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Zhang S, Chen Y, Zhou F, Wang L, Luo Q. Effect of care bundles for acute kidney injury: A systematic review and meta-analysis. PLoS One 2024; 19:e0302179. [PMID: 38630728 PMCID: PMC11023357 DOI: 10.1371/journal.pone.0302179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Acute kidney injury (AKI) is frequent among in-hospital patients with high incidence and mortality. Implementing a series of evidence-based AKI care bundles may improve patient outcomes by reducing changeable standards of care. The aim of this meta-analysis was therefore to appraise the influences of AKI care bundles on patient outcomes. MATERIALS AND METHODS We explored three international databases (PubMed, Embase, and Cochrane Central Register of Controlled Trials) and two Chinese databases (Wanfang Data and China National Knowledge Infrastructure) for studies from databases inception until November 30, 2022, comparing the impact of different AKI care bundles with usual standards of care in patients with or at risk for AKI. The study quality of non-randomized controlled trials and randomized controlled trials was evaluated by the NIH Study Quality Assessment Tool and the Cochrane risk of bias tool. Heterogeneity between studies was appraised by Cochran's Q test and I2 statistics. The possible origins of heterogeneity between studies were assessed adopting Meta-regression and subgroup analyses. Funnel plot asymmetry and Egger regression and Begg correlation tests were performed to discover potential publication bias. Data analysis was completed by software (RevMan 5.3 and Stata 15.0). The primary outcome was short- or long-term mortality. The secondary outcomes involved the incidence and severity of AKI. RESULTS Sixteen studies containing 25,690 patients and 25,903 AKI episodes were included. In high-risk AKI patients determined by novel biomarkers, electronic alert or risk prediction score, the application of AKI care bundles significantly reduced the AKI incidence (OR, 0.71; 95% CI, 0.53-0.96; p = 0.02; I2 = 84%) and AKI severity (OR, 0.59; 95% CI, 0.39-0.89; p = 0.01; I2 = 65%). No strong evidence is available to prove that care bundles can significantly reduce mortality (OR, 1.16; 95% CI, 0.58-2.30; p = 0.68; I2 = 97%). CONCLUSIONS The introduction of AKI care bundles in routine clinical practice can effectively improve the outcomes of patients with or at-risk of AKI. However, the accumulated evidence is limited and not strong enough to make definite conclusions.
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Affiliation(s)
- Shuzhen Zhang
- Department of Nephrology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, People’s Republic of China
| | - Yixin Chen
- Department of Nephrology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, People’s Republic of China
| | - Fangfang Zhou
- Department of Nephrology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, People’s Republic of China
| | - Lailiang Wang
- Department of Nephrology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, People’s Republic of China
| | - Qun Luo
- Department of Nephrology, Ningbo No.2 Hospital, Ningbo, Zhejiang Province, People’s Republic of China
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Xu B, Li W, Zhang Y, Chen Y, Feng J, Song X. Untargeted and spatial-resolved metabolomics characterize serum and tissue-specific metabolic reprogramming in acute kidney injury. Heliyon 2023; 9:e21171. [PMID: 38027662 PMCID: PMC10660029 DOI: 10.1016/j.heliyon.2023.e21171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/15/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Acute kidney injury (AKI) is one of the most common clinical emergencies characterized by rapid progression, difficulty in early diagnosis, and high mortality. Currently, there are no effective AKI early diagnostic methods and treatments. Therefore, identifying new mechanisms of AKI have become urgent for development new targets for early diagnosis and treatment of AKI in the current clinical setting. Methods In this study, systematic analysis and comparison of serum metabolic profiles of clinical AKI patients, chronic kidney disease (CKD) patients, and healthy subjects were performed using untargeted metabolomics. Moreover, the first spatial metabolomic analysis of kidney tissues in an AKI mouse model using MALDI-TOF MS technology was conducted. Differentially expressed metabolites were identified using a comprehensive, publicly available database. The metabolic data obtained were evaluated using principal component analysis, (orthogonal) partial least squares discriminant analysis, and metabolic pathway analysis to explore the unique serum metabolic profile of the patients, as well as to characterize the spatial distribution of differential metabolites in the kidneys of AKI mice. Results Significant changes in the metabolite levels of amino acids, carnitine, and lipids were observed in the AKI and CKD groups versus the healthy population, suggesting that kidney injury may lead to abnormalities in various metabolic pathways, such as amino acids, fatty acids, and lipids. The significant difference between the AKI and CKD groups were found for the first time in these indexes including amino acid, carnitine, fatty acid, and lipid levels. Additionally, spatial metabolomics results revealed that amino acid, carnitine, organic acid, and fatty acid metabolites were more likely significantly altered in the renal cortex, while lipid metabolites were both differentially distributed in the cortex and medulla of the AKI group. Conclusion Abnormalities in the serum metabolism of amino acids, carnitine, and lipids in patients with kidney diseases, such as AKI and CKD, are closely associated with the physiological dysfunction of kidney injury. Metabolic differences between patients with AKI and CKD were compared for the first time, showing that fatty acid oxidative inhibition was more severe in patients with AKI. Furthermore, spatial metabolomics has revealed metabolic reprogramming with tissue heterogeneity in AKI mice model. Our study provides valuable information in the molecular pathological features of AKI in the kidney tissues.
