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Cao L, Guo X, Jia Y, Yang L, Wang H, Yuan S. Effect of Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermic Circulatory Arrest in Aortic Arch Surgery on Postoperative Renal Function: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2020; 9:e017939. [PMID: 32990132 PMCID: PMC7792363 DOI: 10.1161/jaha.120.017939] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Moderate hypothermic circulatory arrest (MHCA) has been widely used in aortic arch surgery. However, the renal function after MHCA remains controversial. We performed a systematic review and meta‐analysis direct comparison of the postoperative renal function of MHCA versus deep hypothermic circulatory arrest (DHCA) in aortic arch surgery. Methods and Results We searched PubMed, Embase, and the Cochrane Library for postoperative renal function after aortic arch surgery with using MHCA and DHCA, published from inception to January 31, 2020. The primary outcome was renal failure. Secondary outcomes were the need for renal therapy and other major postoperative outcomes. The random‐effects model was used for all comparisons to pool the estimates. A total of 14 observational studies with 4142 patients were included. Compared with DHCA, MHCA significantly reduced the incidence of renal failure (odds ratio [OR], 0.76; 95% CI, 0.61–0.94; P=0.011; I2=0.0%) and the need of renal replacement (OR, 0.68; 95% CI, 0.48–0.97; P=0.034; I2=0.0%). Subgroup analysis showed that when the hypothermic circulatory arrest time was <30 minutes, the incidence of renal failure in MHCA group was significantly lower than that in DHCA group (OR, 0.73; 95% CI, 0.54–0.99; P=0.040; I2=1.1%), whereas an insignificant difference between 2 groups when hypothermic circulatory arrest time was >30 minutes (OR, 0.76; 95% CI, 0.51–1.13; P=0.169; I2=17.3%). Conclusions MHCA compared with DHCA reduces the incidence of renal failure and the need for renal replacement. Registration URL: https://www.crd.york.ac.uk/prospero; Unique identifier: CRD42020169348.
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Affiliation(s)
- Liang Cao
- Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Xiaoxiao Guo
- Department of Cardiology Peking Union Medical College Hospital Peking Union Medical College and Chinese Academy of Medical Sciences Beijing China
| | - Yuan Jia
- Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Lijing Yang
- Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hongbai Wang
- Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Su Yuan
- Department of Anesthesiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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302
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Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, Haft J, Bermudez CA, Shah AS, D’Alessandro DA. 2020 EACTS/ELSO/STS/AATS expert consensus on post-cardiotomy extracorporeal life support in adult patients. Eur J Cardiothorac Surg 2020; 59:12-53. [DOI: 10.1093/ejcts/ezaa283] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 04/03/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022] Open
Abstract
Abstract
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Glenn Whitman
- Cardiovascular Surgery Intensive Care, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Milan Milojevic
- Department of Anaesthesiology and Critical Care Medicine, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - David M McMullan
- Department of Cardiac Surgery, Seattle Children Hospital, Seattle, WA, USA
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Christian A Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ashish S Shah
- Department of Cardio-Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David A D’Alessandro
- Department of Cardio-Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA
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303
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Association of uromodulin with acute kidney injury in patients undergoing cardiac surgery. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 17:160-164. [PMID: 33014093 PMCID: PMC7526493 DOI: 10.5114/kitp.2020.99081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/28/2020] [Indexed: 11/25/2022]
Abstract
Uromodulin (Umod) is a protein produced exclusively in the kidneys, and it is the most abundant protein in human urine. Scientific studies show that it can be a valuable diagnostic tool in monitoring kidney function. Clinical applications of Umod are probably wider. One of them is the role of a biomarker in cardiac surgery-associated acute kidney injury (CSA-AKI). Data from scientific studies indicate that a lower level of Umod in urine prior to surgery is associated with a higher risk of developing CSA-AKI after the procedure. A higher serum Umod level is suspected to be a good prognostic factor in the context of renal healing. It seems that the current state of knowledge supports the protective role of Umod in the course of AKI. Large, multi-center clinical trials would allow for the consolidation of preliminary scientific data and a more accurate understanding of the role of Umod as a CSA-AKI biomarker.
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304
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Lorusso R, Whitman G, Milojevic M, Raffa G, McMullan DM, Boeken U, Haft J, Bermudez CA, Shah AS, D'Alessandro DA. 2020 EACTS/ELSO/STS/AATS Expert Consensus on Post-Cardiotomy Extracorporeal Life Support in Adult Patients. Ann Thorac Surg 2020; 111:327-369. [PMID: 33036737 DOI: 10.1016/j.athoracsur.2020.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/16/2022]
Abstract
Post-cardiotomy extracorporeal life support (PC-ECLS) in adult patients has been used only rarely but recent data have shown a remarkable increase in its use, almost certainly due to improved technology, ease of management, growing familiarity with its capability and decreased costs. Trends in worldwide in-hospital survival, however, rather than improving, have shown a decline in some experiences, likely due to increased use in more complex, critically ill patients rather than to suboptimal management. Nevertheless, PC-ECLS is proving to be a valuable resource for temporary cardiocirculatory and respiratory support in patients who would otherwise most likely die. Because a comprehensive review of PC-ECLS might be of use for the practitioner, and possibly improve patient management in this setting, the authors have attempted to create a concise, comprehensive and relevant analysis of all aspects related to PC-ECLS, with a particular emphasis on indications, technique, management and avoidance of complications, appraisal of new approaches and ethics, education and training.
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Affiliation(s)
- Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Heart & Vascular Center, Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
| | - Glenn Whitman
- Cardiac Intensive Care Unit, Johns Hopkins Hospital, Baltimore, Maryland
| | - Milan Milojevic
- Department of Anesthesiology and Critical Care Medicine, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia; Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Giuseppe Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
| | - David M McMullan
- Department of Cardiac Surgery, Seattle Children Hospital, Seattle, Washington
| | - Udo Boeken
- Department of Cardiac Surgery, Heinrich Heine University, Dusseldorf, Germany
| | - Jonathan Haft
- Section of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Christian A Bermudez
- Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashish S Shah
- Department of Cardio-Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A D'Alessandro
- Department of Cardio-Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
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305
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Mutlu H, Gündüz E, Titiz TA, Küçükçetin İÖ. Investigation of AKI with Early Biomarkers After Cardiac Surgery. Braz J Cardiovasc Surg 2020; 35:722-731. [PMID: 33118738 PMCID: PMC7598966 DOI: 10.21470/1678-9741-2019-0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Hüseyin Mutlu
- Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation Antalya Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Emel Gündüz
- Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation Antalya Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Tülin Aydoğdu Titiz
- Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation Antalya Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - İkbal Özen Küçükçetin
- Akdeniz University Faculty of Medicine Department of Anesthesiology and Reanimation Antalya Turkey Department of Anesthesiology and Reanimation, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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306
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Kim WH, Bae J, Ji SH, Shin KW, Kim JT, Lim YJ, Bahk JH. Dividing Stage 1 Acute Kidney Injury After Cardiac or Thoracic Aortic Surgery. Ann Thorac Surg 2020; 111:1458-1464. [PMID: 32956671 DOI: 10.1016/j.athoracsur.2020.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 06/01/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the Kidney Disease: Improving Global Outcomes (KDIGO) criteria are used to define acute kidney injury, the criteria have limitations for including 2 different serum creatinine criteria in stage 1. We hypothesized that there would be differences in clinical outcomes between the 2 subgroups of stage 1 acute kidney injury in patients undergoing cardiac or thoracic aortic surgery. METHODS We reviewed 2510 cases. Patients with KDIGO stage 1 were divided into 2 subgroups (stage 1a: 0.3 mg/dL or greater of absolute increase in serum creatinine, n = 376; and stage 1b: 50% or greater relative increase, n = 365). Propensity score analysis was performed between stage 1a and 1b groups, yielding 240 pairs. We compared the length of hospital stay, the incidence of cardiovascular complications, 5-year all-cause mortality between these subgroups. Overall survival was compared between the subgroups after propensity score matching. We performed sensitivity analysis for Acute Kidney Injury Network (AKIN) criteria. RESULTS Length of hospital stay and 5-year all-cause mortality were worse in patients with KDIGO stage 1b compared with stage 1a. Five-year patient survival was significantly worse in patients with stage 1b compared with stage 1a after matching (log rank test, P = .002). We found similar results regarding AKIN criteria. Subgroup analysis showed that the significant difference in survival existed only when baseline serum creatinine was 0.8 mg/dL or greater. CONCLUSIONS The KDIGO or AKIN criteria for stage 1 acute kidney injury could be further divided into 2 substages with different severity of clinical outcomes. These modified criteria could give additional prognostic information in patients undergoing cardiac or thoracic aortic surgery.
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Affiliation(s)
- Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Won Shin
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jin Lim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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307
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Raina R, Joshi H, Chakraborty R. Changing the terminology from kidney replacement therapy to kidney support therapy. Ther Apher Dial 2020; 25:437-457. [PMID: 32945598 DOI: 10.1111/1744-9987.13584] [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: 05/20/2020] [Revised: 08/16/2020] [Accepted: 09/12/2020] [Indexed: 11/28/2022]
Abstract
Kidney replacement therapy (KRT) is a common supportive treatment for renal dysfunction, especially acute kidney injury. However, critically ill or immunosuppressed patients with renal dysfunction often have dysfunction in other organs as well. To improve patient outcomes, clinicians began to initiate kidney replacement therapy in situations where nonrenal conditions may lead to acute kidney injury, such as septic shock, hematopoietic stem cell transplantation, veno-occlusive renal disease, cardiopulmonary bypass, chemotherapy, tumor lysis syndrome, hyperammonemia, and various others. In this review, we discuss the use of various modes of kidney replacement therapy in treating renal and nonrenal complications to illustrate why kidney support therapy is a more appropriate terminology than kidney replacement therapy.
