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Abstract
Rationale & Objective Risk factors for acute kidney injury (AKI) in the hospital have been well studied. Yet, risk factors for identifying high-risk patients for AKI occurring and managed in the outpatient setting are unknown and may differ. Study Design Predictive model development and external validation using observational electronic health record data. Setting & Participants Patients aged 18-90 years with recurrent primary care encounters, known baseline serum creatinine, and creatinine measured during an 18-month outcome period without established advanced kidney disease. New Predictors & Established Predictors Established predictors for inpatient AKI were considered. Potential new predictors were hospitalization history, smoking, serum potassium levels, and prior outpatient AKI. Outcomes A ≥50% increase in the creatinine level above a moving baseline of the recent measurement(s) without a hospital admission within 7 days defined outpatient AKI. Analytical Approach Logistic regression with bootstrap sampling for backward stepwise covariate elimination was used. The model was then transformed into 2 binary tests: one identifying high-risk patients for research and another identifying patients for additional clinical monitoring or intervention. Results Outpatient AKI was observed in 4,611 (3.0%) and 115,744 (2.4%) patients in the development and validation cohorts, respectively. The model, with 18 variables and 3 interaction terms, produced C statistics of 0.717 (95% CI, 0.710-0.725) and 0.722 (95% CI, 0.720-0.723) in the development and validation cohorts, respectively. The research test, identifying the 5.2% most at-risk patients in the validation cohort, had a sensitivity of 0.210 (95% CI, 0.208-0.213) and specificity of 0.952 (95% CI, 0.951-0.952). The clinical test, identifying the 20% most at-risk patients, had a sensitivity of 0.494 (95% CI, 0.491-0.497) and specificity of 0.806 (95% CI, 0.806-0.807). Limitations Only surviving patients with measured creatinine levels during a baseline period and outcome period were included. Conclusions The outpatient AKI risk prediction model performed well in both the development and validation cohorts in both continuous and binary forms.
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Diagnostic timing dependent characteristics of acute kidney injury following hepatectomy: a retrospective historical cohort analysis. HPB (Oxford) 2021; 23:1897-1905. [PMID: 34092494 DOI: 10.1016/j.hpb.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The timing of diagnosis of post-hepatectomy acute kidney injury (AKI) has rarely been investigated. The aim of this retrospective study was to reveal the differences between AKI subtypes following hepatectomy, as classified by timing of diagnosis. METHOD Post-hepatectomy AKI was classified as very transient AKI (vtAKI; criteria satisfied by the serum creatinine value immediately after surgery) or non-transient AKI (ntAKI; all other AKI types except for vtAKI). Multivariate logistic regression analyses for both AKI types were performed separately to identify differences in known perioperative AKI risk factors. The impacts of each AKI subtype on postoperative complications, hospital stay and renal outcome at discharge were also evaluated. RESULTS AKI was diagnosed in 135 of 750 patients (18.0%); 82 and 53 patients were classified as vtAKI and ntAKI, respectively. In multivariate analysis, even among the perioperative factors associated with whole AKI, there were distinct relationships depending on vtAKI or ntAKI. Furthermore, only ntAKI was associated with postoperative complications, longer hospital stays and impaired renal function at discharge. CONCLUSIONS Based on the results of this study, future post-hepatectomy AKI studies should only include ntAKI and exclude vtAKI, as vtAKI has minimal clinical impact despite accounting for a significant proportion of AKI patients. CLINICAL TRIAL REGISTRATIONS None.
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Perioperative renal protection. Curr Opin Crit Care 2021; 27:676-685. [PMID: 34534999 DOI: 10.1097/mcc.0000000000000881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is a common but underestimated syndrome in the perioperative setting. AKI can be induced by different causes and is associated with increased morbidity and mortality. Unfortunately, no specific treatment options are available at the moment. RECENT FINDINGS AKI is now understood as being a continuum ranging from normal kidney function over AKI and acute kidney disease to ultimately chronic kidney disease. The KDIGO organization recommend in 2012 implementation of preventive bundles in patients at high risk for AKI. In the perioperative setting, relevant measures include hemodynamic optimization, with careful consideration of blood pressure targets, adequate fluid therapy to maintain organ perfusion and avoidance of hyperglycaemia. These measures are most effective if patients at risk are identified as soon as possible and measures are implemented accordingly. Although current point of care functional biomarkers can detect patients at risk earlier than the established damage biomarkers, some components of the preventive bundle are still under investigation. SUMMARY Good evidence exists for the use of biomarkers to identify individual patients at risk for AKI and for the implementation of haemodynamic optimization, abdication of nephrotoxins, adequate fluid administration using balanced crystalloid solutions and glycaemic control. The data for using colloids or the degree of nephrotoxicity of contrast media still remain inconclusive.
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An JN, Kim SG, Song YR. When and why to start continuous renal replacement therapy in critically ill patients with acute kidney injury. Kidney Res Clin Pract 2021; 40:566-577. [PMID: 34781642 PMCID: PMC8685358 DOI: 10.23876/j.krcp.21.043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 07/22/2021] [Indexed: 01/20/2023] Open
Abstract
Acute kidney injury (AKI) is a common condition in critically ill patients, and may contribute to significant medical, social, and economic consequences, including death. Although there have been advances in medical technology, including continuous renal replacement therapy (CRRT), the mortality rate of AKI is high, and there is no fundamental treatment that can reverse disease progression. The decision to implement CRRT is often subjective and based primarily on the clinician’s judgment without consistent and concrete guidelines or protocols regarding when to initiate and discontinue CRRT and how to manage complications. Recently, several randomized controlled trials addressing the initiation of renal replacement therapy in critically ill patients with AKI have been completed, but clinical application of the findings is limited by the heterogeneity of the objectives and research designs. In this review, the advantages and disadvantages of CRRT initiation, clinical guideline recommendations, and the results of currently published clinical trials and meta-analyses are summarized to guide patient care and identify future research priorities.
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Affiliation(s)
- Jung Nam An
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Sung Gyun Kim
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Hallym University Kidney Research Institute, Anyang, Republic of Korea
| | - Young Rim Song
- Division of Nephrology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.,Hallym University Kidney Research Institute, Anyang, Republic of Korea.,Department of Biomedical Gerontology, Graduate School of Hallym University, Chuncheon, Korea
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55
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Obata Y, Kamijo-Ikemori A, Inoue S. Clinical Utility of Urinary Biomarkers for Prediction of Acute Kidney Injury and Chronic Renal Dysfunction After Open Abdominal Aortic Aneurysm Repair. Int J Nephrol Renovasc Dis 2021; 14:371-384. [PMID: 34557017 PMCID: PMC8455295 DOI: 10.2147/ijnrd.s322916] [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: 06/01/2021] [Accepted: 09/03/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose We examined the clinical utility of perioperative monitoring of urinary liver-type fatty acid binding protein (L-FABP), neutrophil gelatinase-associated lipocalin (NGAL), and albumin, for prediction of acute kidney injury (AKI) and prediction of chronic renal dysfunction in patients undergoing open surgical repair (OSR) of an abdominal aortic aneurysm. Patients and Methods Urine and serum samples were obtained perioperatively from 64 such patients (n=64). Patients in whom OSR-related AKI (defined by the Kidney Disease Improving Global Outcomes criteria) occurred were identified. Renal function was evaluated 3 years after OSR in patients with OSR-related AKI. Results The urinary biomarkers examined increased to maximum levels by 2 hours after aortic cross-clamping (AXC), regardless of whether AKI occurred. Notably, the serum creatinine (Cr) levels increased significantly immediately after OSR in patients with AKI (n=19) (vs that in patients without AKI). In patients with AKI, the increased serum Cr elevation rate, the urinary L-FABP levels 2 hours after AXC and immediately after OSR, and a reduction in eGFR documented 3 years after OSR were significantly greater in patients who underwent suprarenal AXC (n=11) than in those who underwent infrarenal AXC (n=8). Furthermore, urinary L-FABP levels 2 hours after AXC correlated significantly with the reductions in eGFR 3 years after OSR in patients with AKI. Conclusion Urinary L-FABP, NGAL and albumin concentrations 2 hours after AXC may be useful for early detection of OSR-related AKI. Furthermore, the increase in urinary L-FABP 2 hours after AXC may be predictive of chronic renal dysfunction in patients with OSR-related AKI.
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Affiliation(s)
- Yumi Obata
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Atsuko Kamijo-Ikemori
- Department of Anatomy, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Soichiro Inoue
- Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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56
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Go AS, Tan TC, Parikh RV, Ambrosy AP, Pravoverov LV, Zheng S, Leong TK. Timing of AKI after urgent percutaneous coronary intervention and clinical outcomes: a high-dimensional propensity score analysis. BMC Nephrol 2021; 22:300. [PMID: 34482839 PMCID: PMC8418923 DOI: 10.1186/s12882-021-02513-9] [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: 12/26/2020] [Accepted: 08/26/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Acute kidney injury is a common complication of percutaneous coronary intervention and has been associated with an increased risk of death and progressive chronic kidney disease. However, whether the timing of acute kidney injury after urgent percutaneous coronary intervention could be used to improve patient risk stratification is not known. Methods We conducted a retrospective cohort study in adults surviving an urgent percutaneous coronary intervention between 2008 and 2013 within Kaiser Permanente Northern California, a large integrated healthcare delivery system, to evaluate the impact of acute kidney injury during hospitalization at 12 (±6), 24 (±6) and 48 (±6) hours after urgent percutaneous coronary intervention and subsequent risks of adverse outcomes within the first year after discharge. We used multivariable Cox proportional hazards models with adjustment for a high-dimensional propensity score for developing acute kidney injury after percutaneous coronary intervention to examine the associations between acute kidney injury timing and all-cause death and worsening chronic kidney disease. Results Among 7250 eligible adults undergoing urgent percutaneous coronary intervention, 306 (4.2%) had acute kidney injury at one or more of the examined time periods after percutaneous coronary intervention. After adjustment, acute kidney injury at 12 (±6) hours was independently associated with higher risks of death (adjusted hazard ratio [aHR] 3.55, 95% confidence interval [CI] 2.19–5.75) and worsening kidney function (aHR 2.40, 95% CI:1.24–4.63). Similar results were observed for acute kidney injury at 24 (±6) hours and death (aHR 3.90, 95% CI:2.29–6.66) and worsening chronic kidney disease (aHR 4.77, 95% CI:2.46–9.23). Acute kidney injury at 48 (±6) hours was associated with excess mortality (aHR 1.97, 95% CI:1.19–3.26) but was not significantly associated with worsening kidney function (aHR 0.91, 95% CI:0.42–1.98). Conclusions Timing of acute kidney injury after urgent percutaneous coronary intervention may be differentially associated with subsequent risk of worsening kidney function but not death.
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Affiliation(s)
- Alan S Go
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA. .,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA. .,Departments of Medicine (Nephrology), Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. .,Department of Medicine (Nephrology), Stanford University, Palo Alto, CA, USA.
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA
| | - Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA.,Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Leonid V Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Sijie Zheng
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA.,Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA.,Department of Medical Education, University of California, San Francisco, CA, USA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94549, USA
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Swan JT, Moore LW, Sparrow HG, Frost AE, Gaber AO, Suki WN. Optimization of Acute Kidney Injury (AKI) Time Definitions Using the Electronic Health Record: A First Step in Automating In-Hospital AKI Detection. J Clin Med 2021; 10:3304. [PMID: 34362089 PMCID: PMC8347988 DOI: 10.3390/jcm10153304] [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: 06/18/2021] [Revised: 07/08/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) definitions were evaluated for cases detected and their respective outcomes using expanded time windows to 168 h. AKI incidence and outcomes with expanded time intervals were identified in the electronic health records (EHRs) from 126,367 unique adult hospital admissions (2012-2014) and evaluated using multivariable logistic regression with bootstrap sampling. The incidence of AKI detected was 7.4% (n = 9357) using a 24-h time window for both serum creatinine (SCr) criterion 1a (≥0.30 mg/dL) and 1b (≥50%) increases from index SCr, with additional cases of AKI identified: 6963 from 24-48 h.; 2509 for criterion 1b from 48 h to 7 days; 3004 cases (expansion of criterion 1a and 1b from 48 to 168 h). Compared to patients without AKI, adjusted hospital days increased if AKI (criterion 1a and 1b) was observed using a 24-h observation window (5.5 days), 48-h expansion (3.4 days), 48-h to 7-day expansion (6.5 days), and 168-h expansion (3.9 days); all are p < 0.001. Similarly, the adjusted risk of in-hospital death increased if AKI was detected using a 24-h observation window (odds ratio (OR) = 16.9), 48-h expansion (OR = 5.5), 48-h to 7-day expansion (OR = 4.2), and 168-h expansion (OR = 1.6); all are p ≤ 0.01. Expanding the time windows for both AKI SCr criteria 1a and 1b standardizes and facilitates EHR AKI detection, while identifying additional clinically relevant cases of in-hospital AKI.
