ABSTRACT
Introduction: Acute kidney injury (AKI) is associated with a very high mortality and an increased risk for progression to chronic kidney disease (CKD). Preclinical studies have identified that NAD+ augmentation as a potential strategy for the prevention and treatment of AKI. NAD+ is the final metabolized form of vitamin B3. A recent clinical study found that COVID-19 related AKI was associated with NAD+ biosynthetic impairment arising in the context of ischemic, inflammatory, or toxic kidney injury. Since there is no availability of vitamin B3 in the country, we tested if I.V. vitamin B complex (vitamin B1, B6 and B12) could improve renal recovery in patients with AKI. By oxidation, vitamin B6 through the pathway of pentose phosphate leads to the formation of NADPH (nicotamide adenine phosphate dinucleotide) an analog of NAD+. Method(s): We conducted randomized, blind, placebo-controlled study in hospitalized patients with AKI (NCT04893733). During the study I.V. vitamin B complex or placebo was given twice a day for 5 consecutive days. In each patient, a protocol-based treatment approach for AKI was used (STOP AKI protocol from the ISN 0by25 trial https://doi.org/10.1371/journal.pmed.1003408). Serum creatinine (sCr) was measured using a point of care device (NOVA Biomedical Xpress CREA) at enrollment and every 24 hours for 7 days, and then at day 30, and day 90. We evaluated if vitamin B complex could improve renal recovery in patients with AKI, reduce the risk of De Novo CKD or CKD progression, and improve survival. Result(s): From September 2020 to September 2021, 260 patients were enrolled. Baseline characteristics are shown on table 1. The drop in sCr values by day 7 was higher in the vitamin B complex group (1.04 vs. 0.33 mg/dl;p < 0.001). Complete recovery was higher in patients randomized to vitamin B complex (59.2% vs. 34.6%;p=0.001), no difference was found in terms of partial recovery (26.2% vs. 27.7%;p=0.888). Non-recovery was lower in patients who received vitamin B complex as compared to placebo (16.6% vs. 37.7%;p < 0.001). At 3 months, the incidence of de novo CKD was lower in patients who received vitamin B complex (19.2% vs. 26.9%;p=0.043) in patients with CKD the progression of the disease was lower in patients who received vitamin B complex (13.1% vs. 20.8%;p=0.023). No differences were found in terms of 90-day mortality (Vitamin B complex 74.3% vs. Placebo 80.1%;0.554). The relative risk of Vitamin B complex for renal recovery was 0.37 (95% CI 0.242 - 0.593;p<0,0001) with a NNT of 3.1 patients with a relative risk for CKD progression or De Novo CKD of 0.47 (95% CI 0.28 - 0.79;p = 0.005) with a NNT of 4.8 patients. Conclusion(s): Vitamin B complex could accelerate renal recovery in patients with AKI;reduce the incidence of De Novo CKD and CKD progression. Our results support ongoing studies investigating the therapeutic potential of NAD+ augmentation as a means to mitigate kidney injury. Conflict of interest Potential conflict of interest: Nova Biomedical MedtronicCopyright © 2023
ABSTRACT
Introduction: Acute kidney injury (AKI) and urinary sediment alterations are frequently associated to COVID-19, adding severity and high mortality risk. Knowledge of patient characteristics, risk factors, adverse outcomes, and regional peculiarities are key in the fight against this new disease. In order to describe the clinical characteristics of COVID-19 kidney involvement in Latin America (LA), the Latin American Society of Nephrology and Hypertension presents preliminary results of an ongoing Registry. Method(s): Repository of patients (Pts) by open invitation to nephrologists in LA. We included pts with confirmed SARS-CoV-2 infection by RT-PCR who developed proteinuria and/or, hematuria and/or AKI. Pts with CKD stage 5, on chronic dialysis or transplanted were excluded. Surveymonkey platform was used for data entry, and the SPSS v22 was used for the analysis. The study was approved by the Institutional Review Board of Clinica Los Olivos (Cochabamba, Bolivia) and a waiver of written consent was granted. Demographic variables, comorbidities, lab, characteristics and causes of AKI, need for kidney replacement therapy (KRT), ICU admission, mechanical ventilation (MV), complications and in-hospital mortality were collected Results: N= 632 pts. Brazil, Mexico, Colombia, Argentina, Peru and Bolivia were the main providers of pts. Median age 63 yrs (IQR, 53-73). Most pts were male (67.2%). One or more comorbidities were present in 86.9% of cases, mainly hypertension, diabetes and obesity. AKI was hospital-acquired in 59.7% and non-oliguric in 58.5%. Other causes of kidney involvement associated to COVID-19 were volume depletion (38.6%), nephrotoxicity (26.7%), and sepsis (23.4%). KRT was implemented in 47.2% but 32 pts (5.1%) needing dialysis were not dialyzed. Non-recovery of renal function was observed in 65.3%. Sixty-six percent of pts were in