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Valdenebro M, Portoles J, Serrano Salazar ML, Muñoz Sánchez A, Alameda-Aguado I, Martín Rodriguez L, Zalamea-Jarrin F, López-Sánchez P. Transitions and Long-Term Clinical Outcomes in Patients Admitted in Intensive Care Units Receiving Continuous Renal Replacement Therapy. J Clin Med 2024; 13:5085. [PMID: 39274298 DOI: 10.3390/jcm13175085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
Introduction: Acute kidney injury (AKI) significantly disrupts vital renal functions and is a common and serious condition in intensive care units (ICUs). AKI leads to extended hospital stays, increases mortality rates, and often necessitates nephrology consultations. Continuous renal replacement therapy (CRRT) plays a central role in managing AKI, requiring a multidisciplinary approach involving nephrologists, intensivists, and anesthesiologists. This study examines the clinical profile and progression of AKI in ICU patients requiring CRRT, with a focus on CRRT indications and modalities. Materials and Methods: We conducted a single-center retrospective observational study on ICU patients with AKI requiring CRRT from January to December 2019. AKI diagnosis followed the RIFLE criteria, and patients who received CRRT for less than 36 h were excluded. Data collected included demographics, hemodynamic parameters, and renal function parameters, with follow-ups at 1 week, 1 month, 6 months, and 12 months. Statistical analyses evaluated outcomes and transitions between CRRT and other renal replacement therapies. Results: Among 123 evaluated patients, 95 met inclusion criteria. Fifteen patients received CRRT for less than 36 h, with an early mortality rate of 80%. The final cohort comprised 80 patients who underwent CRRT for over 36 h, with a mean age of 65.3 years (SD = 13.6) and a Charlson index of 6.4. Patients were categorized based on primary diagnosis into heart failure, cardiac surgery, sepsis, other surgeries, and miscellanea groups. Mortality rates were highest in the heart failure and miscellanea groups. Significant variability was observed in therapy transitions and long-term outcomes. Continuous venovenous hemodiafiltration (CVVHDF) was the most frequently used CRRT modality. Conclusions: This study highlights the variability in CRRT practices and the poor prognosis for critically ill patients with AKI requiring CRRT. Timely nephrology consultation and tailored treatment plans may improve patient outcomes and optimize CRRT utilization. Future research should focus on refining CRRT protocols and exploring preventive strategies for AKI.
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Affiliation(s)
- María Valdenebro
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
| | - Jose Portoles
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
- Medicine Department, Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - María Luisa Serrano Salazar
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
| | - Ana Muñoz Sánchez
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
| | | | - Leyre Martín Rodriguez
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
| | - Felipe Zalamea-Jarrin
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
| | - Paula López-Sánchez
- Nephrology Department, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, 28222 Majadahonda, Spain
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Chou YT, Kan WC, Shiao CC. Acute Kidney Injury and Gut Dysbiosis: A Narrative Review Focus on Pathophysiology and Treatment. Int J Mol Sci 2022; 23:ijms23073658. [PMID: 35409017 PMCID: PMC8999046 DOI: 10.3390/ijms23073658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/10/2022] Open
Abstract
Acute kidney injury (AKI) and gut dysbiosis affect each other bidirectionally. AKI induces microbiota alteration in the gastrointestinal (GI) system, while gut dysbiosis also aggravates AKI. The interplay between AKI and gut dysbiosis is not yet well clarified but worthy of further investigation. The current review focuses on the pathophysiology of this bidirectional interplay and AKI treatment in this base. Both macrophages and neutrophils of the innate immunity and the T helper type 17 cell from the adaptive immunity are the critical players of AKI-induced gut dysbiosis. Conversely, dysbiosis-induced overproduction of gut-derived uremic toxins and insufficient generation of short-chain fatty acids are the main factors deteriorating AKI. Many novel treatments are proposed to deter AKI progression by reforming the GI microbiome and breaking this vicious cycle. Data support the benefits of probiotic treatment in AKI patients, while the results of postbiotics are mainly limited to animals. Prebiotics and synbiotics are primarily discussed in chronic kidney disease patients rather than AKI patients. The effect of adsorbent treatment seems promising, but more studies are required before the treatment can be applied to patients. Immune therapy and some repurposed drugs such as allopurinol are prospects of future treatments and are worth more discussion and survey.
