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Jeppesen KK, Rasmussen SB, Kjaergaard J, Schmidt H, Mølstrøm S, Beske RP, Grand J, Ravn HB, Winther-Jensen M, Meyer MAS, Hassager C, Møller JE. Acute kidney injury after out-of-hospital cardiac arrest. Crit Care 2024; 28:169. [PMID: 38762578 PMCID: PMC11102609 DOI: 10.1186/s13054-024-04936-w] [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: 03/15/2024] [Accepted: 04/29/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant risk factor associated with reduced survival following out-of-hospital cardiac arrest (OHCA). Whether the severity of AKI simply serves as a surrogate measure of worse peri-arrest conditions, or represents an additional risk to long-term survival remains unclear. METHODS This is a sub-study derived from a randomized trial in which 789 comatose adult OHCA patients with presumed cardiac cause and sustained return of spontaneous circulation (ROSC) were enrolled. Patients without prior dialysis dependent kidney disease and surviving at least 48 h were included (N = 759). AKI was defined by the kidney disease: improving global outcome (KDIGO) classification, and patients were divided into groups based on the development of AKI and the need for continuous kidney replacement therapy (CKRT), thus establishing three groups of patients-No AKI, AKI no CKRT, and AKI CKRT. Primary outcome was overall survival within 365 days after OHCA according to AKI group. Adjusted Cox proportional hazard models were used to assess overall survival within 365 days according to the three groups. RESULTS In the whole population, median age was 64 (54-73) years, 80% male, 90% of patients presented with shockable rhythm, and time to ROSC was median 18 (12-26) min. A total of 254 (33.5%) patients developed AKI according to the KDIGO definition, with 77 requiring CKRT and 177 without need for CKRT. AKI CKRT patients had longer time-to-ROSC and worse metabolic derangement at hospital admission. Overall survival within 365 days from OHCA decreased with the severity of kidney injury. Adjusted Cox regression analysis found that AKI, both with and without CKRT, was significantly associated with reduced overall survival up until 365 days, with comparable hazard ratios relative to no AKI (HR 1.75, 95% CI 1.13-2.70 vs. HR 1.76, 95% CI 1.30-2.39). CONCLUSIONS In comatose patients who had been resuscitated after OHCA, patients developing AKI, with or without initiation of CKRT, had a worse 1-year overall survival compared to non-AKI patients. This association remains statistically significant after adjusting for other peri-arrest risk factors. TRIAL REGISTRATION The BOX trial is registered at ClinicalTrials.gov: NCT03141099.
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Affiliation(s)
- Karoline Korsholm Jeppesen
- Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000, Odense C, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sebastian Buhl Rasmussen
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Schmidt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Simon Mølstrøm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Rasmus Paulin Beske
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Johannes Grand
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Hanne Berg Ravn
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Christian Hassager
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Eifer Møller
- Department of Cardiology, Odense University Hospital, J. B. Winsloews Vej 4, 5000, Odense C, Denmark.
- Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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Canney M, Clark EG, Hiremath S. Biomarkers in acute kidney injury: On the cusp of a new era? J Clin Invest 2023; 133:e171431. [PMID: 37395275 DOI: 10.1172/jci171431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
The field of nephrology has been slow in moving beyond the utilization of creatinine as an indicator for chronic kidney disease and acute kidney injury (AKI). Early diagnosis and establishment of etiology, in particular, are important for treatment of AKI. In the setting of hospital-acquired AKI, tubular injury is more common, but acute interstitial nephritis (AIN) has a more treatable etiology. However, it is likely that AIN is under- or misdiagnosed due to current strategies that largely rely on clinical gestalt. In this issue of the JCI, Moledina and colleagues made an elegant case for the chemokine called C-X-C motif ligand 9 (CXCL9) as a biomarker of AIN. The authors used urine proteomics and tissue transcriptomics in patients with and without AIN to identify CXCL9 as a promising, noninvasive, diagnostic biomarker of AIN. These results have clinical implications that should catalyze future research and clinical trials in this space.
