A risk score predicting unplanned renal replacement therapy after coronary catheterization

2021 ◽  
Author(s):  
Junqing Yang ◽  
Yibo He ◽  
Yong Liu ◽  
Jin Liu ◽  
Guoli Sun ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Risk Score ◽  
Coronary Catheterization

Metformin Associated Lactic Acidosis in Clinical Practice – A Case Series

2020 ◽  
Author(s):  
Philipp Schädle ◽  
Otto Tschritter ◽  
Monika Kellerer
Keyword(s):  
Renal Replacement Therapy ◽  
High Risk ◽  
Lactic Acidosis ◽  
Replacement Therapy ◽  
Risk Score ◽  
Risk Group ◽  
Case Series ◽  
Individual Risk ◽  
Volume Depletion ◽  
Screening Criteria

Abstract Aims The aim of this case report is to specify the frequency and mortality of Metformin-Associated Lactic Acidosis (MALA) in emergency medicine, as the diagnosis seems to occur more often than estimated. Methods To identify the subjects, we developed screening criteria for MALA. We measured the serum metformin concentration to confirm the diagnosis in all patients fulfilling these criteria. Retrospectively the patients were grouped according to individual risk (according to a defined risk score) and the application of renal replacement therapy. Results From 2013 until 2018 we were able to identify 11 MALA patients revealing a frequency of 1:4,000 emergency patients. Six patients survived and five died in the follow-up. All three patients in the high-risk group died although all of them received renal replacement therapy. In the low-risk group (three patients, one with renal replacement therapy), all patients survived, while in the intermediate-risk group (five patients, one with renal replacement therapy) three patients survived and two died. Additional severe comorbidities also contributed to mortality. Conclusions Every patient matching the screening criteria of acute renal failure, lactic acidosis and continued intake of metformin can be considered a potential MALA case. A risk score assessment which includes severe comorbidities may help to identify high-risk individuals and should be evaluated in larger studies.To prevent MALA, patients should be trained to immediately interrupt their own metformin use when showing signs of volume depletion. Physicians should be aware of the additional risk factors such as co-medication with diuretics, ACE (angiotensin converting enzyme) ACE inhibitors and NSAIDs (non steroidal anti inflammatory drugs).

P0124PREDICTIVE VALUE OF RENAL RISK SCORE AND CHRONICITY SCORE IN PREDICTING RENAL OUTCOME IN ANCA ASSOCIATED GLOMERULONEPHRITIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yong-Xi Chen ◽  
Xiao-Ning An ◽  
Zhao-Nan Wei
Keyword(s):  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Replacement Therapy ◽  
Risk Score ◽  
End Stage Renal Disease ◽  
Predictive Value ◽  
Renal Outcome ◽  
Histopathological Classification ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal Risk Score (RRS) and Chronicity Score (CS) are both newly proposed tools to predict End stage renal disease (ESRD) which could be applicable in Antineutrophil cytoplasmic antibody (ANCA) associated glomerulonephritis (AGN) patients. Their predictive value has not been fully studied and compared. Method Patients with newly biopsy-proven AGN at Department of Nephrology, Ruijin Hospital were retrospectively studied. Patients were evaluated with RRS and CS for clinical factors, pathological lesions and outcome. Their predictive value of renal survival was also compared with 2010 histological classification. Results There were 252 AGN patients enrolled in current study, including 212 MPA, 12 GPA, 4 EGPA and 24 renal limited vasculitis (RLV). In current study, the median serum creatinine of patients at diagnosis was 245.5 μmol/L (IQR 128-487.5 μmol/L) and median eGFR was 20.3 ml/min (IQR 9-45.3 ml/min). Fifty (19.8%) patients required dialysis at disease onset. The median RRS score at diagnosis was 6 (IQR 0-9) and CS score was 4 (IQR 3-7). During up to 217 months of follow-up (mean 63.9 months), 71(28.2%) patients progressed to end stage renal disease (ESRD) and required renal replacement therapy. Significant differences were found regarding dialysis dependency within RRS and CS groups (p<0.001 and p<0.01 respectively). The C statistic of the predictive models was 0.828 (95% CI, 0.775-0.880) for developing ESRD required renal replacement therapy. The addition of RRS or CS scoring scheme to the model significantly improved discrimination. Compared with the 2010 histopathological classification, RRS and CS both showed adequate and similar discrimination, but significantly greater discrimination than 2010 histopathological classification. Conclusion Among AGN patients, RRS and CS achieved similar discrimination, but the discrimination of RRS was superior.

Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

2016 ◽  
Vol 19 (3) ◽  
pp. 123 ◽  
Author(s):  
Orhan Findik ◽  
Ufuk Aydin ◽  
Ozgur Baris ◽  
Hakan Parlar ◽  
Gokcen Atilboz Alagoz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Renal Replacement Therapy ◽  
Serum Albumin ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Preoperative Serum ◽  
Group I ◽  
Group Ii

<strong>Background:</strong> Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG).<br /><strong>Methods:</strong> We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels &lt;3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL.<br /><strong>Results:</strong> There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; <br />P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. <br /><strong>Conclusion:</strong> Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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