Final Stage of Chronic Kidney Disease with Conservative Kidney Management or Renal Replacement Therapy: A Primary-Care Population Study.

BACKGROUND: Studies focus on the incidence and risk factors (RFs) associated with reaching the final stage of chronic kidney disease (CKD-G5) and receiving kidney replacement therapy (KRT). Analysis of those related to reaching CKD-G5 while receiving conservative kidney management (CKM) has been neglected. METHODS: Retrospective cohort study analysing electronic health records of individuals aged ≥ 50 with eGFR < 60 mL/min/m2. Cumulative incidence rates of CKD-G5, with and without KRT, were calculated. Multinomial regression models determined odds ratios (ORs) for CKD-G5 progression with KRT, CKM, or death. RESULTS: Among 332,164 patients, the cumulative incidence of CKD-G5 was 2.79 cases per 100 person-years. The rates were 1.92 for CKD-G5 with KRT and 0.87 for CKD-G5 with CKM. Low eGFR and albuminuria were the primary RFs. Male gender and uncontrolled blood pressure had a greater impact on KRT (OR = 2.63 CI, 1.63) than on CKD-G5 with CKM (OR = 1.45 CI, 1.31). Increasing age and rurality reduced the probability of KRT but increased the probability of CKD-G5 with CKM. Higher incomes decreased the likelihood of developing CKD-G5 with and without KRT (OR = 0.49 CI). CONCLUSION: One-third of CKD-G5 cases receive CKM. Those are typically older, female, rural residents with lower incomes and with lesser proteinuria or cardiovascular RF. The likelihood of receiving KRT is influenced by location and socioeconomic disparities.

Dynamic profiles and predictive values of some biochemical and haematological quantities in COVID-19 inpatients.

INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in some hospitalized patients has shown some important alterations in laboratory tests. The aim of this study was to establish the most relevant quantities associated with the worst prognosis related to COVID-19. MATERIALS AND METHODS: This was a descriptive, longitudinal, observational and retrospective study, in a cohort of 845 adult inpatients from Bellvitge University Hospital (L'Hospitalet de Llobregat, Barcelona, Spain). A multivariate regression analysis was carried out in demographic, clinical and laboratory data, comparing survivors (SURV) and non-survivors (no-SURV). A receiver operating characteristic analysis was also carried out to establish the cut-off point for poor prognostic with better specificity and sensibility. Dynamic changes in clinical laboratory measurements were tracked from day 1 to day 28 after the onset of symptoms. RESULTS: During their hospital stay, 18% of the patients died. Age, kidney disease, creatinine (CREA), lactate-dehydrogenase (LD), C-reactive-protein (CRP) and lymphocyte (LYM) concentration showed the strongest independent associations with the risk of death in the multivariate regression analysis. Established cut-off values for poor prognosis for CREA, LD, CRP and LYM concentrations were 75.0 µmol /L, 320 U/L, 80.9 mg/L and 0.69 x109/L. Dynamic profile of laboratory findings, were in agreement with the consequences of organ damage and tissue destruction. CONCLUSIONS: Age, kidney disease, CREA, LD, CRP and LYM concentrations in COVID-19 patients from the southern region of Catalonia provide important information for their prognosis. Measurement of LD has demonstrated to be very good indicator of poor prognosis at initial evaluation because of its stability over time.

Survey on Stat Tests in Catalan Clinical Laboratories.