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Affiliation(s)
- Joshua T. Swan
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; (L.W.M.); (A.O.G.)
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (A.E.F.); (W.N.S.)
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Linda W. Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; (L.W.M.); (A.O.G.)
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (A.E.F.); (W.N.S.)
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Harlan G. Sparrow
- System Quality & Patient Safety, Houston Methodist Hospital, Houston, TX 77030, USA;
| | - Adaani E. Frost
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (A.E.F.); (W.N.S.)
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - A. Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX 77030, USA; (L.W.M.); (A.O.G.)
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (A.E.F.); (W.N.S.)
- Department of Medicine, Weill Cornell Medical College, New York, NY 77030, USA
| | - Wadi N. Suki
- Houston Methodist Academic Institute, Houston Methodist Hospital, Houston, TX 77030, USA; (A.E.F.); (W.N.S.)
- Department of Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
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58
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Chen JY, Tsai IJ, Pan HC, Liao HW, Neyra JA, Wu VC, Chueh JS. The Impact of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers on Clinical Outcomes of Acute Kidney Disease Patients: A Systematic Review and Meta-Analysis. Front Pharmacol 2021; 12:665250. [PMID: 34354583 PMCID: PMC8329451 DOI: 10.3389/fphar.2021.665250] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/23/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Acute kidney injury (AKI) may increase the risk of chronic kidney disease (CKD), development of end-stage renal disease (ESRD), and mortality. However, the impact of exposure to angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (ACEi/ARB) in patients experiencing AKI/acute kidney disease (AKD) is still unclear. Methods: In this systematic review, we searched all relevant studies from PubMed, Embase, Cochrane, Medline, Collaboration Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov until July 21, 2020. We evaluated whether the exposure to ACEi/ARB after AKI onset alters recovery paths of AKD and impacts risks of all-cause mortality, recurrent AKI, or incident CKD. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. Results: A total of seven articles, involving 70,801 patients, were included in this meta-analysis. The overall patient mortality rate in this meta-analysis was 28.4%. Among AKI patients, all-cause mortality was lower in ACEi/ARB users than in ACEi/ARB nonusers (log odds ratio (OR) -0.37, 95% confidence interval (CI): -0.42--0.32, p < 0.01). The risk of recurrent adverse kidney events after AKI was lower in ACEi/ARB users than in nonusers (logOR -0.25, 95% CI: -0.33--0.18, p < 0.01). The risk of hyperkalemia was higher in ACEi/ARB users than in nonusers (logOR 0.43, 95% CI: 0.27-0.59, p < 0.01). Patients with continued use of ACEi/ARB after AKI also had lower mortality risk than those prior ACEi/ARB users but who did not resume ACEi/ARB during AKD (logOR -0.36, 95% CI: -0.4--0.31, p < 0.01). Conclusions: Exposure to ACEi/ARB after AKI is associated with lower risks of all-cause mortality, recurrent AKI, and progression to incident CKD. Patients with AKI may have a survival benefit by continued use of ACEi/ARB; however, a higher incidence of hyperkalemia associated with ACEi/ARB usage among these patients deserves close clinical monitoring.
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Affiliation(s)
- Jui-Yi Chen
- Division of Nephrology, Chi Mei Medical Center, Department of Internal Medicine, Tainan, Taiwan
| | - I-Jung Tsai
- Division of Nephrology, Department of Pediatrics, National Taiwan University Children’s Hospital, Taipei, Taiwan
| | - Heng-Chih Pan
- College of Medicine, Graduate Institute of Clinical Medicine, National Taiwan University, Taipei, Taiwan
- Division of Nephrology, Keelung Chang Gung Memorial Hospital, Department of Internal Medicine, Taipei, Taiwan
| | | | - Javier A. Neyra
- Division of Nephrology, Department of Internal Medicine, Bone and Mineral Metabolism, University of Kentucky, Lexington, KY, United States
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- NSARF (National Taiwan University Hospital Study Group of ARF) and TAIPAI (Taiwan Primary Aldosteronism Investigators), Taipei, Taiwan
| | - Jeff S. Chueh
- Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Glickman Urological and Kidney Institute, Cleveland, OH, United States
- Department of Urology, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
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Kister TS, Remmler J, Schmidt M, Federbusch M, Eckelt F, Isermann B, Richter H, Wehner M, Krause U, Halbritter J, Cundius C, Voigt M, Kehrer A, Telle JM, Kaiser T. Acute kidney injury and its progression in hospitalized patients-Results from a retrospective multicentre cohort study with a digital decision support system. PLoS One 2021; 16:e0254608. [PMID: 34252151 PMCID: PMC8274880 DOI: 10.1371/journal.pone.0254608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/29/2021] [Indexed: 01/20/2023] Open
Abstract
In this retrospective multicentric cohort study, we evaluate the potential benefits of a clinical decision support system (CDSS) for the automated detection of Acute kidney injury (AKI). A total of 80,389 cases, hospitalized from 2017 to 2019 at a tertiary care hospital (University of Leipzig Medical Center (ULMC)) and two primary care hospitals (Muldentalkliniken (MTL)) in Germany, were enrolled. AKI was defined and staged according to the Kidney disease: improving global outcomes (KDIGO) guidelines. Clinical and laboratory data was automatically collected from electronic patient records using the frameworks of the CDSS. In our cohort, we found an overall AKI incidence proportion of 12.1%. We identified 6,393/1,703/1,604 cases as AKI stage 1/2/3 (8.0%/2.1%/2.0%, respectively). Administrative coding with N17 (ICD-10-GM) was missing in 55.8% of all AKI cases with the potential for additional diagnosis related groups (DRG) reimbursement of 1,204,200 € in our study. AKI was associated with higher hospital mortality, increased length of hospitalisation and more frequent need of renal replacement therapy. A total of 19.1% of AKI cases (n = 1,848) showed progression to higher AKI stages (progressive AKI) during hospitalization. These cases presented with considerably longer hospitalization, higher rates of renal replacement therapy and increased mortality (p<0.001, respectively). Furthermore, progressive AKI was significantly associated with sepsis, shock, liver cirrhosis, myocardial infarction, and cardiac insufficiency. AKI, and especially its progression during hospitalization, is strongly associated with adverse outcomes. Our automated CDSS enables timely detection and bears potential to improve AKI outcomes, notably in cases of progressive AKI.
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Affiliation(s)
- Thea Sophie Kister
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Remmler
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Maria Schmidt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Martin Federbusch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Felix Eckelt
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Berend Isermann
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
| | - Heike Richter
- Muldentalkliniken GmbH Non-Profit Company, Hospital Grimma and Wurzen, Grimma, Germany
| | - Markus Wehner
- Muldentalkliniken GmbH Non-Profit Company, Hospital Grimma and Wurzen, Grimma, Germany
| | - Uwe Krause
- Muldentalkliniken GmbH Non-Profit Company, Hospital Grimma and Wurzen, Grimma, Germany
| | - Jan Halbritter
- Medical Department III, Division of Nephrology, University of Leipzig Medical Center, Leipzig, Germany
| | - Carina Cundius
- Bereich 1 –Informationsmanagement, University of Leipzig Medical Center, Leipzig, Germany
| | - Markus Voigt
- Bereich 1 –Informationsmanagement, University of Leipzig Medical Center, Leipzig, Germany
| | | | | | - Thorsten Kaiser
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics (ILM), University of Leipzig Medical Center, Leipzig, Germany
- * E-mail:
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60
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Chabala FW, Siew ED, Mutale W, Mulenga L, Mweemba A, Goma F, Banda N, Kaonga P, Wester WC, Heimburger DC, Aliyu MH, Munkombwe D. Prognostic model for nephrotoxicity among HIV-positive Zambian adults receiving tenofovir disoproxil fumarate-based antiretroviral therapy. PLoS One 2021; 16:e0252768. [PMID: 34252117 PMCID: PMC8274919 DOI: 10.1371/journal.pone.0252768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/22/2021] [Indexed: 11/19/2022] Open
Abstract
Persons living with HIV (PLWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) risk suffering TDF-associated nephrotoxicity (TDFAN). TDFAN can result in short- and long-term morbidity, including permanent loss of kidney function, chronic kidney disease (CKD), and end-stage kidney disease (ESKD) requiring dialysis. Currently, there is no model to predict this risk or discern which patients to initiate TDF-based therapy. Consequently, some patients suffer TDFAN within the first few months of initiating therapy before switching to another suitable antiretroviral or a lower dose of TDF. In a prospective observational cohort study of adult Zambian PLWH, we modelled the risk for TDFAN before initiating therapy to identify individuals at high risk for experiencing AKI after initiating TDF-based therapy. We enrolled 205 HIV-positive, ART-naïve adults initiating TDF-based therapy followed for a median of 3.4 months for TDFAN at the Adult Infectious Disease Research Centre (AIDC) in Lusaka, Zambia. We defined TDFAN as meeting any of these acute kidney disease (AKD) criteria: 1) An episode of estimated glomerular filtration rate (eGFR)< 60ml/ min/1.73m2 within 3 months, 2) reduced eGFR by> 35% within 3 months or 3) increased serum creatinine by> 50% within 3 months. A total of 45 participants (22%) developed acute kidney disease (AKD) after TDF-based therapy. The development of AKD within the first 3 months of commencing TDF-based therapy was associated with an increase in baseline serum creatinine, age, baseline eGFR and female sex. We concluded that baseline characteristics and baseline renal function biomarkers predicted the risk for AKD within the first 3-months of TDF-based therapy.
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Affiliation(s)
- Freeman W. Chabala
- Levy Mwanawasa Medical University, Institute of Basic and Biomedical Sciences, Lusaka, Zambia
- The University of Zambia, School of Medicine, Lusaka, Zambia
| | - Edward D. Siew
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Tennessee Valley Health Systems (TVHS), Veterans Affairs, Nashville, TN, United States of America
| | - Wilbroad Mutale
- The University of Zambia, School of Public Health, Lusaka, Zambia
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Lloyd Mulenga
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Aggrey Mweemba
- The University of Zambia, School of Medicine, Lusaka, Zambia
- The University Teaching Hospital, Lusaka, Zambia
| | - Fastone Goma
- The University of Zambia, School of Medicine, Lusaka, Zambia
| | | | - Patrick Kaonga
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
| | - William C. Wester
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- The University Teaching Hospital, Lusaka, Zambia
| | - Douglas C. Heimburger
- The University of Zambia, School of Medicine, Lusaka, Zambia
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Muktar H. Aliyu
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt O’Brien Center for Kidney Disease, Nashville, Tennessee, United States of America
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Meharry Medical College School of Medicine, Nashville, TN, United States of America
| | - Derick Munkombwe
- The University of Zambia, School of Health Sciences, Lusaka, Zambia
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61
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Saadat-Gilani K, Zarbock A. How new biomarkers aid the anesthetist to detect and prevent perioperative acute kidney injury. Curr Opin Anaesthesiol 2021; 34:364-372. [PMID: 33935186 DOI: 10.1097/aco.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is underestimated but common in the perioperative setting. Although the association of this syndrome with an increased morbidity and mortality has been well established, little progress has been made in the diagnosis or prevention of AKI in recent years. This is partly due to the late detection of AKI by conventional criteria based of functional biomarkers, serum creatinine, and urine output. In addition, conceptually AKI is now recognized as being part of a continuum, in which preventive intervention is time critical. This review will summarize the current best available evidence and explain why timely perioperative management does have impact on the development of AKI and overall outcomes for patients. RECENT FINDINGS Damage biomarkers can reliably identify AKI earlier than conventional functional biomarkers, facilitating more timely preventive intervention. Although the interventions published in the Kidney Disease: Improving Global Outcomes guideline are all important, the most relevant preventive options perioperatively include maintenance of adequate volume status and perfusion pressure, and the focus on balanced crystalloid solutions as maintenance fluid. SUMMARY AKI is a time critical syndrome that requires timely detection and damage biomarkers can help to adjust the perioperative management to prevent further injury.
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Affiliation(s)
- Khaschayar Saadat-Gilani
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Germany
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Gorga SM, Carlton EF, Kohne JG, Barbaro RP, Basu RK. Consensus acute kidney injury criteria integration identifies children at risk for long-term kidney dysfunction after multiple organ dysfunction syndrome. Pediatr Nephrol 2021; 36:1637-1646. [PMID: 33427986 PMCID: PMC8087651 DOI: 10.1007/s00467-020-04865-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/12/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND The consensus definition of acute kidney injury (AKI) has evolved since developing the original multiple organ dysfunction syndrome (MODS) definitions. Whether or not risk for adverse short- and long-term outcomes can be identified using the refined AKI criteria in the setting of MODS has not been studied. We hypothesize that incorporation of Kidney Disease: Improving Global Outcome (KDIGO) AKI criteria into existing MODS definitions will have a higher association with major adverse kidney events at 30 days (MAKE30) and will increase the number of patients with MODS. METHODS Post hoc analysis of 410 children admitted to a tertiary care pediatric intensive care unit (PICU) was conducted. MODS was defined using two existing criteria (Goldstein and Proulx) during the first 7 days following ICU admission and then modified by replacement of the kidney injury criteria using the KDIGO AKI definitions (G' and P'). RESULTS MAKE30 occurred in 65 of 410 (16%) children. After substituting KDIGO kidney injury criteria, identification of MAKE30 increased from 46 children (71%) to 53 (82%) and 29 children (45%) to 43 (66%) for the Goldstein and Proulx criteria, respectively. Additionally, identification of MODS increased from 194 (47%) by Goldstein to 224 (55%) by G' and 95 children (23%) by Proulx to 132 (32%) by P'. CONCLUSIONS Substituting KDIGO AKI criteria into existing MODS criteria increases the sensitivity for major adverse kidney events as well as the identification of MODS, improving the detection of children at risk for long-term adverse renal outcomes.
