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USE OF PROTON PUMP INHIBITORS AND THE RISK OF HYPOMAGNESEMIA: A META-ANALYSIS OF OBSERVATIONAL STUDIES
NKF 2015 Spring Clinical Meetings Abstracts
45 HYPOMAGNESEMIA LINKED TO DEPRESSION: A METAANALYSIS Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Wonngarm Kittanamongkolchai, Stephen B Erickson Mayo Clinic, Rochester, MN, USA. The reported risk of depression in patients with hypomagnesemia is contoroversial. The objective of this meta-analysis was to assess the association between depression and hypomagnesemia. A literature search was performed using MEDLINE, EMBASE, Cochrane Database and clinicaltrials.gov from inception through October 2014. Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of depression in patients with hypomagnesemia were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Six observational studies (three cohort studies, two crosssectional studies and a case-control study) with a total of 19,137 patients were identified and included in the data analysis. The pooled risk ratio (RR) of depression in patients with hypomagnesemia was 1.34 (95% CI, 1.01 - 1.79). The association between depression and hypomagnesemia was marginally insignificant after the sensitivity analysis including only cohort and case-control studies with a pooled RR of 1.38 (95% CI, 0.92 – 2.07). Our study demonstrates a potential association between hypomagnesemia and depression. Further studies assessing the benefits of treatment hypomagnesemia in patients with depression are needed.
46 OPTIMUM METHODOLOGY FOR ESTIMATING BASELINE SERUM CREATININE FOR THE ACUTE KIDNEY INJURY DIAGNOSIS AND STAGING Wisit Cheungpasitporn, Charat Thongprayoon, Narat Srivali, Wonngarm Kittanamongkolchai, Patompong Ungprasert, Kianoush Kashani Mayo Clinic, Rochester, MN, USA. Accurate determination of baseline serum creatinine (SCr) would affect the time to diagnosis, classification of AKI. This is a single-center retrospective study conducted at a tertiary referral hospital. All adult ICU patients between January and December 2011, who at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed in this study. The baseline SCr was calculated using either the most recent (SCrrec) or the minimum (SCrmin) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on SCr criterion for AKI of KDIGO definition. The primary outcome was 60-day mortality after ICU admission. Results: Of 9,277 ICU patients, 4,020 were included in the analysis. AKI was detected in 1,204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrrec (P<0.001). While SCrmin and SCrrec agreed in 945 AKI cases, the SCrmin measurement detected AKI earlier than using SCrrec for 1.6 hours (95% CI, 0.9-2.3). Regardless of baseline SCr methodology, the 60-day mortality risk of patients diagnosed with AKI was significantly increased compared to patients without AKI (OR = 3.74; 95% CI, 2.98-4.70). Similarly, the risk of 60-day mortality in patients who met AKI criteria using the SCrmin, but not the SCrrec, was significantly higher than in patients without AKI (OR= 2.04; 95% CI, 1.36-3.00). The C-statistic in predicting 60-day mortality for SCrmin and SCrrec as baseline SCr were 0.70 and 0.68, respectively (P=0.001). Using the minimum value of preadmission SCr as a baseline kidney function can not only detect more AKI cases, but can diagnose AKI sooner. In addition, the use of SCrmin provides better predictive ability for 60-day mortality.
A26
47 TREATMENT EFFECT AND SAFETY OF HIGH FLUID INTAKE FOR THE PREVENTION OF INCIDENT AND RECURRENT KIDNEY STONES: A META-ANALYSIS Wisit Cheungpasitporn, Stephen B Erickson and John C Lieske Mayo Clinic, Rochester, MN, USA. The objectives of this meta-analysis were to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. A literature search was performed from inception through July 2014. Studies that reported relative risks, odds ratios or hazard ratios comparing the risk of kidney stones in patients with high fluid intake vs inadequate fluid intake were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect, generic inverse variance method. Nine studies (2 randomised controlled trials [RCTs]; 7 observational studies) with 273,954 patients were included in the meta-analysis. The pooled RRs of kidney stones in patients with high-fluid intake were 0.40 (95% CI 0.20–0.79) and 0.49 (0.34–0.71) in RCTs and observational studies, respectively. High fluid intake was also significantly associated with reduced recurrent kidney stone risk, with RRs of 0.40 (95% CI 0.20–0.79) and 0.20 (0.09–0.44) in RCTs and observational studies, respectively. Data on compliance and safety of high fluid intake treatment were limited; 1 RCT reported no withdrawals due to adverse events. This meta-analysis demonstrated a significantly reduced risk of incident kidney stones among individuals with high fluid consumption. High fluid consumption also reduced the risk of recurrent kidney stones. Furthermore, the magnitude of risk reduction (~0.5 in both cases) was high. Although increased fluid intake appears to be safe, future studies on its safety in patients with high risk of volume overload or hyponatremia are warranted.