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Affiliation(s)
- Bei Xu
- Department of Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Wanyi Li
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Yamei Zhang
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Yan Chen
- Department of Clinical Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiafu Feng
- Department of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, Sichuan, China
| | - Xiangrong Song
- Department of Critical Care Medicine, Frontiers Science Center for Disease-related Molecular Network, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Krause O, Ziemann CT, Schulze Westhoff M, Schröder S, Krichevsky B, Greten S, Stichtenoth DO, Heck J. What do older patients know about their medication? A cross-sectional, interview-based pilot study. Eur J Clin Pharmacol 2023; 79:1365-1374. [PMID: 37561156 PMCID: PMC10501933 DOI: 10.1007/s00228-023-03548-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE This study sought to analyze the medication knowledge and awareness of medication adjustment options during intercurrent illness (sick day rules) of patients ≥ 70 years treated at a hospital for geriatric medicine in northern Germany. METHODS The study was designed as a cross-sectional, interview-based pilot study, was approved by the Ethics Committee of Hannover Medical School (No. 10274_BO_K_2022; date of approval: 11 March 2022), and enrolled a convenience sample of 100 patients between May and December 2022. RESULTS The median of the average medication knowledge score in the study population (median age 82 years (IQR 75-87); 71% female) was 5 on a scale from 0 to 6 (IQR 3.8-5.6). Women achieved higher average medication knowledge scores than men (median 5.1 (IQR 4-5.6) vs. median 4.3 (IQR 3.6-5.1); p = 0.012), and patients < 80 years achieved higher average medication knowledge scores than patients ≥ 80 years (median 5.4 (IQR 4.9-5.7) vs. median 4.3 (IQR 3.2-5.3); p < 0.001). Sick day rules were known for only 1.1% of drugs for which sick day rules were applicable. Fifty-two percent of the patients reported that their general practitioner contributed most to their medication knowledge, and 66% considered their daily number of drugs to take adequate. CONCLUSION Our study showed that medication knowledge of older patients was overall satisfying. Awareness of sick day rules, however, was poor. Future studies should evaluate the clinical benefits of sick day rules and ways of better communicating sick day rules to patients. In this regard, general practitioners may play a decisive role.
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Affiliation(s)
- Olaf Krause
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Center for Geriatric Medicine, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Corinna T Ziemann
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Benjamin Krichevsky
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Stephan Greten
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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Shin TY, Han H, Min HS, Cho H, Kim S, Park SY, Kim HJ, Kim JH, Lee YS. Prediction of Postoperative Creatinine Levels by Artificial Intelligence after Partial Nephrectomy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1402. [PMID: 37629692 PMCID: PMC10456500 DOI: 10.3390/medicina59081402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: Multiple factors are associated with postoperative functional outcomes, such as acute kidney injury (AKI), following partial nephrectomy (PN). The pre-, peri-, and postoperative factors are heavily intertwined and change dynamically, making it difficult to predict postoperative renal function. Therefore, we aimed to build an artificial intelligence (AI) model that utilizes perioperative factors to predict residual renal function and incidence of AKI following PN. Methods and Materials: This retrospective study included 785 patients (training set 706, test set 79) from six tertiary referral centers who underwent open or robotic PN. Forty-four perioperative features were used as inputs to train the AI prediction model. XG-Boost and genetic algorithms were used for the final model selection and to determine feature importance. The primary outcome measure was immediate postoperative serum creatinine (Cr) level. The secondary outcome was the incidence of AKI (estimated glomerular filtration rate (eGFR) < 60 mL/h). The average difference between the true and predicted serum Cr levels was considered the mean absolute error (MAE) and was used as a model evaluation parameter. Results: An AI model for predicting immediate postoperative serum Cr levels was selected from 2000 candidates by providing the lowest MAE (0.03 mg/dL). The model-predicted immediate postoperative serum Cr levels correlated closely with the measured values (R2 = 0.9669). The sensitivity and specificity of the model for predicting AKI were 85.5% and 99.7% in the training set, and 100.0% and 100.0% in the test set, respectively. The limitations of this study included its retrospective design. Conclusions: Our AI model successfully predicted accurate serum Cr levels and the likelihood of AKI. The accuracy of our model suggests that personalized guidelines to optimize multidisciplinary plans involving pre- and postoperative care need to be developed.
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Affiliation(s)
- Tae Young Shin
- Synergy A.I. Co., Ltd., Seoul 07985, Republic of Korea;
- Department of Urology, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea;
- Department of Urology, College of Medicine, Ewha Womans University, Seoul 07985, Republic of Korea
| | - Hyunho Han
- Department of Urology, College of Medicine, Yonsei University, Seoul 03722, Republic of Korea;
| | - Hyun-Seok Min
- Tomocube, Inc., Daejeon 34109, Republic of Korea; (H.-S.M.); (H.C.)
| | - Hyungjoo Cho
- Tomocube, Inc., Daejeon 34109, Republic of Korea; (H.-S.M.); (H.C.)
| | - Seonggyun Kim
- Department of Urology, College of Medicine, Hallym University, Chuncheon 24253, Republic of Korea;
| | - Sung Yul Park
- Department of Urology, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea;
| | - Hyung Joon Kim
- Department of Urology, College of Medicine, Konyang University, Daejeon 35365, Republic of Korea;
| | - Jung Hoon Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Gwangmyeong 14353, Republic of Korea;
| | - Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, College of Medicine, Chung-Ang University, Gwangmyeong 14353, Republic of Korea;
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Impact of an Electronic Alert in Combination with a Care Bundle on the Outcomes of Acute Kidney Injury. Diagnostics (Basel) 2022; 12:diagnostics12123121. [PMID: 36553128 PMCID: PMC9777607 DOI: 10.3390/diagnostics12123121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Early diagnosis is essential for the appropriate management of acute kidney injury (AKI). We evaluated the impact of an electronic AKI alert together with a care bundle on the progression and mortality of AKI. This was a single-center prospective study that included AKI patients aged ≥ 18 years, whereas those in palliative care, nephrology, and transplantation departments were excluded. An AKI alert was issued in electronic medical records and a care bundle was suggested. A series of classes were administered to the multidisciplinary teams by nephrologists, and a clinical pharmacist audited prescriptions. Patients were categorized into pre-alert and post-alert groups. The baseline characteristics were comparable between the pre-alert (n = 1613) and post-alert (n = 1561) groups. The 30-day mortality rate was 33.6% in the entire cohort and was lower in the post-alert group (30.5% vs. 36.7%; p < 0.001). Age, pulmonary disease, malignancy, and ICU admission were associated with an increase in 30-day mortality. The electronic AKI alert together with a care bundle and a multidisciplinary education program was associated with a reduction in 30-day mortality in patients with AKI.
