Risk Factors for Development of Acute Kidney Injury in Patients with Urinary Tract Infection

<div><p>Acute kidney injury (AKI) is associated with high morbidity and mortality. Urinary tract infection (UTI) may be associated with sepsis or septic shock, and cause sudden deterioration of renal function. This study investigated the clinical characteristics and change of renal function to identify the risk factors for development of AKI in UTI patients. This retrospective study was conducted in a tertiary referral center. From January 2006 to January 2013, a total of 790 UTI patients necessitating hospital admission were included for final analysis. Their demographic and clinical characteristics and comorbidities were collected and compared. Multivariate logistic regression analysis was performed to evaluate the risk factors for AKI in UTI patients. There were 97 (12.3%) patients developing AKI during hospitalization. Multivariate logistic regression analysis showed that patients with older age (OR 1.02, 95% CI 1.00–1.04, <i>P</i> = 0.04), diabetes mellitus (DM) (OR 2.23, 95% CI 1.35–3.68, <i>P</i> = 0002), upper UTI (OR 2.63, 95% CI 1.53–4.56, <i>P</i> = 0001), afebrile during hospitalization (OR 1.71, 95% CI 1.04–2.83, <i>P</i> = 0036) and lower baseline eGFR [baseline eGFR 45–59 mL/min/1.73 m² (OR 2.12, 95% CI 1.12–4.04, <i>P</i> = 0.022), baseline eGFR 30-44 mL/min/1.73 m² (OR 4.44, 95% CI 2.30–8.60 <i>P</i> < 0.001) baseline eGFR < 30 mL/min/1.73 m² (OR 4.72, 95% CI 2.13–10.45, <i>P</i> <0.001), respectively] were associated with increased risk for development of AKI. were associated with increased risk for development of AKI. Physicians should pay attention to UTI patients at risk of AKI (advancing age, DM, upper UTI, afebrile, and impaired baseline renal function).</p></div

Multivairate logistic regression model for factors related to acute kidney injury.

<p>Multivairate logistic regression model for factors related to acute kidney injury.</p

Data_Sheet_1_Effect of far-infrared radiation therapy on von Willebrand factor in patients with chronic kidney disease.docx

BackgroundHemostatic abnormality has contributed to vascular access thrombosis in patients with chronic kidney disease (CKD). Previous studies have demonstrated that far-infrared radiation (FIR) therapy can maintain the patency and maturity of arteriovenous fistulas of patients undergoing hemodialysis (HD). However, prolonged access bleeding is observed once FIR is conducted at the end of dialysis. FIR can block the binding of platelet and von Willebrand factor (vWF), a predictor of hemostatic abnormality and vascular access thrombosis. However, clinical studies exploring FIR and vWF are sparse.MethodsWe recruited 20 HD patients, 21 CKD patients, and 20 controls to examine the alteration of vWF and a disintegrin and metalloproteinase with thrombospondin type 1 repeats 13 (ADAMTS13) following a single 40-min session of FIR therapy. In addition, the alteration of these factors in the HD group was examined following a 40-min FIR session thrice a week for 3 months.ResultsA decreasing trend in the vWF activity-antigen ratio of participants in all groups following a single FIR session was observed. In addition, the ratio in the HD group was significantly lower following 3 months of FIR therapy. The subgroup analysis revealed a consistent trend and multiple regression analysis showed that participants not taking hydroxymethylglutaryl-coenzyme A reductase inhibitor, diabetes mellitus, and higher hemoglobin levels were the significant factors. The alteration of the vWF activity-antigen ratio correlated moderately to that of ADAMTS13 antigen and activity.ConclusionFIR may alter the ratio of ultra-large vWF multimers through ADAMTS13, contributing to inhibiting platelet-endothelium interactions of CKD patients.</p

Multivariate analysis of associations between eGFR and acute kidney injury.

<p>^aN = 790. ^bMultivariate model adjusted for gender, diabetes mellitus, hypertension, congestive heart failure, coronary artery disease, stroke, malignancy, indwelling foley catheter, afebrile, upper UTI, septic shock, baseline eGFR group.</p

Rectangle below: patients included for analyses.