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Affiliation(s)
- Yu-Ting Chou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan;
| | - Wei-Chih Kan
- Department of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
- Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan 71703, Taiwan
- Correspondence: (W.-C.K.); (C.-C.S.)
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary’s Hospital Luodong, Yilan 265, Taiwan
- Saint Mary’s Junior College of Medicine, Nursing and Management, Yilan 26647, Taiwan
- Correspondence: (W.-C.K.); (C.-C.S.)
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Vancomycin-Associated Acute Kidney Injury: A Narrative Review from Pathophysiology to Clinical Application. Int J Mol Sci 2022; 23:ijms23042052. [PMID: 35216167 PMCID: PMC8877514 DOI: 10.3390/ijms23042052] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/12/2022] Open
Abstract
Vancomycin is the most frequently used antibiotic, accounting for up to 35% of hospitalized patients with infection, because of its optimal bactericidal effectiveness and relatively low price. Vancomycin-associated AKI (VA-AKI) is a clinically relevant but not yet clearly understood entity in critically ill patients. The current review comprehensively summarizes the pathophysiological mechanisms of, biomarkers for, preventive strategies for, and some crucial issues with VA-AKI. The pathological manifestations of VA-AKI include acute tubular necrosis, acute tubulointerstitial nephritis (ATIN), and intratubular crystal obstruction. The proposed pathological mechanisms of VA-AKI include oxidative stress and allergic reactions induced by vancomycin and vancomycin-associated tubular casts. Concomitant administration with other nephrotoxic antibiotics, such as piperacillin–tazobactam, high vancomycin doses, and intermittent infusion strategies compared to the continuous infusion are associated with a higher risk of VA-AKI. Several biomarkers could be applied to predict and diagnose VA-AKI. To date, no promising therapy is available. Oral steroids could be considered for patients with ATIN, whereas hemodialysis might be applied to remove vancomycin from the patient. In the future, disclosing more promising biomarkers that could precisely identify populations susceptible to VA-AKI and detect VA-AKI occurrence early on, and developing pharmacological agents that could prevent or treat VA-AKI, are the keys to improve the prognoses of patients with severe infection who probably need vancomycin therapy.
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Segarra A, Del Carpio J, Marco MP, Jatem E, Gonzalez J, Chang P, Ramos N, de la Torre J, Prat J, Torres MJ, Montoro B, Ibarz M, Pico S, Falcon G, Canales M, Huertas E, Romero I, Nieto N. Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients. Clin Kidney J 2021; 14:2524-2533. [PMID: 34950463 PMCID: PMC8690094 DOI: 10.1093/ckj/sfab094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background Models developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI. Methods The study set was 36 852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21 545 non-critical patients admitted to the validation centre in the period from June 2017 to December 2018. Results The incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios (ORs) were conferred by chronic kidney disease, urologic disease and liver disease. Among acute complications, the highest ORs were associated with acute respiratory failure, anaemia, systemic inflammatory response syndrome, circulatory shock and major surgery. The model showed an area under the curve (AUC) of 0.907 [95% confidence interval (CI) 0.902–0.908), a sensitivity of 82.7 (95% CI 80.7–84.6) and a specificity of 84.2 (95% CI 83.9–84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (χ2 = 6.02, P = 0.64). In the validation set, the prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904–0.910), a sensitivity of 81.2 (95% CI 79.2–83.1) and a specificity of 82.5 (95% CI 82.2–83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (χ2 = 4.2, P = 0.83). An online tool (predaki.amalfianalytics.com) is available to calculate the risk of AKI in other hospital environments. Conclusions By using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI during the hospital admission period in non-critically ill patients.