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Affiliation(s)
- Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA.,Department of Nephrology, Akron Children's Hospital, Akron, Ohio, USA
| | - Hirva Joshi
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Ronith Chakraborty
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, Ohio, USA
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308
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Ramakrishnan A, Zheng C, Fontes ML, Lombard FW, Woolard AA, Shi Y, Shotwell MS, Billings FT, Pretorius M, Wanderer JP, Vyas R, Absi TS, Shah AS, Kertai MD. Mean platelet volume and cardiac-surgery–associated acute kidney injury: a retrospective study. Can J Anaesth 2020; 67:1775-1788. [DOI: 10.1007/s12630-020-01811-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/26/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022] Open
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309
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Severe Acute Kidney Injury in Cardiovascular Surgery: Thrombotic Microangiopathy as a Differential Diagnosis to Ischemia Reperfusion Injury. A Retrospective Study. J Clin Med 2020; 9:jcm9092900. [PMID: 32911781 PMCID: PMC7565159 DOI: 10.3390/jcm9092900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/03/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) after cardiovascular surgery (CVS) infers high morbidity and mortality and may be caused by thrombotic microangiopathy (TMA). This study aimed to assess incidence, risk factors, kidney function, and mortality of patients with a postoperative TMA as possible cause of severe AKI following cardiovascular surgery. METHODS We analyzed retrospectively all patients admitted to the ICU after a cardiovascular procedure between 01/2018 and 03/2019 with severe AKI and need for renal replacement therapy (RRT). TMA was defined as post-surgery-AKI including need for RRT, hemolytic anemia, and thrombocytopenia. TMA patients were compared to patients with AKI requiring RRT without TMA. RESULTS Out of 893 patients, 69 (7.7%) needed RRT within one week after surgery due to severe AKI. Among those, 15 (21.7%) fulfilled TMA criteria. Aortic surgery suggested an increased risk for TMA (9/15 (60.0%) vs. 7/54 (31.5%), OR 3.26, CI 1.0013-10.64). Ten TMA patients required plasmapheresis and/or eculizumab, and five recovered spontaneously. Preoperative kidney function was significantly better in TMA patients than in controls (eGFR 92 vs. 60.5 mL/min, p = 0.004). However, postoperative TMA resulted in a more pronounced GFR loss (ΔeGFR -54 vs. -17 mL/min, p = 0.062). There were no deaths in the TMA group. CONCLUSION Our findings suggest TMA as an important differential diagnosis of severe AKI following cardiovascular surgery, which may be triggered by aortic surgery. Therefore, early diagnosis and timely treatment of TMA could reduce kidney damage and improve mortality of AKI following cardiovascular surgery, which should be further investigated.
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310
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Kim JY, Bai Y, Jayne LA, Abdulkader F, Gandhi M, Perreau T, Parikh SV, Gardner DS, Davidson AJ, Sander V, Song MA, Bajwa A, Pabla NS. SOX9 promotes stress-responsive transcription of VGF nerve growth factor inducible gene in renal tubular epithelial cells. J Biol Chem 2020; 295:16328-16341. [PMID: 32887795 DOI: 10.1074/jbc.ra120.015110] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/28/2020] [Indexed: 01/06/2023] Open
Abstract
Acute kidney injury (AKI) is a common clinical condition associated with diverse etiologies and abrupt loss of renal function. In patients with sepsis, rhabdomyolysis, cancer, and cardiovascular disorders, the underlying disease or associated therapeutic interventions can cause hypoxia, cytotoxicity, and inflammatory insults to renal tubular epithelial cells (RTECs), resulting in the onset of AKI. To uncover stress-responsive disease-modifying genes, here we have carried out renal transcriptome profiling in three distinct murine models of AKI. We find that Vgf nerve growth factor inducible gene up-regulation is a common transcriptional stress response in RTECs to ischemia-, cisplatin-, and rhabdomyolysis-associated renal injury. The Vgf gene encodes a secretory peptide precursor protein that has critical neuroendocrine functions; however, its role in the kidneys remains unknown. Our functional studies show that RTEC-specific Vgf gene ablation exacerbates ischemia-, cisplatin-, and rhabdomyolysis-associated AKI in vivo and cisplatin-induced RTEC cell death in vitro Importantly, aggravation of cisplatin-induced renal injury caused by Vgf gene ablation is partly reversed by TLQP-21, a Vgf-derived peptide. Finally, in vitro and in vivo mechanistic studies showed that injury-induced Vgf up-regulation in RTECs is driven by the transcriptional regulator Sox9. These findings reveal a crucial downstream target of the Sox9-directed transcriptional program and identify Vgf as a stress-responsive protective gene in kidney tubular epithelial cells.
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Affiliation(s)
- Ji Young Kim
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.
| | - Yuntao Bai
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Laura A Jayne
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Ferdos Abdulkader
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Megha Gandhi
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Tayla Perreau
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Samir V Parikh
- Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - David S Gardner
- School of Veterinary Medicine and Science, University of Nottingham, Loughborough, Leicestershire, United Kingdom
| | - Alan J Davidson
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Veronika Sander
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
| | - Min-Ae Song
- Division of Environmental Health Science, College of Public Health and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Amandeep Bajwa
- Transplant Research Institute, James D. Eason Transplant Institute, Department of Surgery, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Navjot Singh Pabla
- Division of Pharmaceutics and Pharmacology, College of Pharmacy and Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA.
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311
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Abstract
OBJECTIVES Up to 37% of children admitted to the PICU develop acute kidney injury as defined by Kidney Disease: Improving Global Outcomes criteria. We describe the prevalence of acute kidney injury in a mixed pediatric intensive care cohort using this criteria. As tools to stratify patients at risk of acute kidney injury on PICU admission are lacking, we explored the variables at admission and day 1 that might predict the development of acute kidney injury. DESIGN Single-center retrospective observational study. SETTING Thirty-six-bed surgical/medical tertiary PICU. PATIENTS Children from birth to less than or equal to 16 years old admitted between 2015 and 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical data were extracted from the PICU clinical information system. Patients with baseline creatinine at admission greater than 20 micromol/L above the calculated normal creatinine level were classified as "high risk of acute kidney injury." Models were created to predict acute kidney injury at admission and on day 1. Out of the 7,505 children admitted during the study period, 738 patients (9.8%) were classified as high risk of acute kidney injury at admission and 690 (9.2%) developed acute kidney injury during PICU admission. Compared to Kidney Disease: Improving Global Outcomes criteria as the reference standard, high risk of acute kidney injury had a lower sensitivity and higher specificity compared with renal angina index greater than or equal to 8 on day 1. For the admission model, the adjusted odds ratio of developing acute kidney injury for high risk of acute kidney injury was 4.2 (95% CI, 3.3-5.2). The adjusted odds ratio in the noncardiac cohort for high risk of acute kidney injury was 7.3 (95% CI, 5.5-9.7). For the day 1 model, odds ratios for high risk of acute kidney injury and renal angina index greater than or equal to 8 were 3.3 (95% CI, 2.6-4.2) and 3.1 (95% CI, 2.4-3.8), respectively. CONCLUSIONS The relationship between high risk of acute kidney injury and acute kidney injury needs further evaluation. High risk of acute kidney injury performed better in the noncardiac cohort.
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The Predictive Value of Urinary Kidney Injury Molecular 1 for the Diagnosis of Contrast-Induced Acute Kidney Injury after Cardiac Catheterization: A Meta-Analysis. J Interv Cardiol 2020; 2020:4982987. [PMID: 32863790 PMCID: PMC7443242 DOI: 10.1155/2020/4982987] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/25/2020] [Accepted: 06/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Urinary kidney injury molecule 1 (uKIM-1) is a proximal tubular injury biomarker for predicting acute kidney injury (AKI); its prognostic value varies depending on the clinical and population characteristics. However, the predictive value of uKIM-1 for diagnosis of contrast-induced acute kidney injury (CI-AKI) remains unclear. Method Medline, Embase, ClinicalTrials.gov, Cochrane Library database, and the China National Knowledge Infrastructure (CNKI) were used to identify relevant studies from their inception to November 31, 2019. Studies that met the inclusion criteria were included. Relevant data were extracted to obtain pooled sensitivity (SEN) and specificity (SPE), summary receiver operating characteristic curve (ROC), and area under the ROC (AUC or AUROC). A bivariate mixed-effects regression model was used for data analysis. Results A total of 946 patients from 8 eligible studies were included. Across all the studies, the diagnostic odds ratio (DOR) for uKIM-1 level to predict CI-AKI was 19 (95% CI 10–39), with SEN and SPE of 0.84 and 0.78, respectively. The AUROC for uKIM-1 in predicting CI-AKI was 0.88 (95% CI 0.85–0.90). There was a substantial heterogeneity across the studies (I2 was 37.73% for the summary sensitivity and 69.31% for the summary specificity). Conclusion Urinary KIM-1 has a high predictive value for diagnosis of CI-AKI in patients who have undergone cardiac catheterization.
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Lepère V, Duceau B, Lebreton G, Bombled C, Dujardin O, Boccara L, Charfeddine A, Amour J, Hajage D, Bouglé A. Risk Factors for Developing Severe Acute Kidney Injury in Adult Patients With Refractory Postcardiotomy Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation. Crit Care Med 2020; 48:e715-e721. [PMID: 32697513 DOI: 10.1097/ccm.0000000000004433] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Postcardiotomy cardiogenic shock occurs in 2-6% of patients undergoing cardiac surgery, and 1% of cardiac surgery patients will require mechanical circulatory support using venoarterial extracorporeal membrane oxygenation. Acute kidney injury is a frequent complication in this population and negatively impacts the survival. We aimed to determine whether the timing of extracorporeal membrane oxygenation implantation influences the renal prognosis of these patients. DESIGN Retrospective observational cohort study between January 2013 and December 2016. SETTING An 18-bed surgical ICU in a university hospital. PATIENTS A total of 4,796 consecutive adult patients who underwent cardiac surgery were included in the study, and 347 (7.2%) were assisted with venoarterial extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. The patients who died during the first 48 hours after venoarterial extracorporeal membrane oxygenation implantation were excluded. The complete-case analysis included 257 patients. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was the occurrence, within 10 days following the venoarterial extracorporeal membrane oxygenation implantation, of a stage 3 acute kidney injury defined by the Kidney Disease: Improving Global Outcomes group. One hundred sixty-nine patients (65.7%) presented with a Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury; 14 patients (5.4%) died before the end of the follow-up period, without developing the primary outcome. Ninety-two percent of patients with Kidney Disease: Improving Global Outcomes 3 acute kidney injury received renal replacement therapy, for a median duration of 7 days (3-16 d). Late implantation of venoarterial extracorporeal membrane oxygenation was independently associated with an increased risk of Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury (odds ratio, 2.81 [95% CI, 1.31-6.07]; p = 0.008). The other factors associated with Kidney Disease: Improving Global Outcomes stage 3 acute kidney injury were preoperative left ventricular ejection fraction (odds ratio, 1.03 [95% CI, 1.01-1.05]; p = 0.007), intraoperative plasma transfusion (odds ratio, 1.13 [95% CI, 1.02-1.26]; p = 0.022), increased bilirubinemia level (odds ratio, 1.013 [95% CI, 1.001-1.026]; p = 0.032), and increased creatinine levels (odds ratio, 1.012 [95% CI, 1.006-1.018]; p < 0.001) on the day of implantation. CONCLUSIONS Significant kidney dysfunction is particularly frequent in patients with refractory postcardiotomy cardiogenic shock assisted with venoarterial extracorporeal membrane oxygenation. Early implantation of extracorporeal membrane oxygenation may help prevent acute kidney injury.
