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Lindhardt RB, Rasmussen SB, Riber LP, Lassen JF, Ravn HB. The Impact of Acute Kidney Injury on Chronic Kidney Disease After Cardiac Surgery: A Systematic Review and Meta-analysis. J Cardiothorac Vasc Anesth 2024; 38:1760-1768. [PMID: 38879369 DOI: 10.1053/j.jvca.2024.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES To evaluate the impact of acute kidney injury on transition to chronic kidney disease (CKD) after cardiac surgery and to determine frequency of incident CKD in these patients. DESIGN A systematic review and meta-analysis of observational studies. SETTING Electronic databases Medline and Embase were systematically searched from 1974 to February 6, 2023. PARTICIPANTS Eligible studies were original observational studies on adult cardiac surgery patients, written in the English language, and with clear kidney disease definitions. Exclusion criteria were studies with previously transplanted populations, populations with preoperative kidney impairment, ventricular assist device procedures, endovascular procedures, a kidney follow-up period of <90 days, and studies not presenting necessary data for effect size calculations. INTERVENTIONS Patients developing postoperative acute kidney injury after cardiac surgery were compared with patients who did not develop acute kidney injury. MEASUREMENTS AND MAIN RESULTS The search identified 4,329 unique studies, 87 underwent full-text review, and 12 were included for analysis. Mean acute kidney injury occurrence across studies was 16% (minimum-maximum: 8-50), while mean occurrence of CKD was 24% (minimum-maximum: 3-35), with high variability depending on definitions and follow-up time. Acute kidney injury was associated with increased odds of CKD in all individual studies. The pooled odds ratio across studies was 5.67 (95% confidence interval, 3.34-9.64; p < 0.0001). CONCLUSIONS Acute kidney injury after cardiac surgery was associated with a more than 5-fold increased odds of developing CKD. New-onset CKD occurred in almost 1 in 4 patients in the years after surgery.
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Affiliation(s)
- Rasmus Bo Lindhardt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Faculty, University of Southern Denmark, Odense, Denmark.
| | - Sebastian Buhl Rasmussen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Faculty, University of Southern Denmark, Odense, Denmark
| | - Lars Peter Riber
- Department of Clinical Research, Health Faculty, University of Southern Denmark, Odense, Denmark; Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
| | - Jens Flensted Lassen
- Department of Clinical Research, Health Faculty, University of Southern Denmark, Odense, Denmark; Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Faculty, University of Southern Denmark, Odense, Denmark
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Wang C, Gao Y, Ji B, Li J, Liu J, Yu C, Wang Y. Risk Prediction Models for Renal Function Decline After Cardiac Surgery Within Different Preoperative Glomerular Filtration Rate Strata. J Am Heart Assoc 2024; 13:e029641. [PMID: 38639370 PMCID: PMC11179875 DOI: 10.1161/jaha.123.029641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 01/26/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Our goal was to create a simple risk-prediction model for renal function decline after cardiac surgery to help focus renal follow-up efforts on patients most likely to benefit. METHODS AND RESULTS This single-center retrospective cohort study enrolled 24 904 patients who underwent cardiac surgery from 2012 to 2019 at Fuwai Hospital, Beijing, China. An estimated glomerular filtration rate (eGFR) reduction of ≥30% 3 months after surgery was considered evidence of renal function decline. Relative to patients with eGFR 60 to 89 mL/min per 1.73 m2 (4.5% [531/11733]), those with eGFR ≥90 mL/min per 1.73 m2 (10.9% [1200/11042]) had a higher risk of renal function decline, whereas those with eGFR ≤59 mL/min per 1.73 m2 (5.8% [124/2129]) did not. Each eGFR stratum had a different strongest contributor to renal function decline: increased baseline eGFR levels for patients with eGFR ≥90 mL/min per 1.73 m2, transfusion of any blood type for patients with eGFR 60 to 89 mL/min per 1.73 m2, and no recovery of renal function at discharge for patients with eGFR ≤59 mL/min per 1.73 m2. Different nomograms were established for the different eGFR strata, which yielded a corrected C-index value of 0.752 for eGFR ≥90 mL/min per 1.73 m2, 0.725 for eGFR 60-89 mL/min per 1.73 m2 and 0.791 for eGFR ≤59 mL/min per 1.73 m2. CONCLUSIONS Predictors of renal function decline over the follow-up showed marked differences across the eGFR strata. The nomograms incorporated a small number of variables that are readily available in the routine cardiac surgical setting and can be used to predict renal function decline in patients stratified by baseline eGFR.
