BACKGROUND AND AIMS Acute kidney injury (AKI) is a common complication among patients hospitalized with COVID-19. The incidence of AKI is estimated to be around 5%–80%, according to the series, but data on renal function evolution is limited. Our main objective was to describe the incidence of AKI in patients with SARS-CoV-2 infection; secondarily, we analysed the severity of AKI and medium-term renal function evolution in these patients. METHOD A retrospective observational study that included patients hospitalized a single hospital, diagnosed with SARS-CoV-2 infection, who developed AKI (March-May 2020). We register clinical and demographic characteristics, creatinine upon admission and prior to discharge, as well as creatinine and CKD-EPI glomerular filtration rate (eGFR) after at least 3 months after discharge. CKD was defined according to KDIGO stages based on the eGFR (G3-G5). The KDIGO classification was used to define and classify AKI. Recovery of kidney function was defined as difference in at discharge or post-hospitalization creatinine < 0.3 mg/dL with respect basal creatinine. The clinical follow-up ranged from admission to death or end of study. RESULTS Of 258 patients hospitalized with SARS-CoV-2 infection, AKI occurred in 73 (28.3%). 63% (n = 46) were men; the mean of age was 69 years (57–76). DRA severity: 35 (48%) KDIGO-1, 15 (21%) KDIGO-2 and 23 (31%) KDIGO-3. The mean stay was associated with the severity of AKI: 7 days (3–11) for KDIGO-1, 11 days for KDIGO-2 (5–22) and 12 days (8–35) for KDIGO-3 (P = .02). The stage of CKD established differences in the severity of AKI: 66.6% (n = 6) of the patients with CKD G4–G5 presented AKI-KDIGO 3 versus only 25.0% (n = 4) in the CKD-G3 patients (P = .02). Admission to the ICU was more frequent in KDIGO 2–3 versus KDIGO-1 [39% (n = 15) versus 9% (n = 3); P < .01]. Of the 48 patients discharged, 30 (62.5%) had recovered their baseline renal function upon discharge. Only 2 are still on RRT after 8 months (2.7% of all patients). Of the 25 patients died (34% of patients with AKI) with a median time of 3 days from DRA diagnosis (1–8). Renal function of 35 patients was monitored, which correspond to 19 (54%) KDIGO-1, 8 (23%) KDIGO-2, 8 (23%) KDIGO-3 stages. In these patients, analytical control starting 3 months after hospitalization revealed FG 66 (SD 30; 56–76) mL/min/1.73 m2. We have not found differences in renal function between pre- and post-hospitalization in related test. A total of 77% (n = 37) of discharged patients recovered their baseline renal function in the post-hospitalization control. CONCLUSION The incidence of AKI in the context of COVID-19 in our series was 28.3%, with an associated mortality of 34.2%. Most of the patients presented with AKI KDIGO 1 (47.9%). The severity of AKI is associated with a longer hospital stay, admission to the ICU and the requirement for RRT. The advanced stages of CKD pre-admission showed more severity of AKI. The maintenance in TRS in our series has been 2.7%. Patients who were discharged for recovery/improvement of COVID-19 had normalized kidney function during subsequent follow-up, regardless of the severity of the AKI developed on admission for COVID-19.

