The Role of Pre- and Post-Transplant Hydration Status in Kidney Graft Recovery and One-Year Function.

Background and Objectives: Early improvements to graft function are crucial for good outcomes in kidney transplantation (kTx). Various factors can influence early graft function. This study aimed to evaluate the pre- and post-transplant hydration statuses of kTx recipients using bioimpedance analysis (BIA) and lung ultrasonography (LUS) and to investigate the hydration status' relationship with the function of the transplanted kidney during the first year after transplantation. Materials and Methods: This observational prospective cohort study included deceased kidney recipients transplanted in the Hospital of the Lithuanian University of Health Sciences between September 2016 and January 2023. BIA and LUS were performed before transplantation, on days 3 and 7, and at discharge. Data on recipient and donor clinical characteristics were collected. Graft function was evaluated according to the serum creatinine reduction ratio and the need for dialysis. Hydration status was evaluated by calculating B-lines (BL) on LUS and the ratio of extracellular/total body water on BIA. Results: Ninety-eight kTx recipients were included in the study. Patients with immediate graft function (IGF) were compared to those with slow or delayed graft function (SGF + DGF). Recipients in the SGF + DGF group had a higher sum of BL on LUS before transplantation. After transplantation in early postoperative follow-up, both groups showed hyperhydration as determined by BIA and LUS. After one year, recipients with no BL before transplantation had better graft function than those with BL. Logistic regression analysis showed that having more than one BL in LUS was associated with a 2.5 times higher risk of SGF or DGF after transplantation. Conclusions: This study found that lung congestion detected by LUS before kTx was associated with slower graft recovery and worse kidney function after 1 year. Meanwhile, the hyperhydration status detected by BIA analysis did not correlate with the function of the transplanted kidney.

Assessment of Fluid Status by Bioimpedance Analysis and Central Venous Pressure Measurement and Their Association with the Outcomes of Severe Acute Kidney Injury.

Background and Objectives: Fluid disbalance is associated with adverse outcomes in critically ill patients with acute kidney injury (AKI). In this study, we intended to assess fluid status using bioimpedance analysis (BIA) and central venous pressure (CVP) measurement and to evaluate the association between hyperhydration and hypervolemia with the outcomes of severe AKI. Materials and Methods: A prospective study was conducted in the Hospital of the Lithuanian University of Health Sciences Kauno Klinikos. Forty-seven patients treated at the Intensive Care Unit (ICU) with severe AKI and a need for renal replacement therapy (RRT) were examined. The hydration level was evaluated according to the ratio of extracellular water to total body water (ECW/TBW) of bioimpedance analysis and volemia was measured according to CVP. All of the patients were tested before the first hemodialysis (HD) procedure. Hyperhydration was defined as ECW/TBW > 0.39 and hypervolemia as CVP > 12 cm H2O. Results: According to bioimpedance analysis, 72.3% (n = 34) of patients were hyperhydrated. According to CVP, only 51.1% (n = 24) of the patients were hypervolemic. Interestingly, 69.6% of hypovolemic/normovolemic patients were also hyperhydrated. Of all study patients, 57.4% (n = 27) died, in 29.8% (n = 14) the kidney function improved, and in 12.8% (n = 6) the demand for RRT remained after in-patient treatment. A tendency of higher mortality in hyperhydrated patients was observed, but no association between hypervolemia and outcomes of severe AKI was established. Conclusions: Three-fourths of the patients with severe AKI were hyperhydrated based on bioimpedance analysis. However, according to CVP, only half of these patients were hypervolemic. A tendency of higher mortality in hyperhydrated patients was observed.

Impact of hospitalization on potentially inappropriate prescribing: a cross-sectional study in an acute geriatric hospital in Lithuania.

Background Potentially inappropriate prescribing is frequent among elderly patients admitted to hospitals in many countries. However, the impact of hospitalization on potentially inappropriate medications and potential prescribing omissions has not been studied in depth. Objective This study aimed to investigate the impact of hospitalization on the prevalence of potentially inappropriate medications and potential prescribing omissions among elderly patients admitted to and discharged from an acute care geriatric clinic. Setting Geriatric wards of a teaching hospital in Lithuania. Method This observational cross-sectional study included 76 subjects aged ≥ 65 years. The Beers 2015 Criteria, the EU(7)-PIM list, and the second versions of the Screening Tool of Older Person's Prescriptions and the Screening Tool to Alert doctors to Right Treatment were applied to detect potentially inappropriate medications and potential prescribing omissions. Data were extracted from patient's medical records. Main outcome measure Prevalence of potentially inappropriate medications and potential prescribing omissions on hospital admission and hospital discharge. Results Potentially inappropriate medications were identified among 44.7% to 69.7% of patients upon hospital admission and 59.2% to 72.4% upon hospital discharge. The prevalence of potentially inappropriate medications had increased upon discharge based on each set of criteria. Potential prescribing omissions were detected in 93.4% of patients at admission and 96.1% of patients at discharge. Conclusion Potentially inappropriate prescribing is highly prevalent among older patients hospitalized in the studied setting in Lithuania and hospitalization had not reduced potentially inappropriate medications and potential prescribing omissions. There is a need for interventions aiming to reduce potentially inappropriate prescribing among elderly patients.