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Affiliation(s)
- Victoria Lepère
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Baptiste Duceau
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Guillaume Lebreton
- Sorbonne Université, UMR INSERM 1166, IHU ICAN, AP-HP, Department of Cardio-Vascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Camille Bombled
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Olivier Dujardin
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Lucile Boccara
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Ahmed Charfeddine
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Julien Amour
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - David Hajage
- Sorbonne Université, INSERM, Institut Pierre Louis de Santé Publique, Equipe Pharmacoépidémiologie et évaluation des soins, AP-HP, Hôpital Pitié-Salpêtrière, Département Biostatistique Santé Publique Et Information Médicale, Unité de Recherche Clinique PSL-CFX, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Paris, France
| | - Adrien Bouglé
- Sorbonne Université, Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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314
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De Bono JA, Conte SM, Newcomb AE. Effects of Preoperative Angiotensin-Converting Enzyme Inhibitor Therapy on Postoperative Renal Function in Cardiac Surgery. Heart Lung Circ 2020; 29:1656-1667. [PMID: 32732124 DOI: 10.1016/j.hlc.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
A Best Evidence Topic in cardiac surgery was written according to a structured protocol. The question addressed was-"In patients who undergo cardiac surgery, is preoperative angiotensin-converting enzyme inhibitor therapy associated with postoperative renal dysfunction?" Altogether, 339 papers were found using the reported search. Ten (10) were chosen which best answered the clinical question. The papers were evaluated for bias and heterogeneity using validated tools and the collected results analysed qualitatively. Evidence in the current literature is inconclusive that preoperative administration of angiotensin-converting enzyme inhibitor therapy affects postoperative renal dysfunction in patients undergoing cardiac surgery.
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Affiliation(s)
- Joshua A De Bono
- Cardiothoracic Unit, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia.
| | - Sean M Conte
- Cardiology Unit, St Vincent's Hospital Sydney, Sydney, NSW, Australia
| | - Andrew E Newcomb
- Cardiothoracic Unit, St Vincent's Hospital Melbourne, Melbourne, Vic, Australia
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315
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Tseng PY, Chen YT, Wang CH, Chiu KM, Peng YS, Hsu SP, Chen KL, Yang CY, Lee OKS. Prediction of the development of acute kidney injury following cardiac surgery by machine learning. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:478. [PMID: 32736589 PMCID: PMC7395374 DOI: 10.1186/s13054-020-03179-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/14/2020] [Indexed: 12/14/2022]
Abstract
Background Cardiac surgery–associated acute kidney injury (CSA-AKI) is a major complication that results in increased morbidity and mortality after cardiac surgery. Most established prediction models are limited to the analysis of nonlinear relationships and fail to fully consider intraoperative variables, which represent the acute response to surgery. Therefore, this study utilized an artificial intelligence–based machine learning approach thorough perioperative data-driven learning to predict CSA-AKI. Methods A total of 671 patients undergoing cardiac surgery from August 2016 to August 2018 were enrolled. AKI following cardiac surgery was defined according to criteria from Kidney Disease: Improving Global Outcomes (KDIGO). The variables used for analysis included demographic characteristics, clinical condition, preoperative biochemistry data, preoperative medication, and intraoperative variables such as time-series hemodynamic changes. The machine learning methods used included logistic regression, support vector machine (SVM), random forest (RF), extreme gradient boosting (XGboost), and ensemble (RF + XGboost). The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). We also utilized SHapley Additive exPlanation (SHAP) values to explain the prediction model. Results Development of CSA-AKI was noted in 163 patients (24.3%) during the first postoperative week. Regarding the efficacy of the single model that most accurately predicted the outcome, RF exhibited the greatest AUC (0.839, 95% confidence interval [CI] 0.772–0.898), whereas the AUC (0.843, 95% CI 0.778–0.899) of ensemble model (RF + XGboost) was even greater than that of the RF model alone. The top 3 most influential features in the RF importance matrix plot were intraoperative urine output, units of packed red blood cells (pRBCs) transfused during surgery, and preoperative hemoglobin level. The SHAP summary plot was used to illustrate the positive or negative effects of the top 20 features attributed to the RF. We also used the SHAP dependence plot to explain how a single feature affects the output of the RF prediction model. Conclusions In this study, machine learning methods were successfully established to predict CSA-AKI, which determines risks following cardiac surgery, enabling the optimization of postoperative treatment strategies to minimize the postoperative complications following cardiac surgeries.
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Affiliation(s)
- Po-Yu Tseng
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Li-Nong Street, Beitou District, Taipei, 11221, Taiwan.,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Nephrology, Department of Internal Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
| | - Yi-Ting Chen
- Muen Biomedical and Optoelectronics Technologies Inc., New Taipei City, Taiwan
| | - Chuen-Heng Wang
- Muen Biomedical and Optoelectronics Technologies Inc., New Taipei City, Taiwan
| | - Kuan-Ming Chiu
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Department of Electrical Engineering, Yuan Ze University, Taoyuan City, Taiwan
| | - Yu-Sen Peng
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,College of Electrical and Communication Engineering, Yuan Ze University, Taoyuan City, Taiwan.,Department of Applied Cosmetology, Lee-Ming Institute of Technology, New Taipei City, Taiwan
| | - Shih-Ping Hsu
- Division of Nephrology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Kang-Lung Chen
- Division of Cardiovascular Surgery, Cardiovascular Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan.,Division of Cardiovascular Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Li-Nong Street, Beitou District, Taipei, 11221, Taiwan. .,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan. .,Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. .,Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), Hsinchu, Taiwan.
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, No. 155, Section 2, Li-Nong Street, Beitou District, Taipei, 11221, Taiwan. .,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan. .,China Medical University Hospital, Taichung, Taiwan.
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316
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Chen X, Bai M, Zhao L, Li Y, Yu Y, Zhang W, Ma F, Sun S, Chen X. Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study. J Cardiothorac Surg 2020; 15:195. [PMID: 32723390 PMCID: PMC7388495 DOI: 10.1186/s13019-020-01243-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited. METHODS Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints. RESULTS After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9, 33.9, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well. CONCLUSIONS Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.
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Affiliation(s)
- Xiaolan Chen
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ming Bai
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Lijuan Zhao
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yangping Li
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yan Yu
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Wei Zhang
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Feng Ma
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Shiren Sun
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
| | - Xiangmei Chen
- The Nephrology Department of Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, Shaanxi, China. .,State Key Laboratory of Kidney Disease, Department of Nephrology, Chinese People's Liberation Army General Hospital and Military Medical Postgraduate College, 28th Fuxing Road, Beijing, 100853, China.
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317
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Dellepiane S, Leventhal JS, Cravedi P. T Cells and Acute Kidney Injury: A Two-Way Relationship. Front Immunol 2020; 11:1546. [PMID: 32765535 PMCID: PMC7379378 DOI: 10.3389/fimmu.2020.01546] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/11/2020] [Indexed: 12/29/2022] Open
Abstract
Acute Kidney Injury (AKI) complicates up to 10% of hospital admissions substantially increasing patient morbidity and mortality. Experimental evidence supports that AKI initiation and maintenance results from immune-mediated damage. Exogenous injury sources directly damage renal cells which produce pro-inflammatory mediators recruiting immune cells and furthering kidney injury. Many AKI studies focus on activation of innate immunity; major components include complement pathways, neutrophils, and monocytes. Recently, growing evidence emphasizes T lymphocytes role in affecting AKI pathogenesis and magnitude. In particular, T helper 17 lymphocytes enhance tissue injury by recruiting neutrophils and other inflammatory cells, while regulatory T cells conversely reduce renal injury and facilitate repair. Intriguingly, evidence supports local parenchymal-T cell interactions as essential to producing T cell phenotypic changes affecting long-term kidney and patient survival. Herein, we review T cells effects on AKI and patient outcomes and discuss related new therapeutic approaches to improve outcomes of affected individuals.
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Affiliation(s)
- Sergio Dellepiane
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jeremy S Leventhal
- Division of Nephrology, White Plains Hospital, White Plains, NY, United States
| | - Paolo Cravedi
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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318
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Zhang H, Zhou K, Wang D, Zhang N, Liu J. The predictive value of the intraoperative Renal Pulsatility Index for acute kidney injury in patients undergoing cardiac surgery. Minerva Anestesiol 2020; 86:1161-1169. [PMID: 32615734 DOI: 10.23736/s0375-9393.20.14460-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The incidence of cardiac surgery-associated acute kidney injury (CSA-AKI) is very high. The Renal Resistive Index (RRI) is measured by transesophageal echocardiography (TEE) and can be used to predict the occurrence of CSA-AKI, but few studies have examined the Renal Pulsatility Index (RPI). The objective of this study was to explore the predictive value of intraoperative RPI for CSA-AKI. METHODS This study was a prospective observational study. Seventy-eight patients meeting the inclusion criteria were enrolled. The RPI was measured by TEE after the induction of general anesthesia (T1) and immediately after the surgery (T2). Serum creatinine (Scr) was measured one day before and seven days after the surgery. The diagnosis of AKI was based on the KDIGO diagnostic criteria. Multivariate logistic regression analysis was used to analyze the risk factors for postoperative AKI and to draw the receiver operating characteristic curve (ROC) and analyze its diagnostic value for AKI. RESULTS The incidence of postoperative AKI was 29.5%. The RPI at T2 was higher in the AKI group than in the non-AKI group (2.05±0.69 versus 1.49±0.48, P<0.001). The results of multivariate analysis showed that the RPI at T2 was an independent risk factor for the occurrence of AKI (OR=4.683, 95% CI: 1.592-13.772; P=0.006). The area under the curve (AUC) of the RPI was 0.733 (95% CI: 0.621-0.827) with a cut-off value of 1.86 (sensitivity 60.87%, specificity 85.45% and Youden Index 0.46). CONCLUSIONS An RPI at T2>1.86 is correlated with a higher incidence of postoperative AKI. Treatment guided and personalized on the base of this parameter should be investigated by further dedicated studies.