INTRODUCTION: The Catalan Association of Clinical Laboratory Sciences (ACCLC) conducted a survey on the vast majority of hospital clinical laboratories in Catalonia. In order to establish a debate on the emergency laboratories and aspects related to the stat tests. MATERIALS AND METHODS: An online survey was distributed by ACCLC to 69 hospital laboratories in Catalonia. A 30-question survey was designed with 9 different issues. The questionnaire examined general information regarding the hospital and laboratory model, stat laboratory workload, laboratory information system, quality control, critical values results, authorization/validation of results, laboratory report and human resources, among others. The results were reported in number of laboratories and in percentage (%). RESULTS: The total survey response rate was 59 %. 68.3 % stat laboratories biochemistry, haematology and microbiology departments were integrated. The majority (60.9%) of the stat tests were integrated in part with laboratory core. All laboratories employed laboratory information system and are using barcode system. In 75.6% of laboratories all requests were made electronically. 43.9% of laboratories did not give results in international system, only in conventional units. All laboratories participated in internal and external quality assessment programs. Internal quality controls are processed more than once a day in 80.5% of laboratories. The vast majority of laboratories reported critical results (97.6%). 75% of laboratories have a medical specialist (biochemistry or analysis). The average number of laboratory technicians was 4. CONCLUSIONS: Our study highlighted the variation in how emergency laboratories and stat test are run across Catalonia.

Stability of pH, Blood Gas Partial Pressure, Hemoglobin Oxygen Saturation Fraction, and Lactate Concentration.

BACKGROUND: The storage temperature and time of blood gas samples collected in syringes constitute preanalytical variables that could affect blood gas or lactate concentration measurement results. We analyzed the effect of storage temperature and time delay on arterial or venous blood gas stability related to pH, partial pressure of carbon dioxide (pCO2) and oxygen (pO2), hemoglobin oxygen saturation (sO2), and lactate concentration. METHODS: In total, 1,200 arterial and venous blood sample syringes were analyzed within 10 minutes of collection. The samples were divided into different groups to determine parameter stability at 25, 4-8, and 0-3.9°C and at different storage times, 60, 45, 30, and 15 minutes. Independent sample groups were used for each analysis. Percentage deviations were calculated and compared with acceptance stability limits (1.65× coefficient of variation). Additionally, sample group sub analysis was performed to determine whether stability was concentration-dependent for each parameter. RESULTS: The pH was stable over all storage times at 4-8 and 0-3.9°C and up to 30 minutes at 25°C. pCO2 was stable at ≤60 minutes at all temperatures. pO2 was stable for 45 minutes at 0-3.9°C, and sO2 was stable for 15 minutes at 25°C and for ≤60 minutes at 0-3.9°C. Lactate concentration was stable for 45 minutes at 0-3.9°C. Subanalysis showed that stability was concentration-dependent. CONCLUSIONS: The strictest storage temperature and time criteria (0-3.9°C, 45 minutes) should be adopted for measuring pH, pCO2, pO2, sO2, and lactate concentration in blood gas syringes.

Critical Issues and New Trends on Stat Tests in Clinical Laboratory.

The IX European Symposium of the Clinical Laboratory and In Vitro Diagnostics Industry, entitled "Stat Tests in Clinical laboratory", took place in Barcelona, Catalonia (Spain), between May 17-18, 2017. The scientific program was structured in several round-tables that dealt with the following topics: emergency laboratory models, accreditation of stat tests by ISO 15189, critical issues of stat tests and the new proposals of the in vitro diagnostics industry for emergency laboratories. The aim of the Symposium was the discussion of the transformation that stat tests have generated on clinical laboratories in terms of organization, turnaround time, accreditation, and probable evolution of these laboratories coming years.

Analysis of laboratory critical values at a referral Spanish tertiary university hospital.

INTRODUCTION: The aim of this study was to analyse critical value data from our laboratory and compare our critical value reporting policy with others in the literature. MATERIALS AND METHODS: Analysis of critical values was performed on data obtained over a 6-month period in a tertiary university hospital. RESULTS: We identified 5723 critical values, of which approximately 80% came from STAT testing (4577), 15% from routine inpatients testing (884) and 5% from routine outpatients testing (262). The highest proportion of critical values corresponded to oxygen partial pressure (17.7%), followed by potassium ion (17.6%) concentrations. The parameters associated with the highest critical value notification percentage in emergency patients were pH, haematocrit, glucose, potassium ion and haemoglobin concentrations. In inpatients, these parameters were glucose, phosphate, haemoglobin, sodium ion and potassium ion concentrations. In outpatients, they were calcium and potassium concentrations. CONCLUSIONS: The analysis of critical values in our hospital is in accordance with that reported in the literature. Our findings demonstrate the importance of incorporating improvement actions not only in critical value notification, but especially in the registration of this activity.

