170 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
PS 0478 Nephrology
Clinical Severity of Hyponatremia : Thiazides Vs Psy- chotropics Vs Combination of Both
Hyunju YOON1, Kwang Young LEE1, In O SUN1, Jeong Gwan KIM1, Hye Mi CHOI1, Woong Ki LEE1, Hyeuk Soo LEE1, Choong Sil SEONG1, Byung Sun KIM1
Presbyterian Medical Center, Korea1
Background: The aim of this study is to evaluate the difference of clinical character- istics in patients with hyponatremia, according to the causative drugs such as thiazide diuretics and psychotropic drugs (tricyclics, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, phenothiazines and butyrophenones).
Methods: From 2007 to 2013, 266 patients were diagnosed with hyponatremia. We compared clinical characteristics among thiazide (T) group (n=93), psychotropic drug (P) group (n=83), and combination (C) group (n=90). We investigated the severity of hyponatremia based on initial level of serum sodium, initial symptom of the patients and correction time (serum sodium level = 130 mmol/L).
Results: The mean age was younger in P group than in other two groups (65±8 vs 71±10 vs 74±13 year, P=0.000). There were no difference in initial urine osmolality (378±131 vs 396±154 vs 341±168 mmol/L, P=0.061) and serum osmolality (249±30 vs 244±17 vs 245±37 mmol/L, P=0.528). Serum uric acid level was higher in group T than in group P by Scheffe’s post-hoc analysis (P=0.046). All patients were divided into three categories based on the serum sodium level (mild: >125 mmol/L, moderate:
120-125 mmol/L, severe: <120 mmol/L), patient’s symptom (mild: general weakness, moderate: nausea or vomiting, severe: syncope or seizure). Incidences of severe hy- ponatremia and severe symptoms were not different among groups T, P and C (73.1 vs 67.5 vs 71.1 %, P=0.710, 20.4 vs 30.1 vs 17.8 %, P=0.192). Correction time was signifi - cantly different among groups T, P and C (41.98±26.89 vs 34.91±23.96 vs 51.10±43.86 mg/dL, P=0.026). Correction time was longer in group C than group P by Scheffe’s post-hoc analysis (P=0.010).
Conclusions: Serum sodium level and severity of symptoms were not different among groups T, P and C. Correction time was longer in group C than in group P.
PS 0479 Nephrology
Hypotonic Versus Isotonic Fluid Maintenance Therapy on Biochemical Outcomes after Major Surgery
Wei-Ying JEN1, Margaret L TENG2, Wee-Chuan HING3, Valerie MA1, Shridhar Ganpathi IYER4, Chung-Cheen CHAI1, Horng-Ruey CHUA1
Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore1, Department of Medicine, Yong Loo Lin School of Medicine, Singapore2, Department of Pharmacy, National University Hospital, Singapore3, University Surgical Cluster, National University Hospital, Singapore4
Background: Premixed hypotonic solutions of 0.33% saline + 5% dextrose + 10mmol/
L potassium-chloride (0.33S, tonicity 133mEq/L) and 0.9% saline ±dextrose (NS, tonic- ity 308mEq/L) are common peri-operative maintenance fluids, but their effects on serum biochemistry are unclear.
Methods: Using a single-centre, prospectively-maintained electronic database, we retrospectively examined post-operative biochemistry in adults maintained on exclu- sively 0.33S or NS peri-operatively, from March 2012 to September 2013. Outcomes included new-onset post-operative hyponatremia, hypokalaemia, hypoglycaemia, and acute kidney injury (AKI, =1.5x increase in serum creatinine); multivariate analyses were adjusted for demographics, comorbidities, surgery-types/duration, infusion time/
volumes, and hospital length-of-stay.
Results: We studied 279 patients given 0.33S, and 279 NS controls matched for cu- mulative infusion volume. Mean age was 59(±18) years. More NS patients had diabe- tes mellitus, ischemic heart disease and chronic kidney disease (p<0.05). Surgery types included gastrointestinal/hepatobiliary (43%), orthopaedic (30%) and nephrectomy (3%). Mean fl uid volumes administered were 6.9(±3.3)L of 0.33S and 7.1(±5.6)L of NS (p=0.57), with 100% versus 52% of drips containing dextrose, respectively. More 0.33S patients (versus NS) developed hyponatremia (30% versus 17%, p<0.001); this differ- ence was signifi cant for gastrointestinal/hepatobiliary (p=0.001) but not orthopaedic (p=0.74) surgeries. Less 0.33S patients (versus NS) had hypokalaemia (1% versus 10%, p<0.001), hypoglycaemia (1% versus 4%, p=0.01), and AKI (3% versus 8%, p=0.007).
On multivariate analyses, 0.33S, gastrointestinal/hepatobiliary surgeries and nephrec- tomy were independently associated with hyponatremia; while NS, hypertension,
longer infusion hours, and nephrectomy were independently associated with AKI (p<0.05).
Conclusions: 0.33S infusion in post-surgical patients, especially post-gastrointestinal/
hepatobiliary surgeries, is strongly associated with hyponatremia, but with less hypo- kalaemia or hypoglycaemia, compared with NS. The association between NS adminis- tration and AKI is heavily confounded by baseline comorbidities and requires further prospective evaluation. Both fl uid types are not appropriate for isolated use, and more balanced maintenance fl uids are desired.
PS 0480 Nephrology
The Role of Circulating Tumor Necrosis Factor Recep- tor 1 and 2 in Contrast-Induced Nephropathy
Jung Nam AN1, JinHo HWANG2, Hack-Lyoung KIM3, Sang Hyun KIM3, Dong Ki KIM4, Yun Kyu OH1, Yon Su KIM4, Chun Soo LIM1, Jung Pyo LEE1
SMG-SNU Boramae Medical Center, Korea1, Chung-Ang University Hospital, Korea2, SMG-SNU Bora- mae Medical Center, Korea3, Seoul National University Hospital, Korea4
Background: Contrast-induced nephropathy (CIN) is the important cause of hospital acquired acute kidney injury. Accurate understanding of the pathogenesis and the prevention and early intervention of CIN are crucial. Thus, the aim of this study was to evaluate the clinical role of circulating tumor necrosis factor receptors (cTNFRs) as predictors for CIN.
Methods: During the period of May 2013 to February 2014, a total of 262 patients who underwent coronary angiography and/or percutaneous coronary intervention in Seoul National University Boramae Medical Center, were enrolled. CIN was defi ned as either an increase in serum creatinine (sCr) = 0.25 mg/dL or = 25% within 48 hours after procedure.
Results: Male gender was 64.1%, mean age was 64.6 ± 10.9 years, and the patients with diabetes and chronic kidney disease were 27.5% and 17.6%, respectively. Overall patients had fl uid therapy and 36.3% underwent percutaneous coronary intervention.
CIN developed in 4.2% of patients and the risk factors were younger age, underlying diseases as stroke and chronic kidney disease, the use of N-acetylcysteine, and higher levels of ln(cTNFRs). Increased value of ln(cTNFR1) (OR 18.77; 95% CI 2.57-137.00; P
= 0.004) and ln(cTNFR2) (OR 4.79; 95% CI 1.32-17.43; P = 0.018) were signifi cantly associated with the development of CIN after adjusting other risk factors including baseline renal function. Moreover, increased serum cTNFRs were an independent risk factor for renal function deterioration.
Conclusions: Markedly elevated concentrations of circulating TNFRs were correlated with the occurrence of CIN. The higher serum levels of cTNFRs adversely affected prolonged renal dysfunction without regard to CIN.