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Affiliation(s)
- Mark Canney
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Nanodrugs alleviate acute kidney injury: Manipulate RONS at kidney. Bioact Mater 2023; 22:141-167. [PMID: 36203963 PMCID: PMC9526023 DOI: 10.1016/j.bioactmat.2022.09.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 02/06/2023] Open
Abstract
Currently, there are no clinical drugs available to treat acute kidney injury (AKI). Given the high prevalence and high mortality rate of AKI, the development of drugs to effectively treat AKI is a huge unmet medical need and a research hotspot. Although existing evidence fully demonstrates that reactive oxygen and nitrogen species (RONS) burst at the AKI site is a major contributor to AKI progression, the heterogeneity, complexity, and unique physiological structure of the kidney make most antioxidant and anti-inflammatory small molecule drugs ineffective because of the lack of kidney targeting and side effects. Recently, nanodrugs with intrinsic kidney targeting through the control of size, shape, and surface properties have opened exciting prospects for the treatment of AKI. Many antioxidant nanodrugs have emerged to address the limitations of current AKI treatments. In this review, we systematically summarized for the first time about the emerging nanodrugs that exploit the pathological and physiological features of the kidney to overcome the limitations of traditional small-molecule drugs to achieve high AKI efficacy. First, we analyzed the pathological structural characteristics of AKI and the main pathological mechanism of AKI: hypoxia, harmful substance accumulation-induced RONS burst at the renal site despite the multifactorial initiation and heterogeneity of AKI. Subsequently, we introduced the strategies used to improve renal targeting and reviewed advances of nanodrugs for AKI: nano-RONS-sacrificial agents, antioxidant nanozymes, and nanocarriers for antioxidants and anti-inflammatory drugs. These nanodrugs have demonstrated excellent therapeutic effects, such as greatly reducing oxidative stress damage, restoring renal function, and low side effects. Finally, we discussed the challenges and future directions for translating nanodrugs into clinical AKI treatment. AKI is a common clinical acute syndrome with high morbidity and mortality but without effective clinical drug available. Hypoxia and accumulation of toxic substances are key pathological features of various heterogeneous AKI. Excessive RONS is the core of the pathological mechanism of AKI. The development of nanodrugs is expected to achieve successful treatment in AKI.
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Li J, Wang R, Wan J, Zhu P, Xiao Z, Wang X, Zheng S. Postoperative central venous pressure is associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Front Cardiovasc Med 2022; 9:1016436. [DOI: 10.3389/fcvm.2022.1016436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/01/2022] [Indexed: 11/18/2022] Open
Abstract
ObjectiveThe present study aimed to investigate the association of postoperative central venous pressure (CVP) with acute kidney injury (AKI) and mortality in patients undergoing coronary artery bypass grafting (CABG).MethodPatients who underwent CABG in the MIMIC-III database were included and divided into two groups according to the optimal cutoff value of CVP for postoperative AKI determined by the receiver operating characteristic (ROC) curves. The association of CVP with AKI and mortality was determined by multivariate regression models. A 1:1 propensity score matching (PSM) was performed to balance the influence of potential confounding factors.ResultsA total of 3,564 patients were included and divided into High CVP group (CVP ≥ 10.9 mmHg) and Low CVP group (CVP < 10.9 mmHg) according to the ROC analysis. Patients in High CVP group presented with higher AKI incidence (420 (28.2%) vs. 349 (16.8), p < 0.001), in-hospital mortality (28 (1.9%) vs. 6 (0.3%), p < 0.001) and 4-year mortality (149 (15.8%) vs. 162 (11.1%), p = 0.001). Multivariate regression model showed that CVP was an independent risk factor for the postoperative AKI (OR: 1.071 (1.035, 1.109), p < 0.001), in-hospital mortality (OR: 1.187 (1.026, 1.373), p = 0.021) and 4-year mortality (HR: 1.049 (1.003, 1.096), p = 0.035). A CVP above 10.9 mmHg was significantly associated with about 50% higher risk of AKI (OR: 1.499 (1.231, 1.824), p < 0.001). After PSM, 1004 pairs of score-matched patients were generated. The multivariate logistic model showed that patients with CVP ≥ 10.9 mmHg had a significantly higher risk of AKI (OR: 1.600 (1.268, 2.018), p < 0.001) in the PSM subset. However, CVP, as a continuous or a dichotomic variable, was not independently associated with in-hospital mortality (OR: 1.202 (0.882, 1.637), p = 0.244; OR: 2.636 (0.399, 17.410), p = 0.314) and 4-year mortality (HR: 1.030 (0.974, 1.090), p = 0.297; HR: 1.262 (0.911, 1.749), p = 0.162) in the PSM dataset.ConclusionA mean CVP ≥ 10.9 mmHg within the first 24 h after CABG was independently associated with a higher risk of postoperative AKI.