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Affiliation(s)
| | | | - Maria Paz Marco
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Elias Jatem
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Jorge Gonzalez
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Pamela Chang
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Natalia Ramos
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Judith de la Torre
- Department of Nephrology, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Nephrology, Althaia Foundation, Manresa, Spain
| | - Joana Prat
- Department of Development, Parc Salut Hospital, Barcelona, Spain
- Department of Informatics, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Maria J Torres
- Department of Informatics, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Information, Southern Metropolitan Territorial Management, Barcelona, Spain
| | - Bruno Montoro
- Department of Hospital Pharmacy, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Mercedes Ibarz
- Laboratory Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Silvia Pico
- Laboratory Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Gloria Falcon
- Technical Secretary and Territorial Management of Lleida-Pirineus, Lleida, Spain
| | - Marina Canales
- Technical Secretary and Territorial Management of Lleida-Pirineus, Lleida, Spain
| | - Elisard Huertas
- Informatic Unit of the Catalonian Institute of Health–Territorial Management, Lleida, Spain
| | - Iñaki Romero
- Territorial Management Information Systems, Catalonian Institute of Health, Lleida, Spain
| | - Nacho Nieto
- Department of Informatics, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Information, Southern Metropolitan Territorial Management, Barcelona, Spain
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An X, Guo X, Ye N, Bian W, Han X, Wang G, Cheng H. Risk factors of acute kidney injury in patients with Stanford type B aortic dissection involving the renal artery who underwent thoracic endovascular aortic repair. Ren Fail 2021; 43:1130-1136. [PMID: 35048774 PMCID: PMC8274498 DOI: 10.1080/0886022x.2021.1949349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Acute kidney injury (AKI) is one of the most common and serious complications in patients with type B aortic dissection (TBAD). This study aimed at investigating the incidence and risk factors of in-hospital AKI in TBAD patients involving the renal artery who underwent thoracic endovascular aortic repair (TEVAR) only. Methods A total of 256 patients who were diagnosed as TBAD combined with renal artery involvement were included in this retrospective study. All patients were divided into the AKI group and the non-AKI group according to the KDIGO criteria. The risk factors for AKI were identified using a multivariate logistic regression model. Results A total of 256 patients were included in this study, and the incidence of AKI was 18% (46/256). Patients in the AKI group were more likely to have a higher proportion of the youth, a higher level of body mass index, and a shorter time from onset to admission. Multivariate logistic regression analysis revealed that the youth (age ≤40 years) (OR: 2.853, 95%CI: 1.061–7.668, p = .038) were prone to AKI, and lower estimated glomerular filtration rate (eGFR) (OR: 1.526, per 15-ml/min/1.73 m2 decrease, 95%CI: 1.114–2.092; p = .009), higher diastolic blood pressure (DBP) (OR: 1.418, per 10-mmHg increase; 95%CI: 1.070–1.879; p = .015), and fasting blood glucose (FBG) ≥7 mmol/L on admission (OR: 2.592; 95%CI: 1.299–5.174; p = .007) were independent risk factors for AKI. Conclusions Higher incidence of AKI had been perceived in this study, most of them were young and middle-aged patients. Renopreventive measures should be considered in those high-risk patients with younger age, lower eGFR, higher DBP, and higher FBG on admission.
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Affiliation(s)
- Xiuping An
- Division of Nephrology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Xi Guo
- Division of Diagnostic and Interventional Radiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Nan Ye
- Division of Nephrology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Weijing Bian
- Division of Nephrology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Han
- Division of Diagnostic and Interventional Radiology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Guoqin Wang
- Division of Nephrology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
| | - Hong Cheng
- Division of Nephrology, Beijing AnZhen Hospital, Capital Medical University, Beijing, China
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Hong X, Zhou Y, Wang D, Lyu F, Guan T, Liu Y, Xiao L. Exogenous Wnt1 Prevents Acute Kidney Injury and Its Subsequent Progression to Chronic Kidney Disease. Front Physiol 2021; 12:745816. [PMID: 34819873 PMCID: PMC8606814 DOI: 10.3389/fphys.2021.745816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/18/2021] [Indexed: 12/17/2022] Open
Abstract
Studies suggest that Wnt/β-catenin agonists are beneficial in the treatment of acute kidney injury (AKI); however, it remains elusive about its role in the prevention of AKI and its progression to chronic kidney disease (CKD). In this study, renal Wnt/β-catenin signaling was either activated by overexpression of exogenous Wnt1 or inhibited by administration with ICG-001, a small molecule inhibitor of β-catenin signaling, before mice were subjected to ischemia/reperfusion injury (IRI) to induce AKI and subsequent CKD. Our results showed that in vivo expression of exogenous Wnt1 before IR protected mice against AKI, and impeded the progression of AKI to CKD in mice, as evidenced by both blood biochemical and kidney histological analyses. In contrast, pre-treatment of ICG-001 before IR had no effect on renal Wnt/β-catenin signaling or the progression of AKI to CKD. Mechanistically, in vivo expression of exogenous Wnt1 before IR suppressed the expression of proapoptotic proteins in AKI mice, and reduced inflammatory responses in both AKI and CKD mice. Additionally, exogenous Wnt1 inhibited apoptosis of tubular cells induced by hypoxia-reoxygenation (H/R) treatment in vitro. To conclude, the present study provides evidences to support the preventive effect of Wnt/β-catenin activation on IR-related AKI and its subsequent progression to CKD.