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Affiliation(s)
- Hui Zhang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Kang Zhou
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dongyue Wang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Na Zhang
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jindong Liu
- Department of Anesthesiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China - .,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
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319
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Fu HY, Chou NK, Chen YS, Yu HY. Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass. Asian J Surg 2020; 44:229-234. [PMID: 32624399 DOI: 10.1016/j.asjsur.2020.05.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Acute kidney injury (AKI) after cardiopulmonary bypass (CPB) in patients with pre-existing impaired renal function carries deleterious outcomes but is not frequently evaluated. The optimal CPB strategy for preventing AKI in this vulnerable patient group is still controversial. METHODS A total of 156 patients with preoperative estimated glomerular filtration rate (e-GFR) <30 ml/min but not on chronic dialysis receiving valve operation under CPB were included in the present study. Postoperative AKI was defined as KDIGO (Kidney Disease Improving Global Outcomes) stage 3. Hospital mortality and two-year renal function evolution were compared between patients with postoperative AKI and those without AKI. Risk factors for the development of postoperative AKI were also studied. RESULTS The incidence of postoperative KDIGO-3 was high (44.2%). Hospital mortality was higher in the AKI group (30.4%) than in the non-AKI group (8.0%). Among the hospital survivors, renal function deterioration to permanent dialysis at two years was also more common in AKI group (14.5%) than in non-AKI group (4.6%). Univariate logistic regression for postoperative AKI revealed male gender, increased age, height, weight, BSA, and BMI, high preoperative serum creatinine, prolonged CPB duration, and decreased CPB target temperature as risk factors. However, multivariate analysis revealed only high preoperative serum creatinine and decreased CPB target temperature as significant risk factors for postoperative AKI. CONCLUSION To prevent postoperative AKI in CKD patients, low CPB target temperature is avoided, especially for those with high preoperative serum creatinine levels.
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Affiliation(s)
- Hsun-Yi Fu
- Department of Cardiac Surgery, National Taiwan University Hospital, And School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Nai-Kuan Chou
- Department of Cardiac Surgery, National Taiwan University Hospital, And School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yih-Sharng Chen
- Department of Cardiac Surgery, National Taiwan University Hospital, And School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsi-Yu Yu
- Department of Cardiac Surgery, National Taiwan University Hospital, And School of Medicine, National Taiwan University, Taipei, Taiwan.
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320
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Battistone MA, Mendelsohn AC, Spallanzani RG, Allegretti AS, Liberman RN, Sesma J, Kalim S, Wall SM, Bonventre JV, Lazarowski ER, Brown D, Breton S. Proinflammatory P2Y14 receptor inhibition protects against ischemic acute kidney injury in mice. J Clin Invest 2020; 130:3734-3749. [PMID: 32287042 PMCID: PMC7324186 DOI: 10.1172/jci134791] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/08/2020] [Indexed: 12/24/2022] Open
Abstract
Ischemic acute kidney injury (AKI), a complication that frequently occurs in hospital settings, is often associated with hemodynamic compromise, sepsis, cardiac surgery, or exposure to nephrotoxins. Here, using a murine renal ischemia/reperfusion injury (IRI) model, we show that intercalated cells (ICs) rapidly adopted a proinflammatory phenotype after IRI. Wwe demonstrate that during the early phase of AKI either blockade of the proinflammatory P2Y14 receptor located on the apical membrane of ICs or ablation of the gene encoding the P2Y14 receptor in ICs (a) inhibited IRI-induced increase of chemokine expression in ICs, (b) reduced neutrophil and monocyte renal infiltration, (c) reduced the extent of kidney dysfunction, and (d) attenuated proximal tubule damage. These observations indicate that the P2Y14 receptor participates in the very first inflammatory steps associated with ischemic AKI. In addition, we show that the concentration of the P2Y14 receptor ligand UDP-glucose (UDP-Glc) was higher in urine samples from intensive care unit patients who developed AKI compared with patients without AKI. In particular, we observed a strong correlation between UDP-Glc concentration and the development of AKI in cardiac surgery patients. Our study identifies the UDP-Glc/P2Y14 receptor axis as a potential target for the prevention and/or attenuation of ischemic AKI.
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Affiliation(s)
- Maria Agustina Battistone
- Program in Membrane Biology, Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexandra C. Mendelsohn
- Program in Membrane Biology, Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Raul German Spallanzani
- Division of Immunology, Department of Microbiology and Immunobiology, Harvard Medical School, Boston, Massachusetts, USA
- Evergrande Center for Immunologic Diseases, Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Andrew S. Allegretti
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel N. Liberman
- Program in Membrane Biology, Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Juliana Sesma
- Marsico Lung Institute, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sahir Kalim
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susan M. Wall
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Eduardo R. Lazarowski
- Marsico Lung Institute, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Dennis Brown
- Program in Membrane Biology, Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sylvie Breton
- Program in Membrane Biology, Division of Nephrology, Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA
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321
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Bonavia A, Vece G, Karamchandani K. Prerenal acute kidney injury—still a relevant term in modern clinical practice? Nephrol Dial Transplant 2020; 36:1570-1577. [DOI: 10.1093/ndt/gfaa061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 02/24/2020] [Indexed: 12/11/2022] Open
Abstract
Abstract
The traditional taxonomy of acute kidney injury (AKI) has remained pervasive in clinical nephrology. While the terms ‘prerenal’, ‘intrarenal’ and ‘postrenal’ highlight the diverse pathophysiology underlying AKI, they also imply discrete disease pathways and de-emphasize the nature of AKI as an evolving clinical syndrome with multiple, often simultaneous and overlapping, causes. In a similar vein, prerenal AKI comprises a diverse spectrum of kidney disorders, albeit one that is often managed by using a standardized clinical algorithm. We contend that the term ‘prerenal’ is too vague to adequately convey our current understanding of hypoperfusion-related AKI and that it should thus be avoided in the clinical setting. Practice patterns among nephrologists indicate that AKI-related terminology plays a significant role in the approaches that clinicians take to patients that have this complex disease. Thus, it appears that precise terminology does impact the treatment that patients receive. We will outline differences in the diagnosis and management of clinical conditions lying on the so-called prerenal disease spectrum to advocate caution when administering intravenous fluids to these clinically decompensated patients. An understanding of the underlying pathophysiology may, thus, avert clinical missteps such as fluid and vasopressor mismanagement in tenuous or critically ill patients.
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Affiliation(s)
- Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
- Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Gregory Vece
- The Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Kunal Karamchandani
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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322
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Husain-Syed F, Quattrone MG, Ferrari F, Bezerra P, Lopez-Giacoman S, Danesi TH, Samoni S, de Cal M, Yücel G, Yazdani B, Seeger W, Walmrath HD, Birk HW, Salvador L, Ronco C. Clinical and Operative Determinants of Acute Kidney Injury after Cardiac Surgery. Cardiorenal Med 2020; 10:340-352. [PMID: 32599584 DOI: 10.1159/000507777] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/30/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cardiac surgery-associated acute kidney injury (CSA-AKI) is associated with increased morbidity and mortality. OBJECTIVES We aimed to identify potentially modifiable risk factors for CSA-AKI. METHODS This was asingle-center retrospective cohort study of 495 adult patients undergoing cardiac surgery. AKI was diagnosed and staged using full KDIGO criteria incorporating baseline serum creatinine (SC) levels and correction of postoperative SC levels for fluid balance. We examined the association of routinely available clinical and laboratory data with AKI using multivariate logistic regression modeling. RESULTS A total of 103 (20.8%) patients developed AKI: 16 (15.5%) patients were diagnosed with AKI upon hospital admission, and 87 (84.5%) patients were diagnosed with CSA-AKI. Correction of SC levels for fluid balance increased the number of AKI cases to 104 (21.0%), with 6 patients categorized to different AKI stages. Univariate logistic regression analysis identified five preoperative (age, sex, diabetes mellitus, preoperative systolic pulmonary arterial pressure [PSPAP], acute decompensated heart failure) and five intraoperative predictors of AKI (age, sex, red blood cell [RBC] volume transfused, use of minimally invasive surgery, duration of cardiopulmonary bypass). When all preoperative and intraoperative variables were incorporated into one model, six predictors remained significant (age, sex, use of minimally invasive surgery, RBC volume transfused, PSPAP, duration of cardiopulmonary bypass). Model discrimination performance showed an area under the curve of 0.69 for the model including only preoperative variables, 0.76 for the model including only intraoperative variables, and 0.77 for the model including all preoperative and intraoperative variables. CONCLUSIONS Use of minimally invasive surgery and therapies mitigating PSPAP and intraoperative blood loss may offer protection against CSA-AKI.
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Affiliation(s)
- Faeq Husain-Syed
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany, .,International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy,
| | | | - Fiorenza Ferrari
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Intensive Care, I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Pércia Bezerra
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Salvador Lopez-Giacoman
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | | | - Sara Samoni
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Gökhan Yücel
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany.,First Department of Medicine, Faculty of Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Babak Yazdani
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany.,Fifth Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Werner Seeger
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Hans-Dieter Walmrath
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Horst-Walter Birk
- Division of Nephrology, Pulmonology and Critical Care Medicine, Department of Internal Medicine II, University Hospital Giessen and Marburg, Giessen, Germany
| | - Loris Salvador
- Department of Clinical Chemistry and Hematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine (DIMED), University of Padua, Padua, Italy
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323
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Coulson T, Bailey M, Pilcher D, Reid CM, Seevanayagam S, Williams-Spence J, Bellomo R. Predicting Acute Kidney Injury After Cardiac Surgery Using a Simpler Model. J Cardiothorac Vasc Anesth 2020; 35:866-873. [PMID: 32713734 DOI: 10.1053/j.jvca.2020.06.072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/21/2020] [Accepted: 06/22/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To develop a simple model for the prediction of acute kidney injury (AKI) and renal replacement therapy (RRT) that could be used in clinical or research risk stratification. DESIGN Retrospective analysis. SETTING Multi-institutional. PARTICIPANTS All cardiac surgery patients from September 2016 to December 2018. INTERVENTIONS Observational. MEASUREMENTS AND MAIN RESULTS The study cohort was divided into a development set (75%) and validation set (25%). The following 2 data epochs were used: preoperative data and immediate postoperative data (within 4 h of intensive care unit admission). Univariate statistics were used to identify variables associated with AKI or RRT. Stepwise logistic regression was used to develop a parsimonious model. Model discrimination and calibration were evaluated in the test set. Models were compared with previously published models and with a more comprehensive model developed using the least absolute shrinkage and selection operator. The study included 22,731 patients at 33 hospitals. The incidences of AKI (any stage) and RRT for the present analysis were 5,829 patients (25.6%) and 488 patients (2.1%), respectively. Models were developed for AKI, with an area under the receiver operating curve (AU-ROC) of 0.67 and 0.69 preoperatively and postoperatively, respectively. Models for RRT had an AU-ROC of 0.77 and 0.80 preoperatively and postoperatively, respectively. These models contained between 3 and 5 variables. Comparatively, comprehensive least absolute shrinkage and selection operator models contained between 21 and 26 variables, with an AU-ROC of 0.71 and 0.72 for AKI and 0.84 and 0.87 for RRT respectively. CONCLUSION In the present study, simple, clinically applicable models for predicting AKI and RRT preoperatively and immediate postoperatively were developed. Even though AKI prediction remained poor, RRT prediction was good with a parsimonious model.
