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1. Longitudinal Changes of Serum Creatine Kinase and Acute Kidney Injury among Patients with Severe COVID-19

Author

Juan M. Soto-Fajardo, Valeria J. Castillo-Avalos, Elisa Naomi Hernandez-Paredes, Airy Santillán-Cerón, Jorge E. Gaytan-Arocha, Olynka Vega-Vega, Norma Uribe, Ricardo Correa-Rotter, and Juan C. Ramirez-Sandoval

Subjects
Diseases of the genitourinary system. Urology, RC870-923
Abstract

Background. Acute kidney injury (AKI) is a common complication of COVID-19. Several etiologies have been identified, including pigment deposition likely associated with myopathic damage. Nevertheless, the relationship between longitudinal creatine-kinase trends and renal outcomes is uncertain. Aim. To correlate longitudinal changes in serum creatine-kinase levels with hospital-acquired AKI (beyond 48 h of hospital admission) in severe COVID-19 patients. Methods. This is a retrospective cohort study, and creatine-kinase levels were assessed over time in 1551 hospitalized patients with normal renal function at the time of hospital admission. Results. In subjects who developed hospital-acquired AKI (n = 126, 8.1%), the serum creatine-kinase concentration before AKI onset was not different when compared to patients without AKI (slope of log creatine-kinase/day = −0.09 [95% CI −0.17 to +0.19] vs. +0.03 [95% CI −0.1 to +0.1]). After AKI diagnosis, serum creatine-kinase levels showed a significantly ascendent slope (slope of log creatine-kinase/day after AKI diagnosis = +0.14; 95% CI + 0.05 to +0.3). The AKI evolution was the main factor associated with the creatine-kinase trend. Subjects with persistent AKI (n = 40, 32%) had rising creatine-kinase levels during hospitalization (slope of log creatine-kinase/day = +0.30 95% CI + 0.19 to +0.51). A rising creatine-kinase trend (n = 114, 8%) was associated with a 1.89-fold higher risk of in-hospital death (95% CI 1.14 to 3.16). Nevertheless, this association disappeared after adjusting AKI evolution and LDH baseline levels. Conclusion. In severe COVID-19 patients, a slight increase in creatine-kinase levels was observed after AKI occurrence but not before. Our results show that, at least for the appearance of hospital-acquired AKI, the CK rise does not meet the temporality criterion of causality regarding the occurrence of AKI. Rising creatine-kinase trends were associated with a higher risk of mortality, but this association was modified by AKI evolution and inflammation. There is a limited efficiency for AKI prognosis in the serial follow-up of CK levels in severe COVID-19 patients with normal renal function.

Published
2022
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2. P1477EFFECT OF INTRADIALYTIC EXERCISE IN A MEXICAN MAINTENANCE HEMODIALYSIS POPULATION

Author

César Ulises Ramírez-Salgado, Sagrario Castillo-Juárez, Airy Santillán-Cerón, Adán Rodríguez-García, Carlos Adrián Chávez-Mendoza, and Luis Ignacio Manzo-Arellano

Subjects
Transplantation, education.field_of_study, medicine.medical_specialty, biology, business.industry, medicine.medical_treatment, Population, Serum albumin, medicine.disease, Peritoneal dialysis, Blood pressure, Quality of life, Nephrology, Internal medicine, Diabetes mellitus, biology.protein, Cardiology, Medicine, Hemodialysis, Systole, education, business
Abstract

Background and Aims The use of intradialytic exercise has been associated with improved clearance, oxygen consumption, quality of life, and physical performance. The aim of this study was to describe the association between of intradialytic exercise and some outcomes in a Mexican maintenance hemodialysis (HD) population. Method Observational comparative study that included 84 maintenance HD patients from one HD center in Mexico City. The population was grouped according to the intradialytic exercise local record. The aerobic intradialytic exercise protocol includes cycling for 30-45 min during the first 2 hours of the HD according to each patient’s ability. A retrospective registry of clinical and biochemical parameters was realized. Also, the hemodynamic parameters of the last six HD sessions for each patient was included. Data analysis was carried out through descriptive and inferential statistics. Results Of the total population, 45.2% were men (n= 38) and the mean age was 53.6 + 17 years. Fifty one percent (n= 43) had diabetes mellitus (DM), which resulted more prevalent in the subgroup of patients without intradialytic exercise (p=0.03) No differences between groups were present in age, history of previous peritoneal dialysis or kidney transplant. The rest of baseline data are shown in Table 1. The subgroup of patients who underwent intradialytic exercise presented higher levels of serum albumin (p=0.03) and lower levels of parathormone (p=0.03). A total of 504 HD sessions were analysed and intradialytic exercise was performed in 64.3% (n=324). Patients in the intradialytic exercise program presented high levels of systolic and diastolic blood pressure (graphic 1). Intradialytic hypotension occurred in 5.2% (n=26) and no differences are shown between groups (p=0.78). No mayor side effects were reported. Conclusion The intradialytic exercise could improve nutritional and bone-mineral status markers. The patients in an intradialytic exercise program presented higher levels of blood pressure.

Published
2020

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