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Affiliation(s)
- Xue Hong
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yanni Zhou
- Department of Nephrology, Xiamen Hospital Affiliated to Beijing University of Chinese Medicine, Xiamen, China
| | - Dedong Wang
- Department of Nephrology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Fuping Lyu
- Department of Endocrinology and Diabetes, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Tianjun Guan
- Department of Nephrology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Youhua Liu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Liangxiang Xiao
- Department of Nephrology, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
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Del Carpio J, Marco MP, Martin ML, Craver L, Jatem E, Gonzalez J, Chang P, Ibarz M, Pico S, Falcon G, Canales M, Huertas E, Romero I, Nieto N, Segarra A. External validation of the Madrid Acute Kidney Injury Prediction Score. Clin Kidney J 2021; 14:2377-2382. [PMID: 34754433 PMCID: PMC8573016 DOI: 10.1093/ckj/sfab068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background The Madrid Acute Kidney Injury Prediction Score (MAKIPS) is a recently described tool capable of performing automatic calculations of the risk of hospital-acquired acute kidney injury (HA-AKI) using data from from electronic clinical records that could be easily implemented in clinical practice. However, to date, it has not been externally validated. The aim of our study was to perform an external validation of the MAKIPS in a hospital with different characteristics and variable case mix. Methods This external validation cohort study of the MAKIPS was conducted in patients admitted to a single tertiary hospital between April 2018 and September 2019. Performance was assessed by discrimination using the area under the receiver operating characteristics curve and calibration plots. Results A total of 5.3% of the external validation cohort had HA-AKI. When compared with the MAKIPS cohort, the validation cohort showed a higher percentage of men as well as a higher prevalence of diabetes, hypertension, cardiovascular disease, cerebrovascular disease, anaemia, congestive heart failure, chronic pulmonary disease, connective tissue diseases and renal disease, whereas the prevalence of peptic ulcer disease, liver disease, malignancy, metastatic solid tumours and acquired immune deficiency syndrome was significantly lower. In the validation cohort, the MAKIPS showed an area under the curve of 0.798 (95% confidence interval 0.788–0.809). Calibration plots showed that there was a tendency for the MAKIPS to overestimate the risk of HA-AKI at probability rates ˂0.19 and to underestimate at probability rates between 0.22 and 0.67. Conclusions The MAKIPS can be a useful tool, using data that are easily obtainable from electronic records, to predict the risk of HA-AKI in hospitals with different case mix characteristics.
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Affiliation(s)
| | - Maria Paz Marco
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Maria Luisa Martin
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Lourdes Craver
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Elias Jatem
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Jorge Gonzalez
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Pamela Chang
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
| | | | - Silvia Pico
- Institut de Recerca Biomèdica, Lleida, Spain
| | - Gloria Falcon
- Technical secretary and Territorial Management of Lleida-Pirineus, Lleida, Spain
| | - Marina Canales
- Technical secretary and Territorial Management of Lleida-Pirineus, Lleida, Spain
| | - Elisard Huertas
- Territorial Management Information Systems, Catalonian Institute of Health, Lleida, Spain
| | - Iñaki Romero
- Territorial Management Information Systems, Catalonian Institute of Health, Lleida, Spain
| | - Nacho Nieto
- Informatic Unit of the Catalonian Institute of Health-Territorial Management, Lleida, Spain
| | - Alfons Segarra
- Department of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