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Affiliation(s)
- Chunrong Wang
- From the Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Yuchen Gao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Bingyang Ji
- Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jun Li
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jia Liu
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Chunhua Yu
- From the Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
| | - Yuefu Wang
- Department of Surgical Critical Care Medicine, Beijing Shijitan HospitalCapital Medical UniversityBeijingChina
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Zaky A, Younan DS, Meers B, Miller D, Melvin RL, Benz D, Davies J, Kidd B, Mathru M, Tolwani A. A pilot study to explore patterns and predictors of delayed kidney decline after cardiopulmonary bypass. Sci Rep 2024; 14:6739. [PMID: 38509206 PMCID: PMC10954642 DOI: 10.1038/s41598-024-57079-x] [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: 11/22/2023] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
There is no current consensus on the follow up of kidney function in patients undergoing cardiopulmonary bypass (CPB). The main objectives of this pilot study is to collect preliminary data on kidney function decline encountered on the first postoperative visit of patients who have had CPB and to identify predictors of kidney function decline post hospital discharge. Design: Retrospective chart review. Adult patients undergoing open heart procedures utilizing CPB. Patient demographics, type of procedure, pre-, intra-, and postoperative clinical, hemodynamic echocardiographic, and laboratory data were abstracted from electronic medical records. Acute kidney disease (AKD), and chronic kidney disease (CKD) were diagnosed based on standardized criteria. Interval change in medications, hospital admissions, and exposure to contrast, from hospital discharge till first postoperative visit were collected. AKD, and CKD as defined by standardized criteria on first postoperative visit. 83 patients were available for analysis. AKD occurred in 27 (54%) of 50 patients and CKD developed in 12 (42%) out of 28 patients. Older age was associated with the development of both AKD and CKD. Reduction in right ventricular cardiac output at baseline was associated with AKD (OR: 0.5, 95% CI: 0.3, 0.79, P = 0.01). Prolongation of transmitral early diastolic filling wave deceleration time was associated with CKD (OR: 1.02, 95% CI: 1.01, 1.05, P = 0.03). In-hospital acute kidney injury (AKI) was a predictor of neither AKD nor CKD. AKD and CKD occur after CPB and may not be predicted by in-hospital AKI. Older age, right ventricular dysfunction and diastolic dysfunction are important disease predictors. An adequately powered longitudinal study is underway to study more sensitive predictors of delayed forms of kidney decline after CPB.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA.
| | - Duraid S Younan
- Department of Surgery, Staten Island University, Staten Island, USA
| | - Bradley Meers
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Miller
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ryan L Melvin
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - David Benz
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - James Davies
- Department of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, USA
| | - Brent Kidd
- Division of Critical Care, Department of Anesthesiology, University of Kansas Medical Center, Kansas City, USA
| | - Mali Mathru
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, 950 Jefferson Tower, 625 19th Street South, Birmingham, AL, 35249-6810, USA
| | - Ashita Tolwani
- Department of Nephrology, University of Alabama at Birmingham, Birmingham, USA
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Penaud V, Duburcq T, Bureau C, Salmon Gandonnière C, Arrestier R, Henri S, Dres M, Jacquier S, Prost ND, Giraud R, Ricard JD, Roux D, Uhel F, Legouis D, Verney C. Kidney Increase Natriuresis but Not Glomerular Filtration Under Veno-venous ECMO, a Retrospective Study. J Intensive Care Med 2024; 39:146-152. [PMID: 37632128 DOI: 10.1177/08850666231195755] [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] [Indexed: 08/27/2023]
Abstract
PURPOSE Acute kidney injury is a frequent complication of acute respiratory distress syndrome (ARDS). We aim to study the evolution of kidney function in patients presenting severe ARDS and requiring veno-venous extracorporeal membrane oxygenation (VV ECMO). METHODS We conducted a multicenter retrospective study, including adult patients requiring VV ECMO for ARDS. The primary outcome was the evolution of the serum creatinine level after VV ECMO initiation. Secondary outcomes were change in urine output, and urine biochemical parameters after VV ECMO initiation. RESULTS One hundred and two patients were included. VV ECMO was initiated after a median of 6 days of mechanical ventilation, mainly for ARDS caused by COVID-19 (73%). Serum creatinine level did not significantly differ after VV ECMO initiation (P = .20). VV ECMO was associated with a significant increase in daily urine output (+6.6 mL/kg/day, [3.8;9.3] P < .001), even after adjustment for potential confounding factors; with an increase in natriuresis. The increase in urine output under VV ECMO was associated with a reduced risk of receiving kidney replacement therapy (OR 0.4 [0.2;0.8], P = .026). CONCLUSIONS VV ECMO initiation in severe ARDS is associated with an increase in daily urine output and natriuresis, without change in glomerular filtration rate.