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Lesão renal aguda em pacientes críticos em ventilação mecânica com pressão positiva. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ao0326345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Tolan NV, Ahmed S, Terebo T, Virk ZM, Petrides AK, Ransohoff JR, Demetriou CA, Kelly YP, Melanson SE, Mendu ML. The Impact of Outpatient Laboratory Alerting Mechanisms in Patients with AKI. KIDNEY360 2021; 2:1560-1568. [PMID: 35372977 PMCID: PMC8785781 DOI: 10.34067/kid.0003312021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/14/2021] [Indexed: 02/04/2023]
Abstract
Background AKI is an abrupt decrease in kidney function associated with significant morbidity and mortality. Electronic notifications of AKI have been utilized in patients who are hospitalized, but their efficacy in the outpatient setting is unclear. Methods We evaluated the effect of two outpatient interventions: an automated comment on increasing creatinine results (intervention I; 6 months; n=159) along with an email to the provider (intervention II; 3 months; n=105), compared with a control (baseline; 6 months; n=176). A comment was generated if a patient's creatinine increased by >0.5 mg/dl (previous creatinine ≤2.0 mg/dl) or by 50% (previous creatinine >2.0 mg/dl) within 180 days. Process measures included documentation of AKI and clinical actions. Clinical outcomes were defined as recovery from AKI within 7 days, prolonged AKI from 8 to 89 days, and progression to CKD with in 120 days. Results Providers were more likely to document AKI in interventions I (P=0.004; OR, 2.80; 95% CI, 1.38 to 5.67) and II (P=0.01; OR, 2.66; 95% CI, 1.21 to 5.81). Providers were also more likely to discontinue nephrotoxins in intervention II (P<0.001; OR, 4.88; 95% CI, 2.27 to 10.50). The median time to follow-up creatinine trended shorter among patients with AKI documented (21 versus 42 days; P=0.11). There were no significant differences in clinical outcomes. Conclusions An automated comment was associated with improved documented recognition of AKI and the additive intervention of an email alert was associated with increased discontinuation of nephrotoxins, but neither improved clinical outcomes. Translation of these findings into improved outcomes may require corresponding standardization of clinical practice protocols for managing AKI.
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Affiliation(s)
- Nicole V. Tolan
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Salman Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Tolumofe Terebo
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | - Athena K. Petrides
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Jaime R. Ransohoff
- Department of Epidemiology, Bloomberg School of Public Health, Baltimore, Maryland
| | - Christiana A. Demetriou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- The Cyprus School of Molecular Medicine, The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus
| | - Yvelynne P. Kelly
- Department of Critical Care Medicine, St. James Hospital, Dublin, Ireland
| | - Stacy E.F. Melanson
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mallika L. Mendu
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Goswami EAS, Sexton E, Fadrowski JJ. Pediatric Nurse and Pharmacist Knowledge of Acute Kidney Injury. Hosp Pediatr 2021; 11:871-877. [PMID: 34301718 DOI: 10.1542/hpeds.2020-005773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES In this study, we assessed the knowledge and experience of pediatric pharmacists and nurses at a US tertiary-care pediatric center regarding the risk factors for, recognition of, and best practices for managing an acute kidney injury (AKI) in children. METHODS The authors developed a survey to assess the attitudes and knowledge of nurses and pharmacists regarding AKI in hospitalized children, which was reviewed by a small multidisciplinary group for content and length. The final 16-item survey consisted of demographic, self-assessment and attitude, and knowledge questions. All pediatric pharmacists and nurses at the study site received a voluntary online survey via e-mail. Data were analyzed by using descriptive statistics. RESULTS A survey was sent to 620 nurses and 50 pharmacists; 148 (25%) and 22 (44%), respectively, completed it. Most respondents were <35 years old and had ≤10 years of experience in both their professions and pediatrics. A total of 72% of pediatric nurses felt identification of AKI was within their scope of practice, and ∼60% felt confident in their ability to do so. More than 80% of pediatric pharmacists felt confident in their abilities to adjust medication doses in pediatric patients with AKI, but <60% felt confident in their ability to estimate the glomerular filtration rate in these patients. Nurses and pharmacists were able to correctly identify specific AKI criteria 60% to 70% and 70% to 90% of the time, respectively. CONCLUSIONS Although pediatric nurses and pharmacists have knowledge of AKI prevention and mitigation, gaps exist, and there is a desire for education in recognition of their key roles in the clinical team.
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Affiliation(s)
| | | | - Jeffrey J Fadrowski
- Division of Pediatric Nephrology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Yu C, Guo D, Yao C, Zhu Y, Liu S, Kong X. Development and Validation of a Nomogram for Predicting Drug-Induced Acute Kidney Injury in Hospitalized Patients: A Case-Control Study Based on Propensity-Score Matching. Front Pharmacol 2021; 12:657853. [PMID: 34194322 PMCID: PMC8238493 DOI: 10.3389/fphar.2021.657853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Drug-induced acute kidney injury (D-AKI) is associated with increased mortality and longer hospital stays. This study aims to establish a nomogram to predict the occurrence of D-AKI in hospitalized patients in a multi-drug environment. Methods: A single center retrospective study among adult hospitalized patients was conducted from July 2019 to September 2019 based on the Adverse Drug Events Active Surveillance and Assessment System-2 developed by our hospital. According to the propensity score matching algorithm, four controls per case were matched to eliminate the confounding bias caused by individual baseline variables. The predictors for D-AKI were obtained by logistic regression equation and used to establish the nomogram. Results: Among 51,772 hospitalized patients, 332 were diagnosed with D-AKI. After matching, 288 pairs and 1,440 patients were included in the study, including 1,005 cases in the development group and 435 cases in the validation group. Six variables were independent predictors for D-AKI: alcohol abuse, the concurrent use of nonsteroidal anti-inflammatory drugs or diuretics, chronic kidney disease, lower baseline red blood cell count and neutrophil count ≥7 × 109/L. The area under the curve (AUC) of the prediction model in the development group and validation group were 0.787 (95%CI, 0.752–0.823) and 0.788 (95%CI, 0.736–0.840), respectively. The GiViTI calibration belts showed that the model had a good prediction accuracy for the occurrence of D-AKI (p > 0.05). Conclusion: This nomogram can help identify patients at high risk of D-AKI, which was useful in preventing the progression of D-AKI and treating it in the early stages.