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Carpio JD, Marco MP, Martin ML, Ramos N, de la Torre J, Prat J, Torres MJ, Montoro B, Ibarz M, Pico S, Falcon G, Canales M, Huertas E, Romero I, Nieto N, Gavaldà R, Segarra A. Development and Validation of a Model to Predict Severe Hospital-Acquired Acute Kidney Injury in Non-Critically Ill Patients. J Clin Med 2021; 10:3959. [PMID: 34501406 PMCID: PMC8432169 DOI: 10.3390/jcm10173959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The current models developed to predict hospital-acquired AKI (HA-AKI) in non-critically ill fail to identify the patients at risk of severe HA-AKI stage 3. OBJECTIVE To develop and externally validate a model to predict the individual probability of developing HA-AKI stage 3 through the integration of electronic health databases. METHODS Study set: 165,893 non-critically ill hospitalized patients. Using stepwise logistic regression analyses, including demography, chronic comorbidities, and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI stage 3. This model was then externally validated in 43,569 non-critical patients admitted to the validation center. RESULTS The incidence of HA-AKI stage 3 in the study set was 0.6%. Among chronic comorbidities, the highest odds ratios were conferred by ischemic heart disease, ischemic cerebrovascular disease, chronic congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease and liver disease. Among acute complications, the highest odd ratios were associated with acute respiratory failure, major surgery and exposure to nephrotoxic drugs. The model showed an AUC of 0.906 (95% CI 0.904 to 0.908), a sensitivity of 89.1 (95% CI 87.0-91.0) and a specificity of 80.5 (95% CI 80.2-80.7) to predict HA-AKI stage 3, but tended to overestimate the risk at low-risk categories with an adequate goodness-of-fit for all risk categories (Chi2: 16.4, p: 0.034). In the validation set, incidence of HA-AKI stage 3 was 0.62%. The model showed an AUC of 0.861 (95% CI 0.859-0.863), a sensitivity of 83.0 (95% CI 80.5-85.3) and a specificity of 76.5 (95% CI 76.2-76.8) to predict HA-AKI stage 3 with an adequate goodness of fit for all risk categories (Chi2: 15.42, p: 0.052). CONCLUSIONS Our study provides a model that can be used in clinical practice to obtain an accurate dynamic assessment of the individual risk of HA-AKI stage 3 along the hospital stay period in non-critically ill patients.
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Affiliation(s)
- Jacqueline Del Carpio
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Maria Paz Marco
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Maria Luisa Martin
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
| | - Judith de la Torre
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
- Department of Nephrology, Althaia Foundation, 08243 Manresa, Spain
| | - Joana Prat
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Development, Parc Salut Hospital, 08019 Barcelona, Spain
| | - Maria J. Torres
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Information, Southern Metropolitan Territorial Management, 08028 Barcelona, Spain
| | - Bruno Montoro
- Department of Hospital Pharmacy, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Mercedes Ibarz
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
- Laboratory Department, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Silvia Pico
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
- Laboratory Department, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Gloria Falcon
- Technical Secretary and Territorial Management of Lleida-Pirineus, 25198 Lleida, Spain; (G.F.); (M.C.)
| | - Marina Canales
- Technical Secretary and Territorial Management of Lleida-Pirineus, 25198 Lleida, Spain; (G.F.); (M.C.)
| | - Elisard Huertas
- Informatic Unit of the Catalonian Institute of Health—Territorial Management, 25198 Lleida, Spain;
| | - Iñaki Romero
- Territorial Management Information Systems, Catalonian Institute of Health, 25198 Lleida, Spain;
| | - Nacho Nieto
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Information, Southern Metropolitan Territorial Management, 08028 Barcelona, Spain
| | | | - Alfons Segarra
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
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9
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Mas-Font S, Herrera-Gutierrez ME, Gómez-González C, Herrera-Rojas D, Montoiro-Allue R, Sánchez-Morán F, García-García MA. Epidemiology of contrast-associated acute kidney injury in critical patients. NEFROCON study. Med Intensiva 2021; 45:e31-e33. [PMID: 34454897 DOI: 10.1016/j.medine.2021.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022]
Affiliation(s)
- S Mas-Font
- Servicio de Medicina Intensiva, Hospital Arnau de Vilanova, Valencia, Spain.