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Affiliation(s)
- Victor Penaud
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
| | | | - Côme Bureau
- Médecine Intensive et Réanimation - R3S, AP-HP, Hôpital Pitié-Salpêtrière, Paris Sorbonne Université, Paris, France
- Sorbonne Université, INSERM_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Charlotte Salmon Gandonnière
- Université François Rabelais, CHRU de Tours, Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSep Research Network, Tours, France
| | - Romain Arrestier
- Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Université Paris Est Créteil, Créteil, France
| | - Samuel Henri
- Médecine Intensive Réanimation, CHU Lille, Lille, France
| | - Martin Dres
- Médecine Intensive et Réanimation - R3S, AP-HP, Hôpital Pitié-Salpêtrière, Paris Sorbonne Université, Paris, France
- Sorbonne Université, INSERM_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - Sophie Jacquier
- Université François Rabelais, CHRU de Tours, Médecine Intensive Réanimation, INSERM CIC 1415, CRICS-TriggerSep Research Network, Tours, France
| | - Nicolas De Prost
- Médecine Intensive Réanimation, AP-HP, Hôpitaux Universitaires Henri-Mondor, Université Paris Est Créteil, Créteil, France
| | - Raphael Giraud
- Département de Soins Intensifs, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Jean-Damien Ricard
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
- Université Paris Cité, UMR1137 IAME, INSERM, Paris, France
| | - Damien Roux
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Paris, France
| | - Fabrice Uhel
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
- Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, Institut Necker-Enfants Malades, Paris, France
| | - David Legouis
- Département de Soins Intensifs, Hôpitaux Universitaires de Genève, Genève, Suisse
- Département de physiologie cellulaire, Faculté de Médecine, Université de Genève, Genève, Suisse
| | - Charles Verney
- Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
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Svedjeholm R, Ferrari G, Vanky F, Friberg Ö, Holm J. Glutamate infusion associated with reduced rises of p-Copeptin after coronary surgery: Substudy of GLUTAMICS II. Acta Anaesthesiol Scand 2023; 67:1373-1382. [PMID: 37365871 DOI: 10.1111/aas.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Glutamate plays a key role for post-ischaemic recovery of myocardial metabolism. According to post hoc analyses of the two GLUTAMICS trials, patients without diabetes benefit from glutamate with less myocardial dysfunction after coronary artery bypass surgery (CABG). Copeptin reflects activation of the Arginine Vasopressin system and is a reliable marker of heart failure but available studies in cardiac surgery are limited. We investigated whether glutamate infusion is associated with reduced postoperative rises of plasma Copeptin (p-Copeptin) after CABG. METHODS A prespecified randomised double-blind substudy of GLUTAMICS II. Patients had left ventricular ejection fraction ≤0.30 or EuroSCORE II ≥3.0 and underwent CABG ± valve procedure. Intravenous infusion of 0.125 M L-glutamic acid or saline at 1.65 mL/kg/h was commenced 10-20 min before the release of the aortic cross-clamp and then continued for another 150 min P-Copeptin was measured preoperatively and postoperatively on day one (POD1) and day three. The primary endpoint was an increase in p-Copeptin from the preoperative level to POD1. Postoperative stroke ≤24 h and mortality ≤30 days were safety outcomes. RESULTS We included 181 patients of whom 48% had diabetes. The incidence of postoperative mortality ≤30 days (0% vs. 2.1%; p = .50) and stroke ≤24 h (0% vs. 3.2%; p = .25) did not differ between the glutamate group and controls. P-Copeptin increased postoperatively with the highest values recorded on POD1 without significant inter-group differences. Among patients without diabetes, p-Copeptin did not differ preoperatively but postoperative rise from preoperative level to POD1 was significantly reduced in the glutamate group (73 ± 66 vs. 115 ± 102 pmol/L; p = .02). P-Copeptin was significantly lower in the Glutamate group on POD1 (p = .02) and POD 3 (p = .02). CONCLUSIONS Glutamate did not reduce rises of p-Copeptin significantly after moderate to high-risk CABG. However, glutamate was associated with reduced rises of p-Copeptin among patients without diabetes. These results agree with previous observations suggesting that glutamate mitigates myocardial dysfunction after CABG in patients without diabetes. Given the exploratory nature of these findings, they need to be confirmed in future studies.