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Affiliation(s)
- Chengxuan Yu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Daihong Guo
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Chong Yao
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Yu Zhu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Siyuan Liu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Xianghao Kong
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,College of Pharmacy, Chongqing Medical University, Chongqing, China
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Xiong W, Xiong Z, Song A, Lei C, Ye C, Zhang C. Relieving lipid accumulation through UCP1 suppresses the progression of acute kidney injury by promoting the AMPK/ULK1/autophagy pathway. Am J Cancer Res 2021; 11:4637-4654. [PMID: 33754018 PMCID: PMC7978316 DOI: 10.7150/thno.56082] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Rationale: Acute kidney injury (AKI) is a serious clinical emergency with an acute onset, rapid progression, and poor prognosis. Recent evidence suggests that AKI is accompanied by significant metabolic abnormalities, including alterations in lipid metabolism. However, the specific changes in lipids in AKI, and their role and regulation mechanisms are currently unclear. Methods: Quantitative metabolomics was performed in AKI models to reveal the differences of lipid metabolism-related products. Regulated pathway was detected by western blot, qRT-PCR, immunoblot analysis and immunohistochemistry. Results: The present study systematically analyzes the changes in lipid composition in AKI for the first time and find that the degree of lipid accumulation was highly correlated with uncoupling protein 1 (UCP1). Importantly, relieving lipid accumulation in AKI by upregulating UCP1 can significantly inhibit the progression of AKI through promoting AMPK/ULK1/autophagy pathway. Conclusions: The present findings suggest that lipid accumulation in AKI is directly regulated by UCP1, which can activate cell autophagy and thus significantly inhibit disease progression. It will provide new ideas and targets for the treatment of AKI.
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Silence of Long Noncoding RNA SNHG14 Alleviates Ischemia/Reperfusion-Induced Acute Kidney Injury by Regulating miR-124-3p/MMP2 Axis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8884438. [PMID: 33490282 PMCID: PMC7803415 DOI: 10.1155/2021/8884438] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/30/2020] [Accepted: 12/19/2020] [Indexed: 12/21/2022]
Abstract
Purpose Ample evidence has proved that lncRNAs are pivotal regulators in acute kidney injury (AKI). Here, we focus on the role and mechanism of lncRNA SNHG14 in ischemia/reperfusion- (I/R-) caused AKI. Methods I/R and hypoxia/reoxygenation (H/R) were applied to induce rats and HK-2 cells to establish AKI models in vivo and in vitro. Relative expression of SNHG14, miR-124-3p, and MMP2 was determined by qRT-PCR. HE staining was used to evaluate pathological changes in renal tissues, and acute tubular necrosis (ATN) score was calculated. Renal function was evaluated by measuring serum creatinine content and blood urea nitrogen content. Levels of IL-1β, IL-6, and TNF-α were measured by ELISA. Cell viability was examined by MTT assay. Oxidative stress was assessed by measuring SOD, MDA, and ROS levels. The target of SNHG14 or miR-124-3p was verified by DLR assay. Protein expression of MMP2 was examined by western blot. Results SNHG14 was boosted in renal tissues of I/R-stimulated rats and H/R-induced HK-2 cells, while miR-124-3p was diminished in H/R-stimulated HK-2 cells. Si-SNHG14 or miR-124-3p mimics repressed inflammation and oxidative stress and enhanced cell viability in H/R-stimulated HK-2 cells. Sh-SNHG14 mitigated I/R-induced AKI in rats. MiR-124-3p was targeted by SNHG14, and MMP2 was targeted by miR-124-3p. Inhibition of miR-124-3p or upregulation of MMP2 reversed inhibitory effects of SNHG14 silence on inflammation and oxidative stress as well as the promoting effect of SNHG14 silence on cell viability in H/R-induced HK-2 cells. Conclusion Knockdown of SNHG14 alleviated I/R-induced AKI by miR-124-3p-mediated downregulation of MMP2.
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Basu RK, Hackbarth R, Gillespie S, Akcan-Arikan A, Brophy P, Bagshaw S, Alobaidi R, Goldstein SL. Clinical phenotypes of acute kidney injury are associated with unique outcomes in critically ill septic children. Pediatr Res 2021; 90:1031-1038. [PMID: 33531676 PMCID: PMC7852056 DOI: 10.1038/s41390-021-01363-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 12/25/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Assessment of acute kidney injury (AKI) in septic patients remains imprecise. In adults, the classification of septic patients by clinical AKI phenotypes (severity and timing) demonstrates unique associations with patient outcome vs. broadly defined AKI. METHODS In a multinational prospective observational study, AKI diagnosis in critically ill septic children was stratified by duration (transient vs. persistent) and severity (mild vs. severe by creatinine change and urine output). The outcomes of interest were mortality and intensive care unit resource complexity at 28 days. RESULTS Seven hundred and fifty-seven septic children were studied (male 52.7%, age 4.6 years (1.5-11.9)). Mortality (overall 12.1%) was different between severe AKI and mild AKI (18.3 vs. 4.4%, p < 0.001) as well as intensive care unit (ICU) complexity (overall 34.5%, 45 vs. 21.7%, p < 0.001). Patients with Persistent AKI had fewer ICU-free days (17 (7, 21) vs. 24 (17, 26), p < 0.001) and higher ICU complexity (52.8 vs. 22.9%, p = 0.002) than transient AKI, even after exclusion of patients with early mortality. AKI phenotypes incorporating temporal and severity data correlate with unique survival (range 4.4-21.6%) and ICU-free days (range of 15-25 days) CONCLUSIONS: The outcome of septic children with AKI changes by clinical phenotype. Our findings underscore the importance of prognostic enrichment in sepsis and AKI for the purpose of trial design and patient management. IMPACT Although AKI occurs commonly in patients with sepsis (S-AKI), outcomes for children with S-AKI varies based on the severity and timing of the AKI. Existing S-AKI pediatric data utilize a broad singular definition of kidney injury. Increasing the precision of AKI classification results in a new understanding of how S-AKI associates with patient outcome. A refined classification of S-AKI identifies subgroups of children, making possible a targeted and a personalized medicine approach to S-AKI study and management.