<p>Rectangle below: patients included for analyses.</p

Structural and Dynamic Histomorphometric Parameters of Experimental Chronic Kidney Disease Rats that did or did not Undergo Parathyroidectomy.^*

<p>*N = 26 rats. Data reported as mean ± SD. Abbreviations: CKD, chronic kidney disease; PTX+CKD, parathyroidectomy and chronic kidney disease; MS/BS, percent mineralized bone surface; MAR, mineral apposition rate; BFR, bone formation rate; OV/BV, osteoid volume ratio; OS/BS, osteoid surface ratio; O.Th, osteoid thickness; OMT, osteoid maturation time</p><p>^ap < 0.01, compared with sham-operated control group.</p><p>^bp < 0.01, compared with CKD group.</p><p>^cp < 0.05, compared with sham-operated control group.</p><p>^dp < 0.05, compared with CKD group. NS, no significant (p > 0.05)</p><p>Structural and Dynamic Histomorphometric Parameters of Experimental Chronic Kidney Disease Rats that did or did not Undergo Parathyroidectomy.^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0133278#t001fn001" target="_blank">*</a>}</p

Dynamic bone histomorphometry with calcein-fluorescent labeling.

<p>The distance between the 2 lines of calcein label is greater in the chronic kidney disease (CKD) than in the control group. The PTX and chronic kidney disease (PTX+CKD) group had fewer areas with 2 labels, and the distance between the 2 lines of calcein label was smaller, indicating lower bone turnover in the PTX+CKD than in the CKD group. Scale bar = 50 μm.</p

Comparison of serum biochemical parameters between control CKD and PTX +CKD group.

<p>(A) Serum phosphate levels. (B) Serum calcium levels. (C) Serum intact PTH levels. (D) Serum FGF-23 levels. (E) Serum Vitamin D (1,25-(OH)₂D₃) levels. (F) Serum ALP levels. (G) Serum osteocalcin levels. (H) Serum CTX levels. n = 8 control, n = 9 CKD, n = 9 PTX +CKD. Results were presented as mean ± SEM. * p < 0.05, ** p < 0.01, *** p < 0.001.</p

Data_Sheet_1_Reduced Risk of Sepsis and Related Mortality in Chronic Kidney Disease Patients on Xanthine Oxidase Inhibitors: A National Cohort Study.docx

BackgroundAdvanced chronic kidney disease (CKD) patients are at higher risk of sepsis-related mortality following infection and bacteremia. Interestingly, the urate-lowering febuxostat and allopurinol, both xanthine oxidase inhibitors (XOis), have been suggested to influence the sepsis course in animal studies. In this study, we aim to investigate the relationship between XOis and infection/sepsis risk in pre-dialysis population.MethodsPre-dialysis stage 5 CKD patients with gout were identified through the National Health Insurance Research Database (NHIRD) in Taiwan from 2012 to 2016. Outcomes were also compared with national data.ResultsIn our nationwide, population-based cohort study, 12,786 eligible pre-dialysis stage 5 CKD patients were enrolled. Compared to non-users, febuxostat users and allopurinol users were associated with reduced sepsis/infection risk [hazard ratio (HR), 0.93; 95% confidence interval (CI), 0.87–0.99; P = 0.0324 vs. HR, 0.92; 95% CI, 0.86–0.99; P = 0.0163]. Significant sepsis/infection-related mortality risk reduction was associated with febuxostat use (HR, 0.68; 95% CI, 0.52–0.87). Subgroup analysis demonstrated preference of febuxostat over allopurinol in sepsis/infection-related mortality among patients younger than 65 years of age, stain users, non-steroidal anti-inflammatory drug non-users, and non-diabetics. There was no significant difference in major adverse cardiac and cerebrovascular event (MACCE) risk between users and non-users while reduced risk of all-cause mortality was observed for XOi users.ConclusionsUse of XOi in pre-dialysis stage 5 CKD patients may be associated with reduced risk of sepsis/infection and their related mortality without increased MACCE and overall mortality.</p