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Affiliation(s)
- Rolf Svedjeholm
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Gabriele Ferrari
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Farkas Vanky
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
| | - Örjan Friberg
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Jonas Holm
- Department of Thoracic and Vascular Surgery, Department of Health, Medicine and Caring Sciences, Unit of Cardiovascular Medicine, Linköping University, Linköping, Sweden
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Molina Andújar A, Escudero VJ, Piñeiro GJ, Lucas A, Rovira I, Matute P, Ibañez C, Blasco M, Quintana LF, Sandoval E, Sánchez MC, Quintana E, Poch E. Impact of cardiac surgery associated acute kidney injury on 1-year major adverse kidney events. FRONTIERS IN NEPHROLOGY 2023; 3:1059668. [PMID: 37675375 PMCID: PMC10479748 DOI: 10.3389/fneph.2023.1059668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/24/2023] [Indexed: 09/08/2023]
Abstract
Background The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and the risk of chronic kidney disease (CKD) has been found to be higher in these patients compared to the AKI-free population. The aim of our study was to assess the risk of major adverse kidney events (MAKE) [25% or greater decline in estimated glomerular filtration rate (eGFR), new hemodialysis, and death] after cardiac surgery in a Spanish cohort and to evaluate the utility of the score developed by Legouis D et al. (CSA-CKD score) in predicting the occurrence of MAKE. Methods This was a single-center retrospective study of patients who required cardiac surgery with cardiopulmonary bypass (CPB) during 2015, with a 1-year follow-up after the intervention. The inclusion criteria were patients over 18 years old who had undergone cardiac surgery [i.e., valve substitution (VS), coronary artery bypass graft (CABG), or a combination of both procedures]. Results The number of patients with CKD (eGFR < 60 mL/min) increased from 74 (18.3%) to 97 (24%) within 1 year after surgery. The median eGFR declined from 85 to 82 mL/min in the non-CSA-AKI patient group and from 73 to 65 mL/min in those with CSA-AKI (p = 0.024). Fifty-eight patients (1.4%) presented with MAKE at the 1-year follow-up. Multivariate logistic regression analysis showed that the only variable associated with MAKE was CSA-AKI [odds ratio (OR) 2.386 (1.31-4.35), p = 0.004]. The median CSA-CKD score was higher in the MAKE cohort [3 (2-4) vs. 2 (1-3), p < 0.001], but discrimination was poor, with a receiver operating characteristic curve (AUC) value of 0.682 (0.611-0.754). Conclusion Any-stage CSA-AKI is associated with a risk of MAKE after 1 year. Further research into new measures that identify at-risk patients is needed so that appropriate patient follow-up can be carried out.