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Affiliation(s)
- Rajit K. Basu
- grid.189967.80000 0001 0941 6502Division of Pediatric Critical Care, Children’s Healthcare of Atlanta, Emory University, Atlanta, GA USA
| | - Richard Hackbarth
- grid.416230.20000 0004 0406 3236Division of Pediatric Critical Care, Helen DeVos Children’s Hospital, Spectrum Health, Grand Rapids, MI USA
| | - Scott Gillespie
- grid.189967.80000 0001 0941 6502Department of Pediatrics, Division of Biostatistics, Emory University, Atlanta, GA USA
| | - Ayse Akcan-Arikan
- grid.416975.80000 0001 2200 2638Department of Pediatrics, Sections of Critical Care and Nephrology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX USA
| | - Patrick Brophy
- grid.438870.00000 0004 0451 2572Department of Pediatrics, Golisano Children’s Hospital, Fort Myers, FL USA
| | - Sean Bagshaw
- grid.17089.37Stollery Children’s Hospital, University of Alberta, Edmonton, AB Canada
| | - Rashid Alobaidi
- grid.17089.37Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - Stuart L. Goldstein
- grid.239573.90000 0000 9025 8099Center for Acute Care Nephrology, Cincinnati Children’s Hospital, Cincinnati, OH USA
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13
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Liu P, Shi D. Calcitonin Gene-Related Peptide Attenuates LPS-Induced Acute Kidney Injury by Regulating Sirt1. Med Sci Monit 2020; 26:e923900. [PMID: 32673294 PMCID: PMC7384332 DOI: 10.12659/msm.923900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Acute kidney injury (AKI) caused by sepsis is a very dangerous clinical complication. This study explored the effects of calcitonin gene-related peptides (CGRP) on AKI and its mechanisms. MATERIAL AND METHODS We cultured renal proximal tubular epithelial cells (HK-2 cells) and induced AKI models using LPS. Recombinant human CGRP was used to stimulate HK-2 cells and we detected markers of kidney injury (KIM-1 and NGAL) to determine the protective effect of CGRP on HK-2 cells. In addition, we constructed Sirt1-overexpressing lentivirus and small interfering RNA to increase or decrease Sirt1 expression in HK-2 cells to verify that CGRP protects HK-2 cells by regulating Sirt1. RESULTS After CGRP stimulation of HK-2 cells, LPS-induced HK-2 cell damage was significantly ameliorated, showing a decrease in the expression of KIM-1, NGAL, and inflammatory factors. In addition, Sirt1 was significantly increased in CGRP-stimulated HK-2 cells. After transfection of HK-2 cells with Lenti-Sirt1, inflammation and damage of HK-2 cells were both reduced, indicating that Sirt1 has a protective effect on HK-2 cells and can mediate the protective effect of CGRP on HK-2 cells. Therefore, the protective effect of CGRP on HK-2 cells was also attenuated after reducing Sirt1 in HK-2 cells. Finally, we used CGRP to treat LPS-induced mice and verified the protective effect of CGRP on mouse AKI. CONCLUSIONS CGRP has a significant anti-inflammatory effect. In the treatment of AKI, CGRP can increase the expression of Sirt1 to exert an anti-inflammatory effect and has a good protective effect on LPS-induced HK-2 cells.
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Affiliation(s)
- Pingli Liu
- Department of Emergency Critical Care Medicine, The Fourth People's Hospital of Jinan, Jinan, Shandong, China (mainland)
| | - Dongmei Shi
- Department of Emergency Critical Care Medicine, The Fourth People's Hospital of Jinan, Jinan, Shandong, China (mainland)
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14
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AKI: an increasingly recognized risk factor for CKD development and progression. J Nephrol 2020; 33:1171-1187. [PMID: 32651850 DOI: 10.1007/s40620-020-00793-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
Acute kidney injury (AKI) is an increasing health burden with high morbidity and mortality rates worldwide. AKI is a risk factor for chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD). Rapid action is required to find treatment options for AKI, plus to anticipate the development of CKD and other complications. Therefore, it is essential to understand the pathophysiology of AKI to CKD transition. Over the last several years, research has revealed maladaptive repair to be an interplay of cell death, endothelial dysfunction, tubular epithelial cell senescence, inflammatory processes and more-terminating in fibrosis. Various pathological mechanisms have been discovered and reveal targets for potential interventions. Furthermore, there have been clinical efforts measures for AKI prevention and progression including the development of novel biomarkers and prediction models. In this review, we provide an overview of pathophysiological mechanisms involved in kidney fibrosis. Furthermore, we discuss research gaps and promising therapeutic approaches for AKI to CKD progression.
