Effect of replacement therapy (CRRT) and hemodialysis (IHD) on severe acute renal failure.

Hyperkalemia, metabolic acidosis, and acute uremia are the main symptoms in patients with severe acute renal failure (SARF). Its clinical symptoms are obvious, and it is extremely harmful. It needs to take active and effective measures for treatment. CRRT refers to any extracorporeal blood purification treatment technique designed to replace impaired renal function for 24 h or nearly 24 h. Hemodialysis treatment is a treatment process in which the patient's blood is discharged from the body, passes through the dialysis membrane and dialysis machine, removes excess toxins and water in the body, corrects electrolyte and acid-base disorders, and then returns the blood to the body. In order to explore the efficacy of replacement therapy and hemodialysis in the treatment of severe acute renal failure, the data samples were randomly divided into observation group and control group, who were given conventional treatment, hemodialysis and replacement therapy, respectively. Clinical data show that after replacement therapy and hemodialysis in patients with severe acute renal failure in the observation group, the levels of parathyroid hormone, renin, and quality of life were all improved, with an improvement rate of 9.47%, which has certain promotional value.

Calculation of the estimated glomerular filtration rate using the 2021 CKD-EPI creatinine equation and whole blood creatinine values measured with Radiometer ABL 827 FLEX.

OBJECTIVES: Estimated glomerular filtration rate (eGFR) can be calculated using serum/plasma creatinine measured with automated chemistry analyzers. It is unclear whether eGFR can be calculated using creatinine values measured in whole blood (WB creatinine). The aim of this study is to determine the comparability between the eGFR calculated using WB creatinine and plasma creatinine. METHODS: Blood samples from 1,073 patients presented to the emergency department (ED), perioperative areas, intensive care unit (ICU) or nuclear medicine were used to determine the accuracy of WB creatinine. For each sample, WB creatinine was first measured with Radiometer ABL827 FLEX blood gas analyzer, then plasma creatinine was measured with Roche Cobas702 chemistry analyzer after samples were centrifuged. In a subset of 247 samples with the information of age and sex, whole blood eGFR (WB eGFR) and plasma eGFR were calculated using WB creatinine and plasma creatinine and the 2021 chronic kidney disease epidemiology collaboration (CKD-EPI) creatinine equation, respectively. RESULTS: WB creatinine correlated with plasma creatinine linearly with a slope of 1.06 and an intercept of -0.01. The coefficient of determination (R2) was 0.99. WB eGFR correlated with plasma eGFR linearly with a slope of 0.95, intercept of -1.63, and R2 of 0.97. Comparing to plasma eGFR, the sensitivity and specificity for WB eGFR to identify those with high risk (eGFR<30 mL/min/1.73 m2) and low risk (eGFR>45 mL/min/1.73 m2) for kidney injuries was 100 and 92.2%, respectively. The overall concordance in classifying the four stages of kidney damage between WB eGFR and plasma eGFR was 87.9%. CONCLUSIONS: WB creatinine measured with Radiometer ABL827 Flex can be used to calculate eGFR using the 2021 CKD-EPI creatinine equation. The sensitivity and specificity for WB eGFR to identify those with high and low risks for potential kidney injuries are acceptable in patients needing rapid assessment of their kidney functions.

Point-of-Care Capillary Blood Creatinine: A Prospective study in Cardiology and Nephrology Outpatients.

BACKGROUND: The radiological or interventional use of contrast medium exposes patients to a risk of contrast-induced nephropathy. Pre-existing kidney failure is a major risk factor. Point-of-Care Capillary blood creatinine tests are promising; their speed might help to optimize treatment decisions and patient care in these situations. METHODS: The objective of the present study was to assess the ability of a new point of care capillary blood creatinine test (Stat Sensor X-press, Nova Biomedical Cooperation, Waltham, MA, USA) to diagnose kidney failure, relative to a standard lab-based plasma creatinine assay. A total of 113 patients 33 women (29.2%) were included. The capillary blood creatinine concentration was significantly correlated with the plasma creatinine concentration in both men (Pearson's r [95% Confidence Interval (CI)] = 0.84 [0.75 - 0.89]; p<0.001) and women (Pearson's r [95%CI] = 0.95 [0.89 - 0.97]; p<0.001). The test's diagnostic performance was satisfactory, its sensitivity was 70% [35 - 93] in women and 78% [52 - 94] in men, and its specificity was 91% [72 - 99] in woman and 93% [84 - 98] in men. CONCLUSION: Rapid Point-of Care Capillary creatinine test is an easy-to-use, accurate tool for detecting kidney failure before a patient is exposed to procedures involving contrast medium. The POC test performed less well in patients over the age of 75 and in patients with high plasma creatinine level.

Associations Between Kidney Dysfunction and Risk Factors in Patients with Transurethral Resection of the Prostate.