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Affiliation(s)
- Alícia Molina Andújar
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | | | - Gaston J. Piñeiro
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Alvaro Lucas
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Irene Rovira
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Purificación Matute
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Cristina Ibañez
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Anesthesiology Department, Hospital Clinic, Barcelona, Spain
| | - Miquel Blasco
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Luis F. Quintana
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Elena Sandoval
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Marina Chorda Sánchez
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Perfusion Department, Hospital Clinic, Barcelona, Spain
| | - Eduard Quintana
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Cardiovascular Surgery Department, Hospital Clinic, Barcelona, Spain
| | - Esteban Poch
- Nephrology and Kidney Transplantation Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine, University of Barcelona, Barcelona, Spain
- Institut d’investigacions biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Mild and moderate to severe early acute kidney injury following cardiac surgery among patients with heart failure and preserved vs. mid-range vs. reduced ejection fraction. Eur J Anaesthesiol 2022; 39:673-684. [DOI: 10.1097/eja.0000000000001713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Legouis D, Criton G, Assouline B, Le Terrier C, Sgardello S, Pugin J, Marchi E, Sangla F. Unsupervised clustering reveals phenotypes of AKI in ICU COVID-19 patients. Front Med (Lausanne) 2022; 9:980160. [PMID: 36275817 PMCID: PMC9579431 DOI: 10.3389/fmed.2022.980160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Acute Kidney Injury (AKI) is a very frequent condition, occurring in about one in three patients admitted to an intensive care unit (ICU). AKI is a syndrome defined as a sudden decrease in glomerular filtration rate. However, this unified definition does not reflect the various mechanisms involved in AKI pathophysiology, each with its own characteristics and sensitivity to therapy. In this study, we aimed at developing an innovative machine learning based method able to subphenotype AKI according to its pattern of risk factors. Methods We adopted a three-step pipeline of analyses. First, we looked for factors associated with AKI using a generalized additive model. Second, we calculated the importance of each identified AKI related factor in the estimated AKI risk to find the main risk factor for AKI, at the single patient level. Lastly, we clusterized AKI patients according to their profile of risk factors and compared the clinical characteristics and outcome of every cluster. We applied this method to a cohort of severe COVID-19 patients hospitalized in the ICU of the Geneva University Hospitals. Results Among the 248 patients analyzed, we found 7 factors associated with AKI development. Using the individual expression of these factors, we identified three groups of AKI patients, based on the use of Lopinavir/Ritonavir, baseline eGFR, use of dexamethasone and AKI severity. The three clusters expressed distinct characteristics in terms of AKI severity and recovery, metabolic patterns and hospital mortality. Conclusion We propose here a new method to phenotype AKI patients according to their most important individual risk factors for AKI development. When applied to an ICU cohort of COVID-19 patients, we were able to differentiate three groups of patients. Each expressed specific AKI characteristics and outcomes, which probably reflect a distinct pathophysiology.
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Affiliation(s)
- David Legouis
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
- Laboratory of Nephrology, Department of Medicine and Cell Physiology, University Hospital of Geneva, Geneva, Switzerland
- *Correspondence: David Legouis
| | - Gilles Criton
- Geneva School of Economics and Management, University of Geneva, Geneva, Switzerland
| | - Benjamin Assouline
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Christophe Le Terrier
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Sebastian Sgardello
- Department of Surgery, Center Hospitalier du Valais Romand, Sion, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Elisa Marchi
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Frédéric Sangla
- Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
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Patil S, Choudhary S. Deep convolutional neural network for chronic kidney disease prediction using ultrasound imaging. BIO-ALGORITHMS AND MED-SYSTEMS 2021. [DOI: 10.1515/bams-2020-0068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Abstract
Objectives
Chronic kidney disease (CKD) is a common disease and it is related to a higher risk of cardiovascular disease and end-stage renal disease that can be prevented by the earlier recognition and diagnosis of individuals at risk. Even though risk factors for CKD have been recognized, the effectiveness of CKD risk classification via prediction models remains uncertain. This paper intends to introduce a new predictive model for CKD using US image.
Methods
The proposed model includes three main phases “(1) preprocessing, (2) feature extraction, (3) and classification.” In the first phase, the input image is subjected to preprocessing, which deploys image inpainting and median filtering processes. After preprocessing, feature extraction takes place under four cases; (a) texture analysis to detect the characteristics of texture, (b) proposed high-level feature enabled local binary pattern (LBP) extraction, (c) area based feature extraction, and (d) mean intensity based feature extraction. These extracted features are then subjected for classification, where “optimized deep convolutional neural network (DCNN)” is used. In order to make the prediction more accurate, the weight and the activation function of DCNN are optimally chosen by a new hybrid model termed as diversity maintained hybrid whale moth flame optimization (DM-HWM) model.