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Affiliation(s)
- Stephen M Gorga
- Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, F-6890, Ann Arbor, MI, 48109, USA.
| | - Erin F Carlton
- Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, F-6890, Ann Arbor, MI, 48109, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Joseph G Kohne
- Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, F-6890, Ann Arbor, MI, 48109, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Ryan P Barbaro
- Department of Pediatrics, University of Michigan Medical School, 1500 E. Medical Center Drive, F-6890, Ann Arbor, MI, 48109, USA
- Susan B. Meister Child Health Evaluation and Research (CHEAR) Center, University of Michigan, Ann Arbor, MI, USA
| | - Rajit K Basu
- Children's Healthcare of Atlanta/Emory University, Atlanta, GA, USA
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Bagshaw SM, Al-Khafaji A, Artigas A, Davison D, Haase M, Lissauer M, Zacharowski K, Chawla LS, Kwan T, Kampf JP, McPherson P, Kellum JA. External validation of urinary C-C motif chemokine ligand 14 (CCL14) for prediction of persistent acute kidney injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:185. [PMID: 34059102 PMCID: PMC8166095 DOI: 10.1186/s13054-021-03618-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/25/2021] [Indexed: 01/09/2023]
Abstract
Background Persistent acute kidney injury (AKI) portends worse clinical outcomes and remains a therapeutic challenge for clinicians. A recent study found that urinary C–C motif chemokine ligand 14 (CCL14) can predict the development of persistent AKI. We aimed to externally validate urinary CCL14 for the prediction of persistent AKI in critically ill patients. Methods This was a secondary analysis of the prospective multi-center SAPPHIRE study. We evaluated critically ill patients with cardiac and/or respiratory dysfunction who developed Kidney Disease: Improving Global Outcomes (KDIGO) stage 2–3 AKI within one week of enrollment. The main exposure was the urinary concentration of CCL14 measured at the onset of AKI stage 2–3. The primary endpoint was the development of persistent severe AKI, defined as ≥ 72 h of KDIGO stage 3 AKI or death or renal-replacement therapy (RRT) prior to 72 h. The secondary endpoint was a composite of RRT and/or death by 90 days. We used receiver operating characteristic (ROC) curve analysis to assess discriminative ability of urinary CCL14 for the development of persistent severe AKI and multivariate analysis to compare tertiles of urinary CCL14 and outcomes. Results We included 195 patients who developed KDIGO stage 2–3 AKI. Of these, 28 (14%) developed persistent severe AKI, of whom 15 had AKI ≥ 72 h, 12 received RRT and 1 died prior to ≥ 72 h of KDIGO stage 3 AKI. Persistent severe AKI was associated with chronic kidney disease, diabetes mellitus, higher non-renal APACHE III score, greater fluid balance, vasopressor use, and greater change in baseline serum creatinine. The AUC for urinary CCL14 to predict persistent severe AKI was 0.81 (95% CI, 0.72–0.89). The risk of persistent severe AKI increased with higher values of urinary CCL14. RRT and/or death at 90 days increased within tertiles of urinary CCL14 concentration. Conclusions This secondary analysis externally validates urinary CCL14 to predict persistent severe AKI in critically ill patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03618-1.
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Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2-124 Clinical Sciences Building, 8440-112 ST NW, Edmonton, AB, T6G 2B7, Canada.
| | - Ali Al-Khafaji
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, 3550 Terrace St., Scaife Hall, Suite 600, Pittsburgh, PA, 15213, USA
| | - Antonio Artigas
- Critical Care Department, Corporacion Sanitaria Universitaria Parc Tauli, CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Parc Tauli 1, 08208, Sabadell, Spain
| | - Danielle Davison
- Department of Anesthesiology and Critical Care Medicine, School of Medicine and Health Sciences, George Washington University, 900 23rd St. NW, Washington, DC, 20037, USA
| | - Michael Haase
- Diaverum Renal Care Center, 14469 Potsdam, Germany and Medical Faculty, Otto Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Matthew Lissauer
- Division of Acute Care Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, 125 Patterson Street, New Brunswick, NJ, 07746, USA
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Lakhmir S Chawla
- Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Thomas Kwan
- Astute Medical, Inc. (a bioMérieux company), 3550 General Atomics Ct, San Diego, CA, 92121, USA
| | - J Patrick Kampf
- Astute Medical, Inc. (a bioMérieux company), 3550 General Atomics Ct, San Diego, CA, 92121, USA
| | - Paul McPherson
- Astute Medical, Inc. (a bioMérieux company), 3550 General Atomics Ct, San Diego, CA, 92121, USA
| | - John A Kellum
- Department of Critical Care Medicine, Center for Critical Care Nephrology, University of Pittsburgh, 3550 Terrace St., Scaife Hall, Suite 600, Pittsburgh, PA, 15213, USA
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Gameiro J, Carreiro C, Fonseca JA, Pereira M, Jorge S, Gouveia J, Lopes JA. Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis. Clin Kidney J 2021; 14:1379-1387. [PMID: 33959267 PMCID: PMC8087131 DOI: 10.1093/ckj/sfaa130] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse short- and long-term consequences. Acute kidney disease (AKD) reflects the continuing pathological processes and adverse events developing after AKI. We aimed to evaluate the association of AKD, long-term adverse renal function and mortality in a cohort of patients with sepsis. METHODS We performed a retrospective analysis of adult patients with septic AKI admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Patients were categorized according to the development of AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. AKD was defined as presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. RESULTS From 256 selected patients with septic AKI, 53.9% developed AKD. The 30-day mortality rate was 24.5% (n = 55). The mean long-term follow-up was 45.9 ± 43.3 months. The majority of patients experience an adverse renal outcome [n = 158 (61.7%)] and 44.1% (n = 113) of patients died during follow-up. Adverse renal outcomes, 30-day mortality and long-term mortality after hospital discharge were more frequent among AKD patients [77.5 versus 43.2% (P < 0.001), 34.1 versus 6.8% (P < 0.001) and 64.8 versus 49.1% (P = 0.025), respectively]. The 5-year cumulative probability of survival was 23.2% for AKD patients, while it was 47.5% for patients with no AKD (log-rank test, P < 0.0001). In multivariate analysis, AKD was independently associated with adverse renal outcomes {adjusted hazard ratio [HR] 2.87 [95% confidence interval (CI) 2.0-4.1]; P < 0.001} and long-term mortality [adjusted HR 1.51 (95% CI 1.0-2.2); P = 0.040]. CONCLUSIONS AKD after septic AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Carolina Carreiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - José Agapito Fonseca
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Marta Pereira
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Sofia Jorge
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - João Gouveia
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - José António Lopes
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
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Acute Kidney Injury Recovery Patterns in Critically Ill Patients: Results of a Retrospective Cohort Study. Crit Care Med 2021; 49:e683-e692. [PMID: 33826581 DOI: 10.1097/ccm.0000000000005008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Acute kidney injury, acute kidney injury severity, and acute kidney injury duration are associated with both short- and long-term outcomes. Despite recent definitions, only few studies assessed pattern of renal recovery and time-dependent competing risks are usually disregarded. Our objective was to describe pattern of acute kidney injury recovery, change of transition probability over time and their risk factors. DESIGN Monocenter retrospective cohort study. Acute kidney injury was defined according to Kidney Disease Improving Global Outcomes definition. Renal recovery was defined as normalization of both serum creatinine and urine output criteria. Competing risk analysis, time-inhomogeneous Markov model, and group-based trajectory modeling were performed. SETTING Monocenter study. PATIENTS Consecutive patients admitted in ICU from July 2018 to December 2018 were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three-hundred fifty patients were included. Acute kidney injury occurred in 166 patients at ICU admission, including 64 patients (38.6%) classified as acute kidney disease according to Acute Disease Quality Initiative definition and 44 patients (26.5%) who could not be classified. Cumulative incidence of recovery was 25 % at day 2 (95% CI, 18-32%) and 35% at day 7 (95% CI, 28-42%). After adjustment, need for mechanical ventilation (subdistribution hazard ratio, 0.42; 95% CI, 0.23-0.74) and severity of the acute kidney injury (stage 3 vs stage 1 subdistribution hazard ratio, 0.11; 95% CI, 0.03-0.35) were associated with lack of recovery. Group-based trajectory modeling identified three clusters of temporal changes in this setting, associated with both acute kidney injury recovery and patients' outcomes. CONCLUSIONS In this study, we demonstrate Acute Disease Quality Initiative to allow recovery pattern classification in 75% of critically ill patients. Our study underlines the need to take into account competing risk factors when assessing recovery pattern in critically ill patients.
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Jeyaruban A, Hoy W, Cameron A, Healy H, Wang Z, Zhang J, Mallett A. Determining the association between the type of intervention for ischaemic heart disease and mortality and morbidity in patients with chronic kidney disease. Intern Med J 2021; 52:1190-1195. [PMID: 33755278 DOI: 10.1111/imj.15297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 03/07/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Association between chronic kidney disease (CKD) and ischaemic heart disease (IHD) is well known. Clinically, because of the use of intra-arterial contrast, coronary angiograms are sometimes not performed to avoid further deterioration in kidney function amongst CKD patients. Therefore, our aim is to identify whether intervention for non-ST elevation myocardial infarction (NStemi) is associated with increased mortality or further renal deterioration. METHOD A retrospective observational cohort study was undertaken involving 144 patients with diagnosis of IHD in the CKD.QLD registry from May 2011 to August 2017, with minimum of 2 years follow-up. Patients were divided into two groups based on whether they obtained an interventional or medical management for NStemi. RESULTS 59 patients had medical management and 85 patients had intervention for IHD. Patients in the medical management group were observed to be significantly older (median:78vs69years,p<0.05) with worse baseline renal function (median:31vs36ml/min/1.73m3 ,<0.05) and higher serum urate level (median:0.5vs0.4mmol/L,p=0.2). The interventional group had lower prevalence of diabetes, dyslipidaemia, cerebrovascular disease and peripheral vascular disease, , although this was not significant Kaplan-Meier analysis revealed a significant decrease in mean survival of medically managed group compared to interventional group. Furthermore, post adjustment for age and above comorbidities, medically managed group and higher age were associated with significantly higher mortality. However, the patients in the medically managed and interventional groups had no significant difference in delta eGFR. CONCLUSION In this observational study, intervention for IHD was associated with increased survival with no change in renal disease progression in comparison to medically managed patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Jeyaruban
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
| | - W Hoy
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - A Cameron
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - H Healy
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
| | - Z Wang
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - J Zhang
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD
| | - A Mallett
- CKD.QLD and NHMRC CKD.CRE, Brisbane, Queensland.,Faculty of Medicine, The University of Queensland, Herston, QLD.,Kidney Health Service, Royal Brisbane and Women's Hospital, Herston, QLD
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Gameiro J, Marques F, Lopes JA. Long-term consequences of acute kidney injury: a narrative review. Clin Kidney J 2021; 14:789-804. [PMID: 33777362 PMCID: PMC7986368 DOI: 10.1093/ckj/sfaa177] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
The incidence of acute kidney injury (AKI) has increased in the past decades. AKI complicates up to 15% of hospitalizations and can reach up to 50-60% in critically ill patients. Besides the short-term impact of AKI in patient outcomes, several studies report the association between AKI and adverse long-term outcomes, such as recurrent AKI episodes in 25-30% of cases, hospital re-admissions in up to 40% of patients, an increased risk of cardiovascular events, an increased risk of progression of chronic kidney disease (CKD) after AKI and a significantly increased long-term mortality. Despite the long-term impact of AKI, there are neither established guidelines on the follow-up care of AKI patients, nor treatment strategies to reduce the incidence of sequelae after AKI. Only a minority of patients have been referred to nephrology post-discharge care, despite the evidence of improved outcomes associated with nephrology referral by addressing cardiovascular risk and risk of progression to CKD. Indeed, AKI survivors should have specialized nephrology follow-up to assess kidney function after AKI, perform medication reconciliation, educate patients on nephrotoxic avoidance and implement strategies to prevent CKD progression. The authors provide a comprehensive review of the transition from AKI to CKD, analyse the current evidence on the long-term outcomes of AKI and describe predisposing risk factors, highlight the importance of follow-up care in these patients and describe the current therapeutic strategies which are being investigated on their impact in improving patient outcomes.