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Affiliation(s)
- Tim Coulson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia; Department of Anesthesia, Austin Health, Melbourne, Melbourne, Australia.
| | - Michael Bailey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia
| | - Dave Pilcher
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Intensive Care, Alfred Health, Melbourne, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; School of Public Health, Curtin University, Perth, Australia
| | - Siven Seevanayagam
- Department of Anesthesia, Austin Health, Melbourne, Melbourne, Australia
| | - Jenni Williams-Spence
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, University of Melbourne, Melbourne, Australia; Department of Anesthesia, Austin Health, Melbourne, Melbourne, Australia
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324
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Griffin BR, Bronsert M, Reece TB, Pal JD, Cleveland JC, Fullerton DA, Faubel S, Aftab M. Creatinine elevations from baseline at the time of cardiac surgery are associated with postoperative complications. J Thorac Cardiovasc Surg 2020; 163:1378-1387. [PMID: 32739165 DOI: 10.1016/j.jtcvs.2020.03.174] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 03/05/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Baseline kidney function is a key predictor of postoperative morbidity and mortality. Whether an increased creatinine at the time of surgery, compared with the lowest creatinine in the 3 months before surgery, is associated with poor outcomes has not been evaluated. We examined whether creatinine elevations from "baseline" were associated with adverse postoperative outcomes. METHODS A total of 1486 patients who underwent cardiac surgery at the University of Colorado Hospital between January 2011 and May 2016 met inclusion criteria. "Change in creatinine from baseline" was defined as the difference between the immediate presurgical creatinine value and the lowest creatinine value within 3 months preceding surgery. Outcomes evaluated were in-hospital mortality, postoperative infection, postoperative stroke, development of stage 3 acute kidney injury, intensive care unit length of stay, and hospital length of stay. Outcomes were adjusted using a balancing score to account for differences in patient characteristics. RESULTS There were significant increases in the odds of postoperative infection (odds ratio, 1.17; confidence interval, 1.02-1.34; per 0.1 mg/dL increase in creatinine), stage 3 acute kidney injury (odds ratio, 1.44; confidence interval; 1.18-1.75), intensive care unit length of stay (odds ratio, 1.13; confidence interval, 1.01-1.26), and hospital length of stay (odds ratio, 1.09; confidence interval, 1.05-1.13). There was a significant increase in mortality in the unadjusted analysis, although not after adjustment using a balancing score. There was no association with postoperative stroke. CONCLUSIONS Elevations in creatinine at the time of surgery above the "baseline" level are associated with increased postoperative morbidity. Baseline creatinine should be established before surgery, and small changes in creatinine should trigger heightened vigilance in the postoperative period.
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Affiliation(s)
- Benjamin R Griffin
- Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Michael Bronsert
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and Surgical Outcomes and Applied Research, University of Colorado, Aurora, Colo
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Jay D Pal
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Joseph C Cleveland
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - David A Fullerton
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo
| | - Sarah Faubel
- Division of Nephrology, University of Colorado Anschutz Medical Campus, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo
| | - Muhammad Aftab
- Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora, Colo; Rocky Mountain Regional VA Medical Center, Aurora, Colo.
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325
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Xu N, Zhang Q, Wu G, Lv D, Zheng Y. Derivation and Validation of a Risk Prediction Model for Vancomycin-Associated Acute Kidney Injury in Chinese Population. Ther Clin Risk Manag 2020; 16:539-550. [PMID: 32606713 PMCID: PMC7319536 DOI: 10.2147/tcrm.s253587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 12/03/2022] Open
Abstract
Background Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) infection; however, nephrotoxicity happened with a high incidence of 15%~40%. Weighting the risk before receiving vancomycin treatment facilitates timely prevention of nephrotoxicity, but no standardized strategy exists for this purpose. Methods A retrospective cohort study was performed. A total of 524 hospitalized patients treated with vancomycin were included in this study. They were divided into derivation cohort (n=341) and externally validation cohort (n=183) according to their admission time. Using univariate and multivariable logistic regression, we identified potential predictors of vancomycin-associated acute kidney injury (AKI) and developed a risk score by plotting nomogram. The predictive performance of this novel risk score was assessed and validated by discrimination and calibration. Besides, the risk score was also compared with existing prediction models according to integrated discrimination index (IDI) and net reclassification index (NRI). Results The incidence of AKI was 16.1% (55/341) in the derivation cohort and 16.4% (30/183) in the validation cohort. Three factors (vancomycin serum trough concentration, piperacillin/tazobactam and furosemide) were determined as predictors for vancomycin-associated AKI. The established three-item risk score showed a comparable discrimination in both derivation cohort (AUC=0.793, 95% CI: 0.732–0.855) and validation cohort (AUC=0.788, 95% CI: 0.698–0.877). The risk score also demonstrated a good calibration in the derivation cohort (χ2=6.079, P=0.638>0.05) and validation cohort (χ2=5.665, P=0.686>0.05). Compared with prediction by Cmin alone, this risk score significantly improved reclassification accuracy (IDI=0.050, 95% CI: 0.024–0.076, P<0.001, NRI=0.166, 95% CI: 0.044–0.289, P=0.007). Conclusion The established model in this study is a simplified three-item risk score, which provides a robust tool for the prediction of AKI after receiving vancomycin treatment.
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Affiliation(s)
- Nana Xu
- Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Qiao Zhang
- Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Guolan Wu
- Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Duo Lv
- Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
| | - Yunliang Zheng
- Research Center of Clinical Pharmacy, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China.,Zhejiang Provincial Key Laboratory for Drug Evaluation and Clinical Research, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China
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326
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The incidence and associations of acute kidney injury in trauma patients admitted to critical care: A systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 86:141-147. [PMID: 30358765 DOI: 10.1097/ta.0000000000002085] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND As more patients are surviving the initial effects of traumatic injury clinicians are faced with managing the systemic complications of severe tissue injury. Of these, acute kidney injury (AKI) may be a sentinel complication contributing to adverse outcomes. OBJECTIVE To establish the incidence of AKI in patients admitted to critical care after major trauma, to explore any risk factors and to evaluate the association of AKI with outcomes. DATA SOURCES Systematic search of MEDLINE, Excerpta Medica database and Cochrane library from January 2004 to April 2018. STUDY SELECTION Studies of adult major trauma patients admitted to critical care that applied consensus AKI criteria (risk injury failure loss end stage [RIFLE], AKI network, or kidney disease improving global outcomes) and reported clinical outcomes were assessed (PROSPERO Registration: CRD42017056781). Of the 35 full-text articles selected from the screening, 17 (48.6%) studies were included. DATA EXTRACTION AND SYNTHESIS We followed the PRISMA guidelines and study quality was assessed using the Newcastle-Ottawa score. The pooled incidence of AKI and relative risk of death were estimated using random-effects models. MAIN OUTCOMES AND MEASURES Incidence of AKI was the primary outcome. The secondary outcome was study-defined mortality. RESULTS We included 17 articles describing AKI outcomes in 24,267 trauma patients. The pooled incidence of AKI was 20.4% (95% confidence interval [CI], 16.5-24.9). Twelve studies reported the breakdown of stages of AKI with 55.7% of patients classified as RIFLE-R or stage 1, 30.3% as RIFLE-I or stage 2, and 14.0% as RIFLE-F or stage 3. The pooled relative risk of death with AKI compared was 3.6 (95% CI, 2.4-5.3). In addition, there was a concordant increase in odds of death among six studies that adjusted for multiple variables (adjusted odds ratio, 2.7; 95% CI, 1.9-3.8; p = <0.01). CONCLUSION Acute kidney injury is common after major trauma and associated with increased mortality. Future research is warranted to reduce the potential for harm associated with this subtype of AKI. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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327
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Dong P, Xue FS, Liu SH. Identification of risk factors for acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass. J Cardiothorac Surg 2020; 15:99. [PMID: 32414397 PMCID: PMC7229587 DOI: 10.1186/s13019-020-01152-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
The letter to the editor made several comments on possible issues in the recent article by Zhang et al. determining the risk factors of acute kidney injury after pulmonary endarterectomy with cardiopulmonary bypass, which has been published in Journal of Cardiothoracic Surgery at December 30, 2019.
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Affiliation(s)
- Peng Dong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China.
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, People's Republic of China
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328
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Hou Q, Yu X, Cheng Z, Han Z, Liu F, Dou J, An C, Chen X, Yu J, Liang P. Acute kidney injury after nephron sparing surgery and microwave ablation: focus on incidence, survival impact and prediction. Int J Hyperthermia 2020; 37:470-478. [PMID: 32396482 DOI: 10.1080/02656736.2020.1752944] [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] [Indexed: 01/15/2023] Open
Abstract
Purpose: To compare acute kidney injury (AKI) incidence between nephron sparing surgery (NSS) and microwave ablation (MWA) for T1a RCC patients, reveal the effect of AKI on survival prognosis, construct AKI nomogram and use Law of Total Probability for survival probability (SP) prediction.Materials and methods: Patients were studied retrospectively after NSS (n = 1267) or MWA (n = 210) from January 1, 2011 to June 30, 2017. Using one to one Propensity Score Matching (PSM), 158 pairs of patients were identified for the cohort study. AKI incidence, risk factors and impact on survival outcomes were analyzed using Chi-square test, logistic and cox regression analysis. AKI risk and SP were predicted by nomogram and Law of Total Probability. The performance of the nomogram was assessed with respect to its discrimination, calibration, and clinical usefulness.Results: AKI occurred more commonly in NSS (27.85%) cohort, when compared to MWA (17.72%) cohort (p = 0.032), but treatment modality was not independently predictive of AKI occurrence (odds ratio [OR]: 0.598; 95% confidence interval [CI]: 0.282-1.265; p = 0.178). The 5-yr overall survival (OS) was lower in AKI patients (73.5%) compared with non-AKI patients (94.8%; p < 0.001). AKI was an independent risk factor for all-cause mortality in RCC patients (hazard ratio [HR]: 2.820; 95% confidence interval [CI]: 1.110-7.165; p = 0.029). Predictors for both NSS- and MWA-related AKI included tumor diameter, baseline eGFR and CCI score. RENAL score and tumor blood supply can predict AKI after NSS and MWA, respectively. The AKI normograms demonstrated good discrimination, with AUCs >0.86, excellent calibration and net benefits at the decision curve analysis with probabilities ≥5%. SP predicted by Law of Total Probability was comparable to actual OS.Conclusion: AKI was an early indicator for poor overall survival in RCC patients. It can be predicted by several oncological parameters. Nomogram and Law of Total Probability can accurately predict AKI risk and SP.