ICU and 67.2% underwent MV. However, 3.3% and 2.5% pts needing ICU and MV respectively did not receive it. Proteinuria (PU) at admission was present in 62.5% of 280 evaluable pts. which had more CKD, severity of AKI and the underlying condition and higher mortality rate. In those pts without PU at admission, onset of PU during hospital stay was observed in 15.4% (29/188) which had more hypertension, COVID-19 MODS as cause of AKI, more severe AKI as well as organ dysfunction. Complications in the general population occurred in 79.7%, mainly sepsis (44.9%). All-cause mortality was 57.4%. Variables independently associated to mortality were age (RR 0.95), COVID-19 DOMS (RR 2.46), nephrotoxicity (RR 2.07), oliguria (RR 2.28), non-recovery of AKI (1.97), ICU admisssion (RR 25.6) and MV (2.51). Conclusion(s): This regional cohort of COVID-19 patients showed that kidney involvement is usually found in elderly males patients with associated comorbidities. AKI was predominantly hospital-acquired and non-oliguric. COVID-19 multi-organ dysfunction syndrome (MODS), volume depletion, nephrotoxicity and sepsis were main causes of AKI. Almost half patients required KRT. Of note, a number of pts needing KRT, ICU admission or MV were not treated for not recorded reasons. PU at admission was frequent and associated to CKD, severe clinical condition, worse renal outcomes and increased mortality. In-hospital onset of PU was linked to hypertension, COVID-19 MODS as cause of AKI, and severity of kidney, respiratory and hemodynamic failure. No conflict of interestCopyright © 2021
ABSTRACT
Introduction: The appearance of the COVID -19 pandemic in the early months of 2020 has changed the way education is delivered, by drastically reducing face to face interaction. In the light of the current situation, professional bodies have ramped up virtual modes of education in the form of webinars, quizzes and various gamifications of learning formats. @ISN Education and its social media team has been in the forefront in presenting and propagating educational initiatives using social media and interacting with ISN Education Working Group and the Academy platform since early 2020. In this study we look at the changing dynamics of online nephrology education in 2020, focussing on @ISN Education Webinars and Quizzes. Methods: The study looks at the participation, attendance, interest rating and attentiveness of the webinars (and the linked social media activities) conducted by the @ISN Education in 2020.The data regarding the webinars conducted by the ISN Education group from May 2019 till November 2020 was collected and analysed for the number of registrations, attendance, attentiveness and interest rating. The data collected was compared between two time points (May 2019 to December 2019 vs January 2020 to November 2020) to better understand the impact of the pandemic on virtual educational initiatives. Data generated from social media activities (Twitter, Facebook, YouTube) and quizzes linked to these webinars in 2020 was analysed.Statistical Analysis was done using SPSS Version 22. Results: There were 7 webinars in 2019 and 11 in 2020 till November 2020. The total number of registrations in 2020 was higher than in 2019 (4729 vs 1299:p=0.079). Similarly, the number of attendees in 2020 was higher than in 2019 (2146 vs 465;p=0.084). This was expected as there were more webinars in 2020 (11) than in 2019 (7). The mean (±sd) registrations and attendees in 2020 were still higher than in 2019. (registrations 429.91 ±40.269 in 2020 vs. 185.57 ±96.609 in 2019, p=0.08 and attendees 195.09 ±180.65 in 2020 vs 66.43±36.65 in 2019,p=0.08). The percentage of registrants who actually attended the webinars in 2019 (35.8%) was significantly lower than in 2020 (45.4%)(p=0.01). In 2020 the percentage of attendance was higher in April-June (48%), July -September (49.1%) than in the Jan -March (41.7%). The Spanish language webinars had a lesser attendance perhaps a result of the time at which the webinars were conducted (morning hours in Latin America) All webinars were promoted and introduced on Twitter, Facebook and LinkedIn. 3 webinars were introduced in Instagram also.Twitter was the most commonly used media tool for promotion of the webinars(78.5%) and Instagram was least preferred(6%). The webinar titled “COVID19 for the Nephrologist- Real life experience from Italy” was the most popular webinar with 2940 engagements and 41978 impressions on Twitter and had the highest quiz engagement. Conclusions: The webinars conducted by @ISN Education had a higher level of meaningful participation (registration and attendance) during the COVID 19 pandemic. A robust social media interaction in relation to the webinars was noted and demonstrated to be a useful tool to propagate the educational content. A quiz linked to the webinars also garnered interest and had encouraging participation statistics. No conflict of interest