ANRIL as a genetic marker for cardiovascular events in renal transplant patients - an observational follow-up cohort study.

Cardiovascular disease is the leading cause of morbidity and mortality in kidney transplant recipients. Several single-nucleotide polymorphisms (SNPs) in the ANRIL gene pathway have been associated with cardiovascular events (CE). The main objective was to ascertain whether ANRIL (rs10757278) and CARD8 (rs2043211) SNPs could mediate susceptibility to CE. This was an observational follow-up cohort study of renal transplant recipients at Bellvitge University Hospital (Barcelona) from 2000 to 2014. A total of 505 recipients were followed up until achievement of a CE. Patients who did not achieve the endpoint were followed up until graft loss, lost to follow-up or death. Survival analysis was used to ascertain association between genetic markers, clinical data, and outcome. Fifty-three patients suffered a CE after renal transplantation. Results showed a significant association between ANRIL SNP and CE. Homozygous GG for the risk allele showed higher risk for CE than A carriers for the protective allele [HR = 2.93(1.69-5.11), P < 0.0001]. This effect was maintained when it was analyzed in combination with CARD8, suggesting that CARD8 SNP could play a role in the ANRIL mechanism. However, our study does not clarify the molecular mechanism for the CARD8 SNP regulation by ANRIL. ANRIL SNP may predispose to the development of CE after successful kidney transplantation.

Reference intervals for a complete blood count on an automated haematology analyser Sysmex XN in healthy adults from the southern metropolitan area of Barcelona.

BACKGROUND: The examination of peripheral blood is routinely used as a basic test in daily medical practice. Reliable reference intervals are necessary to avoid misdiagnoses, and the establishment of those intervals is an important task for clinical laboratories.The aim of the present study was to establish the reference intervals for complete blood count (CBC) on a Sysmex XN haematology analyser in healthy adults from the southern metropolitan area of Barcelona (Spain). METHODS: A total of 213 apparently healthy adults who received a general health examination at Hospital Universitari de Bellvitge were recruited to this study. Blood samples collected in K3EDTA tubes were analysed on a Sysmex XN. Statistically relevant gender based partition was assessed, outliers removed, and the reference intervals calculated in concordance with Clinical and Laboratory Standards Institute (CLSI) EP28-A3C guidelines. RESULTS: The CBC reference intervals were established in 191 adults (64 men and 127 women) who fulfilled all of the inclusion criteria. Significant gender-dependent differences in red blood cells, haematocrit, haemoglobin and platelets were found. The rest of the CBC reference intervals were obtained from the overall data. CONCLUSIONS: We report CBC reference intervals established on a Sysmex XN analyser, a widely used automated analyser for which reference intervals were previously lacking in the literature. However, these reference intervals we recommend should be validated by individual laboratories for the local population as recommended by CLSI.

Reference interval for immature platelet fraction on Sysmex XN haematology analyser in adult population.

INTRODUCTION: The Sysmex XN-series haematology analyser has newly adopted a fluorescent channel to measure immature platelet fraction (IPF). To promote the clinical utility of this promising parameter, establishing a reliable reference interval is mandatory. According to previous studies, IPF values may be affected by the employed analyser and the ethnic background of the individual, but no differences seem to be found between individuals' genders. Therefore, this study aimed to define the reference interval for IPF in a Spanish population following Clinical and Laboratory Standard Institute (CLSI) guidelines. MATERIALS AND METHODS: A total of 153 healthy Caucasian adults from Spain met the inclusion criteria. IPF measurement was performed by means of a Sysmex XN-2000 haematology analyser. A non-parametric percentile method was used to calculate the reference intervals in accordance with CLSI guidelines. RESULTS: The obtained reference interval for IPF on the Sysmex XN-2000 was 1.6-9.6% (90% confidence intervals (CIs) were 1.5-1.8 and 9.3-11.5, respectively). No significant gender difference in IPF reference intervals was observed (P = 0.101). CONCLUSIONS: This study provides, for the first time, a reference interval for IPF using a Sysmex XN-2000 in a Spanish population, ranging from 1.6 to 9.6%. These data are needed to evaluate platelet production in several conditions such as thrombocytopenia, inflammatory states and cardiovascular diseases, as well as for future research.