Background and Aims Tunneled catheter-related bacteremia (TCRB) is a common and severe cause of bacteremia among hemodialysis (HD)-dependent patients. TCRB have reported incidence of 0.5 to 5.5 events per 1000 catheter days and are associated with increased morbidity and death. The main objetive of our study is determinate the incidence of TCRB in our hospital and, secondarily, to analyze our microbiology, recurrence and reinfection rates. Method The study is an observational retrospective evaluation of medical records of patients in whom a TC for HD was implanted in the period from January 1, 2005, to December 31, 2018. The TC were implanted by nephrologists, following a preimplantation and management protocol agreed with the Infectious Diseases Unit. Patients were followed up from TC insertion until the study end date or first of recovery kidney function, kidney transplantation, transition to peritoneal dialysis or death. CRB definition was according Spanish Clinical Guidelines on Vascular Access for Haemodialysis: positive blood culture accompanied by fever or clinical signs of sepsis, without another posible site of infection. We recorded demographic, clinical and TC-related variables (conditions of catheter insertion, site of catheter insertion and duration of use, etc.). Exclusion criteria for our study were the lack of clinical follow-up due to belonging to a different hospital area. Results A total of 393 TC were implantated over a period of 13 years. After applying exclusion criteria, we investigated 341 TC implanted in 279 patients: 265 into the intern jugular vein, 71 into the subclavian and 5 in femoral vein. The mean age of the included patients was 63 (range 19-93 years). Fifty-one percent of catheter was implanted in male patients. Forty-six percent of the patients suffered from diabetes mellitus. In 55% of the cases, the cause of CT implantation was the difficulty of creating an internal vascular access. In total there were 91 CRB in 58 patients, with a rate of 0.48 infections per 1000 catheter days (figure 1), occurring at median 461 days (range 143-443 days) after catheter insertion. Within that group, 82.4% occurred after 6 months from the implementation of the CPT. Only 6 (6.59%) took place in the 30 days after implantation. Gram-positive organisms accounted of 85%, with a predominance of Staphylococcus epidermidis (47%) followed by Staphylococcus aureus (25%). A broad spectrum of Gram-negative bacteria accounts for 14% of patients. Nineteen TC were removed by CRB, with a rate of 5.5% of total functioning TC. CRB was the cause of death in 7 of the 279 patients (2.5%). During the study, 12 (13% of CRB) recurrences and 30 (32% of CRB) reinfections events have been identified. Conclusion The incidence of CRB in our population was found to be lower that previous studies. It usually appears in the long term, with Gram-positive germs as the most frequently involved. The temporality and low recurrence rate suggest that our protocol has been effective. The high rate of reinfection orients a certain individual predisposition to suffer from CRB. Identification of potential predicting risk factors could reduce the morbimortality of these patients.

Background and Aims Hyperkalemia constitutes an electrolyte imbalance that frequently appears in patients with Chronic Renal Disease (CKD) and is related to an increase in morbidity and mortality. Today, computerization of laboratory systems allows us to have access to these data to analyze the real prevalence of hyperkalemia in these patients, which we currently do not know. Our purpose is to analyze the frequency and characteristics of nephrologic patients with hyperkalemia and identify the most prevalent areas. Method Using a coding established by the laboratory, we have selected all patients with potassium greater than 5.5 mEq / l in analytics requested by any nephrologist of our hospital during the months of January to March 2019. It was established as mild hyperkalemia values up to 5.5mEq / l, and up to 6.5 mEq / l, severe hyperkalemia. We retrospectively analyzed the characteristics of these patients and the prevalence according to etiology and units within our service, relating potassium levels to the prescription of hyperkalemiant or related drugs. Results After analyzing the data, using as a reference the total number of patients seen in each area, we obtain an estimated total prevalence of 3.5% (86/2480). We found a distribution by sex with a predominance of men (56%), with a mean age of 62 years. The highest prevalence is obtained in the Hemodialysis unit (39.8%), followed by Peritoneal Dialysis (11%), Transplantation (5%), Hospitalization (4.3%), Interconsultations (3.8%), ERCA (2.7%) and External Consultations (0.6%). 