PURPOSE: Benign prostate hyperplasia (BPH) with urinary retention can result in kidney dysfunction. Several risk factors might influence deterioration in kidney function. The aims of this study were to assess the association between kidney dysfunction and risk factors in patients with transurethral resection of the prostate (TURP). METHODS: We reviewed medical records of BPH patients managed by TURP and having high levels of blood urea and creatinine. Data collected were age, history of hypertension, diabetes mellitus (DM), urinary tract infection (UTI), urinary retention, and urinary tract stones, duration of obstruction, and blood-urea and -creatinine levels before and after TURP. Chi-suare and paired t- tests were used. RESULTS: There were 64 patients in the study. More were aged 60-69 years (42.2%) than other age-groups, 53.1% had a history of hypertension, 12.5% DM, 35.9% UTI, all urinary retention, 14.1% urinary tract stones, and 92.2% obstruction duration <14 days. There were significant differences in blood-urea and -creatinine levels between before and after TURP (p<0.001). There were no significant differences between age-group, hypertension, DM, UTI, urinary retention, urinary stones, or duration of obstruction with kidney dysfunction after TURP (p>0.001). CONCLUSION: Age, hypertension, DM, UTI, urinary retention, urinary tract stones, and duration of obstruction can be risk factors of kidney dysfunction in TURP patients, and TURP might improve blood-urea and -creatinine levels. There was no significant association between kidney recovery and kidney dysfunction with the number of risk factors in TURP and pre-TURP patients.

Seroprevalence of Infection with Feline Morbilliviruses Is Associated with FLUTD and Increased Blood Creatinine Concentrations in Domestic Cats.

Feline morbilliviruses (FeMV) are fairly newly discovered paramyxoviruses found in cats. The first description indicated an association with widely distributed chronic kidney disease (CKD) in the host species. In various studies, a global prevalence and a further genotype, designated FeMV-2, and the involvement of other organ systems in infected individuals were shown. Using an immunofluorescence assay, we detected an overall seroprevalence of FeMV in almost half of the cats investigated (n = 380), with a significantly increased proportion in younger animals. In comparison to European Shorthair cats, the rate of seropositivity is higher in pedigree cats. Regardless of the breed, FeMV infection was associated with increased blood creatinine concentrations, suggesting an association with CKD. Further analysis indicated that this association was the strongest in animals having high IFA titers against FeMV-2. In addition, a significant association between FeMV-positive status and the prevalence of feline lower urinary tract disease (FLUTD, or idiopathic cystitis) was detected. This association was dominated by cats having antibodies against FeMV-1 only. To further evaluate the positive correlation between FeMV seroprevalence and CKD as well as FLUTD, consideration of additional clinical characteristics and laboratory parameters is warranted, and controlled infection studies with both FeMV genotypes are necessary. Clinicians should, however, be aware of a possible link between renal and lower urinary tract disease and FeMV infections.

Combination of medical and health care based on digital smartphone-powered photochemical dongle for renal function management.

Currently, the global healthcare market is increasing at high speed with the impendent global aging issue. Healthcare Industry 4.0 has emerged as an efficient solution towards the aging issue since it was integrated with ubiquitous medical sensors, big health processing platform, high bandwidth, speed technologies, and medical services, etc. It is believed to fulfil the requirement of the tremendously growing health market. The acquisition of medical data acts as the dominant precondition to implement the Healthcare Industry 4.0. In the same way, the widely available smartphone could serve as the best biomedical information collect station. In this study, a smartphone-powered photochemical dongle is demonstrated to precisely estimate blood creatinine from the fingertip blood, which works as a highly compact reflectance spectral analyzer with an enzymatically dry chemical test strip. Comparing with conventional laboratory facility for the evaluation and treatment of chronic kidney disease (CKD), it implemented the platform of point care with agreed accuracy. In order to estimate the efficiency of treatment and recovery of the CKD, the proposed photochemical dongle would provide a flexible and rapid platform for point of care. Furthermore, the proposed measured technology is very promising method for remote CKD management.

[Effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture].