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Affiliation(s)
- Joana Gameiro
- Department of Medicine, Division of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - Filipe Marques
- Department of Medicine, Division of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
| | - José António Lopes
- Department of Medicine, Division of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
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Soranno DE, Kirkbride-Romeo L, Wennersten SA, Ding K, Cavasin MA, Baker P, Altmann C, Bagchi RA, Haefner KR, Steinkühler C, Montford JR, Keith B, Gist KM, McKinsey TA, Faubel S. Acute Kidney Injury Results in Long-Term Diastolic Dysfunction That Is Prevented by Histone Deacetylase Inhibition. ACTA ACUST UNITED AC 2021; 6:119-133. [PMID: 33665513 PMCID: PMC7907538 DOI: 10.1016/j.jacbts.2020.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/06/2023]
Abstract
This is the first long-term (1-year) study to evaluate both the kidney and systemic sequelae of acute kidney injury in mice. Serial kidney function was measured via transcutaneous glomerular filtration rate. AKI resulted in diastolic dysfunction, followed by hypertension. Ejection fraction was preserved. One year after AKI, cardiac ATP levels were reduced compared with sham controls. Mice treated with the histone deacetylase inhibitor, ITF2357, maintained normal diastolic function normal blood pressure, and normal cardiac ATP after AKI. Metabolomics data suggest that treatment with ITF2357 preserves pathways related to energy metabolism.
Growing epidemiological data demonstrate that acute kidney injury (AKI) is associated with long-term cardiovascular morbidity and mortality. Here, the authors present a 1-year study of cardiorenal outcomes following bilateral ischemia-reperfusion injury in male mice. These data suggest that AKI causes long-term dysfunction in the cardiac metabolome, which is associated with diastolic dysfunction and hypertension. Mice treated with the histone deacetylase inhibitor, ITF2357, had preservation of cardiac function and remained normotensive throughout the study. ITF2357 did not protect against the development of kidney fibrosis after AKI.
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Affiliation(s)
- Danielle E Soranno
- Department of Pediatrics, Pediatric Nephrology, University of Colorado, Aurora, Colorado, USA.,Department of Medicine, Division of Renal Disease and Hypertension, University of Colorado, Aurora, Colorado, USA.,Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lara Kirkbride-Romeo
- Department of Pediatrics, Pediatric Nephrology, University of Colorado, Aurora, Colorado, USA
| | - Sara A Wennersten
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Kathy Ding
- Department of Pediatrics, Pediatric Nephrology, University of Colorado, Aurora, Colorado, USA
| | - Maria A Cavasin
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Peter Baker
- Department of Pediatrics, Clinical Genetics and Metabolism, University of Colorado, Aurora, Colorado, USA
| | - Christopher Altmann
- Department of Medicine, Division of Renal Disease and Hypertension, University of Colorado, Aurora, Colorado, USA
| | - Rushita A Bagchi
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Korey R Haefner
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | | | - John R Montford
- Department of Medicine, Division of Renal Disease and Hypertension, University of Colorado, Aurora, Colorado, USA.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA
| | - Brysen Keith
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Katja M Gist
- Department of Pediatrics, Pediatric Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Timothy A McKinsey
- Consortium for Fibrosis Research & Translation, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.,Department of Medicine, Division of Cardiology, University of Colorado, Aurora, Colorado, USA
| | - Sarah Faubel
- Department of Medicine, Division of Renal Disease and Hypertension, University of Colorado, Aurora, Colorado, USA
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Wingert T, Grogan T, Cannesson M, Sapru A, Ren W, Hofer I. Acute Kidney Injury and Outcomes in Children Undergoing Noncardiac Surgery: A Propensity-Matched Analysis. Anesth Analg 2021; 132:332-340. [PMID: 32739953 DOI: 10.1213/ane.0000000000005069] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery. METHODS Patients ≤18 years of age who underwent noncardiac surgery with serum creatinine during the 12 months preceding surgery and no history of end-stage renal disease were included in this retrospective observational study at a single tertiary academic hospital. Patients were evaluated during the first 7 days after surgery for development of any stage of AKI, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were classified into stages of KDIGO AKI for the purposes of describing prevalence. For further analyses, patients were grouped into those who developed any stage of AKI postoperatively and those who did not. Additionally, the time point at which each patient was first diagnosed with stage I AKI or greater was also assessed. Pre-, intra-, and postoperative factors were compared between the 2 groups. A multivariable Cox proportional hazards regression model was created to examine the time to first diagnosis of AKI using all nonredundant covariates. Analysis of the association of AKI with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and a multivariable Cox proportional hazards regression model. RESULTS A total of 25,203 cases between 2013 and 2018 occurred; 8924 met inclusion criteria. Among this cohort, the observed prevalence of postoperative AKI was 3.2% (288 cases; confidence interval [CI], 2.9-3.6). The multivariable Cox model showed American Society of Anesthesiologists (ASA) status to be associated with the development of postoperative AKI. Several other factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models but found not to be significantly associated after adjustment. The multivariable Cox analyses with propensity-matched controls showed an estimated hazard ratio of 3.28 for mortality (CI, 1.71-6.32, P < .001) and 1.55 for 30-day readmission (CI, 1.08-2.23, P = .018) in children who developed AKI versus those who did not. CONCLUSIONS In children undergoing noncardiac surgery, postoperative AKI occurred in 3.2% of patients. Several factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models. After adjustment, only ASA status was found to be significantly associated with AKI in children after noncardiac surgery. Postoperative AKI was found to be associated with significantly higher rates of mortality and 30-day readmission in multivariable, time-varying models with propensity-matched controls.
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Affiliation(s)
- Theodora Wingert
- From the Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California
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Ikizler TA, Parikh CR, Himmelfarb J, Chinchilli VM, Liu KD, Coca SG, Garg AX, Hsu CY, Siew ED, Wurfel MM, Ware LB, Faulkner GB, Tan TC, Kaufman JS, Kimmel PL, Go AS. A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death. Kidney Int 2021; 99:456-465. [PMID: 32707221 PMCID: PMC7374148 DOI: 10.1016/j.kint.2020.06.032] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving three months and more after hospitalization with or without AKI who were matched on center, pre-admission CKD status, and an integrated priority score based on age, prior cardiovascular disease or diabetes mellitus, preadmission estimated glomerular filtration rate (eGFR) and treatment in the intensive care unit during the index hospitalization between December 2009-February 2015, with follow-up through November 2018. All participants had assessments of kidney function before (eGFR) and at three months and annually (eGFR and proteinuria) after the index hospitalization. Associations of AKI with outcomes were examined after accounting for pre-admission and three-month post-discharge factors. Among 769 AKI (73% Stage 1, 14% Stage 2, 13% Stage 3) and 769 matched non-AKI adults, AKI was associated with higher adjusted rates of incident CKD (adjusted hazard ratio 3.98, 95% confidence interval 2.51-6.31), CKD progression (2.37,1.28-4.39), heart failure events (1.68, 1.22-2.31) and all-cause death (1.78, 1.24-2.56). AKI was not associated with major atherosclerotic cardiovascular events in multivariable analysis (0.95, 0.70-1.28). After accounting for degree of kidney function recovery and proteinuria at three months after discharge, the associations of AKI with heart failure (1.13, 0.80-1.61) and death (1.29, 0.84-1.98) were attenuated and no longer significant. Thus, assessing kidney function recovery and proteinuria status three months after AKI provides important prognostic information for long-term clinical outcomes.
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Affiliation(s)
- T Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Himmelfarb
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Vernon M Chinchilli
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Steven G Coca
- Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark M Wurfel
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington, USA
| | - Lorraine B Ware
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Georgia Brown Faulkner
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - James S Kaufman
- Renal Section, Veterans Affairs New York Harbor Health Care System and New York University School of Medicine, New York, New York, USA
| | - Paul L Kimmel
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA; Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA; Departments of Medicine (Nephrology), Health Research and Policy, Stanford University, Stanford, California, USA.
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71
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Deferrari G, Cipriani A, La Porta E. Renal dysfunction in cardiovascular diseases and its consequences. J Nephrol 2021; 34:137-153. [PMID: 32870495 PMCID: PMC7881972 DOI: 10.1007/s40620-020-00842-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
It is well known that the heart and kidney and their synergy is essential for hemodynamic homeostasis. Since the early XIX century it has been recognized that cardiovascular and renal diseases frequently coexist. In the nephrological field, while it is well accepted that renal diseases favor the occurrence of cardiovascular diseases, it is not always realized that cardiovascular diseases induce or aggravate renal dysfunctions, in this way further deteriorating cardiac function and creating a vicious circle. In the same clinical field, the role of venous congestion in the pathogenesis of renal dysfunction is at times overlooked. This review carefully quantifies the prevalence of chronic and acute kidney abnormalities in cardiovascular diseases, mainly heart failure, regardless of ejection fraction, and the consequences of renal abnormalities on both organs, making cardiovascular diseases a major risk factor for kidney diseases. In addition, with regard to pathophysiological aspects, we attempt to substantiate the major role of fluid overload and venous congestion, including renal venous hypertension, in the pathogenesis of acute and chronic renal dysfunction occurring in heart failure. Furthermore, we describe therapeutic principles to counteract the major pathophysiological abnormalities in heart failure complicated by renal dysfunction. Finally, we underline that the mild transient worsening of renal function after decongestive therapy is not usually associated with adverse prognosis. Accordingly, the coexistence of cardiovascular and renal diseases inevitably means mediating between preserving renal function and improving cardiac activity to reach a better outcome.
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Affiliation(s)
- Giacomo Deferrari
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy.
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy.
| | - Adriano Cipriani
- Grown-Up Congentital Heart Disease Center (GUCH Center), Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Rapallo, GE, Italy
| | - Edoardo La Porta
- Department of Cardionephrology, Istituto Clinico Ligure Di Alta Specialità (ICLAS), GVM Care and Research, Via Mario Puchoz 25, 16035, Rapallo, GE, Italy
- Department of Internal Medicine (DiMi), University of Genoa, Genoa, Italy
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72
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Wilson FP, Martin M, Yamamoto Y, Partridge C, Moreira E, Arora T, Biswas A, Feldman H, Garg AX, Greenberg JH, Hinchcliff M, Latham S, Li F, Lin H, Mansour SG, Moledina DG, Palevsky PM, Parikh CR, Simonov M, Testani J, Ugwuowo U. Electronic health record alerts for acute kidney injury: multicenter, randomized clinical trial. BMJ 2021; 372:m4786. [PMID: 33461986 PMCID: PMC8034420 DOI: 10.1136/bmj.m4786] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury. DESIGN Double blinded, multicenter, parallel, randomized controlled trial. SETTING Six hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers. PARTICIPANTS 6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. INTERVENTIONS An electronic health record based "pop-up" alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient's medical record. MAIN OUTCOME MEASURES A composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury. RESULTS 6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes. CONCLUSIONS Alerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury. TRIAL REGISTRATION ClinicalTrials.gov NCT02753751.
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Affiliation(s)
- F Perry Wilson
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Melissa Martin
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yu Yamamoto
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Caitlin Partridge
- Joint Data Analytics Team, Yale School of Medicine, New Haven, CT, USA
| | - Erica Moreira
- Joint Data Analytics Team, Yale School of Medicine, New Haven, CT, USA
| | - Tanima Arora
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Aditya Biswas
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Harold Feldman
- Department of Epidemiology and Biostatistics and the Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Amit X Garg
- Department of Epidemiology and Biostatistics and Department of Medicine, Division of Nephrology, Schulich School of Medicine & Dentistry, Western University, ON, Canada
| | - Jason H Greenberg
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Monique Hinchcliff
- Department of Medicine, Section of Rheumatology, Allergy and Immunology, Yale University School of Medicine, New Haven, CT, USA
| | - Stephen Latham
- Yale Interdisciplinary Center for Bioethics, Yale Law School, New Haven, CT, USA
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Haiqun Lin
- Rutgers University Biomedical and Health Sciences, Newark, NJ, USA
| | - Sherry G Mansour
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Dennis G Moledina
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Paul M Palevsky
- Medicine and Clinical & Translational Science, University of Pittsburgh School of Medicine and Renal Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Chirag R Parikh
- Department of Medicine, Division of Nephrology, John Hopkins Medicine, Baltimore, MD, USA
| | - Michael Simonov
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeffrey Testani
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT, USA
| | - Ugochukwu Ugwuowo
- Department of Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT, USA
- Clinical and Translational Research Accelerator, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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73
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Vázquez-Carballo C, Guerrero-Hue M, García-Caballero C, Rayego-Mateos S, Opazo-Ríos L, Morgado-Pascual JL, Herencia-Bellido C, Vallejo-Mudarra M, Cortegano I, Gaspar ML, de Andrés B, Egido J, Moreno JA. Toll-Like Receptors in Acute Kidney Injury. Int J Mol Sci 2021; 22:ijms22020816. [PMID: 33467524 PMCID: PMC7830297 DOI: 10.3390/ijms22020816] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Acute kidney injury (AKI) is an important health problem, affecting 13.3 million individuals/year. It is associated with increased mortality, mainly in low- and middle-income countries, where renal replacement therapy is limited. Moreover, survivors show adverse long-term outcomes, including increased risk of developing recurrent AKI bouts, cardiovascular events, and chronic kidney disease. However, there are no specific treatments to decrease the adverse consequences of AKI. Epidemiological and preclinical studies show the pathological role of inflammation in AKI, not only at the acute phase but also in the progression to chronic kidney disease. Toll-like receptors (TLRs) are key regulators of the inflammatory response and have been associated to many cellular processes activated during AKI. For that reason, a number of anti-inflammatory agents targeting TLRs have been analyzed in preclinical studies to decrease renal damage during AKI. In this review, we updated recent knowledge about the role of TLRs, mainly TLR4, in the initiation and development of AKI as well as novel compounds targeting these molecules to diminish kidney injury associated to this pathological condition.