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Affiliation(s)
- Qidi Hou
- School of Medicine, Nankai University, Tianjin, China.,Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Xiaoling Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhigang Cheng
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Zhiyu Han
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Fangyi Liu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Jianping Dou
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Chao An
- Department of Minimal invasive intervention, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong Province, China
| | - Xiaoqiong Chen
- Department of Ultrasonic imaging, First Affiliated Hospital of Hunan University of Chinese Medicine, Changsha, Hunan Province, China
| | - Jie Yu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- School of Medicine, Nankai University, Tianjin, China.,Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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Li Y, Xu J, Wang Y, Zhang Y, Jiang W, Shen B, Ding X. A novel machine learning algorithm, Bayesian networks model, to predict the high-risk patients with cardiac surgery-associated acute kidney injury. Clin Cardiol 2020; 43:752-761. [PMID: 32400109 PMCID: PMC7368305 DOI: 10.1002/clc.23377] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiac surgery-associated acute kidney injury (CSA-AKI) is a well-recognized complication with an ominous outcome. HYPOTHESIS Bayesian networks (BNs) not only can reveal the complex interrelationships between predictors and CSA-AKI, but predict the individual risk of CSA-AKI occurrence. METHODS During 2013 and 2015, we recruited 5533 eligible participants who underwent cardiac surgery from a tertiary hospital in eastern China. Data on demographics, clinical and laboratory information were prospectively recorded in the electronic medical system and analyzed by gLASSO-logistic regression and BNs. RESULTS The incidences of CSA-AKI and severe CSA-AKI were 37.5% and 11.1%. BNs model revealed that gender, left ventricular ejection fractions (LVEF), serum creatinine (SCr), serum uric acid (SUA), platelet, and aortic cross-clamp time (ACCT) were found as the parent nodes of CSA-AKI, while ultrafiltration volume and postoperative central venous pressure (CVP) were connected with CSA-AKI as children nodes. In the severe CSA-AKI model, age, proteinuria, and SUA were directly linked to severe AKI; the new nodes of NYHA grade and direct bilirubin created relationships with severe AKI through was related to LVEF, surgery types, and SCr level. The internal AUCs for predicting CSA-AKI and severe AKI were 0.755 and 0.845, which remained 0.736 and 0.816 in the external validation. Given the known variables, the risk for CSA-AKI can be inferred at individual levels based on the established BNs model and prior information. CONCLUSION BNs model has a high accuracy, good interpretability, and strong generalizability in predicting CSA-AKI. It facilitates physicians to identify high-risk patients and implement protective strategies to improve the prognosis.
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Affiliation(s)
- Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Jiarui Xu
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Yimei Wang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Yunlu Zhang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Wuhua Jiang
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Bo Shen
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
| | - Xiaoqiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Medical Center of Kidney, Shanghai, China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, China.,Shanghai Institute of Kidney and Dialysis, Shanghai, China.,Hemodialysis Quality Control Center of Shanghai, Shanghai, China
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330
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Griffin BR, Gist KM, Faubel S. Current Status of Novel Biomarkers for the Diagnosis of Acute Kidney Injury: A Historical Perspective. J Intensive Care Med 2020; 35:415-424. [PMID: 30654681 PMCID: PMC7333543 DOI: 10.1177/0885066618824531] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is a common and serious medical condition associated with significant increases in morbidity, mortality, and cost of care. Because of the high incidence and poor outcomes associated with AKI, there has been significant interest in the development of new therapies for the prevention and treatment of the disease. A lack of efficacy in drug trials led to the concern that AKI was not being diagnosed early enough for an effective intervention and that a rise in serum creatinine itself is not a sensitive-enough marker. Researchers have been searching for novel biomarkers that can not only assess a decline in kidney function but also demonstrate structural damage to the kidney and at time points earlier than increases in serum creatinine measurements allow. Over the past 10 years, there have been 3300 new publications and hundreds of new biomarkers investigated, yet concern still remains regarding AKI biomarker performance. The AKI biomarkers are yet to be widely utilized in clinical practice, leading some to question whether AKI biomarkers will ever reach their initial promise. However, we believe that biomarkers are an important part of current and future AKI research and clinical management. In this review, we compare the historical contexts of acute myocardial ischemia and AKI biomarker development to illustrate the progress that has been made within AKI biomarker research in a relatively short period of time and also to point out key differences between the disease processes that have been barriers to widespread AKI biomarker adoption. Finally, we discuss potential paths by which biomarkers can lead to appropriate AKI treatment responses that lower morbidity and mortality.
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Affiliation(s)
- Benjamin R. Griffin
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katja M. Gist
- Department of Pediatrics, The Heart Institute, University of Colorado, Aurora, CO, USA
| | - Sarah Faubel
- Division of Renal Diseases and Hypertension, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Renal Section, Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA
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331
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Acute Kidney Injury in Patients With Acute Respiratory Distress Syndrome: The Chicken or the Egg? Crit Care Med 2020; 47:1273-1274. [PMID: 31415313 DOI: 10.1097/ccm.0000000000003882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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332
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Pisano A, Torella M, Yavorovskiy A, Landoni G. The Impact of Anesthetic Regimen on Outcomes in Adult Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:711-729. [PMID: 32434720 DOI: 10.1053/j.jvca.2020.03.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/18/2020] [Accepted: 03/29/2020] [Indexed: 11/11/2022]
Abstract
Despite improvements in surgical techniques and perioperative care, cardiac surgery still is burdened by relatively high mortality and frequent major postoperative complications, including myocardial dysfunction, pulmonary complications, neurologic injury, and acute kidney injury. Although the surgeon's skills and volume and patient- and procedure-related risk factors play a major role in the success of cardiac surgery, there is growing evidence that also optimizing perioperative care may improve outcomes significantly. The present review focuses on the aspects of perioperative care that are strictly related to the anesthesia regimen, with special reference to volatile anesthetics and neuraxial anesthesia, whose effect on outcome in adult cardiac surgery has been investigated extensively.
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Affiliation(s)
- Antonio Pisano
- Department of Critical Care, Cardiac Anesthesia and Intensive Care Unit, AORN Dei Colli, Monaldi Hospital, Naples, Italy
| | - Michele Torella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Andrey Yavorovskiy
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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333
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Milne B, Gilbey T, Ostermann M, Kunst G. Pro: We Should Stop ACE Inhibitors Early Before Cardiac Surgery to Prevent Postoperative Acute Kidney Injury. J Cardiothorac Vasc Anesth 2020; 34:2832-2835. [PMID: 32418831 DOI: 10.1053/j.jvca.2020.03.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St. Thomas' Hospital, London, UK
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cardiovascular Medicine and Sciences, King's College London British Heart Foundation Centre of Excellence, Faculty of Life Sciences and Medicine, London, UK.
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334
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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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335
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Liu FK, Xue FS, Liu SH. Establishment of a risk model for acute kidney injury after cardiac surgery. Gen Thorac Cardiovasc Surg 2020; 68:1603-1604. [DOI: 10.1007/s11748-020-01355-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
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336
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Niendorf T, Seeliger E, Cantow K, Flemming B, Waiczies S, Pohlmann A. Probing renal blood volume with magnetic resonance imaging. Acta Physiol (Oxf) 2020; 228:e13435. [PMID: 31876349 DOI: 10.1111/apha.13435] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023]
Abstract
Damage to the kidney substantially reduces life expectancy. Renal tissue hypoperfusion and hypoxia are key elements in the pathophysiology of acute kidney injury and its progression to chronic kidney disease. In vivo assessment of renal haemodynamics and tissue oxygenation remains a challenge. Blood oxygenation level-dependent (BOLD) magnetic resonance imaging (MRI) is sensitive to changes in the effective transversal relaxation time (T2 *) in vivo, and is non-invasive and indicative of renal tissue oxygenation. However, the renal T2 * to tissue pO2 relationship is not governed exclusively by renal blood oxygenation, but is affected by physiological confounders with alterations in renal blood volume fraction (BVf) being of particular relevance. To decipher this interference probing renal BVf is essential for the pursuit of renal MR oximetry. Superparamagnetic iron oxide nanoparticle (USPIO) preparations can be used as MRI visible blood pool markers for detailing alterations in BVf. This review promotes the opportunities of MRI-based assessment of renal BVf. Following an outline on the specifics of renal oxygenation and perfusion, changes in renal BVf upon interventions and their potential impact on renal T2 * are discussed. We also describe the basic principles of renal BVf assessment using ferumoxytol-enhanced MRI in the equilibrium concentration regimen. We demonstrate that ferumoxytol does not alter control of renal haemodynamics and oxygenation. Preclinical applications of ferumoxytol enhanced renal MRI as well as considerations for its clinical implementation for examining renal BVf changes are provided alongside practical considerations. Finally, we explore the future directions of MRI-based assessment of renal BVf.