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Chang JF, Chou YS, Wu CC, Chen PC, Ko WC, Liou JC, Hsieh CY, Lin WN, Wen LL, Chang SW, Tung TH, Wang TM. A Joint Evaluation of Neurohormone Vasopressin-Neurophysin II-Copeptin and Aortic Arch Calcification on Mortality Risks in Hemodialysis Patients. Front Med (Lausanne) 2020; 7:102. [PMID: 32296707 PMCID: PMC7136408 DOI: 10.3389/fmed.2020.00102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/09/2020] [Indexed: 01/05/2023] Open
Abstract
Objective: Systemic hypoperfusion is intricately involved in neurohormone secretion, vascular calcification (VC) related impaired vasodilation, and luminal stenosis. We aimed to conduct a joint evaluation of vasopressin-neurophysin II-copeptin peptide (VP) and advanced aortic arch calcification (AAC) on all-cause and cardiovascular (CV) mortality in maintenance hemodialysis (MHD) patients. Methods: Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed for different groups of VP and AAC in 167 MHD patients. The modification effect between higher VP and advanced AAC on mortality risk was examined using an interaction product term. Results: Interactions between VP and AAC with respect to all-cause and CV mortality were statistically significant. In multivariable analysis, higher VP predicted all-cause and CV mortality [aHR: 2.2 (95% confidence interval (CI): 1.1–4.5)] and 2.6 (95% CI: 1.1–4.6), respectively. Advanced AAC was associated with incremental risks of all-cause and CV mortality [aHR: 2.1 (95% CI: 1.1–4.0)and 2.5 (95% CI: 1.0–4.3), respectively]. Patients with combined higher VP (>101.5 ng/mL) and advanced AAC were at the greatest risk of all-cause and CV mortality [aHR: 4.7 (95% CI: 1.2–16.2)and 4.9 (95% CI: 1.1–18.9), respectively]. Conclusion: Combined VP and advanced AAC predict not only all-cause but also CV death in MHD patients, and a joint evaluation is more comprehensive than single marker. In light of hypoperfusion and ischemic events in vital organs, VP and AAC could act as more robust dual marker for prognostic assessment.
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Affiliation(s)
- Jia-Feng Chang
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Graduate Institute of Aerospace and Undersea Medicine, Academy of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan.,Division of Nephrology, Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.,Renal Care Joint Foundation, New Taipei City, Taiwan.,College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Shao Chou
- Department of Emergency Medicine, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Chang-Chin Wu
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan.,Department of Orthopedics, En Chu Kong Hospital, New Taipei City, Taiwan.,Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Po-Cheng Chen
- Department of Urology, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Wen-Chin Ko
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.,Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | - Jian-Chiun Liou
- School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Chih-Yu Hsieh
- School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,Department of Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Wei-Ning Lin
- Graduate Institution of Biomedical and Pharmaceutical Science, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Li Wen
- Department of Medical Laboratory Science and Biotechnology, Yuanpei University, Hsinchu, Taiwan.,Department of Clinical Laboratory, En Chu Kong Hospital, New Taipei City, Taiwan
| | - Shu-Wei Chang
- Department of Civil Engineering, National Taiwan University, Taipei, Taiwan
| | - Tao-Hsin Tung
- Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Ting-Ming Wang
- Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Lanktree MB, Pei Y. Does elevated urinary Dkkopf-3 level predict vulnerability to kidney injury during cardiac surgery? ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:S296. [PMID: 32016015 DOI: 10.21037/atm.2019.11.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew B Lanktree
- Divsion of Nephrology, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
| | - York Pei
- Divsion of Nephrology, University Health Network and University of Toronto, Toronto, Ontario, Canada
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