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15
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Scott J, Finch T, Bevan M, Maniatopoulos G, Gibbins C, Yates B, Kilimangalam N, Sheerin N, Kanagasundaram NS. Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England. BMJ Open 2019; 9:e032925. [PMID: 31831546 PMCID: PMC6924771 DOI: 10.1136/bmjopen-2019-032925] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Around one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care. DESIGN Mixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods. SETTING AND PARTICIPANTS Three secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101). ANALYSIS Qualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ2 and Wilcoxon signed-rank test for differences in current and future normalisation. RESULTS Participants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation, legitimation) or unsuccessful normalisation (initiation, differentiation, skill set workability, systematisation). CONCLUSIONS Clinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Tracy Finch
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Mark Bevan
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Chris Gibbins
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Bryan Yates
- Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
| | | | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Nigel Suren Kanagasundaram
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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16
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Sabatino A, Regolisti G, di Mario F, Ciuni A, Palumbo A, Peyronel F, Maggiore U, Fiaccadori E. Validation by CT scan of quadriceps muscle thickness measurement by ultrasound in acute kidney injury. J Nephrol 2019; 33:109-117. [PMID: 31729699 DOI: 10.1007/s40620-019-00659-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accelerated muscle wasting still represents a major issue in critically ill patients. However, a key problem in the intensive care unit is the lack of adequate tools for bedside evaluation of muscle mass. Moreover, when acute kidney injury (AKI) coexists, fluid overload and/or rapid fluid shifts due to renal replacement therapies that frequently occur and may interfere with muscle mass assessment. The purpose of this study is to validate muscle ultrasound (US) by a gold standard (muscle CT scan) for the assessment of quadriceps muscle thickness in critically ill patients with AKI. METHODS Quadriceps rectus femoris thickness and quadriceps vastus intermedius thickness of critically ill patients with AKI were blindly assessed at the same leg sites by both US and computed tomography (CT) scan. Using bivariate mixed-model linear regression analysis, we estimated, average difference in thickness between measurement sites, agreement (differential and proportional bias) of US compared to CT, and precision of the two methods, and eventually performed Bland-Altman analysis for repeated measurements on pooled results. RESULTS We analyzed 233 couples of measurements (30 patients). Average muscle thickness ranged between 1.0 and 1.6, depending on the measurement site. When comparing US to CT, both the observed differential bias (between + 0.04 and + 0.26 cm depending on the muscle site) and the proportional bias (between 82 and 98% of the reference values, depending on the muscle site) were not statistically significant. However, precision analysis showed that US scan tended to be slightly less precise in comparison to CT. Bland-Altman analysis on pooled results showed that the 95% limits of agreement between the US and CT were narrow, ranging from - 0.34 to + 0.36 cm. CONCLUSION In critically ill patients with AKI, quadriceps muscle thickness assessment based on US is unbiased, although it occurs with a minor loss of precision compared to CT.
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Affiliation(s)
- Alice Sabatino
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Giuseppe Regolisti
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy.,Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Francesca di Mario
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy.,Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Andrea Ciuni
- Radiologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Anselmo Palumbo
- Radiologia, Azienda Ospedaliera-Universitaria Parma, Parma, Italy
| | - Francesco Peyronel
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy.,Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Umberto Maggiore
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy.,Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliera-Universitaria Parma, Via Gramsci 14, 43126, Parma, Italy. .,Scuola di Specializzazione in Nefrologia, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy.
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17
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Abdelaziz TS, Fouda R, Hussin WM, Elyamny MS, Abdelhamid YM. Preventing acute kidney injury and improving outcome in critically ill patients utilizing risk prediction score (PRAIOC-RISKS) study. A prospective controlled trial of AKI prevention. J Nephrol 2019; 33:325-334. [PMID: 31712987 DOI: 10.1007/s40620-019-00671-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 11/06/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) has significant impact on mortality and morbidity in critically ill patients. METHODS A prospective controlled interventional pilot study composed of observation and intervention arms was run at two different Intensive care unit (ICU) sites. A recently validated risk prediction score was used to predict the AKI in critically ill patients at high risk of developing AKI. All patients with established AKI at the time of recruitment were excluded from the study. A package of early preventive measures, including an early nephrology review was applied to high risk patients in the intervention arm to prevent AKI development. RESULTS We have recruited 108 patients at the intervention site and 98 patients at the observation site. The primary outcome measure was the AKI incidence. AKI incidence was significantly lower in the intervention arm than its incidence in the observation arm (11% vs 26%, p = 0.002). The median Time till recovery of AKI episodes was significantly lower in the intervention arm (3(1) vs. 5(2) days, p = 0.014) 0.30 day mortality was lower in the intervention arm, however, not statistically significant. CONCLUSION Our pilot study showed that it was feasible to apply a simple risk score to implement early preventive measures to high risk patients, consequently, mitigating the risk of AKI development and reducing the time till recovery of AKI episodes. Multicentre studies are needed to confirm this favourable effect.
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Affiliation(s)
- Tarek Samy Abdelaziz
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt.
| | - Ragai Fouda
- Medical ICU, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Wessam M Hussin
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Mohamed S Elyamny
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
| | - Yasser M Abdelhamid
- Department of Internal Medicine, KasrAlainy Hospitals, Cairo University Hospitals, Cairo, Egypt
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18
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Pistolesi V, Zeppilli L, Fiaccadori E, Regolisti G, Tritapepe L, Morabito S. Hypophosphatemia in critically ill patients with acute kidney injury on renal replacement therapies. J Nephrol 2019; 32:895-908. [PMID: 31515724 DOI: 10.1007/s40620-019-00648-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/06/2019] [Indexed: 02/08/2023]
Abstract
Hypophosphatemia is a common but often underestimated electrolyte derangement among intensive care unit (ICU) patients. Low phosphate levels can lead to cellular dysfunction with potentially relevant clinical manifestations (e.g., muscle weakness, respiratory failure, lethargy, confusion, arrhythmias). In critically ill patients with severe acute kidney injury (AKI) renal replacement therapies (RRTs) represent a well-known risk factor for hypophosphatemia, especially if the most intensive and prolonged modalities of RRT, such as continuous RRT or prolonged intermittent RRT, are used. Currently, no evidence-based specific guidelines are available for the treatment of hypophosphatemia in the critically ill; however, considering the potentially negative impact of hypophosphatemia on morbidity and mortality, strategies aimed at reducing its incidence and severity should be timely implemented in the ICUs. In the clinical setting of critically ill patients on RRT, the most appropriate strategy could be to anticipate the onset of RRT-related hypophosphatemia by implementing the use of phosphate-containing solutions for RRT through specifically designed protocols. The present review is aimed at summarizing the most relevant evidence concerning epidemiology, prognostic impact, prevention and treatment of hypophosphatemia in critically ill patients with AKI on RRT, with a specific focus on RRT-induced hypophosphatemia.