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Affiliation(s)
- Thoralf Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Erdmann Seeliger
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Kathleen Cantow
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Bert Flemming
- Institute of Physiology Charité – Universitätsmedizin Berlin Campus Mitte, and Center for Cardiovascular Research (CCR) Berlin Germany
| | - Sonia Waiczies
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Andreas Pohlmann
- Berlin Ultrahigh Field Facility (B.U.F.F.) Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
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337
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Tojo K, Mihara T, Goto T. Effects of intraoperative tidal volume on incidence of acute kidney injury after cardiovascular surgery: A retrospective cohort study. J Crit Care 2020; 56:152-156. [DOI: 10.1016/j.jcrc.2019.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 12/23/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
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338
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Ribociclib mitigates cisplatin-associated kidney injury through retinoblastoma-1 dependent mechanisms. Biochem Pharmacol 2020; 177:113939. [PMID: 32229099 DOI: 10.1016/j.bcp.2020.113939] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/24/2020] [Indexed: 12/20/2022]
Abstract
Aberrant cell cycle activation is a hallmark of carcinogenesis. Recently three cell cycle targeting cyclin-dependent kinase 4/6 (CDK4/6) inhibitors have been approved for the treatment of metastatic breast cancer. CDK4/6 inhibitors suppress proliferation through inhibition of CDK4/6-dependent retinoblastoma-1 (Rb1) phosphorylation and inactivation, a key regulatory step in G1-to-S-phase transition. Importantly, aberrant cell cycle activation is also linked with several non-oncological diseases including acute kidney injury (AKI). AKI is a common disorder caused by toxic, inflammatory, and ischemic damage to renal tubular epithelial cells (RTECs). Interestingly, AKI triggered by the anti-cancer drug cisplatin can be mitigated by ribociclib, a CDK4/6 inhibitor, through mechanisms that remain unclear. Employing in vivo cell cycle analysis and functional Rb1 knock-down, here, we have examined the cellular and pharmacological basis of the renal protective effects of ribociclib during cisplatin nephrotoxicity. Remarkably, siRNA-mediated Rb1 silencing or RTEC-specific Rb1 gene ablation did not alter the severity of cisplatin-associated AKI; however, it completely abrogated the protective effects conferred by ribociclib administration. Furthermore, we find that cisplatin treatment evokes CDK4/6 activation and Rb1 phosphorylation in the normally quiescent RTECs, however, this is not followed by S-phase entry likely due to DNA-damage induced G1 arrest. The cytoprotective effects of ribociclib are thus not a result of suppression of S-phase entry but are likely dependent on the maintenance of Rb1 in a hypo-phosphorylated and functionally active form under stress conditions. These findings delineate the role of Rb1 in AKI and illustrate the pharmacological basis of the renal protective effects of CDK4/6 inhibitors.
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339
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Affiliation(s)
- Christopher T Ryan
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
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340
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Safadi S, Hommos MS, Enders FT, Lieske JC, Kashani KB. Risk Factors for Acute Kidney Injury in Hospitalized Non-Critically Ill Patients: A Population-Based Study. Mayo Clin Proc 2020; 95:459-467. [PMID: 32008812 PMCID: PMC7060836 DOI: 10.1016/j.mayocp.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 05/08/2019] [Accepted: 06/05/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop and validate an acute kidney injury (AKI) risk prediction model for hospitalized non-critically ill patients. PATIENTS AND METHODS We retrospectively identified all Olmsted County, Minnesota, residents admitted to non-intensive care unit (ICU) wards at Mayo Clinic Hospital, Rochester, Minnesota, in 2013 and 2014. The cohort was divided into development and validation sets by year. The primary outcome was hospital-acquired AKI defined by Kidney Disease: Improving Global Outcomes criteria. Cox regression was used to analyze mortality data. Comorbid risk factors for AKI were identified, and a multivariable model was developed and validated. RESULTS The development and validation cohorts included 3816 and 3232 adults, respectively. Approximately 10% of patients in both cohorts had AKI, and patients with AKI had an increased risk of death (hazard ratio, 3.62; 95% CI, 2.97-4.43; P<.001). Significant univariate determinants of AKI were preexisting kidney disease, diabetes mellitus, hypertension, heart failure, vascular disease, coagulopathy, pulmonary disease, coronary artery disease, cancer, obesity, liver disease, and weight loss (all P<.05). The final multivariable model included increased baseline serum creatinine value, admission to a medical service, pulmonary disease, diabetes mellitus, kidney disease, cancer, hypertension, and vascular disease. The area under the receiver operating characteristic curves for the development and validation cohorts were 0.71 (95% CI, 0.69-0.75) and 0.75 (95% CI, 0.72-0.78), respectively. CONCLUSION Hospital-acquired AKI is common in non-ICU inpatients and is associated with worse outcomes. Patient data at admission can be used to identify increased risk; such patients may benefit from more intensive monitoring and earlier intervention and testing with emerging biomarkers.
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Affiliation(s)
- Sami Safadi
- Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore
| | - Musab S Hommos
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Felicity T Enders
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - John C Lieske
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Division of Clinical Core Laboratory Services, Mayo Clinic, Rochester, MN
| | - Kianoush B Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
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341
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Wu Q, Yang H, Bo H, Fu M, Zhong X, Liang G, Xu Y, Hu Z, Zhang Z, Jin X, Kang Y. Predictive role of estimated glomerular filtration rate prior to surgery in postsurgical acute kidney injury among very elderly patients: a retrospective cohort study. Ren Fail 2020; 41:866-874. [PMID: 31517563 PMCID: PMC6758700 DOI: 10.1080/0886022x.2019.1662440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Acute kidney injury (AKI) is a common complication after surgery. Because of unpredictable and variable age-dependent physical decline, the incidence, risk factor of postsurgical AKI and the predictive power of estimated glomerular filtration rate prior to surgery (eGFRpreSurg) has not been fully elucidated in very elderly patients. Methods: All discharged patients aged ≥80 years without chronic kidney disease who underwent surgery prior to intensive care unit (ICU) admission from 2017 through 2018 were included. Clinical, biological and surgical data were recorded. Mean of outpatient creatinine values from the year prior to ICU admission was used as the baseline value to determine the occurrence of AKI. Postoperative AKI was diagnosed according to Kidney Disease Improving Global Outcomes criteria. Results: Among 243 very elderly postoperative patients admitted during the study period, 48 had AKI during their ICU stay. The occurrence of postsurgical AKI was associated with longer ventilation times (p < .001) and higher mortality (p < .001). The eGFRpreSurg, which is calculated based on the Modification of Diet in Renal Disease study equation, was a risk factor for postoperative AKI (OR = 2.662, p = .010). The incidence of postoperative AKI was significantly higher among patients with lower eGFRpreSurg than among those with an eGFRpreSurg ≥ 70 mL/min/1.73 m2 (p = .003). Conclusion: Postsurgical AKI in very elderly patients has a high incidence and is a risk factor for mortality. Our study confirmed that eGFRpreSurg could be used as an index for AKI risk stratification.
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Affiliation(s)
- Qin Wu
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Hao Yang
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Hong Bo
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Min Fu
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Xi Zhong
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Guanlin Liang
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Yujun Xu
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Zhi Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
| | - Yan Kang
- Department of Critical Care Medicine, West China Hospital, Sichuan University , Chengdu , China
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342
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Hayek SS, Leaf DE, Samman Tahhan A, Raad M, Sharma S, Waikar SS, Sever S, Camacho A, Wang X, Dande RR, Ibrahim NE, Baron RM, Altintas MM, Wei C, Sheikh-Hamad D, Pan JSC, Holliday MW, Januzzi JL, Weisbord SD, Quyyumi AA, Reiser J. Soluble Urokinase Receptor and Acute Kidney Injury. N Engl J Med 2020; 382:416-426. [PMID: 31995687 PMCID: PMC7065830 DOI: 10.1056/nejmoa1911481] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury is common, with a major effect on morbidity and health care utilization. Soluble urokinase plasminogen activator receptor (suPAR) is a signaling glycoprotein thought to be involved in the pathogenesis of kidney disease. We investigated whether a high level of suPAR predisposed patients to acute kidney injury in multiple clinical contexts, and we used experimental models to identify mechanisms by which suPAR acts and to assess it as a therapeutic target. METHODS We measured plasma levels of suPAR preprocedurally in patients who underwent coronary angiography and patients who underwent cardiac surgery and at the time of admission to the intensive care unit in critically ill patients. We assessed the risk of acute kidney injury at 7 days as the primary outcome and acute kidney injury or death at 90 days as a secondary outcome, according to quartile of suPAR level. In experimental studies, we used a monoclonal antibody to urokinase plasminogen activator receptor (uPAR) as a therapeutic strategy to attenuate acute kidney injury in transgenic mice receiving contrast material. We also assessed cellular bioenergetics and generation of reactive oxygen species in human kidney proximal tubular (HK-2) cells that were exposed to recombinant suPAR. RESULTS The suPAR level was assessed in 3827 patients who were undergoing coronary angiography, 250 who were undergoing cardiac surgery, and 692 who were critically ill. Acute kidney injury developed in 318 patients (8%) who had undergone coronary angiography. The highest suPAR quartile (vs. the lowest) had an adjusted odds ratio of 2.66 (95% confidence interval [CI], 1.77 to 3.99) for acute kidney injury and 2.29 (95% CI, 1.71 to 3.06) for acute kidney injury or death at 90 days. Findings were similar in the surgical and critically ill cohorts. The suPAR-overexpressing mice that were given contrast material had greater functional and histologic evidence of acute kidney injury than wild-type mice. The suPAR-treated HK-2 cells showed heightened energetic demand and mitochondrial superoxide generation. Pretreatment with a uPAR monoclonal antibody attenuated kidney injury in suPAR-overexpressing mice and normalized bioenergetic changes in HK-2 cells. CONCLUSIONS High suPAR levels were associated with acute kidney injury in various clinical and experimental contexts. (Funded by the National Institutes of Health and others.).
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Affiliation(s)
- Salim S Hayek
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - David E Leaf
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Ayman Samman Tahhan
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Mohamad Raad
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Shreyak Sharma
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Sushrut S Waikar
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Sanja Sever
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Alex Camacho
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Xuexiang Wang
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Ranadheer R Dande
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Nasrien E Ibrahim
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Rebecca M Baron
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Mehmet M Altintas
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Changli Wei
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - David Sheikh-Hamad
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Jenny S-C Pan
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Michael W Holliday
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - James L Januzzi
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Steven D Weisbord
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Arshed A Quyyumi
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
| | - Jochen Reiser
- From the Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor (S.S.H.); the Divisions of Renal Medicine (D.E.L., S. Sharma, S.S.W.) and Pulmonary and Critical Care Medicine (R.M.B.), Brigham and Women's Hospital, the Section of Nephrology, Department of Medicine, Boston University School of Medicine (S.S.W.), and the Divisions of Nephrology (S. Sever) and Cardiology (A.C., N.E.I., J.L.J.), Massachusetts General Hospital - all in Boston; Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta (A.S.T., M.R., A.A.Q.); the Department of Medicine, Rush University Medical Center, Chicago (X.W., R.R.D., M.M.A., C.W., J.R.); the Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston (D.S.-H., J.S.-C.P., M.W.H.); and the Veterans Affairs Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, Pittsburgh (S.D.W.)