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Affiliation(s)
- Cristina Vázquez-Carballo
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (C.V.-C.); (S.R.-M.); (L.O.-R.); (C.H.-B.)
| | - Melania Guerrero-Hue
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, 14004 Córdoba, Spain; (M.G.-H.); (C.G.-C.); (J.L.M.-P.); (M.V.-M.)
| | - Cristina García-Caballero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, 14004 Córdoba, Spain; (M.G.-H.); (C.G.-C.); (J.L.M.-P.); (M.V.-M.)
| | - Sandra Rayego-Mateos
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (C.V.-C.); (S.R.-M.); (L.O.-R.); (C.H.-B.)
| | - Lucas Opazo-Ríos
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (C.V.-C.); (S.R.-M.); (L.O.-R.); (C.H.-B.)
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain
| | - José Luis Morgado-Pascual
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, 14004 Córdoba, Spain; (M.G.-H.); (C.G.-C.); (J.L.M.-P.); (M.V.-M.)
| | - Carmen Herencia-Bellido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (C.V.-C.); (S.R.-M.); (L.O.-R.); (C.H.-B.)
| | - Mercedes Vallejo-Mudarra
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, 14004 Córdoba, Spain; (M.G.-H.); (C.G.-C.); (J.L.M.-P.); (M.V.-M.)
| | - Isabel Cortegano
- Immunobiology Department, Carlos III Health Institute, 28220 Majadahonda (Madrid), Spain; (I.C.); (M.L.G.); (B.d.A.)
| | - María Luisa Gaspar
- Immunobiology Department, Carlos III Health Institute, 28220 Majadahonda (Madrid), Spain; (I.C.); (M.L.G.); (B.d.A.)
| | - Belén de Andrés
- Immunobiology Department, Carlos III Health Institute, 28220 Majadahonda (Madrid), Spain; (I.C.); (M.L.G.); (B.d.A.)
| | - Jesús Egido
- Renal, Vascular and Diabetes Research Laboratory, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, 28040 Madrid, Spain; (C.V.-C.); (S.R.-M.); (L.O.-R.); (C.H.-B.)
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), 28040 Madrid, Spain
- Correspondence: (J.E.); (J.A.M.); Tel.: +34-915504800 (J.E.); +34-957-218039 (J.A.M.)
| | - Juan Antonio Moreno
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Hospital Universitario Reina Sofía, 14004 Córdoba, Spain; (M.G.-H.); (C.G.-C.); (J.L.M.-P.); (M.V.-M.)
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), 28029 Madrid, Spain
- Department of Cell Biology, Physiology and Immunology, University of Cordoba, 140471 Cordoba, Spain
- Correspondence: (J.E.); (J.A.M.); Tel.: +34-915504800 (J.E.); +34-957-218039 (J.A.M.)
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Acute and Chronic Kidney Dysfunction and Outcome After Stroke Thrombectomy. Transl Stroke Res 2021; 12:791-798. [PMID: 33398648 PMCID: PMC8421282 DOI: 10.1007/s12975-020-00881-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022]
Abstract
Data on the impact of kidney dysfunction on outcome in patients with stroke due to large vessel occlusion are scarce. The few available studies are limited by only considering single kidney parameters measured at one time point. We thus investigated the influence of both chronic kidney disease (CKD) and acute kidney injury (AKI) on outcome after mechanical thrombectomy. We included consecutive patients with anterior circulation large vessel occlusion stroke receiving mechanical thrombectomy at our center over an 8-year period. We extracted clinical data from a prospective registry and investigated kidney serum parameters at admission, the following day and throughout hospital stay. CKD and AKI were defined according to established nephrological criteria. Unfavorable outcome was defined as scores of 3–6 on the modified Rankin Scale 3 months post-stroke. Among 465 patients, 31.8% had an impaired estimated glomerular filtration rate (eGFR) at admission (< 60 ml/min/1.73 m2). Impaired admission eGFR was related to unfavorable outcome in univariable analysis (p = 0.003), but not after multivariable adjustment (p = 0.96). Patients frequently met AKI criteria at admission (24.5%), which was associated with unfavorable outcome in a multivariable model (OR 3.03, 95% CI 1.73–5.30, p < 0.001). Moreover, patients who developed AKI during hospital stay also had a worse outcome (p = 0.002 in multivariable analysis). While CKD was not associated with 3-month outcome, we identified AKI either at admission or throughout the hospital stay as an independent predictor of unfavorable prognosis in this study cohort. This finding warrants further investigation of kidney–brain crosstalk in the setting of acute stroke.
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75
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Mo M, Pan L, Huang Z, Liang Y, Liao Y, Xia N. Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury. Front Endocrinol (Lausanne) 2021; 12:737996. [PMID: 35002952 PMCID: PMC8727769 DOI: 10.3389/fendo.2021.737996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE We aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients. METHODS Clinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model. RESULTS The development cohort enrolled 730 patients with a median follow-up time of 87 (40-98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043-1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951-0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678-13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930-0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287-3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p < 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839-0.921) and 0.798 (95% CI = 0.720-0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability. CONCLUSION We developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI.
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Affiliation(s)
- Manqiu Mo
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling Pan
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zichun Huang
- Department of Cardiovascular Thoracic Surgery, The Third Affiliated Hospital of Guangxi Medical University: Nanning Second People’s Hospital, Nanning, China
| | - Yuzhen Liang
- Department of Endocrinology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yunhua Liao
- Department of Nephrology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ning Xia
- Geriatric Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- *Correspondence: Ning Xia,
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An Evaluation of Commonly Used Surrogate Baseline Creatinine Values to Classify AKI During Acute Infection. Kidney Int Rep 2021; 6:645-656. [PMID: 33732979 PMCID: PMC7938202 DOI: 10.1016/j.ekir.2020.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 12/03/2020] [Accepted: 12/15/2020] [Indexed: 02/02/2023] Open
Abstract
Introduction Classification of acute kidney injury (AKI) requires a premorbid baseline creatinine, often unavailable in studies in acute infection. Methods We evaluated commonly used surrogate and imputed baseline creatinine values against a "reference" creatinine measured during follow-up in an adult clinical trial cohort. Known AKI incidence (Kidney Disease: Improving Global Outcomes [KDIGO] criteria) was compared with AKI incidence classified by (1) back-calculation using the Modification of Diet in Renal Disease (MDRD) equation with and without a Chinese ethnicity correction coefficient; (2) back-calculation using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation; (3) assigning glomerular filtration rate (GFR) from age and sex-standardized reference tables; and (4) lowest measured creatinine during admission. Back-calculated distributions were performed using GFRs of 75 and 100 ml/min. Results All equations using an assumed GFR of 75 ml/min underestimated AKI incidence by more than 50%. Back-calculation with CKD-EPI and GFR of 100 ml/min most accurately predicted AKI but misclassified all AKI stages and had low levels of agreement with true AKI diagnoses. Back-calculation using MDRD and assumed GFR of 100 ml/min, age and sex-reference GFR values adjusted for good health, and lowest creatinine during admission performed similarly, best predicting AKI incidence (area under the receiver operating characteristic curves [AUC ROCs] of 0.85, 0.87, and 0.85, respectively). MDRD back-calculation using a cohort mean GFR showed low total error (22%) and an AUC ROC of 0.85. Conclusion Current methods for estimating baseline creatinine are large sources of potential error in acute infection studies. Preferred alternatives include MDRD equation back-calculation with a population mean GFR, age- and sex-specific GFR values corrected for "good health," or lowest measured creatinine. Studies using surrogate baseline creatinine values should report specific methodology.
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77
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Abstract
Asia is the largest and most populous continent and has huge differences in socioeconomic status, development, and health care between the different countries and regions within each country. This manifests in the varied causes of acute kidney injury (AKI), particularly higher rates of community-acquired AKI and in the differential access to health care for the population. Because of resource limitations, prevention and treatment of AKI is a difficult challenge. This review highlights the differences in AKI in Asia compared with the developed world and discusses prevention and treatment of AKI within the context of resource limitations.
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78
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Lee WJ, Kim DB, Her SH, Park CS, Lee JM, Kim HY, Chung WS. Prognostic Value of Estimated Glomerular Filtration Rate 3-6 Months after Percutaneous Coronary Intervention. Cardiorenal Med 2020; 11:77-86. [PMID: 33333516 DOI: 10.1159/000512817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/03/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The prognostic significance of follow-up (f/u) renal function for patients undergoing percutaneous coronary intervention (PCI) remains unknown. This study sought to investigate the prognostic implications of f/u renal function in patients undergoing PCI. METHODS A drug-eluting stent registry was used. We divided patients into 4 groups according to the change in the estimated glomerular filtration rate (eGFR) before PCI and 3-6 months after PCI. Patients with normal pre-PCI eGFR and f/u eGFR were assigned to group 1. Those with normal pre-PCI eGFR and abnormal f/u eGFR were assigned to group 2. Patients with abnormal pre-PCI eGFR and normal f/u eGFR were assigned to group 3. Patients with abnormal pre-PCI eGFR and f/u eGFR were allocated into group 4. RESULTS A total of 4,899 PCI patients were enrolled. The death rate in group 1, 2, 3, and 4 at 3 years was 2, 11, 4, and 9%, respectively. This showed significant differences between groups, except between groups 2 and 4. The prognosis of a group with aggravation from normal renal function was worse than that of a group with recovery from abnormal renal function. A prediction model that combines clinical risk factors and f/u eGFR has more power for predicting clinical outcomes than a combination of clinical risk factors and pre-PCI eGFR. CONCLUSION Post-PCI eGFR was more accurate for predicting patient outcomes than pre-PCI eGFR.
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Affiliation(s)
- Won Jik Lee
- Department of Cardiology, College of Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Dong-Bin Kim
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea,
| | - Sung-Ho Her
- Department of Cardiology, College of Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea
| | - Chul Soo Park
- Department of Cardiology, College of Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Min Lee
- Department of Cardiology, College of Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Hee-Yeol Kim
- Department of Cardiology, College of Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Wook Sung Chung
- Department of Cardiology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Lima NKS, Farias WRA, Cirilo MAS, Oliveira AG, Farias JS, Aires RS, Muzi-Filho H, Paixão ADO, Vieira LD. Renal ischemia-reperfusion leads to hypertension and changes in proximal tubule Na + transport and renin-angiotensin-aldosterone system: Role of NADPH oxidase. Life Sci 2020; 266:118879. [PMID: 33310030 DOI: 10.1016/j.lfs.2020.118879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Acute renal injury (AKI) is a risk factor for the development of hypertension, which involves oxidative stress, changes in Na+ handling, and the intrarenal renin-angiotensin-aldosterone system (RAAS) as underlying mechanisms. We investigated in rats whether renal ischemia-reperfusion (IR) leads to changes in the proximal tubule ATP-dependent Na+ transport and the intrarenal content of RAAS components, as well as the role of NADPH oxidase. Rats weighing 300-350 g were submitted to AKI by bilateral IR (n = 25). After IR injury, the animals were followed up for 4 weeks. One part (n = 7) received daily treatment with the NADPH oxidase inhibitor apocynin (100 mg/kg, drinking water), while another part (n = 9) received apocynin 24 h before and after IR. One group was submitted to sham surgery (n = 8). Four weeks after IR, the rats presented elevated systolic blood pressure, as well as increased lipid peroxidation, NADPH oxidase activity, (Na++K+)ATPase activity, and upregulation of type 1 angiotensin II receptor in the renal cortex. On the other hand, there was a decrease in Na+-ATPase activity and downregulation of the isoforms 1 and 2 of the angiotensin-converting enzyme, type 2 angiotensin II receptor, and of the α and ε isoforms of protein kinase C. Most of these alterations was prevented by both apocynin treatment protocols. Thus, we conclude that AKI-induced by IR may induce changes in proximal tubule ATPases and RAAS components compatible with renal Na+ retention and hypertension. These data also indicate that the NADPH oxidase represents a key factor in the origin of these alterations.