65% had moderate hyperkalemia (defined as potassium levels of 5.5-6.5 mEq / l). Regarding the etiology of CKD, the most prevalent were: Vascular (29.2%), Diabetic (20.7%), Glomerular (19.5%) and Interstitial (14.6%). These etiologies also coincide with higher mean potassium levels, although without significant differences. There is also an increase in potassium levels the lower the glomerular filtration rate. However, when performing linear regression analysis we found no significant differences. Analyzing the drugs, it should be noted that the patients with the highest potassium levels were those taking anticoagulants, anticalcineurinics or resins (mean 6.17 mEq / l), finding significant differences only with the resins. In addition, most did not take ACE inhibitors, ARA-II or Beta blockers. Conclusion The prevalence of hyperkalemia in our population represents 3.5%. Being in most cases mild-moderate. The prevalence of hyperkalemia is higher in protein and kidney nephropathies and vascular nephropathies, probably associated with increased use of antiproteinuric drugs with hyperkalemic effect. Hyperkalemia is more prevalent in patients in patients undergoing renal replacement therapy reaching 40% in hemodialysis. The prevalence in CKD has been lower than expected, possibly in relation to greater patient awareness and adherence to the indications. Despite not finding a significant relationship, (due to the size of the sample) there is a relationship with the prescription of hyperkalemiant drugs. Resin prescription does not correct hyperkalemia

Background and Aims Acute Kidney Injury (AKI) is an insufficiently reported clinical entity with significant impact on overall mortality, hospital stay and associated costs, increasing the risk of progression to Chronic Kidney Disease. It is especially relevant in hospitalized patients, where the incidence has doubled in the last decade, reaching 22-25%. Aims: Know the reported incidence of AKI in the Andalusian Autonomous Community, and its impact on mortality, average stay and associated costs. Method Cross-sectional descriptive study that analyzes data from all Andalusian hospitals, extracted from CMBDA corresponding to 2017. Hospitalization episodes, reference units, episodes with AKI at discharge, exitus and average stays were collected. An associated cost estimate analysis was also carried out using as reference the costs/day hospitalization in each SAS Assistance Unit according to BOJA Number 218 (14nov2016). The groups were compared according to the presence of the diagnosis of AKI. Results There were 525,757 hospital admissions in Andalusia; 25,727 reported the diagnosis of AKI at discharge, assuming an incidence of 4.89%. Patients with AKI total 316,938 stays, with an average stay of 15.5 + 13.8 days, compared to 6.5 + 6 days in which they have no associated diagnosis (p <0.01). The estimated costs associated with the diagnosis of AKI were 168,922,706 euros, with a cost / episode of 24,693 euros vs 3796 in the rest (p <0.01) (AKI/noAKI cost ratio: 6.5), and a cost / day / patient of 823 + 437 euros for AKI compared to 571 euros in the rest. The overall mortality associated with AKI was 26.8% (median 16.6%) vs. 4.76% (median 0.7%) in the rest (p <0.01). AKI/noAKI mortality ratio: 16. These data may be underestimated since the completion of the CMBDA is not complete in all hospitals and also the diagnosis of AKI may have been present and not reported upon discharge. Estimated costs did not include dialysis sessions. Conclusion The incidence of hospital AKI in our Autonomous Community is lower than that reported in the literature, probably due to inadequate reporting to CMBD. In spite of the limitations, our data show the impact of the diagnosis of AKI in hospitalized patients, multiplying by 2.5 the average stay, by 6.5 the associated costs and by 16 mortality, assuming a big problem Public Health that makes it imperative to develop measures to reduce the impact it entails.

Background and Aims The AKI index is increasing, reaching 22% in hospitalized patients. Despite the negative impact it implies, in daily practice its management remains suboptimal and there is little awareness of the problem. Aims: Know the incidence of AKI in a Third-level hospital; its impact on mortality, average stay and associated costs. Method Descriptive cross-sectional study of data extracted from CMBDA corresponding to a third level hospital during 2016-17. We analyze: hospitalization episodes, referral assistance units, AKI episodes at discharge, stays and exitus. To calculate associated costs, we use as reference the costs/day-hospitalization per Healthcare Unit in SAS according to BOJA-Number 218 (14nov2016). We compare groups according to presence/no AKI. Limitations: These data may be underestimated since the diagnosis of AKI may be present and not reported upon discharge; Nor do we include dialysis costs. Results 56,816 revenues were produced; 3,589 reported AKI (incidence: 6.31%). Patients with AKI add 42,801 stays; Average stay of 18.4 days in 2016, 16.4 in 2017, compared to 6.6 and 8.7 days respectively when FRA is not associated (p <0.01). The estimated costs associated with the FRA were 22,815,558 euros, with a cost / episode of 6023 euros, compared to 3523 euros in patients without FRA. The overall associated mortality AKI was 23.2% vs 11% in the rest (p <0.01). Average stay, costs and mortality vary widely according to the Assistance Units, the impact being especially worrying in Surgical Units (table). Conclusion The incidence of AKI in our hospital lower than that referred to in the literature probably responds to inadequate registration in discharge reports. Despite the limitations, our data demonstrate the impact of the diagnosis of AKI in hospitalized patients, doubling the average stay, costs and mortality. These differences are accentuated in some Assistance Units, being especially alarming in Surgical Units.