Results
The accuracy of adopted model at 40th training percentage was 44.72, 11.02, 5.59, 3.92, 3.92, 3.57, 2.59, 1.71, 1.68, and 0.42% superior to traditional artificial neural networks (ANN), support vector machine (SVM), NB, J48, NB-tree, LR, composite hypercube on iterated random projection (CHIRP), CNN, moth flame optimization (MFO), and whale optimization algorithm (WOA) models.
Conclusions
Finally, the superiority of the adopted scheme is validated over other conventional models in terms of various measures.
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Affiliation(s)
- Smitha Patil
- Research Scholar, VTU , RC Sir MVIT , Bengaluru , India
- Assistant Professor, Presidency University , Bengaluru , India
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Choe SH, Cho H, Bae J, Ji SH, Yoon HK, Lee HJ, Lee JH, Kim JT, Kim WH. Severity and Duration of Acute Kidney Injury and Chronic Kidney Disease after Cardiac Surgery. J Clin Med 2021; 10:1556. [PMID: 33917221 PMCID: PMC8067973 DOI: 10.3390/jcm10081556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
We aimed to evaluate whether the duration and stage of acute kidney injury (AKI) are associated with the occurrence of chronic kidney disease (CKD) in patients undergoing cardiac or thoracic aortic surgery. A total of 2009 cases were reviewed. The patients with postoperative AKI stage 1 and higher stage were divided into transient (serum creatinine elevation ≤48 h) or persistent (>48 h) AKI, respectively. Estimated glomerular filtration rate (eGFR) values during three years after surgery were collected. Occurrence of new-onset CKD stage 3 or higher or all-cause mortality was determined as the primary outcome. Multivariable Cox regression and Kaplan-Meier survival analysis were performed. The Median follow-up of renal function after surgery was 32 months. The cumulative incidences of our primary outcome at one, two, and three years after surgery were 19.8, 23.7, and 26.1%. There was a graded significant association of AKI with new-onset CKD during three years after surgery, except for transient stage 1 AKI (persistent stage 1: HR 3.11, 95% CI 2.62-4.91; transient higher stage: HR 4.07, 95% CI 2.98-6.11; persistent higher stage: HR 13.36, 95% CI 8.22-18.72). There was a significant difference in survival between transient and persistent AKI at the same stage. During three years after cardiac surgery, there was a significant and graded association between AKI stages and the development of new-onset CKD, except for transient stage 1 AKI. This association was stronger when AKI lasted more than 48 h at the same stage. Both duration and severity of AKI provide prognostic value to predict the development of CKD.
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Affiliation(s)
- Suk Hyung Choe
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Hyeyeon Cho
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Jinyoung Bae
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Sang-Hwan Ji
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Ji-Hyun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Jin-Tae Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, #101 Daehak-ro, Jongno-GU, Seoul 03080, Korea
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Dong N, Piao H, Du Y, Li B, Xu J, Wei S, Liu K. Development of a practical prediction score for acute renal injury after surgery for Stanford type A aortic dissection. Interact Cardiovasc Thorac Surg 2020; 30:746-753. [PMID: 32044962 DOI: 10.1093/icvts/ivaa011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/22/2019] [Accepted: 01/15/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common complication of cardiovascular surgery that is associated with increased mortality, especially after surgeries involving the aorta. Early detection and prevention of AKI in patients with aortic dissection may help improve outcomes. The objective of this study was to develop a practical prediction score for AKI after surgery for Stanford type A acute aortic dissection (TAAAD). METHODS This was a retrospective cohort study that included 2 independent hospitals. A larger cohort of 326 patients from The Second Hospital of Jilin University was used to identify the risk factors for AKI and to develop a risk score. The derived risk score was externally validated in a separate cohort of 102 patients from the other hospital. RESULTS The scoring system included the following variables: (i) age >45 years; (ii) body mass index >25 kg/m2; (iii) white blood cell count >13.5 × 109/l; and (iv) lowest perioperative haemoglobin <100 g/l, cardiopulmonary bypass duration >150 min and renal malperfusion. On receiver operating characteristic curve analysis, the score predicted AKI with fair accuracy in both the derivation [area under the curve 0.778, 95% confidence interval (CI) 0.726-0.83] and the validation (area under the curve 0.747, 95% CI 0.657-0.838) cohorts. CONCLUSIONS We developed a convenient scoring system to identify patients at high risk of developing AKI after surgery for TAAAD. This scoring system may help identify patients who require more intensive postoperative management and facilitate appropriate interventions to prevent AKI and improve patient outcomes.