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Affiliation(s)
- Natália K S Lima
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Wilka R A Farias
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Marry A S Cirilo
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Angélica G Oliveira
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Juliane S Farias
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Regina S Aires
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil
| | - Humberto Muzi-Filho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; National Center for Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana D O Paixão
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil; National Center for Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leucio D Vieira
- Department of Physiology and Pharmacology, Federal University of Pernambuco, Recife, Brazil; National Center for Structural Biology and Bioimaging/CENABIO, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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80
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Ransley DG, See EJ, Mizrahi A, Robbins R, Bellomo R. Inpatient and outpatient nephrology management of critically ill patients with acute kidney injury. Nephrology (Carlton) 2020; 26:319-327. [PMID: 33263208 DOI: 10.1111/nep.13838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/02/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Acute kidney injury (AKI) during critical illness increases the risk of subsequent chronic kidney disease. Guidelines recommend inpatient nephrology assessment and review at 3 months. OBJECTIVES To quantify the prevalence and predictors of inpatient and outpatient nephrology follow-up of AKI patients admitted to critical care areas within a tertiary hospital. METHODS Retrospective study of all critically ill adults with AKI between January 1, 2012 and December 31, 2016 with a baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 and alive and independent of renal replacement therapy for 30 days after hospital discharge. We used logistic regression models to examine the primary outcome of nephrology review at 3 months. Secondary outcomes included inpatient nephrology review, renal recovery at discharge and the development of a major adverse kidney event (MAKE) at 1 year. RESULTS Of 702 critically ill patients with AKI (mean age 66 years, 64% male, baseline eGFR 78 mL/min/1.73 m2 ), 43 patients (6%) received nephrology follow-up at 3 months and 63 patients (9%) at 1 year. Nephrology follow-up occurred more frequently in patients with a higher baseline creatinine, a higher discharge creatinine and greater severity of AKI. Seventy patients (10%) underwent inpatient nephrology review. Overall, 414 (59%) had recovery of renal function by the time of discharge and 239 (34%) developed a MAKE at 12 months. CONCLUSION Inpatient and outpatient nephrology follow-up of AKI patients after admission to a critical care area was uncommon although one-third developed a MAKE. These findings provide the rationale for controlled studies of nephrology follow-up.
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Affiliation(s)
- David G Ransley
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Emily J See
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.,Centre for Integrated Critical Care, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Department for Continuing Education, University of Oxford, Oxford, UK
| | - Alice Mizrahi
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Ray Robbins
- Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.,Centre for Integrated Critical Care, School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,Data Analytics Research and Evaluation Centre, The University of Melbourne and Austin Hospital, Melbourne, Victoria, Australia.,School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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81
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Ilaria G, Kianoush K, Ruxandra B, Francesca M, Mariarosa C, Davide G, Claudio R. Clinical adoption of Nephrocheck® in the early detection of acute kidney injury. Ann Clin Biochem 2020; 58:6-15. [PMID: 33081495 DOI: 10.1177/0004563220970032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Acute kidney injury is a common complication of acute illnesses and is associated with increased morbidity and mortality. Over the past years several acute kidney injury biomarkers for diagnostication, decision-making processes, and prognosis of acute kidney injury and its outcomes have been developed and validated. Among these biomarkers, tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7), the so-called cell cycle arrest biomarkers, showed a superior profile of accuracy and stability even in patients with substantial comorbidities. Therefore, in 2014, the US Food and Drug Administration approved the use of the product of TIMP-2 and IGFBP7 ([TIMP-2] × [IGFBP7]), known as cell cycle arrest biomarkers, to aid critical care physicians and nephrologists in the early prediction of acute kidney injury in the critical care setting. To date, Nephrocheck® is the only commercially available test for [TIMP-2] × [IGFBP7]. In this narrative review, we describe the growing clinical and investigational momentum of biomarkers, focusing on [TIMP-2] × [IGFBP7], as one of the most promising candidate biomarkers. Additionally, we review the current state of clinical implementation of Nephrocheck®.
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Affiliation(s)
- Godi Ilaria
- International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital, Vicenza, Italy.,Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care Medicine, University of Padova, Padova, Italy
| | - Kashani Kianoush
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Boteanu Ruxandra
- International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital, Vicenza, Italy
| | - Martino Francesca
- International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Carta Mariarosa
- Clinical Chemistry and Laboratory medicine, San Bortolo Hospital, Vicenza, Italy
| | - Giavarina Davide
- Clinical Chemistry and Laboratory medicine, San Bortolo Hospital, Vicenza, Italy
| | - Ronco Claudio
- International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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82
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Saadat-Gilani K, Zarbock A, Meersch M. Perioperative Renoprotection: Clinical Implications. Anesth Analg 2020; 131:1667-1678. [DOI: 10.1213/ane.0000000000004995] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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83
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Dyschloremia is associated with failure to restore renal function in survivors with acute kidney injury: an observation retrospective study. Sci Rep 2020; 10:19623. [PMID: 33184400 PMCID: PMC7661702 DOI: 10.1038/s41598-020-76798-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
Dyschloremia is common in critically ill patients. However, little is known about the effects of dyschloremia on renal function in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). A total of 483 patients who received CRRT for AKI were selected and divided into three groups according to their serum chloride concentrations at the time of CRRT initiation. At 90 days after initiating CRRT, renal outcome, i.e., non-complete renal recovery, or renal failure, was assessed in the three groups. The hypochloremia group (serum chloride concentrations < 96 mEq/L, n = 60), the normochloremia group (serum chloride concentrations, 96–111 mEq/L, n = 345), and the hyperchloremia group (serum chloride concentrations > 111 mEq/L, n = 78) were classified. The simplified acute physiology score III was higher in the hyperchloremia and hypochloremia groups than in the normochloremia group. Multivariate logistic regression analyses showed that hypochloremia (odds ratio, 5.12; 95% confidence interval [CI], 2.56–10.23; P < 0.001) and hyperchloremia (odds ratio, 2.53; 95% CI, 1.25–5.13; P = 0.01) were significantly associated with non-complete renal recovery. Similar trends were observed for renal failure. This study showed that dyschloremia was independently associated with failure in restoring renal function following AKI.
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84
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Nishimoto M, Murashima M, Kokubu M, Matsui M, Eriguchi M, Samejima KI, Akai Y, Tsuruya K. Anemia following acute kidney injury after noncardiac surgery and long-term outcomes: the NARA-AKI cohort study. Clin Kidney J 2020; 14:673-680. [PMID: 35261759 PMCID: PMC8894936 DOI: 10.1093/ckj/sfaa184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Indexed: 02/01/2023] Open
Abstract
Abstract
Background
This study was conducted to investigate whether acute kidney injury (AKI) is an independent predictor of anemia and whether anemia following AKI is a mediator of mortality after AKI.
Methods
This is a retrospective cohort study. Adults with noncardiac surgery from 2007 to 2011 were included. Obstetric or urological surgery, missing data or preoperative dialysis were excluded. Subjects were followed until the end of 2015 or lost to follow-up. Exposures of interest were postoperative AKI. Outcome variables were hematocrit values at 3, 6 and 12 months postoperatively and mortality. Associations between AKI and hematocrit or association between AKI and mortality were examined by multivariable linear regression or Cox regression, respectively.
Results
Among 6692 subjects, 445 (6.6%) developed AKI. Among those with postoperative data, AKI was independently associated with lower hematocrit at 3, 6 and 12 months postoperatively, with coefficients of −0.79 [95% confidence interval (CI) −1.47 to −0.11; n = 1750], −1.35 (−2.11 to −0.60; n = 1558) and −0.91 (−1.59 to −0.22; n = 2463), respectively. Higher stages or longer duration of AKI were associated with more severe anemia. AKI was associated with higher mortality after 3 months postoperatively with a hazard ratio of 1.54 (95% CI 1.12–2.12). Further adjustment with hematocrit at 3 months attenuated the association. The mediation effect was significant (P = 0.02) by mediation analysis.
Conclusions
AKI was an independent predictor of anemia following AKI. Higher mortality associated with AKI was at least partially mediated by anemia following AKI. Whether correction of anemia following AKI improves mortality requires further research.
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Affiliation(s)
| | - Miho Murashima
- Department of Nephrology, Nara Medical University, Nara, Japan
- Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Maiko Kokubu
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | - Masaru Matsui
- Department of Nephrology, Nara Medical University, Nara, Japan
- Department of Nephrology, Nara Prefecture General Medical Center, Nara, Japan
| | | | | | - Yasuhiro Akai
- Department of Nephrology, Nara Medical University, Nara, Japan
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85
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Taber-Hight E, Shah S. Acute Kidney Injury in Pregnancy. Adv Chronic Kidney Dis 2020; 27:455-460. [PMID: 33328061 DOI: 10.1053/j.ackd.2020.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/07/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Abstract
Acute kidney injury in pregnancy is a public health problem and a significant cause of maternal and fetal morbidity and mortality. The incidence of pregnancy-related acute kidney injury has increased in the developed countries, theorized to be the result of an increase in pregnancies in advanced maternal age, and continues to remain higher in developing countries owing to inadequate antenatal care. While hyperemesis gravidarum is a common cause of pregnancy-related acute kidney injury during the first trimester, complications such as preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, acute fatty liver disease of pregnancy, thrombotic thrombocytopenic purpura, and hemolytic uremic syndrome are important causes of acute kidney injury later in the pregnancy. Diagnosis of pregnancy-related acute kidney injury can be difficult owing to lack of diagnostic criteria and overlapping clinical features between various causes. General measures to treat pregnancy-related acute kidney injury include identification of the underlying cause of kidney injury, intravenous fluid resuscitation, timely initiation of dialysis if needed, and prompt fetal delivery, if necessary. Specific treatment includes steroid and immunosuppressive therapy for glomerulonephritis; prompt delivery for severe preeclampsia, hemolysis, elevated liver enzymes, and low platelet count syndrome, and acute fatty liver of pregnancy; and plasmapheresis and eculizumab for thrombotic microangiopathies such as thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome.
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86
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Gameiro J, Fonseca JA, Marques F, Lopes JA. Management of Acute Kidney Injury Following Major Abdominal Surgery: A Contemporary Review. J Clin Med 2020; 9:E2679. [PMID: 32824854 PMCID: PMC7463962 DOI: 10.3390/jcm9082679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/05/2020] [Accepted: 08/14/2020] [Indexed: 12/12/2022] Open
Abstract
Acute kidney injury (AKI) is a frequent occurrence following major abdominal surgery and is independently associated with both in-hospital and long-term mortality, as well as with a higher risk of progressing to chronic kidney disease (CKD) and cardiovascular events. Postoperative AKI can account for up to 40% of in-hospital AKI cases. Given the differences in patient characteristics and the pathophysiology of postoperative AKI, it is inappropriate to assume that the management after noncardiac and nonvascular surgery are the same as those after cardiac and vascular surgery. This article provides a comprehensive review on the available evidence on the management of postoperative AKI in the setting of major abdominal surgery.
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Affiliation(s)
- Joana Gameiro
- Division of Nephrology and Renal Transplantation, Department of Medicine, Centro Hospitalar Lisboa Norte, EPE. Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal; (J.A.F.); (F.M.); (J.A.L.)
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87
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Gien J, Soranno D. Identifying the Patient at Risk for Acute Kidney Injury: Pediatric Sepsis Biomarker Risk Model Study. Am J Respir Crit Care Med 2020; 201:764-766. [PMID: 32032496 PMCID: PMC7124719 DOI: 10.1164/rccm.202001-0216ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jason Gien
- Department of PediatricsUniversity of ColoradoAurora, Colorado
| | - Danielle Soranno
- Department of PediatricsDepartment of Bioengineeringand.,Department of MedicineUniversity of ColoradoAurora, Colorado
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88
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Brandenburger T, Lorenzen JM. Diagnostic and Therapeutic Potential of microRNAs in Acute Kidney Injury. Front Pharmacol 2020; 11:657. [PMID: 32477132 PMCID: PMC7240101 DOI: 10.3389/fphar.2020.00657] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/22/2020] [Indexed: 01/22/2023] Open
Abstract
During hospital stay, about 20% of adult patients experience an episode of acute kidney injury (AKI), which is characterized by a rapid decrease in kidney function. Diagnostic tools regarding early diagnosis of kidney dysfunction prior to AKI and markers of renal recovery are not available. Additionally, there is no therapeutic option for the treatment of AKI. Thus, better and more specific diagnostic and therapeutic options are urgently needed in daily clinical practice. NoncodingRNAs (ncRNAs) have come into focus of research in the context of AKI in the last decade. The best characterized group of ncRNAs are microRNAs (miRNAs). An increasing body of literature has shown that miRNAs are involved in the pathogenesis of AKI and that they are promising future tools in the diagnosis and therapy of AKI. However, there are obstacles to be overcome before miRNAs can be transferred to patient care. This review will give an overview of our current knowledge of miRNA involvement in the context of AKI while critically evaluating their diagnostic and therapeutic potential.