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Affiliation(s)
- Valentina Pistolesi
- UO Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università di Roma, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Laura Zeppilli
- UO Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università di Roma, Viale del Policlinico, 155, 00161, Rome, Italy.,UOC Nefrologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Fiaccadori
- UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Giuseppe Regolisti
- UO Nefrologia, Azienda Ospedaliero-Universitaria Parma, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Luigi Tritapepe
- UO Anestesia e Terapia Intensiva in Cardiochirurgia, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università di Roma, Rome, Italy
| | - Santo Morabito
- UO Dialisi, Azienda Ospedaliero-Universitaria Policlinico Umberto I, "Sapienza" Università di Roma, Viale del Policlinico, 155, 00161, Rome, Italy
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19
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Takaori K, Uchino S, Takinami M. Impact of point-of-care creatinine monitoring on early detection of acute kidney injury in critical illness. J Nephrol 2019; 32:927-935. [PMID: 31512198 DOI: 10.1007/s40620-019-00641-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 08/14/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the utility and accuracy of creatinine measurement using point-of-care (POC) blood gas analysis compared to standard laboratory assay and to assess the effectiveness of frequent creatinine monitoring using POC blood gas analysis with respect to early detection of acute kidney injury (AKI). METHODS We performed a single center retrospective observational study in 398 patients admitted to the intensive care unit. We investigated the clinical concordance of creatinine values measured by POC blood gas analysis (Cr-BG) compared to those measured by laboratory assay (Cr-lab). We compared the time to reach AKI diagnosis according to the KDIGO criteria using Cr-BG (KD-BG) to the standard criteria using Cr-lab (KD-lab). RESULTS Cr-BG correlated well with Cr-lab for day 1 (n = 375, R2 = 0.98, p < 0.001) and during the whole study period (n = 1258, R2 = 0.99, p < 0.001). The KD-BG measurement allowed the identification of 6.3% more patients (60.6%) as AKI than the KD-lab measurement. Approximately one-third of the patients were staged as AKI using the KD-BG measurement more than 6 h earlier than that using the KD-lab measurement. CONCLUSIONS The KDIGO criteria using POC blood gas analysis were clinically useful. Frequent creatinine monitoring using POC analysis can allow an earlier detection of AKI.
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Affiliation(s)
- Kaori Takaori
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan.
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan
| | - Masanori Takinami
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, 3-19-18, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8471, Japan
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20
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Guan C, Li C, Xu L, Zhen L, Zhang Y, Zhao L, Zhou B, Che L, Wang Y, Xu Y. Risk factors of cardiac surgery-associated acute kidney injury: development and validation of a perioperative predictive nomogram. J Nephrol 2019; 32:937-945. [PMID: 31243735 DOI: 10.1007/s40620-019-00624-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Cardiac surgery-associated acute kidney injury (CSA-AKI), one of the most severe complications in patients with cardiac surgery, is associated with considerable morbidity, mortality and high costs thus placing a heavy burden to society. Therefore, we aimed to build a predictive model based on preoperative features in order to early recognize and intervene for patients with high risk of CSA-AKI. METHODS In this retrospective cohort study, baseline perioperative hospitalization information of patients who underwent cardiac surgery from October 2012 to October 2017 were screened. After multivariate logistic regression, identified independent predictive factors associated with CSA-AKI were incorporated into the nomogram and the discriminative ability and predictive accuracy of the model was assessed by concordance index (C-Index). Additionally, internal validation was performed by using bootstrapping technology with 1000 resamples to reduce the over-fit bias. RESULTS In all 4395 patients with cardiac surgery October 2012-October 2017, no patients were excluded for the continuous renal replacement therapy (CRRT) before surgery while 2495 patients were excluded due to only one or less than one Scr assay post-surgery. In the end, a total of 1900 patients were enrolled in the study, of which 698 patients (74.89%) developed AKI stage 1, 158 (16.96%) AKI stage 2 and 76 (8.15%) AKI stage 3. After multivariate logistic regression, age, perioperative estimated glomerular filtration rate (eGFR), lactate dehydrogenase (LDH), prothrombin time (PT), with a history of surgery, transfusion, cardiac arrhythmia, coronary heart disease (CHD), or chronic kidney disease (CKD), using calcium channel blocker (CCB), proton pump inhibitors (PPI), non-steroidal anti-inflammatory drugs (NSAID), antibiotic or statin before surgery were predictive factors of CSA-AKI. In addition, the nomogram demonstrated a good accuracy in estimating CSA-AKI, with an C-Index and a bootstrap-corrected one of 0.796 (SD = 0.018, 95% CI 0.795-0.797) and 0.789 (SD = 0.015, 95% CI 0.788-0.790), respectively. Moreover, calibration plots showed an optimal consistency with the actual presence of CSA-AKI. CONCLUSION The novel predictive nomogram achieved a good preoperative prediction of CSA-AKI within the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Though the model, the risk of an individual patient with "subclinical AKI" undergoing cardiac surgery could be determined earlier and such application was helpful for timely intervention in order to improve patient's prognosis.