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Affiliation(s)
- Ning Dong
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China.,Department of Emergency Medicine, First Hospital of Bethune, Jilin University, Changchun, China
| | - Hulin Piao
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Yu Du
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Bo Li
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Jian Xu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Shibo Wei
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, Second Hospital of Bethune, Jilin University, Changchun, China
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Li CW, Cheng Y, Xue FS, Yuan YJ. A commentary on "a simple four-factor preoperative recipient scoring model for prediction of 90-day mortality after adult liver transplantation: A retrospective cohort study" (Int. J. Surg. 2020; 81, 26-31). Int J Surg 2020; 83:63-64. [PMID: 32931974 DOI: 10.1016/j.ijsu.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Cheng-Wen Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Yi Cheng
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China.
| | - Yu-Jing Yuan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, NO. 95 Yong-An Road, Xi-Cheng District, Beijing, 100050, PR China
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A commentary on "Incidence, predictors and validation of risk scores to predict postoperative mortality after noncardiac vascular surgery, a prospective cohort study" (Int J Surg 2020;73:89-93). Int J Surg 2020; 77:181-182. [PMID: 32276078 DOI: 10.1016/j.ijsu.2020.03.066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022]
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Dong P, Xue FS, Liu SH, Wan L. Assessing risk factors and associated complications of acute kidney injury after craniotomy. Clin Neurol Neurosurg 2020; 193:105784. [PMID: 32203704 DOI: 10.1016/j.clineuro.2020.105784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Peng Dong
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Shao-Hua Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Lei Wan
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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Dong N, Liu J, Wang Z, Gao N, Pang L, Xing J. Development of a practical prediction scoring system for severe acute organophosphate poisoning. J Appl Toxicol 2020; 40:889-896. [PMID: 32030807 DOI: 10.1002/jat.3950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 11/07/2022]
Abstract
Acute organophosphorus poisoning (AOPP) is a serious public health issue, especially in the rural areas. This study was designed to establish a scoring system to assess the risk of cases with severe AOPP. A retrospective cohort study was conducted at two independent hospitals. The derivation cohort included 444 patients with AOPP and the validation cohort included 274 patients. A risk score for patients with severe AOPP was developed. The rates of severe AOPP cases were 20.7% and 20.1% in the derivation and validation cohorts, respectively. A scoring system for severe AOPP risk was developed that included: (1) age >50 years, (2) white blood cell count of >15 × 109 /L, (3) plasma cholinesterase of <360 U/L, (4) plasma albumin of <35 g/L, (5) blood pH <7.3, and (6) lactic acid >3.0 mmol/L. The predicted score in severe cases of AOPP had good accuracy in both the derivation (area under the receiver operating characteristic curve [AUC] 0.88, 95% confidence interval [CI], 0.85-0.92) and validation cohorts (AUC 0.83, 95% CI, 0.77-0.90). A practical bedside prediction scoring system was developed for patients with severe AOPP. The routine use of this scoring system could rapidly assist in identifying patients at higher risk who require more intensive care or transfer to a larger better-equipped hospital.
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Affiliation(s)
- Ning Dong
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Junlan Liu
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Zhihao Wang
- Department of Geriatrics, the Fist Hospital of Jilin University, Changchun, China
| | - Nan Gao
- Department of Emergency, the Third Clinical Hospital of Changchun Traditional Chinese Medicine University, Changchun, China
| | - Li Pang
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
| | - Jihong Xing
- Department of Emergency, the Fist Hospital of Jilin University, Changchun, China
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