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Affiliation(s)
- Timo Brandenburger
- Department of Anesthesiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Johan M Lorenzen
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
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89
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Very early changes in serum creatinine are associated with 30-day mortality after cardiac surgery. Eur J Anaesthesiol 2020; 37:898-907. [DOI: 10.1097/eja.0000000000001214] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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90
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Haase-Fielitz* A, Elitok* S, Schostak M, Ernst M, Isermann B, Albert C, Robra BP, Kribben A, Haase M. The Effects of Intensive Versus Routine Treatment in Patients with Acute Kidney Injury. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:289-296. [PMID: 32530412 PMCID: PMC7297063 DOI: 10.3238/arztebl.2020.0289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 10/17/2019] [Accepted: 02/10/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND In patients with acute kidney injury (AKI), specialized treatment-initiated in response to an early-warning system- may be beneficial compared with routine treatment. METHOD To explore effect estimators in a pilot trial (DRKS00010530), patients with AKI on regular wards of a university hospital were treated either in the usual way (control group) or more intensively (intervention group). The subjects were allotted randomly to the two treatment groups. The more intensive treatment consisted of an early warning system for a rise in the serum creatinine concentration, immediate consultation of a specialist, and the issuance of a patient kidney passport. The primary endpoint was recovery of renal function after AKI during the index hospitalization. Renal complications and process indicators were the secondary endpoints. RESULTS The proportion of patients whose renal function returned to baseline after AKI was 50% in the intervention group (N = 26) and 42% in the control group (N = 26) (odds ratio 1.4, 95% confidence interval [0.5; 4.0], p = 0.58). The calculated glomerular filtration rate went down, from hospital admission to discharge, by 3 mL/min/1.73 m2 (1st-3rd quartile: [6; -20]) in the intervention group and by 13 mL/min/1.73 m2 in the control group (1st-3rd quartile: [0; -25]; p = 0.09). Complications of AKI such as hyperkalemia, pulmonary edema, and renal acidosis were rarer in the intervention group (15% versus 39%; p = 0.03). In the intervention group, compared with the control group, the cause of AKI was identified more frequently (27% versus 4%; p = 0.05); drugs with relevance to the kidney were discontinued more frequently (65% versus 31%; p = 0.01); and the diagnosis of AKI was more frequently documented in the patient's chart (58% versus 37%; p = 0.03). CONCLUSION Specialized consultations supported by an early warning system for AKI seem to be beneficial for patients. The findings of this pilot trial should be verified in larger-scale randomized controlled trials.
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Affiliation(s)
- Anja Haase-Fielitz*
- *Joint first authors
- Department of Cardiology, Brandenburg Heart Center, Immanuel Hospital, Bernau
- Brandenburg Medical School Theodor Fontane
- Institute of Social Medicine and Health Systems Research, Magdeburg University, Magdeburg
| | - Saban Elitok*
- Department of Nephrology and Endocrinology, Ernst von Bergmann Hospital, Potsdam
| | - Martin Schostak
- Department of Urology and Pediatric Urology, Magdeburg University Hospital, Magdeburg
| | - Martin Ernst
- Department of Orthopedics and Trauma Surgery, Ameos Hospital, Schönebeck
| | - Berend Isermann
- Institute of Laboratory Medicine, Leipzig University Hospital, Leipzig
| | - Christian Albert
- Diaverum Renal Care Center Am Neuen Garten, Potsdam
- Faculty of Medicine, Otto-von-Guericke University of Magdeburg
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Magdeburg University, Magdeburg
| | | | - Michael Haase
- Diaverum Renal Care Center Am Neuen Garten, Potsdam
- Faculty of Medicine, Otto-von-Guericke University of Magdeburg
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91
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The Clinical Course of Acute Kidney Disease after Cardiac Surgery: A Retrospective Observational Study. Sci Rep 2020; 10:6490. [PMID: 32300140 PMCID: PMC7162986 DOI: 10.1038/s41598-020-62981-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/22/2020] [Indexed: 11/16/2022] Open
Abstract
Acute kidney disease (AKD), or renal dysfunction persisting >7 days after an initiating event of acute kidney injury, is a rising concern. This study aimed to elucidate the clinical course of AKD after cardiac surgery with data on post-cardiac surgery patients admitted to intensive care units (ICU) at 18 Japanese hospitals during 2012–2014. Using multivariable logistic models, we evaluated the association of AKD with 90-day mortality and the 50% eGFR decline during 2-year follow-up compared to eGFR at 90 days. AKD was defined as an elevation in serum creatinine to at least 1.5-fold from baseline in >7 days after ICU admission. Of the 3,605 eligible patients undergoing cardiac surgery, 403 patients (11.2%) had AKD. Multivariable analysis revealed that the adjusted odds ratio (OR) of AKD for 90-day mortality was 63.0 (95% confidence interval [CI], 27.9–180.6). In addition, the adjusted OR of AKD for 50% eGFR decline was 3.56 (95% CI, 2.24–5.57) among hospital survivors. In conclusion, AKD after cardiac surgery was associated with higher 90-day mortality and renal function decline after hospital discharge.
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92
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Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol 2020; 30:3516-3527. [PMID: 32080754 PMCID: PMC7248019 DOI: 10.1007/s00330-020-06690-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 12/21/2022]
Abstract
Objectives To investigate the prognosis including major adverse kidney events within 30 days (MAKE30) and 90-day and 1-year adverse outcome in hospitalized patients with post-contrast acute kidney injury (PC-AKI) to identify high-risk factors. Methods This retrospective observational study included 288 PC-AKI patients selected from 277,898 patients admitted to hospitals from January 2015 to December 2015. PC-AKI was defined according to the 2018 guideline of European Society of Urogenital Radiology. Multivariable Cox regression and logistic regression analyses were used to analyze main outcome and risk factors. Results PC-AKI patients with AKI stage ≥ 2 had much higher incidence of MAKE30 than those with AKI stage 1 (RR = 7.027, 95% CI 4.918–10.039). Persistent renal dysfunction, heart failure, central nervous system failure, baseline eGFR < 60 mL/min/1.73 m2, oliguria or anuria, blood urea nitrogen ≥ 7.14 mmol/L, respiratory failure, and shock were independent risk factors of 90-day or 1-year adverse prognosis (p < 0.05). Compared with transient renal dysfunction, PC-AKI patients with persistent renal dysfunction had a higher all-cause mortality rate (RR = 3.768, 95% CI 1.612–8.810; RR = 4.106, 95% CI 1.765–9.551) as well as combined endpoints of death, chronic kidney disease, or end-stage renal disease (OR = 3.685, 95% CI 1.628–8.340; OR = 5.209, 95% CI 1.730–15.681) within 90 days or 1 year. Conclusions PC-AKI is not always a transient, benign creatininopathy, but can result in adverse outcome. AKI stage is independently correlated to MAKE30 and persistent renal dysfunction may exaggerate the risk of long-term adverse events. Key Points • PC-AKI can result in adverse outcome such as persistent renal dysfunction, dialysis, chronic kidney disease (CKD), end-stage renal disease (ESRD), or death. • AKI stage is independently correlated to MAKE30. • Persistent renal dysfunction may exaggerate the risk of long-term adverse events. Electronic supplementary material The online version of this article (10.1007/s00330-020-06690-3) contains supplementary material, which is available to authorized users.
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93
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Noble RA, Lucas BJ, Selby NM. Long-Term Outcomes in Patients with Acute Kidney Injury. Clin J Am Soc Nephrol 2020; 15:423-429. [PMID: 32075806 PMCID: PMC7057296 DOI: 10.2215/cjn.10410919] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The long-term sequelae of AKI have received increasing attention so that its associations with a number of adverse outcomes, including higher mortality and development of CKD, are now widely appreciated. These associations take on particular importance when considering the high incidence of AKI, with a lack of proven interventions and uncertainties around optimal care provision meaning that the long-term sequelae of AKI present a major unmet clinical need. In this review, we examine the published data that inform our current understanding of long-term outcomes following AKI and discuss potential knowledge gaps, covering long-term mortality, CKD, progression to ESKD, proteinuria, cardiovascular events, recurrent AKI, and hospital readmission.
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Affiliation(s)
- Rebecca A Noble
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and.,Department of Renal Medicine, Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Bethany J Lucas
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and.,Department of Renal Medicine, Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
| | - Nicholas M Selby
- Centre for Kidney Research and Innovation, Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, United Kingdom; and .,Department of Renal Medicine, Royal Derby Hospital, Derby Hospitals NHS Foundation Trust, Derby, United Kingdom
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94
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Shah S, Meganathan K, Christianson AL, Harrison K, Leonard AC, Thakar CV. Pregnancy-Related Acute Kidney Injury in the United States: Clinical Outcomes and Health Care Utilization. Am J Nephrol 2020; 51:216-226. [PMID: 32045905 DOI: 10.1159/000505894] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/01/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) during pregnancy is a public health problem and is associated with maternal and fetal morbidity and mortality. Clinical outcomes and health care utilization in pregnancy-related AKI, especially in women with diabetes, are not well studied. METHODS Using data from the 2006 to 2015 Nationwide Inpatient Sample, we identified 42,190,790 pregnancy-related hospitalizations in women aged 15-49 years. We determined factors associated with AKI, including race/ethnicity, and associations between AKI and inpatient mortality, and between AKI and cardiovascular (CV) events, during pregnancy-related hospitalizations. We calculated health care expenditures from pregnancy-related AKI hospitalizations. RESULTS Overall, the rate of AKI during pregnancy-related hospitalizations was 0.08%. In the adjusted regression analysis, a higher likelihood of AKI during pregnancy-related hospitalizations was seen in 2015 (OR 2.20; 95% CI 1.89-2.55) than in 2006; in older women aged 36-40 years (OR 1.49; 95% CI 1.36-1.64) and 41-49 years (OR 2.12; 95% CI 1.84-2.45) than in women aged 20-25 years; in blacks (OR 1.52; 95% CI 1.40-1.65) and Native Americans (OR 1.45; 95% CI 1.10-1.91) than in whites, and in diabetic women (OR 4.43; 95% CI 4.04-4.86) than in those without diabetes. Pregnancy-related hospitalizations with AKI were associated with a higher likelihood of inpatient mortality (OR 13.50; 95% CI 10.47-17.42) and CV events (OR 9.74; 95% CI 9.08-10.46) than were hospitalizations with no AKI. The median cost was higher for a delivery hospitalization with AKI than without AKI (USD 18,072 vs. 4,447). CONCLUSION The rates of pregnancy-related AKI hospitalizations have increased during the last decade. Factors associated with a higher likelihood of AKI during pregnancy included older age, black and Native American race/ethnicity, and diabetes. Hospitalizations with pregnancy-related AKI have an increased risk of inpatient mortality and CV events, and a higher health care utilization than do those without AKI.
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Affiliation(s)
- Silvi Shah
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio, USA,
| | | | | | - Kathleen Harrison
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio, USA
| | - Anthony C Leonard
- Department of Family and Community Medicine, University of Cincinnati, Cincinnati, Ohio, USA
| | - Charuhas V Thakar
- Division of Nephrology, Kidney C.A.R.E. (Clinical Advancement, Research and Education) Program, University of Cincinnati, Cincinnati, Ohio, USA
- Cincinnati VA Medical Center, Cincinnati, Ohio, USA
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95
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Pinier C, Gatault P, Fauchier L, Angoulvant D, François M, Barbet C, Bailly E, Noble J, Chevallier E, Rabot N, Büchler M, Sautenet B, Halimi JM. Specific impact of past and new major cardiovascular events on acute kidney injury and end-stage renal disease risks in diabetes: a dynamic view. Clin Kidney J 2020; 13:17-23. [PMID: 32083616 PMCID: PMC7025370 DOI: 10.1093/ckj/sfz028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Interconnections between major cardiovascular events (MCVEs) and renal events are recognized in diabetes, however, the specific impact of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS) on the risk of end-stage renal disease (ESRD) on top of established renal risk factors is unclear in type 2 diabetes mellitus. METHODS We conducted a retrospective study in 861 consecutive patients followed in a nephrology setting during the 2000-13 period. RESULTS The mean age was 70 ± 10 years, 65.1% were men and the estimated glomerular filtration rate (eGFR) was 42.4 ± 21.0 mL/min/1.73 m2. During follow-up (median 59 months), 194 patients reached ESRD. A history of AF, HF or ACS was associated with an increased risk of reduced baseline eGFR. In turn, reduced baseline eGFR resulted in a greater risk of new MCVE (especially HF) during follow-up. Finally, all new MCVEs were risk factors for subsequent acute kidney injury (AKI) {HF: hazard ratio [HR] 8.99 [95% confidence interval (CI) 7.06-11.4]; AF: HR 5.42 (3.91-7.52); ACS: HR 8.82 (6.24-12.5); all P < 0.0001} and ESRD [HF: HR 5.52 (95% CI 4.01-7.60), P < 0.0001; AF: HR 3.48 (2.30-5.21), P < 0.0001; ACS: HR 2.31 (1.43-3.73), P = 0.0006]. The AF- and HF-associated risks of ESRD were significant after adjustments on all renal risks of ESRD (gender, blood pressure, eGFR, albuminuria, renin-angiotensin blockers, retinopathy and AKI), but the association was less strong for ACS. Importantly, no association was noted between other major events such as stroke or infections and the risk of ESRD. CONCLUSIONS Past and new cardiovascular events (more HF and AF than ACS) have a strong, independent impact on the development of ESRD above and beyond established risk factors in diabetes.
