WCN26-5036 ULTRASOUND GUIDED INSERTION OF TRANSHEPATIC HEMODIALYSIS CATHETERS WITH POST-INSERTION X-RAY; A LIFESAVING TECHNIQUE

higher likelihood of urgent dialysis initiation and early mortality.Body mass index (BMI) has been proposed as a risk factor for PO-AKI, but findings are inconsistent, and data on urgent-start dialysis are limited.We aimed to evaluate the association between BMI and postoperative urgent-start hemodialysis after lower gastrointestinal (GI) surgery.Methods: This retrospective observational cohort study used data from the nationwide administrative claims and the DPC database.In brief, >1,000 hospitals, including all 81 academic hospitals in Japan, contribute to the DPC database.Approximately 7,000,000 cases are added to the database annually and include almost 50% of all hospital admissions in Japan.Patients aged 18-89 years who underwent lower GI surgery were included.Non-dialysis-dependent Chronic Kidney Disease (NDD-CKD) was defined as registry-listed CKD (stages 2-5) with no dialysis before hospital day 4. Participants were stratified into quartiles based on their BMI: Q1 (low BMI: # 19.7 kg/m2), Q2 (normal BMI: 19.7-22.1 kg/m2), Q3 (high BM: 22.1-24.7 kg/m2), and Q4 (obese BMI: $ 24.7 kg/m2).The primary outcome was postoperative urgent-start hemodialysis during the index hospitalization.Multivariate logistic regression analysis was used to estimate adjusted odds ratios (aORs) across BMI quartiles, adjusting for baseline characteristics.Results: Of 156,851 patients, 2,814 had NDD-CKD and 154,037 had no CKD.The mean age of the cohort was 65.7 17.2 years, with 53.8% (n = 110,275) being men.Among NDD-CKD patients, the proportion of postoperative urgent-start dialysis was highest in the low BMI group (Q1: 28.1%) compared with the normal BMI (Q2: 26.4%), high BMI (Q3: 17.5%), and obese BMI (Q4: 18.1%) groups.After adjustment, higher BMI was associated with lower odds of urgent-start dialysis (Q4 vs Q2: aOR 0.93, 95% CI 0.883-0.973,p<0.001;Q3 vs Q2: aOR 0.95, 95% CI 0.903-0.994).Conversely, among non-CKD patients, the proportion requiring urgent-start dialysis was highest in the obese BMI group (Q4: 0.51%) versus the normal BMI group (Q2: 0.20%).Adjusted analysis showed higher odds in Q4 (Q4 vs Q2: aOR 1.004, 95% CI 1.002-1.005,p<0.001).Conclusion: Among patients with NDD-CKD undergoing lower GI surgery, higher BMI (Q3-Q4) was associated with lower odds of postoperative urgent-start dialysis.However, among non-CKD patients, higher BMI was associated with higher odds of urgent-start dialysis.The impact of elevated BMI on postoperative renal outcomes appears to differ by baseline CKD status.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.