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Zhou H, Yang L, Wang G, Zhang C, Fang Z, Lei G, Shi S, Li J. Remote Ischemic Preconditioning Prevents Postoperative Acute Kidney Injury After Open Total Aortic Arch Replacement: A Double-Blind, Randomized, Sham-Controlled Trial. Anesth Analg 2020; 129:287-293. [PMID: 30896603 DOI: 10.1213/ane.0000000000004127] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute kidney injury is a common complication after open total aortic arch replacement but lacks effective preventive strategies. Remote ischemic preconditioning has controversial results of its benefit to the kidney and may perform better in high-risk patients of acute kidney injury. We investigated whether remote ischemic preconditioning would prevent postoperative acute kidney injury after open total aortic arch replacement. METHODS We enrolled 130 patients scheduled for open total aortic arch replacement and randomized them to receive either remote ischemic preconditioning (4 cycles of 5-minute right upper limb ischemia and 5-minute reperfusion) or sham preconditioning (4 cycles of 5-minute right upper limb pseudo ischemia and 5-minute reperfusion), both via blood pressure cuff inflation and deflation. The primary end point was the incidence of acute kidney injury within 7 days after the surgery defined by the Kidney Disease: Improving Global Outcomes criteria. Secondary end point included short-term clinical outcomes. RESULTS Significantly fewer patients developed postoperative acute kidney injury with remote ischemic preconditioning compared with sham (55.4% vs 73.8%; absolute risk reduction, 18.5%; 95% CI, 2.3%-34.6%; P = .028). Remote ischemic preconditioning significantly reduced acute kidney injury stage II-III (10.8% vs 35.4%; P = .001). Remote ischemic preconditioning shortened the mechanical ventilation duration (18 hours [interquartile range, 14-33] versus 25 hours [interquartile range, 17-48]; P = .01), whereas no significant differences were observed between groups in other secondary outcomes. CONCLUSIONS Remote ischemic preconditioning prevented acute kidney injury after open total aortic arch replacement, especially severe acute kidney injury and shortened mechanical ventilation duration. The observed renoprotective effects of remote ischemic preconditioning require further investigation in both clinical research and the underlying mechanism.
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Affiliation(s)
- Hui Zhou
- From the Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Lijing Yang
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guyan Wang
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Congya Zhang
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongrong Fang
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guiyu Lei
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Shi
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Li
- Department of Anesthesiology, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Coulson TG, McPhilimey E, Falter F, Abu-Omar Y, Klein AA. The Association Between Pulsatile Cardiopulmonary Bypass and Acute Kidney Injury After Cardiac Surgery: A Before-and-After Study. J Cardiothorac Vasc Anesth 2020; 34:108-113. [DOI: 10.1053/j.jvca.2019.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 01/22/2023]
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Shi N, Liu K, Fan Y, Yang L, Zhang S, Li X, Wu H, Li M, Mao H, Xu X, Ma SP, Xiao P, Jiang S. The Association Between Obesity and Risk of Acute Kidney Injury After Cardiac Surgery. Front Endocrinol (Lausanne) 2020; 11:534294. [PMID: 33123083 PMCID: PMC7573233 DOI: 10.3389/fendo.2020.534294] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the relationship between obesity and the risk of AKI after cardiac surgery (CS-AKI) in a cohort study. METHODS A total of 1,601 patients undergoing cardiac surgery were collected and their incidence of CS-AKI was recorded. They were divided into underweight, normal weight, overweight, and obese groups. Logistic regression was used to estimate the association between BMI (body mass index) and CS-AKI risk. Then, a meta-analysis of published cohort studies was conducted to confirm this result using PubMed and Embase databases. RESULTS A significant association was observed in this independent cohort after adjusting age, gender, hypertension and New York Heart Association classification (NYHA) class. Compared with normal BMI group (18.5 ≤ BMI < 24.0), the individuals with aberrant BMI level had an increased AKI risk (OR: 1.68, 95% CI: 1.01-2.78) for BMI < 18.5 group and (OR: 1.43, 95% CI: 0.96-2.15) for BMI ≥ 28.0. Interestingly, the U-shape curve showed the CS-AKI risk reduced with the increasing of BMI when BMI ≤ 24.0. As BMI increases with BMI > 24.0, the risk of developing CS-AKI increased significantly. In the confirmed meta-analysis, compared with normal weight, overweight group with cardiac surgery had higher AKI risk (OR: 1.28, 95% CI: 1.16-1.41, Pheterogeneity = 0.49). The similar association was found in obesity subgroup (OR: 1.79, 95% CI: 1.57-2.03, Pheterogeneity = 0.42). CONCLUSION In conclusion, the results suggested that abnormal BMI was a risk factor for CS-AKI independently.
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Affiliation(s)
- Ning Shi
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Kang Liu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Yuanming Fan
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Lulu Yang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Song Zhang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Xu Li
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
| | - Hanzhang Wu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Meiyuan Li
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Xueqiang Xu
- Department of Nephrology, Jiangsu Province Hospital, Nanjing, China
| | - Shi-Ping Ma
- State Key Laboratory of Natural Medicines, China Pharmaceutical University, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
| | - Pingxi Xiao
- Department of Cardiology, The Affiliated Sir Run Run Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
| | - Shujun Jiang
- Clinical Metabolomics Center, China Pharmaceutical University, Nanjing, China
- Department of Infectious Diseases, Nanjing Hospital of Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Nanjing, China
- *Correspondence: Shujun Jiang, ; Pingxi Xiao, ; Shi-Ping Ma,
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346
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Zhang C, Wang G, Zhou H, Lei G, Yang L, Fang Z, Shi S, Li J, Han Z, Song Y, Liu S. Preoperative platelet count, preoperative hemoglobin concentration and deep hypothermic circulatory arrest duration are risk factors for acute kidney injury after pulmonary endarterectomy: a retrospective cohort study. J Cardiothorac Surg 2019; 14:220. [PMID: 31888760 PMCID: PMC6937636 DOI: 10.1186/s13019-019-1026-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
Background Acute kidney injury (AKI) is a major postoperative morbidity of patients undergoing cardiac surgery and has a negative effect on prognosis. The kidney outcomes after pulmonary endarterectomy (PEA) have not yet been reported; However, several perioperative characteristics of PEA may induce postoperative AKI. The objective of our study was to identify the incidence and risk factors for postoperative AKI and its association with short-term outcomes. Methods This was a single-center, retrospective, observational, cohort study. Assessments of AKI diagnosis was executed based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Results A total of 123 consecutive patients who underwent PEA between 2014 and 2018 were included. The incidence of postoperative AKI was 45% in the study population. Stage 3 AKI was associated with worse short-term outcomes and 90-day mortality (p < 0.001, p = 0.002, respectively). The independent predictors of postoperative AKI were the preoperative platelet count (OR 0.992; 95%CI 0.984–0.999; P = 0.022), preoperative hemoglobin concentration (OR 0.969; 95%CI 0.946–0.993; P = 0.01) and deep hypothermic circulatory arrest (DHCA) time (OR 1.197; 95%CI 1.052–1.362; P = 0.006) in the multivariate analysis. Conclusion The incidence of postoperative AKI was relatively high after PEA compared with other types of cardiothoracic surgeries. The preoperative platelet count, preoperative hemoglobin concentration and DHCA duration were modifiable predictors of AKI, and patients may benefit from some low-risk, low-cost perioperative measures.
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Affiliation(s)
- Congya Zhang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China. .,Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Hui Zhou
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Guiyu Lei
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Lijing Yang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Zhongrong Fang
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Sheng Shi
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Li
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Zhiyan Han
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Yunhu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
| | - Sheng Liu
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, People's Republic of China
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Ortega-Loubon C, Tamayo E, Jorge-Monjas P. Reply: Cardiac surgery-associated acute kidney injury-A protective armor rather than a lethal ammunition. J Thorac Cardiovasc Surg 2019; 159:e261. [PMID: 31839223 DOI: 10.1016/j.jtcvs.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/05/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Christian Ortega-Loubon
- Department of Cardiac Surgery, Clinical University Hospital of Valladolid, Valladolid, Spain; BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain
| | - Eduardo Tamayo
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain; Department of Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain
| | - Pablo Jorge-Monjas
- BioCritic Group for Biomedical Research in Critical Care Medicine, Valladolid, Spain; Department of Anesthesiology and Critical Care, Clinical University Hospital of Valladolid, Valladolid, Spain
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348
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Chen LS, Singh RJ. Utilities of traditional and novel biomarkers in the management of acute kidney injury. Crit Rev Clin Lab Sci 2019. [DOI: 10.1080/10408363.2019.1689916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Li-Sheng Chen
- Research and Development Directorate (J-9), Defense Health Agency, Silver Spring, MD, USA
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Wieruszewski PM, Wittwer ED. Is Dexmedetomidine the Key for Reducing Acute Kidney Injury After Cardiac Surgery? J Cardiothorac Vasc Anesth 2019; 34:614-615. [PMID: 31791854 DOI: 10.1053/j.jvca.2019.10.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 10/29/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Patrick M Wieruszewski
- Department of Pharmacy, Mayo Clinic, Rochester, MN; Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN
| | - Erica D Wittwer
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Group, Mayo Clinic, Rochester, MN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Santana-Santos E, Kanke PH, Vieira RDCA, Oliveira LBD, Ferretti-Rebustini REDL, Menezes AFD, Barreto ÍDDC, Hajjar LA. Impacto do controle glicêmico intensivo na lesão renal aguda: ensaio clínico randomizado. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Avaliar o impacto do controle glicêmico intensivo na redução da incidência de lesão renal aguda em pacientes adultos submetidos à cirurgia cardíaca. Métodos Ensaio clínico randomizado que avaliou 95 pacientes submetidos a duas estratégias de controle glicêmico. Os pacientes foram randomizados para o grupo intervenção (GI), com a meta de manutenção da glicemia pós-operatória entre 90 e 110 mg/dl. Nos pacientes alocados no grupo convencional (GC) o objetivo era a manutenção da glicemia entre 140 e 180 mg/dl. O ajuste da dose de insulina foi baseado em medições de glicose no sangue arterial não diluído, em intervalos de uma hora por meio de um sistema de monitoramento de glicose e beta-cetona no sangue. Resultados A incidência de LRA foi de 53,7% (KDIGO estágios 1, 2 ou 3). Não houve diferença significante entre os grupos quanto ao desfecho primário (p=0,294). Entretanto, observou-se maior frequência de recuperação da função renal (p=0,010), na alta da UTI (p=0,028) e alta hospitalar (p=0,048) entre os pacientes submetidos ao controle glicêmico convencional. A utilização do controle glicêmico intensivo esteve associada com maior tempo de permanência na UTI (p=0,031). O número de episódios de hipoglicemia foi semelhante nos dois grupos (1,6 ± 0,9 vs. 1,3 ± 0,6, p=0,731), demonstrando a segurança das estratégias utilizadas. Conclusão Não se observou o impacto do controle glicêmico intensivo na redução da incidência de lesão renal aguda. Em contrapartida, os pacientes tratados no GC apresentaram maior frequência de recuperação da função renal.
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