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Affiliation(s)
- Cédric Pinier
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Philippe Gatault
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
| | - Laurent Fauchier
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Denis Angoulvant
- EA4245, François-Rabelais University, Tours, France
- Service de Cardiologie, Hôpital Trousseau, CHU Tours, Tours, France
| | - Maud François
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Christelle Barbet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Elodie Bailly
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Johan Noble
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Eloi Chevallier
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Nolwenn Rabot
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
| | - Matthias Büchler
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
| | - Bénédicte Sautenet
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- Inserm U1246, François-Rabelais University, Tours, France
- FCRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France
| | - Jean-Michel Halimi
- Service de Néphrologie-Hypertension, Dialyses, Transplantation Rénale, Hôpital Bretonneau, CHU Tours, Tours, France
- EA4245, François-Rabelais University, Tours, France
- FCRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, France
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96
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Acute kidney injury in hospitalized children: consequences and outcomes. Pediatr Nephrol 2020; 35:213-220. [PMID: 30386936 PMCID: PMC7223774 DOI: 10.1007/s00467-018-4128-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/18/2022]
Abstract
Over the past decade, the nephrology and critical care communities have adopted a consensus approach to diagnosing acute kidney injury (AKI) and, as a result, we have seen transformative changes in our understanding of pediatric AKI epidemiology. The data regarding outcomes among neonates and children who develop AKI have become far more robust and AKI has been clearly linked with an increased need for mechanical ventilation, longer inpatient stays, and higher mortality. Though AKI was historically thought to be self-limited, we now know that renal recovery is far from universal, particularly when AKI is severe; the absence of recovery from AKI also carries longitudinal prognostic implications. AKI survivors, especially those without full recovery, are at risk for chronic renal sequelae including proteinuria, hypertension, and chronic kidney disease. This review comprehensively describes AKI-related outcomes across the entire pediatric age spectrum, using the most rigorous studies to identify the independent effects of AKI events.
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97
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Inflammation as a predictor of acute kidney injury and mediator of higher mortality after acute kidney injury in non-cardiac surgery. Sci Rep 2019; 9:20260. [PMID: 31889082 PMCID: PMC6937243 DOI: 10.1038/s41598-019-56615-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/14/2019] [Indexed: 11/25/2022] Open
Abstract
This retrospective cohort study examined the roles of inflammation in acute kidney injury (AKI). Serum albumin and C-reactive protein (CRP) were used as markers of inflammation. Adults who underwent non–cardiac surgery from 2007 to 2011 were included. Exclusion criteria were urological surgery, obstetric surgery, missing data, and pre-operative dialysis. Subjects were followed until the end of 2015 or loss to follow-up. Associations between pre–operative albumin or CRP and post-operative AKI or association between AKI and mortality were examined by logistic or Cox regression, respectively. Mediation analyses were performed using albumin and CRP as mediators. Among 4,538 subjects, 272 developed AKI. Pre-operative albumin was independently associated with AKI (odds ratio [95% confidence interval (CI)]: 0.63 [0.48–0.83]). During a median follow-up of 4.5 years, 649 died. AKI was significantly associated with mortality (hazard ratio [HR] [95% CI]: 1.58 [1.22–2.04]). Further adjustment for pre-operative albumin and CRP attenuated the association (HR [95% CI]: 1.28 [0.99–1.67]). The proportions explained by mediating effects of lnCRP and albumin were 29.3% and 39.2% and mediation effects were statistically significant. In conclusion, inflammation is a predictor of AKI and a mediator of mortality after AKI. Interventions targeting inflammation might improve outcomes of AKI.
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98
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See EJ, Toussaint ND, Bailey M, Johnson DW, Polkinghorne KR, Robbins R, Bellomo R. Risk factors for major adverse kidney events in the first year after acute kidney injury. Clin Kidney J 2019; 14:556-563. [PMID: 33623679 PMCID: PMC7886537 DOI: 10.1093/ckj/sfz169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 11/08/2019] [Indexed: 01/29/2023] Open
Abstract
Background Acute kidney injury (AKI) survivors are at increased risk of major adverse kidney events (MAKEs), including chronic kidney disease (CKD), end-stage kidney disease (ESKD) and death. High-risk AKI patients may benefit from specialist follow-up, but factors associated with increased risk have not been reported. Methods We conducted a retrospective study of AKI patients admitted to a single centre between 2012 and 2016 who had a baseline estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 and were alive and independent of renal replacement therapy (RRT) at 30 days following discharge. AKI was identified using International Classification of Diseases, Tenth Revision codes and staged according to the Kidney Disease: Improving Global Outcomes criteria. Patients were excluded if they were kidney transplant recipients or if AKI was attributed to intrinsic kidney disease. We performed Cox regression models to examine MAKEs in the first year, defined as the composite of CKD (sustained 25% drop in eGFR), ESKD (requirement for chronic RRT or sustained eGFR <15 mL/min/1.73 m2) or death. We examined secondary outcomes (CKD, ESKD and death) using Cox and competing risk regression analyses. Results We studied 2101 patients (mean ± SD age 69 ± 15 years, baseline eGFR 72 ± 23 mL/min/1.73 m2). Of these, 767 patients (37%) developed at least one MAKE (429 patients developed CKD, 21 patients developed ESKD, 375 patients died). MAKEs occurred more frequently with older age [hazard ratio (HR) 1.16 per decade, 95% confidence interval (CI) 1.10–1.24], greater severity of AKI (Stage 2 HR 1.38, 95% CI 1.16–1.64; Stage 3 HR 1.62, 95% CI 1.31–2.01), higher serum creatinine at discharge (HR 1.04 per 10 µmol/L, 95% CI 1.03–1.06), chronic heart failure (HR 1.41, 95% CI 1.19–1.67), liver disease (HR 1.68, 95% CI 1.39–2.03) and malignancy (non-metastatic HR 1.44, 95% CI 1.14–1.82; metastatic HR 2.26, 95% CI 1.80–2.83). Traditional risk factors (e.g. diabetes and cardiovascular disease) had limited predictive value. Conclusions More than a third of AKI patients develop MAKEs within the first year. Clinical variables available at the time of discharge can help identify patients at increased risk of such events.
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Affiliation(s)
- Emily J See
- School of Medicine, University of Melbourne, Melbourne, Australia.,Department for Continuing Education, University of Oxford, Oxford, UK.,Department of Intensive Care, Austin Hospital, Heidelberg, Australia
| | - Nigel D Toussaint
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
| | - Michael Bailey
- School of Medicine, University of Melbourne, Melbourne, Australia.,Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Woolloongabba, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Australasian Kidney Trials Network, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia
| | - Kevan R Polkinghorne
- School of Medicine, Monash University, Melbourne, Australia.,Department of Nephrology, Monash Health, Clayton, Australia.,Department of Epidemiology and Preventative Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Raymond Robbins
- Data Analytics Research and Evaluation, The University of Melbourne and Austin Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- School of Medicine, University of Melbourne, Melbourne, Australia.,Department of Intensive Care, Austin Hospital, Heidelberg, Australia.,Data Analytics Research and Evaluation, The University of Melbourne and Austin Hospital, Melbourne, Australia
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99
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Zhang J, Crichton S, Dixon A, Seylanova N, Peng ZY, Ostermann M. Cumulative fluid accumulation is associated with the development of acute kidney injury and non-recovery of renal function: a retrospective analysis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:392. [PMID: 31796077 PMCID: PMC6891953 DOI: 10.1186/s13054-019-2673-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
Background Acute kidney injury (AKI) is common in patients in the intensive care unit (ICU) and may be present on admission or develop during ICU stay. Our objectives were (a) to identify factors independently associated with the development of new AKI during early stay in the ICU and (b) to determine the risk factors for non-recovery of AKI. Methods We retrospectively analysed prospectively collected data of patients admitted to a multi-disciplinary ICU in a single tertiary care centre in the UK between January 2014 and December 2016. We identified all patients without AKI or end-stage renal failure on admission to the ICU and compared the outcome and characteristics of patients who developed AKI according to KDIGO criteria after 24 h in the ICU with those who did not develop AKI in the first 7 days in the ICU. Multivariable logistic regression was applied to identify factors associated with the development of new AKI during the 24–72-h period after admission. Among the patients with new AKI, we identified those with full, partial or no renal recovery and assessed factors associated with non-recovery. Results Among 2525 patients without AKI on admission, the incidence of early ICU-acquired AKI was 33.2% (AKI I 41.2%, AKI II 35%, AKI III 23.4%). Body mass index, Sequential Organ Failure Assessment score on admission, chronic kidney disease (CKD) and cumulative fluid balance (FB) were independently associated with the new development of AKI. By day 7, 69% had fully recovered renal function, 8% had partial recovery and 23% had no renal recovery. Hospital mortality was significantly higher in those without renal recovery. Mechanical ventilation, diuretic use, AKI stage III, CKD, net FB on first day of AKI and cumulative FB 48 h later were independently associated with non-recovery with cumulative fluid balance having a U-shape association. Conclusions Early development of AKI in the ICU is common and mortality is highest in patients who do not recover renal function. Extreme negative and positive FB were strong risk factors for AKI non-recovery.
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Affiliation(s)
- Jing Zhang
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Siobhan Crichton
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Alison Dixon
- Department of Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nina Seylanova
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Sechenov Biomedical Science and Technology Park, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Zhiyong Y Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
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100
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Lysak N, Hashemighouchani H, Davoudi A, Pourafshar N, Loftus TJ, Ruppert M, Efron PA, Rashidi P, Bihorac A, Ozrazgat-Baslanti T. Cardiovascular death and progression to end-stage renal disease after major surgery in elderly patients. BJS Open 2019; 4:145-156. [PMID: 32011817 PMCID: PMC6996640 DOI: 10.1002/bjs5.50232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/11/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Reliable estimates for risk of cardiovascular-specific mortality and progression to end-stage renal disease (ESRD) among elderly patients undergoing major surgery are not available. This study aimed to develop simple risk scores to predict these events. METHODS In a single-centre cohort of elderly patients undergoing major surgery requiring hospital stay longer than 24 h, progression to ESRD and long-term cardiovascular-specific mortality were modelled using multivariable subdistribution hazard models, adjusting for co-morbidity, frailty and type of surgery. RESULTS Before surgery, 2·9 and 11·9 per cent of 16 655 patients had ESRD and chronic kidney disease (CKD) respectively. During the hospital stay, 46·9 per cent of patients developed acute kidney injury (AKI). Patients with kidney disease had a significantly higher risk of cardiovascular-specific (CV) mortality compared with patients without kidney disease (adjusted hazard ratio (HR) for CKD without AKI 1·60, 95 per cent c.i. 1·25 to 2·01; AKI without CKD 1·70, 1·52 to 1·87; AKI with CKD 2·80, 2·50 to 3·20; ESRD 5·21, 4·32 to 6·27), as well as increased progression to ESRD (AKI without CKD 5·40, 3·44 to 8·35; CKD without AKI 8·80, 4·60 to 17·00; AKI with CKD 31·60, 19·90 to 49·90). CV Death and ESRD Risk scores were developed to predict CV mortality and progression to ESRD. Calculated CV Death and ESRD Risk scores performed well with c-statistics: 0·77 (95 per cent c.i. 0·76 to 0·78) and 0·82 (0·78 to 0·86) respectively at 1 year. CONCLUSION Kidney disease in elderly patients undergoing major surgery is associated with a high risk of CV mortality and progression to ESRD. Risk scores can augment the shared decision-making process of informed consent and identify patients requiring postoperative renal-protective strategies.
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Affiliation(s)
- N Lysak
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - H Hashemighouchani
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - A Davoudi
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - N Pourafshar
- Health Sciences Centre, University of Virginia, Charlottesville, Virginia, USA
| | - T J Loftus
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - M Ruppert
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - P A Efron
- Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - P Rashidi
- Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - A Bihorac
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
| | - T Ozrazgat-Baslanti
- Department of Medicine, University of Florida, Gainesville, Florida, USA.,Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, Florida, USA
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