EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Dental age estimation of Jordanian children: applicability of Demirjian method

ABSTRACT Objectives: To evaluate the accuracy of Demirjian method in estimating the chronological age of male and female Jordanian children and to establish a new dental age curve if the Demirjian method was not found to be accurate. Methods: Orthopantomograms (OPTs) of 1374 Caucasian Jordanian children (684 females and 690 males) aged 4 to16 years were selected and the dental age was determined by Demirjian method. The chronological ages of the children were obtained by subtracting their birthdates from the date of taking the radiograph. The OPTs were obtained from Archives of Dental Teaching Clinics /XXX and other private orthodontic practices in Irbid and Amman. Results: Demirjian method overestimated chronological age in female and male subjects aged 4 to 8 years. Afterwards, the method underestimated chronological age in females aged 9-11 years and 14-16 years. In male subjects, chronological age was underestimated in subjects aged 9-12 years and 15-16 years. New the dental age curves for Jordanian females and males were constructed. The constants for the quadratic model for the new curves were (b0=-25.341, b1=17.557, b2=-0.623) for females and (b0=-29.809, b1=17.396, b2=-0.595) for males. Conclusion: Demirjian method overestimated the chronological age of Jordanians below the age of 8 years and underestimated the age of Jordanians above 8 years. A new DA standard for Jordanian children was developed and tested for accuracy

Utility Of Standardized Pre-CTA Hydration Protocol On Patients Referred For Transcatheter Aortic Valve Replacement

Introduction: ECG-gate computed tomography angiography (CTA) is the standard technique for pre-procedural planning prior to transcatheter aortic valve replacement (TAVR). CTA requires use of potentially nephrotoxic iodinated contrast, limiting use in patients with renal dysfunction. We evaluated the utility of a tiered hydration protocol in patients with renal dysfunction referred for TAVR. Methods: 258 patients (52.7% male, age 79 ± 8 years) who underwent TAVR between 1/1/18 and 12/30/18 were retrospectively evaluated. Pre-procedural CTA was performed per institutional protocols with weight based contrast dosing. Patients requiring hemodialysis prior to CTA were excluded. Patients with GFR \u3c22ml/min did not receive CTA. Patients with GFR 22 - 40 ml/min underwent hydration protocol guidelines: Outpatients received normal saline (NS) at ≤3 mL/kg over one hour pre-procedure/test and 1 to 1.5 mL/kg/hour during and up to six hours post-procedure/test. Inpatients received normal saline for 1 mL/kg/hour for 6 to 12 hours pre-procedure/test, intra-procedure, and up to 12 hours post-procedure. Results: Total baseline creatinine was 1.08 ± 0.41 ng/dL. Hydration protocol patient creatinine levels were 1.67 ± 0.41 ng/dL. Upper quartile of creatinine was 1.91 ng/dL (range 0.79 - 2.65 ng/dL). Average CTA contrast dose was 100 ± 23 mL. 43 (17%) of patients received pre-CTA hydration protocol. Hydration protocol NS total infusion volumes were 490 ± 119 mL (range 40-100ml). Duration between CT and TAVR was 86 ± 155 days. Pre-TAVR creatinine was 1.09 ± 0.39, creatinine at discharge was 1.06 ± 0.73. 3 patients (1%) had ≥1 increase in CKD grade at discharge. No patients required dialysis prior to discharge or within 1 month of TAVR. No complications from hydration protocol were identified. Conclusions: Utilization of a routine pre-TAVR CT hydration protocol in patients at risk for contrast induced nephropathy is feasible and associated with no new renal dysfunction prior to TAVR, and low rates of new renal dysfunction post TAVR. In TAVR patients hydration carries risks and further study is needed to identify whether a more conservative hydration protocol can be utilized