Development and validation of a measurement procedure based on ultra-high performance liquid chromatography-tandem mass spectrometry for simultaneous measurement of ß-lactam antibiotic concentration in human plasma.

BACKGROUND: The administration of ß-lactam antibiotics in continuous infusion could let optimize the pharmacokinetic/pharmacodynamic parameters, especially in the treatment of serious bacterial infections. In this context, and also due to variability in their plasmatic concentrations, therapeutic drug monitoring (TDM) may be useful to optimize dosing and, therefore, be useful for the clinicians. MATERIAL AND METHODS: We developed and validated a measurement procedure based on ultra-high performance liquid chromatography-tandem mass spectrometry for simultaneous measurement of amoxicillin, ampicillin, cloxacillin, piperacillin, cefepime, ceftazidime, cefuroxime, aztreonam and meropenem concentrations in plasma. The chromatographic separation was achieved using an Acquity®-UPLC® BEH™ (2.1×100mm id, 1.7µm) reverse-phase C18 column, with a water/acetonitrile linear gradient containing 0.1% formic acid at a 0.4mL/min flow rate. ß-Lactam antibiotics and their internal standards were detected by electrospray ionization mass spectrometry in multiple reaction monitoring mode. RESULTS: Chromatography run time was 7.0min and ß-lactam antibiotics eluted at retention times ranging between 1.08 and 1.91min. The lower limits of quantification were between 0.50 and 1.00mg/L. Coefficients of variation and relative bias absolute values were <13.3% and 14.7%, respectively. Recovery values ranged from 55.7% to 84.8%. Evaluation of the matrix effect showed ion enhancement for all antibiotics. No interferences or carry-over were observed. CONCLUSIONS: Our measurement procedure could be applied to daily clinical laboratory practice to measure the concentration of ß-lactam antibiotics in plasma, for instance in patients with bone and joint infections and critically ill patients.

Measurement of ceftazidime concentration in human plasma by ultra-performance liquid chromatography-tandem mass spectrometry. Application to critically ill patients and patients with osteoarticular infections.

Ceftazidime is an antibiotic belonging to the third generation of the cephalosporin family. It is indicated in the treatment of serious, simple or mixed bacterial infections, and its administration in continuous or intermittent infusion allows optimization of the concentration of antibiotic to keep it above the minimum inhibitory concentration. We developed and validated a chromatographic method by ultra-performance liquid chromatography-tandem mass spectrometry to measure ceftazidime concentration in human plasma. Following extraction with acetonitrile and 1,2-dichloroethane, the chromatographic separation was achieved using an Acquity ® UPLC ® BEH(TM) (2.1 × 100 mm i.d., 1.7 µm) reverse-phase C18 column, with a water-acetonitrile linear gradient containing 0.1% formic acid at a 0.4 mL/min flow rate. Ceftazidime and its internal standard (cefotaxime) were detected by electrospray ionization mass spectrometry in positive ion multiple reaction monitoring mode using mass-to-charge transitions of 547.0 → 467.9/396.1 and 456.0 → 395.8/324.1, respectively. The limit of quantification was 0.58 mg/L and linearity was observed in the range 0.58-160 mg/L. Coefficients of variation and absolute relative biases were <9.8 and 8.4%. The mean recovery for ceftazidime was 74.4 ± 8.1%. Evaluation of the matrix effect showed ion enhancement, and no carry-over was observed. The validated method could be applied to daily clinical laboratory practice to measure the concentration of ceftazidime in plasma.