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Affiliation(s)
- Chen Guan
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Chenyu Li
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Lingyu Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Li Zhen
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yue Zhang
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Long Zhao
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Bin Zhou
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Lin Che
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yanfei Wang
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yan Xu
- Department of Nephrology, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
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21
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Hong WZ, Haroon S, Lau T, Hui SH, Ma V, Goh JX, Chua HR. Transitional care program to facilitate recovery following severe acute kidney injury. J Nephrol 2019; 32:605-613. [PMID: 31090023 DOI: 10.1007/s40620-019-00616-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/05/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with acute kidney injury needing prolonged renal replacement therapy (AKI-RRT) may benefit from a structured care process in form of an AKI transitional care program (ATCP), to facilitate RRT weaning and recovery. METHODS We examined outcomes following ATCP implementation in adults with AKI-RRT from a tertiary institution (versus pre-ATCP controls), including mortality, cumulative hospital days, and renal function over one year; RRT and haemodialysis catheter days in initial 90 days. RESULTS We studied 89 patients with age 62 ( ± 15) years. 47% had septic AKI, 20% cardiorenal syndrome, and 29% had baseline eGFR < 30 mL/min/1.73 m2. Comparing 45 ATCP patients with 44 controls: 64% and 45% received continuous RRT (CRRT) (p = 0.07), with comparable rates of heart failure (24% versus 25%), ICU care (67% versus 70%), RRT successfully weaned (71% versus 75%), respectively; corresponding mortality rates were 24% and 32% (p = 0.44), hospital days of 205 (197-213) and 223 (215-232) per 1000 patient-days alive over one year (p = 0.002); with comparable RRT and catheter days. Serial serum creatinine in months following RRT cessation were comparable between either survivor-group. On multivariate analysis, heart failure or having received CRRT independently predicted mortality and longer hospital days (p < 0.05); ATCP was independently associated with reduced hospital days (p < 0.001). 17 ATCP patients and 14 controls required outpatient RRT weaning, with catheter days of 607 (568-648) and 683 (638-731) per 1000 patient-days in initial 90 days, respectively (p = 0.01). CONCLUSIONS Implementing a structured care pathway in patients with AKI-RRT may help reduce hospitalization, and reduce haemodialysis catheter days in the subgroup for outpatient RRT weaning.
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Affiliation(s)
- Wei-Zhen Hong
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Sabrina Haroon
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Titus Lau
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Soh-Heng Hui
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Nursing, National University Hospital, Singapore, Singapore
| | - Valerie Ma
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore
| | - Jing-Xian Goh
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore.,Department of Nursing, National University Hospital, Singapore, Singapore
| | - Horng-Ruey Chua
- Division of Nephrology, University Medicine Cluster, National University Hospital, Singapore, Singapore. .,Department of Medicine, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, 10 Medicine Office, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Republic of Singapore.
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Kobayashi D, Kuriyama N, Yanase F, Takahashi O, Aoki K, Komatsu Y. Angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use prior to medical intensive care unit admission and in-hospital mortality: propensity score-matched cohort study. J Nephrol 2019; 32:595-603. [PMID: 30937855 DOI: 10.1007/s40620-019-00603-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to evaluate whether angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use prior to medical intensive care unit (ICU) admission was associated with in-hospital mortality and length of ICU stay. METHODS A propensity score-matched cohort study was conducted at single center from 2004 to 2016. We included all adult patients who were admitted to the ICU due to internal medicine-related conditions. We compared patients who had used ACEIs/ARBs prior to ICU admission to patients who had not. Our primary and secondary outcomes were in-hospital mortality and length of stay among survivors and the deceased. Propensity scores were calculated via logistic regression analyses with forward stepwise selection. An odds ratio (OR) for primary outcome was calculated via logistic regression. Sensitivity analyses were performed using conditional logistic regression models including different sets of covariates to confirm our results. RESULTS 3095 patients were admitted to the ICU. Overall, 693 patients were identified via matching, 231 of whom had used ACEIs/ARBs and 462 of whom had not. None of the baseline characteristics differed significantly between groups. Among them, 131 (18.9%) died. Those who had used ACEIs/ARBs had a lower rate of mortality (p < 0.01). Length of ICU stay did not differ significantly between those with ACEIs/ARBs and those without among survivors (p = 0.43) and the deceased (p = 0.14). The OR for mortality was 0.51 (95% confidence interval 0.32-0.79). The results of the sensitivity analyses confirmed the results (ORs 0.4 6-0.53; all were statistically significant). CONCLUSION Prior ACEI/ARB use may be related to in-hospital mortality among medical ICU patients.
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Affiliation(s)
- Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan. .,Fujita Health University, Toyoake, Japan.
| | - Nagato Kuriyama
- Department of Epidemiology for Community Health and Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Fumitaka Yanase
- Department of Intensive Care Unit, Saitama Medical Center Jichi Medical University, Omiya, Japan
| | - Osamu Takahashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Aoki
- Department of Anesthesia and Intensive Care Unit, St. Luke's International Hospital, Tokyo, Japan
| | - Yasuhiro Komatsu
- Division of Nephrology, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan
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Prevalence and mortality due to acute kidney injuries in patients with influenza A (H1N1) viral infection: A systemic narrative review. Int J Health Sci (Qassim) 2019; 13:56-62. [PMID: 31341456 PMCID: PMC6619458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION There is limited evidence of studying the associated factors of acute kidney injury (AKI) among patients with influenza A (H1N1) virus infection pandemic in 2009. AKI is one of the most prevalent complications in the intensive care unit. Its incidence is associated with high mortality and negative impacts on long-term survival. The aim of this narrative review was to determine the prevalence and mortality due to AKI, among patients admitted with the H1N1 virus. MATERIALS AND METHODS A narrative review of studies reporting about treatment measures and mortality associated with AKI during the H1N1 pandemic over a 10-year period (from September 2009 to August 2018), was performed. We searched the following databases; EMBASE, Medline/PubMed, NHS evidence, Google Scholar, and the Cochrane Library. Our inclusion revealed 20 studies of patients (n = 3579) who were admitted with H1N1 infection and developed AKI. RESULTS In this study, 33% of patients (n = 1164) who were admitted with H1N1 infection had developed AKI. Within the first 5 years (2009 to 2013), 36% of patients (n = 1013) developed AKI. Within the next 5 years (2014-2018), 812 patients were admitted with the H1N1 infection and 18% of patients (n = 150) had developed AKI. Over the 10 years, there was a 50% reduction in the number of patients who developed AKI (2009 and 2018) (P < 0.0001). CONCLUSION Patients showed varied responses to treatment measures, depending on their geographical location, comorbidities, and other characteristics. Despite a reasonable prevalence of AKI among patients with the H1N1 virus infection, the mortality over the last 10 years was reduced, with renal replacement therapy as a common therapy in most studies.
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Contrast medium induced acute kidney injury: a narrative review. J Nephrol 2018; 31:797-812. [DOI: 10.1007/s40620-018-0498-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/14/2018] [Indexed: 12/24/2022]
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