| | - M E Herrera-Gutierrez
- Servicio de Medicina Intensiva, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - C Gómez-González
- Servicio de Medicina Intensiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D Herrera-Rojas
- Servicio de Medicina Intensiva, Hospital de Valme, Sevilla, Spain
| | - R Montoiro-Allue
- Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - F Sánchez-Morán
- Servicio de Medicina Intensiva, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - M A García-García
- Servicio de Medicina Intensiva, Hospital de Sagunto, Sagunto (Valencia), Spain
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10
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Hyperbaric Oxygen Preconditioning Upregulates Heme OxyGenase-1 and Anti-Apoptotic Bcl-2 Protein Expression in Spontaneously Hypertensive Rats with Induced Postischemic Acute Kidney Injury. Int J Mol Sci 2021; 22:ijms22031382. [PMID: 33573145 PMCID: PMC7866496 DOI: 10.3390/ijms22031382] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 12/19/2022] Open
Abstract
Renal ischemia and reperfusion (I/R) injury is the most common cause of acute kidney injury (AKI). Pathogenesis of postischemic AKI involves hemodynamic changes, oxidative stress, inflammation process, calcium ion overloading, apoptosis and necrosis. Up to date, therapeutic approaches to treat AKI are extremely limited. Thus, the aim of this study was to evaluate the effects of hyperbaric oxygen (HBO) preconditioning on citoprotective enzyme, heme oxygenase-1 (HO-1), pro-apoptotic Bax and anti-apoptotic Bcl-2 proteins expression, in postischemic AKI induced in normotensive Wistar and spontaneously hypertensive rats (SHR). The animals were randomly divided into six experimental groups: SHAM-operated Wistar rats (W-SHAM), Wistar rats with induced postischemic AKI (W-AKI) and Wistar group with HBO preconditioning before AKI induction (W-AKI + HBO). On the other hand, SHR rats were also divided into same three groups: SHR-SHAM, SHR-AKI and SHR-AKI + HBO. We demonstrated that HBO preconditioning upregulated HO-1 and anti-apoptotic Bcl-2 protein expression, in both Wistar and SH rats. In addition, HBO preconditioning improved glomerular filtration rate, supporting by significant increase in creatinine, urea and phosphate clearances in both rat strains. Considering our results, we can also say that even in hypertensive conditions, we can expect protective effects of HBO preconditioning in experimental model of AKI.
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11
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Rudd KE, Cizmeci EA, Galli GM, Lundeg G, Schultz MJ, Papali A. Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:87-98. [PMID: 33432912 PMCID: PMC7957240 DOI: 10.4269/ajtmh.20-1242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.
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Affiliation(s)
- Kristina E. Rudd
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elif A. Cizmeci
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Gabriela M. Galli
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ganbold Lundeg
- Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Alfred Papali
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Critical Care and Anaesthesia, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary & Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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12
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Mas-Font S, Herrera-Gutiérrez ME, Gómez-González C, Herrera-Rojas D, Montoiro-Allue R, Sánchez-Morán F, García-García MA. Epidemiology of contrast-associated acute kidney injury in critical patients. NEFROCON study. Med Intensiva 2020; 45:S0210-5691(20)30255-2. [PMID: 32859409 DOI: 10.1016/j.medin.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- S Mas-Font
- Servicio de Medicina Intensiva. Hospital Arnau de Vilanova, Valencia, España.
| | - M E Herrera-Gutiérrez
- Servicio de Medicina Intensiva. Hospital Regional Universitario de Málaga, Málaga, España
| | - C Gómez-González
- Servicio de Medicina Intensiva. Hospital Universitario Virgen del Rocío, Sevilla, España
| | - D Herrera-Rojas
- Servicio de Medicina Intensiva. Hospital de Valme, Sevilla, España
| | - R Montoiro-Allue
- Servicio de Medicina Intensiva. Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - F Sánchez-Morán
- Servicio de Medicina Intensiva. Hospital General Universitario de Castellón, Castellón de la Plana, España
| | - M A García-García
- Servicio de Medicina Intensiva. Hospital de Sagunto, Sagunto (Valencia), España
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13
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Independent Predictive Ability of Procalcitonin of Acute Kidney Injury among Critically Ill Patients. J Clin Med 2020; 9:jcm9061939. [PMID: 32575833 PMCID: PMC7355446 DOI: 10.3390/jcm9061939] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/29/2022] Open
Abstract
It is unclear whether serum procalcitonin (PCT) levels rise in patients with acute kidney injury (AKI), and it is also unclear whether the elevation of PCT levels in this setting is independent of the existence of infection and impaired renal clearance. We conducted a retrospective study in a regional teaching hospital in Taiwan to evaluate the AKI-predictive ability of serum PCT among critically ill patients. We enrolled 330 patients (mean age, 70.5 ± 16.4 years; 57.0% men) who were admitted to the intensive care unit (ICU) from 1 July 2016, to 31 December 2016, and who had serum PCT measurement performed within 24 h after ICU admission. We used the generalized additive model and generalized linear model to evaluate the association of serum PCT levels and renal function variables. In addition, we used the multivariate logistic regression method to demonstrate serum PCT level as an independent predictor of AKI in both the non-infected patients (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.12–1.71, p = 0.003) and the infected patients (OR = 1.23, 95% CI = 1.03–1.46, p = 0.020). In conclusion, serum PCT level at ICU admission is an independent predictor of developing AKI irrespective of infection among critically ill patients.
