P0567ACUTE KIDNEY INJURY IN OBSTRUCTIVE UROPATHY; EPIDEMIOLOGY, RENAL OUTCOME AND MORTALITY

Background and Aims Urinary tract obstruction (UTO) is a common clinical problem leading to acute or chronic renal impairment. Unlike pediatric population in which congenital anomalies of urinary tract account for a majority of UTO and contribute to end stage renal disease (ESRD), etiologies, clinical manifestation and outcome in adult UTO remain uncertain due to lack of large epidemiological data. Method We performed a multi-center, retrospective study analyzing 1,711 patients who underwent percutaneous nephrostomy (PCN) from 2001 to 2015. Results The most common cause of UTO was malignancies (55.6%) followed by urolithiasis (28.5%) and others. Metastatic colorectal cancer were the most common type of malignancies. Patients with UTO caused by malignancies were significantly older, had more advanced stage acute kidney injury (AKI) and higher mortality rate, while those with urolithiasis had higher prevalence of hypertension, diabetes, cardio-cerebro-vascular diseases. Eighty two percentage of patients developed AKI and 15.2% of patients needed a temporary dialysis. Older age, malignancy associated UTO and high uric acid level were independently associated with AKI. Among patients with AKI, 38.2% patients showed a renal functional recovery defined as eGFR ≥60ml/min/1.73m2 on day 7 after PCN. Multivariate analysis showed that older age and lower hemoglobin level were independent factors predicting a nonrecovery of renal function. During the median follow up period of ∼∼months, overall mortality rate was 33.9% with the highest rate was found in malignancy associated UTO (51.9%), followed by other causes (15.9%) and urolithiasis (8.8%). Malignancy associated UTO (OR 4.754, 95% CI 3.151-7.174, p<0.001), lower albumin level (OR 0.731, 95% CI 0.568-0.942, p<0.001) and stage 3 AKI (OR 2.529, 95% CI 1.332-4.803, p=0.005) were found to be independently associated with mortality. However, the impact of AKI on overall mortality was more prominent in non-malignancy associated UTO with stepwise increase of mortality as KDIGO stage increased. Conclusion In conclusion, malignancy is the most common cause of upper UTO in adults and AKI is frequently associated. Short term renal recovery after PCN was observed only in 38.2% patients and older age, lower hemoglobin level were associated with nonrecovery of renal function. Malignancy associated UTO showed the highest mortality rate compared to urolithiasis or other causes and stage 3 AKI as well as lower hemoglobin and lower albumin level were found to be independent predictors of mortality in UTO.

Not Residual Kidney Removal but Peritoneal Clearance Dominates in Uric Acid Control in Peritoneal Dialysis

Background: There’s a paucity of systematic study focusing on clearance of uric acid (UA) in peritoneal dialysis (PD). The aim of this study was to investigate peritoneal UA removal and its influencing factors in PD patients. Methods: This was a cross-sectional study. Patients who performed peritoneal equilibration test (PET) and Kt/V from April 1, 2018 to August 31, 2019 were enrolled. The demographic data, clinical and laboratory parameters including the UA levels in the dialysate, blood and urine samples were collected. Results: Finally, there were 180 prevalent PD patients (52.8% male). Compared with normal serum UA (SUA) group, the hyperuricemia group showed significantly lower peritoneal UA clearance (39.1±6.2 vs. 42.0±8.0 L/week/1.73m2, P=0.008). Peritoneal UA clearance but not residual kidney removal was revealed to be independently associated with continuous [standardized coefficients (β) -0.21, 95% confidence interval (CI) -0.07, -0.006] and categorical SUA level [odds ratio (OR) 0.91, 95% CI 0.84,0.98]. Furthermore, the higher (high or high-average) transporters showed greater peritoneal UA clearance than the lower (low or low-average) transporters (42.0±7.0 vs. 36.4±5.6 L/week/1.73 m2, P<0.001). Among the widely used solute removal indicators, peritoneal creatinine clearance (CCL) performed best to predict higher peritoneal UA clearance in ROC analysis [area under curve (AUC) 0.96, 95% CI 0.93-0.99]. In multiple linear regression, lower albumin level (β -0.06, 95%CI -2.09, -0.19), higher transporters (β 0.06, 95%CI 0.05, 1.69) and greater peritoneal CCL (β 0.95, 95%CI 0.81, 0.93) were independently associated with higher peritoneal UA clearance. Conclusions: It was peritoneal removal but not residual kidney function that dominated in SUA balance of PD patients. Albumin level, peritoneal transport type and peritoneal CCL were identified as independent determinants of peritoneal UA clearance.

The Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio in Patients with Multiple Myeloma: A Retrospective Study

Background: The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have been shown to serve as simple and inexpensive prognostic markers for various conditions such as colorectal cancer, gastric cancer, lung cancer, advanced heart failure, and other cardiovascular diseases [1-3]. However, limited data exist about the significance of the NLR and PLR in patients with multiple myeloma (MM). Objective: The objective of this study is to determine the prognostic significance of the NLR and PLR in multiple myeloma patients in terms of survival. Methods: A retrospective chart review study was conducted for 175 patients who met the criterion of diagnosis for MM between January 2004 and September 2014. All subjects with 1) Acute infection 2) human immunodeficiency virus infection 3) chronic liver disease 4) collagen vascular disease 4) previous or concomitant other malignancies 5) primary/secondary thrombocytopenia 6) chronic anti-inflammatory medication user, will be excluded from our study. After excluded 14 patients, data from 161 patients were analyzed. The relationship between NLR and PLR, and baseline characteristics, laboratory parameters, overall survival, staging and subtype of Multiple Myeloma will be analyzed using Chi-square test or independent t-test as appropriate. The NLR and PLR were obtained at the time of diagnosis of MM. The optimum cut-off point of the NLR and PLR was determined based on the receiver operating characteristic (ROC) curve. Pearson's correlation coefficient (r) was computed for the correlation between the NLR and the PLR. Overall survival was calculated using the Kaplan-Meier method. Univariate and multivariate analyses using Cox proportional hazards regression models were performed to evaluate the independent prognostic significance of the NLR. Results: The median age of diagnosis was 69 years. Patients were divided into high and low NLR groups and high and low PLR groups, according to cut-off points from the ROC curve for NLR and PLR, which were 2.78 and 155.58, respectively. There was significant positive correlation between the NLR and PLR (r = 0.312; P = 0.000)(figure 1). Patients in the high NLR group is more likely to be male (P=0.002), has lower Hb level (P=0.001), has lower GFR (P=0.003), has lower albumin level (P=0.002), has higher WBC (P=0.013), has higher B2-microglobulin level (P=0.026), and has higher staging (P=0.001). Patients in the high PLR group is more likely to have a lower albumin level (P=0.009) and higher staging (P=0.028). The high NLR group experienced inferior median survival compared to the lower NLR group (37 vs. 66 months; log rank p-value of 0.005)(figure 2a). However, there were no statistical differences in median survival between high and low PLR (45 vs. 62 months; P = 0.077)(figure 2b). Multivariate analysis demonstrated that NLR is an independent predictor for overall survival for MM patients (HR 5.090; P = 0.002). Conclusions: We demonstrated that the NLR, but not the PLR, is an independent prognostic factor for overall survival in MM. References 1. Guthrie, G.J., et al., The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol, 2013. 88 (1): p. 218-30. 2. Bhat, T., et al., Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther, 2013. 11 (1): p. 55-9. 3. Yuksel, M., et al., The association between platelet/lymphocyte ratio and coronary artery disease severity. Anadolu Kardiyol Derg, 2014. Figure 1. Pearson correlation between the NLR and PLR (r = 0.312). Figure 1. Pearson correlation between the NLR and PLR (r = 0.312). Figure 2. Kaplan-Meier survival analysis for overall survival based on NLR (2a) and PLR (2b). Figure 2. Kaplan-Meier survival analysis for overall survival based on NLR (2a) and PLR (2b). Disclosures No relevant conflicts of interest to declare.

Clinical Manifestations Vary with Different Age Spectrums in Infants with Kawasaki Disease

Background. Kawasaki disease (KD) is an acute systemic vasculitis with unknown etiology. The diagnosis of KD depends on clinical manifestations. The prevalence of coronary artery abnormality (CAA) is 11.0% and results in cardiac sequelae, such as myocardial infarction or coronary aneurysm, which are the most serious complications in KD.Methods. We divided KD's children into different age groups: ≤6 months old, 7 months to 1 year old, and >1 year old, respectively. Different parameters were compared in each group.Results. Infants ≤6 months old are less likely to fulfill KD's major diagnostic criteria within 10 days, are prone to develop incomplete KD with the lowest cholesterol level, and have the greatest chance to have CAA and the laboratory features associated with CAA, such as the longest time needed to confirm CA diagnosis, lower hemoglobin level, lower albumin level, and higher platelet count. Infants <1 year old develop higher percentage of leukocytosis and sterile pyuria. But this group has fewer patients with neck lymphadenopathy.