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
Am J Kidney Dis. 2015;65(4):A1-A93
45 HYPOMAGNESEMIA LINKED TO DEPRESSION: A METAANALYSIS Wisit Cheungpasitporn, Charat Thongprayoon, Michael A Mao, Wonngarm Kittanamongkolchai, Stephen B Erickson Mayo Clinic, Rochester, MN, USA. The reported risk of depression in patients with hypomagnesemia is contoroversial. The objective of this meta-analysis was to assess the association between depression and hypomagnesemia. A literature search was performed using MEDLINE, EMBASE, Cochrane Database and clinicaltrials.gov from inception through October 2014. Studies that reported odds ratios, relative risks or hazard ratios comparing the risk of depression in patients with hypomagnesemia were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Six observational studies (three cohort studies, two crosssectional studies and a case-control study) with a total of 19,137 patients were identified and included in the data analysis. The pooled risk ratio (RR) of depression in patients with hypomagnesemia was 1.34 (95% CI, 1.01 - 1.79). The association between depression and hypomagnesemia was marginally insignificant after the sensitivity analysis including only cohort and case-control studies with a pooled RR of 1.38 (95% CI, 0.92 – 2.07). Our study demonstrates a potential association between hypomagnesemia and depression. Further studies assessing the benefits of treatment hypomagnesemia in patients with depression are needed.
46 OPTIMUM METHODOLOGY FOR ESTIMATING BASELINE SERUM CREATININE FOR THE ACUTE KIDNEY INJURY DIAGNOSIS AND STAGING Wisit Cheungpasitporn, Charat Thongprayoon, Narat Srivali, Wonngarm Kittanamongkolchai, Patompong Ungprasert, Kianoush Kashani Mayo Clinic, Rochester, MN, USA. Accurate determination of baseline serum creatinine (SCr) would affect the time to diagnosis, classification of AKI. This is a single-center retrospective study conducted at a tertiary referral hospital. All adult ICU patients between January and December 2011, who at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed in this study. The baseline SCr was calculated using either the most recent (SCrrec) or the minimum (SCrmin) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on SCr criterion for AKI of KDIGO definition. The primary outcome was 60-day mortality after ICU admission. Results: Of 9,277 ICU patients, 4,020 were included in the analysis. AKI was detected in 1,204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrrec (P<0.001). While SCrmin and SCrrec agreed in 945 AKI cases, the SCrmin measurement detected AKI earlier than using SCrrec for 1.6 hours (95% CI, 0.9-2.3). Regardless of baseline SCr methodology, the 60-day mortality risk of patients diagnosed with AKI was significantly increased compared to patients without AKI (OR = 3.74; 95% CI, 2.98-4.70). Similarly, the risk of 60-day mortality in patients who met AKI criteria using the SCrmin, but not the SCrrec, was significantly higher than in patients without AKI (OR= 2.04; 95% CI, 1.36-3.00). The C-statistic in predicting 60-day mortality for SCrmin and SCrrec as baseline SCr were 0.70 and 0.68, respectively (P=0.001). Using the minimum value of preadmission SCr as a baseline kidney function can not only detect more AKI cases, but can diagnose AKI sooner. In addition, the use of SCrmin provides better predictive ability for 60-day mortality.
A26
47 TREATMENT EFFECT AND SAFETY OF HIGH FLUID INTAKE FOR THE PREVENTION OF INCIDENT AND RECURRENT KIDNEY STONES: A META-ANALYSIS Wisit Cheungpasitporn, Stephen B Erickson and John C Lieske Mayo Clinic, Rochester, MN, USA. The objectives of this meta-analysis were to evaluate the treatment effect of high fluid intake on the incidence of kidney stones, and to assess the compliance and safety of high fluid intake to prevent kidney stones. A literature search was performed from inception through July 2014. Studies that reported relative risks, odds ratios or hazard ratios comparing the risk of kidney stones in patients with high fluid intake vs inadequate fluid intake were included. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect, generic inverse variance method. Nine studies (2 randomised controlled trials [RCTs]; 7 observational studies) with 273,954 patients were included in the meta-analysis. The pooled RRs of kidney stones in patients with high-fluid intake were 0.40 (95% CI 0.20–0.79) and 0.49 (0.34–0.71) in RCTs and observational studies, respectively. High fluid intake was also significantly associated with reduced recurrent kidney stone risk, with RRs of 0.40 (95% CI 0.20–0.79) and 0.20 (0.09–0.44) in RCTs and observational studies, respectively. Data on compliance and safety of high fluid intake treatment were limited; 1 RCT reported no withdrawals due to adverse events. This meta-analysis demonstrated a significantly reduced risk of incident kidney stones among individuals with high fluid consumption. High fluid consumption also reduced the risk of recurrent kidney stones. Furthermore, the magnitude of risk reduction (~0.5 in both cases) was high. Although increased fluid intake appears to be safe, future studies on its safety in patients with high risk of volume overload or hyponatremia are warranted.
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Am J Kidney Dis. 2015;65(4):A1-A93