clearances (CrCl) less than 60 mL/min. The purpose of this study is to compare the efficacy and safety of nitrofurantoin for the treatment of acute cystitis in male and female veterans with variable degrees of renal dysfunction. Methods A retrospective chart review was conducted in adult patients who received nitrofurantoin for acute cystitis in the outpatient setting between May 1, 2018 and May 1, 2019. The primary outcomes were rates of clinical cure as compared between males and females, and across various renal function groups (CrCl greater than 60 mL/min, 30 to 60 mL/min, and less than 30 mL/min) following treatment with nitrofurantoin. The secondary outcome was adverse event rates. Results A total of 446 patients were included with 278 females and 168 males. Overall clinical cure rate was 86.5% (n=386). Clinical cure rate did not vary between genders (p=0.0851) or CrCl ranges (p=1.0) as shown in the tables. Benign prostatic hyperplasia (BPH) was associated with decreased odds of clinical cure (OR 0.50 [95% CI 0.26-0.97], p=0.0404) in addition to cirrhosis (OR 0.22 [95% CI 0.06-0.91], p=0.0357). Adverse events occurred in 2% of patients and did not vary based on gender or renal function. RATES OF CLINICAL CURE Conclusion There was no statistically significant difference in clinical cure with nitrofurantoin between genders and various renal impairments. However, history of BPH and cirrhosis were associated with decreased efficacy. Subgroup analysis also revealed lower efficacy in males with CrCl greater than 60 mL/min versus females with similar renal function. This study adds to the growing body of literature suggesting that renal dysfunction with CrCl of 30 to 60 mL/min may not carry the risk of treatment failure and adverse effects previously associated with nitrofurantoin, but large randomized trials are needed to confirm these results. Disclosures All Authors: No reported disclosures

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Influence of volume administration on Doppler-based renal resistive index, renal hemodynamics and renal function in medical intensive care unit patients with septic-induced acute kidney injury: a pilot study

International Urology and Nephrology ◽

10.1007/s11255-016-1312-1 ◽

2016 ◽

Vol 48 (8) ◽

pp. 1327-1334 ◽

Cited By ~ 9

Author(s):

Tobias Lahmer ◽

Sebastian Rasch ◽

Christopher Schnappauf ◽

Roland M. Schmid ◽

Wolfgang Huber

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Renal Function ◽

Intensive Care ◽

Pilot Study ◽

Medical Intensive Care Unit ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Medical Intensive Care

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Transcranial Doppler ultrasound analysis of resistive index in rostral and caudal cerebral arteries in dogs

Journal of Veterinary Science ◽

10.4142/jvs.2005.6.1.61 ◽

2005 ◽

Vol 6 (1) ◽

pp. 61 ◽

Cited By ~ 7

Author(s):

Minho Seo ◽

Hojung Choi ◽

Kichang Lee ◽

Mincheol Choi ◽

Junghee Yoon

Keyword(s):

Doppler Ultrasound ◽

Transcranial Doppler ◽

Cerebral Arteries ◽

Resistive Index ◽

Transcranial Doppler Ultrasound

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Use of Pamidronate for Hypercalcemia of Malignancy in Renal Dysfunction

Journal of Pharmacy Practice ◽

10.1177/0897190019883162 ◽

2019 ◽

pp. 089719001988316 ◽

Cited By ~ 1

Author(s):

Sarah J. Norman ◽

David J. Reeves ◽

Lindsay M. Saum

Keyword(s):

Renal Function ◽

Renal Dysfunction ◽

Chart Review ◽

Kidney Injury ◽

Retrospective Chart Review ◽

Primary Objective ◽

Limited Impact ◽

Hypercalcemia Of Malignancy ◽

Baseline Renal Function ◽

Community Teaching

Background: Few studies have been conducted investigating the use of bisphosphonates in hypercalcemia of malignancy (HCM) in the setting of renal dysfunction. Objective: The primary objective was to compare the incidence of acute kidney injury (AKI) within 7 days of receiving pamidronate for the treatment of HCM with pre-existing renal dysfunction versus normal renal function at the time of pamidronate administration. The secondary objectives explored the effects of pamidronate doses and infusion rates on the safety and efficacy in those with pre-existing renal dysfunction for the treatment of HCM. Methods: A retrospective chart review was conducted on patients who received pamidronate for the treatment of HCM at a community teaching hospital in Indianapolis, Indiana, from January 1, 2013, to May 31, 2017. Results: A total of 141 pamidronate administrations were included (116 patients had normal baseline renal function, and 25 patients had pre-existing renal dysfunction before pamidronate administration for the treatment of HCM). Two (8%) patients developed AKI in the pre-existing renal dysfunction group, compared with 4 (3.4%) patients in those without pre-existing renal dysfunction ( P = .288). For those with pre-existing renal dysfunction, the incidence of AKI did not differ based on the dosage of pamidronate given ( P = .762) or infusion rates ( P = .373). Conclusion: Pamidronate appears to have limited impact on renal function at doses up to 90 mg in the setting of pre-existing renal dysfunction for the treatment of HCM.

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Semiquantitative Power Doppler Ultrasound Score to Predict Acute Kidney Injury in Patients With Sepsis or Cardiac Failure: A Prospective Observational Study

Journal of Intensive Care Medicine ◽

10.1177/0885066619887333 ◽

2019 ◽

Vol 36 (1) ◽

pp. 115-122 ◽

Cited By ~ 1

Author(s):

Hai Jun Zhi ◽

Jing Zhao ◽

Shen Nie ◽

Yun Jie Ma ◽

Xiao Ya Cui ◽

...

Keyword(s):

Acute Kidney Injury ◽

Doppler Ultrasound ◽

Cardiac Failure ◽

Power Doppler ◽

Resistive Index ◽

Kidney Injury ◽

Renal Resistive Index ◽

Power Doppler Ultrasound ◽

Predictive Values ◽

Ultrasound Score

Background: Diagnosing acute kidney injury (AKI) stage 3 in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary output and serum creatinine, which may be of limited value. This study aimed to explore the diagnostic performance of renal resistive index (RRI) and semiquantitative power Doppler ultrasound (PDU) scores in predicting AKI stage 3 in patients with sepsis or cardiac failure. Methods: This study is a prospective observational study that included 83 patients (40 with sepsis and 43 with cardiac failure). Renal resistive index and semiquantitative PDU scores were measured within 6 hours following admission to the intensive care unit. Acute kidney injury was defined according to the criteria set by Kidney Disease Improving Global Outcomes. Results: The predictive values of RRI (area under the curve [AUC] = 0.772, 95% confidence interval [CI] = 0.658-0.886) and PDU score (AUC = 0.780, 95% CI = 0.667-0.892) were similar in all patients. Power Doppler ultrasound score (AUC = 0.910, 95% CI = 0.815-1.000) could effectively predict AKI stage 3 in the cardiac failure subgroup, and the optimal cutoff for this parameter was ≤ 1 (sensitivity = 87.5%, specificity = 92.6%, Youden index = 0.801, accuracy in our population = 90.7%). However, PDU scores (AUC = 0.620, 95% CI = 0.425-0.814) could not predict AKI stage 3 in the sepsis subgroup. The predictive values of RRI for AKI stage 3 in the cardiac failure (AUC = 0.820, 95% CI = 0.666-0.974) and sepsis (AUC = 0.724, 95% CI = 0.538-0.910) subgroups were similar. Conclusions: Power Doppler ultrasound scores could effectively predict AKI stage 3 in patients with cardiac failure but not in patients with sepsis. Renal resistive index is a poor predictor of AKI stage 3 in patients with sepsis or cardiac failure.

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