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14
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Kovacevic S, Ivanov M, Miloradovic Z, Brkic P, Vajic UJ, Zivotic M, Mihailovic-Stanojevic N, Jovovic D, Karanovic D, Jeremic R, Nesovic-Ostojic J. Hyperbaric oxygen preconditioning and the role of NADPH oxidase inhibition in postischemic acute kidney injury induced in spontaneously hypertensive rats. PLoS One 2020; 15:e0226974. [PMID: 31914135 PMCID: PMC6948727 DOI: 10.1371/journal.pone.0226974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 12/09/2019] [Indexed: 12/14/2022] Open
Abstract
Renal ischemia/reperfusion injury is a common cause of acute kidney injury (AKI) and hypertension might contribute to the increased incidence of AKI. The purpose of this study was to investigate the effects of single and combined hyperbaric oxygen (HBO) preconditioning and NADPH oxidase inhibition on oxidative stress, kidney function and structure in spontaneously hypertensive rats (SHR) after renal ischemia reperfusion injury. HBO preconditioning was performed by exposing to pure oxygen (2.026 bar) twice a day for two consecutive days for 60 minutes, and 24h before AKI induction. For AKI induction, the right kidney was removed and ischemia was performed by clamping the left renal artery for 45 minutes. NADPH oxidase inhibition was induced by apocynin (40 mg/kg b.m., intravenously) 5 minutes before reperfusion. AKI significantly increased renal vascular resistance and reduced renal blood flow, which were significantly improved after apocynin treatment. Also, HBO preconditioning, with or without apocynin treatment showed improvement on renal hemodynamics. AKI significantly increased plasma creatinine, urea, phosphate levels and lipid peroxidation in plasma. Remarkable improvement, with decrease in creatinine, urea and phosphate levels was observed in all treated groups. HBO preconditioning, solitary or with apocynin treatment decreased lipid peroxidation in plasma caused by AKI induction. Also, combined with apocynin, it increased catalase activity and solitary, glutathione reductase enzyme activity in erythrocytes. While AKI induction significantly increased plasma KIM– 1 levels, HBO preconditioning, solitary or with apocynin decreased its levels. Considering renal morphology, significant morphological alterations present after AKI induction were significantly improved in all treated groups with reduced tubular dilatation, tubular necrosis in the cortico-medullary zone and PAS positive cast formation. Our results reveal that NADPH oxidase inhibition and hyperbaric oxygen preconditioning, with or without NADPH oxidase inhibition may have beneficial effects, but their protective role should be evaluated in further studies.
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Affiliation(s)
- Sanjin Kovacevic
- Department of Pathophysiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
- * E-mail: (SK); (JNO)
| | - Milan Ivanov
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Zoran Miloradovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Predrag Brkic
- Department of Medical Physiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Una Jovana Vajic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Maja Zivotic
- Department of Pathology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Nevena Mihailovic-Stanojevic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Djurdjica Jovovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Danijela Karanovic
- Institute for Medical Research, Department of Cardiovascular Physiology, University of Belgrade, Belgrade, Serbia
| | - Rada Jeremic
- Department of Medical Physiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Jelena Nesovic-Ostojic
- Department of Pathophysiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
- * E-mail: (SK); (JNO)
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15
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Zamorskii II, Drachuk VM, Shchudrova TS, Goroshko OM, Kopchuk TG. Amelioration of Rhabdomyolysis-Induced Acute Kidney Injury by Ademetionine. Biophysics (Nagoya-shi) 2019. [DOI: 10.1134/s0006350919050257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Onuigbo MA, Samuel E, Agbasi N. Hospital-acquired nephrotoxic exposures in the precipitation of acute kidney injury – A case series analysis and a call for more preventative nephrology practices. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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