OBJECTIVE: To observe the effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture. METHODS: Form January 2013 to December 2014, 767 elder patients with hip fracture were treated in our hospital including 253 males and 514 females, aged from 65 to 96 years old with an average of(75.67±6.81) years old. According blood urea and creatinine levels, the 767 hip fracture patients were divided into four groups as follow: group A(blood urea>=5 mmol/L, creatinine>=70 µmol/L); group B (blood urea>=5 mmol/L, creatinine<70 µmol/L); group C (blood urea<5 mmol/L, creatinine>=70 µmol/L); group D(blood urea<5 mmol/L, creatinine<70 µmol/L). In group A, there were 211 patients including 70 males and 141 females, aged from 65 to 95 years old with an average of(80.24±6.51) years old; in group B, there were 355 patients including 125 males and 230 females, aged from 65 to 93 years old with an average of(78.46±7.09) years old; in group C, there were 36 patients including 11 males and 25 females, aged from 65 to 95 years old with an average of (77.83±6.78) years old; in group D, there were 165 patients including 47 males and 118 females, aged from 65 to 96 years old with an average of (76.71±8.35) years old. The survivals and dead patients in four groups were collected and in-hospital mortality rate, 3-month, 12-month and 18-month mortality rate of patients were calculated. COX regression analysis was performed on these data, and clinical significance of serum urea and creatinine at admission in the elderly patients was researched. RESULTS: All 767 hip fracture patients were followed up from 18 to 24 months with an average of (21.33±1.25) months, 159 patients were died in follow up period. The in-hospital mortality rate in 3-month, 12-month and 18-month mortality rate of the patients with high blood urea and high blood creatinine (urea>=5 mmol/L, creatinine>=70 µmol/L) were 2.37%, 9.95%, 16.11% and 26.07%, and were higher than other three groups respectively. COX regression analysis revealed that the independent predictors effecting the mortality rate included age [P=0.000, OR=1.375, 95%CI(1.155, 1.637)], blood urea at admission [P=0.000, OR=1.375, 95%CI(1.155, 1.637)], and blood creatinine at admission[P=0.037, OR=1.213, 95%CI(1.121, 1.484)]. CONCLUSIONS: Elderly hip fracture patients with high serum urea and high serum creatinine at admission indicate higher fatality rate. Age, serum urea and serum creatinine at admission were independent predictors of fatality rate of elderly hip fracture patients.

Effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture / 中国骨伤

<p><b>OBJECTIVE</b>To observe the effect of admission blood urea and creatinine levels on mortality in elderly patients with hip fracture.</p><p><b>METHODS</b>Form January 2013 to December 2014, 767 elder patients with hip fracture were treated in our hospital including 253 males and 514 females, aged from 65 to 96 years old with an average of(75.67±6.81) years old. According blood urea and creatinine levels, the 767 hip fracture patients were divided into four groups as follow: group A(blood urea>=5 mmol/L, creatinine>=70 μmol/L); group B (blood urea>=5 mmol/L, creatinine<70 μmol/L); group C (blood urea<5 mmol/L, creatinine>=70 μmol/L); group D(blood urea<5 mmol/L, creatinine<70 μmol/L). In group A, there were 211 patients including 70 males and 141 females, aged from 65 to 95 years old with an average of(80.24±6.51) years old; in group B, there were 355 patients including 125 males and 230 females, aged from 65 to 93 years old with an average of(78.46±7.09) years old; in group C, there were 36 patients including 11 males and 25 females, aged from 65 to 95 years old with an average of (77.83±6.78) years old; in group D, there were 165 patients including 47 males and 118 females, aged from 65 to 96 years old with an average of (76.71±8.35) years old. The survivals and dead patients in four groups were collected and in-hospital mortality rate, 3-month, 12-month and 18-month mortality rate of patients were calculated. COX regression analysis was performed on these data, and clinical significance of serum urea and creatinine at admission in the elderly patients was researched.</p><p><b>RESULTS</b>All 767 hip fracture patients were followed up from 18 to 24 months with an average of (21.33±1.25) months, 159 patients were died in follow up period. The in-hospital mortality rate in 3-month, 12-month and 18-month mortality rate of the patients with high blood urea and high blood creatinine (urea>=5 mmol/L, creatinine>=70 μmol/L) were 2.37%, 9.95%, 16.11% and 26.07%, and were higher than other three groups respectively. COX regression analysis revealed that the independent predictors effecting the mortality rate included age [=0.000, OR=1.375, 95%CI(1.155, 1.637)], blood urea at admission [=0.000, OR=1.375, 95%CI(1.155, 1.637)], and blood creatinine at admission[=0.037, OR=1.213, 95%CI(1.121, 1.484)].</p><p><b>CONCLUSIONS</b>Elderly hip fracture patients with high serum urea and high serum creatinine at admission indicate higher fatality rate. Age, serum urea and serum creatinine at admission were independent predictors of fatality rate of elderly hip fracture patients.</p>

Clinical research progress of biological markers for acute kidney injury / 中国小儿急救医学

Acute kidney injury(AKI) is a clinical syndrome characterized as acute renal dysfunction with difficult treatment and high mortality,and is one of the most common complications in critically ill patients.Till now,the blood creatinine and urine volume were widely used to diagnose AKI in clinic,but both of them could not represent the change of renal function timely and accurately.Some new biomarkers provide new probable criteria for early diagnosis and treatment of AKI.In this paper,we make a review on new biological markers focused on AKI research at present.