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Rhee H, Jang GS, Kim S, Lee W, Jeon H, Kim DW, Ye BM, Kim HJ, Kim MJ, Kim SR, Kim IY, Song SH, Seong EY, Lee DW, Lee SB. Worsening or improving hypoalbuminemia during continuous renal replacement therapy is predictive of patient outcome: a single-center retrospective study. J Intensive Care 2022; 10:25. [PMID: 35672868 PMCID: PMC9171968 DOI: 10.1186/s40560-022-00620-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/31/2022] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Hypoalbuminemia at the initiation of continuous renal replacement therapy (CRRT) is a risk factor for poor patient outcomes. However, it is unknown whether the patterns of changes in serum albumin levels during CRRT can be used to predict patient outcomes.
Methods
This retrospective study analyzed data that had been consecutively collected from January 2016 to December 2020 at the Third Affiliated Hospital. We included patients with acute kidney injury who received CRRT for ≥ 72 h. We divided the patients into four groups based on their serum albumin levels (albumin ≥ 3.0 g/dL or < 3.0 g/dL) at the initiation and termination of CRRT.
Results
The 793 patients in this study were categorized into the following albumin groups: persistently low, 299 patients (37.7%); increasing, 85 patients (10.4%); decreasing, 195 patients (24.6%); and persistently high, 214 patients (27.1%). In-hospital mortality rates were highest in the persistently low and decreasing groups, followed by the increasing and persistently high groups. The hazard ratio for in-hospital mortality was 0.481 (0.340–0.680) in the increasing group compared to the persistently low group; it was 1.911 (1.394–2.620) in the decreasing group compared to the persistently high group. The length of ICU stay was 3.55 days longer in the persistently low group than in the persistently high group.
Conclusions
Serum albumin levels changed during CRRT, and monitoring of patterns of change in serum albumin levels is useful for predicting in-hospital mortality and the length of ICU stay.
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Hansrivijit P, Yarlagadda K, Puthenpura MM, Ghahramani N, Thongprayoon C, Vaitla P, Cheungpasitporn W. A meta-analysis of clinical predictors for renal recovery and overall mortality in acute kidney injury requiring continuous renal replacement therapy. J Crit Care 2020; 60:13-22. [PMID: 32731101 DOI: 10.1016/j.jcrc.2020.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/03/2020] [Accepted: 07/12/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine clinical predictors for continuous renal replacement therapy (CRRT) discontinuation in patients with acute kidney injury (AKI). MATERIALS AND METHODS Ovid MEDLINE, EMBASE, and Cochrane Library were searched. The protocol is registered on researchregistry.com (reviewregistry909). Our criteria included non-end-stage kidney disease adults who required CRRT for AKI. Renal recovery was defined by CRRT discontinuation. Risk of bias was assessed using ROBINS-I tool. RESULTS We classified our analyses into renal recovery cohort and overall mortality cohort. All studies were observational. For renal recovery cohort, increasing urine output at time of CRRT discontinuation, elevated initial SOFA score and serum creatinine at CRRT initiation were predictive of renal recovery with OR 1.021 (95%CI = 1.011-1.031), 0.869 (95%CI = 0.811-0.932) and 0.995 (95%CI = 0.996-0.999), respectively. For overall mortality cohort, age and presence of sepsis were significantly associated with overall mortality with OR of 1.028 (95%CI = 1.008-1.048) and 2.160 (95%CI = 0.973-1.932), respectively. CONCLUSIONS Urine output at CRRT discontinuation, lower initial SOFA score, and lower serum creatinine levels at CRRT initiation were associated with higher likelihood of renal recovery. Increasing age and the presence of sepsis were associated with increased overall mortality from AKI on CRRT. However, there were limited data on co-morbidities which might preclude their inclusion in our analysis.
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Affiliation(s)
- Panupong Hansrivijit
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17104, USA.
| | - Keerthi Yarlagadda
- Department of Internal Medicine, University of Pittsburgh Medical Center Pinnacle, Harrisburg, PA 17104, USA.
| | - Max M Puthenpura
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA 19129, USA.
| | - Nasrollah Ghahramani
- Division of Nephrology, Department of Medicine, Penn State University College of Medicine, Hershey, PA 17033, USA.
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
| | - Wisit Cheungpasitporn
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Blanco-Gozalo V, Casanova AG, Sancho-Martínez SM, Prieto M, Quiros Y, Morales AI, Martínez-Salgado C, Agüeros-Blanco C, Benito-Hernández A, Ramos-Barron MA, Gómez-Alamillo C, Arias M, López-Hernández FJ. Combined use of GM2AP and TCP1-eta urinary levels predicts recovery from intrinsic acute kidney injury. Sci Rep 2020; 10:11599. [PMID: 32665654 PMCID: PMC7360779 DOI: 10.1038/s41598-020-68398-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022] Open
Abstract
Deficient recovery from acute kidney injury (AKI) has immediate and long-term health, clinical and economic consequences. Pre-emptive recovery estimation may improve nephrology referral, optimize decision making, enrollment in trials, and provide key information for subsequent clinical handling and follow-up. For this purpose, new biomarkers are needed that predict outcome during the AKI episode. We hypothesized that damage pattern-specific biomarkers are expected to more closely associate to outcome within distinct subpopulations (i.e. those affected by specific pathological processes determining a specific outcome), as biomarker pleiotropy (i.e. associated to phenomena unrelated to AKI) introduced by unselected, heterogeneous populations may blur statistics. A panel of urinary biomarkers was measured in patients with AKI and their capacity to associate to normal or abnormal recovery was studied in the whole cohort or after sub-classification by AKI etiology, namely pre-renal and intrinsic AKI. A combination of urinary GM2AP and TCP1-eta best associates with recovery from AKI, specifically within the sub-population of renal AKI patients. This two-step strategy generates a multidimensional space in which patients with specific characteristics (i.e. renal AKI patients with good or bad prognosis) can be identified based on a collection of biomarkers working serially, applying pathophysiology-driven criteria to estimate AKI recovery, to facilitate pre-emptive and personalized handling.
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Affiliation(s)
- Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfredo G Casanova
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Prieto
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Yaremi Quiros
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain.,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain.,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Consuelo Agüeros-Blanco
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Adalberto Benito-Hernández
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain. .,Department of Physiology and Pharmacology, University of Salamanca, Edificio Departamental, S-20, Campus Miguel de Unamuno, 37007, Salamanca, Spain. .,Instituto de Estudios de Ciencias de La Salud de Castilla y León (IECSCYL), Soria, Spain. .,Group of Translational Research On Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain. .,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain. .,National Network for Kidney Research REDINREN, RD016/0009/0025, Instituto de Salud Carlos III, Madrid, Spain.
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