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Ehmann MR, Klein EY, Zhao X, Mitchell J, Menez S, Smith A, Levin S, Hinson JS. Epidemiology and Clinical Outcomes of Community-Acquired Acute Kidney Injury in the Emergency Department: A Multisite Retrospective Cohort Study. Am J Kidney Dis 2024; 83:762-771.e1. [PMID: 38072210 DOI: 10.1053/j.ajkd.2023.10.009] [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: 05/26/2023] [Revised: 09/26/2023] [Accepted: 10/07/2023] [Indexed: 02/02/2024]
Abstract
RATIONALE & OBJECTIVE The prevalence of community-acquired acute kidney injury (CA-AKI) in the United States and its clinical consequences are not well described. Our objective was to describe the epidemiology of CA-AKI and the associated clinical outcomes. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 178,927 encounters by 139,632 adults at 5 US emergency departments (EDs) between July 1, 2017, and December 31, 2022. PREDICTORS CA-AKI identified using KDIGO (Kidney Disease: Improving Global Outcomes) serum creatinine (Scr)-based criteria. OUTCOMES For encounters resulting in hospitalization, the in-hospital trajectory of AKI severity, dialysis initiation, intensive care unit (ICU) admission, and death. For all encounters, occurrence over 180 days of hospitalization, ICU admission, new or progressive chronic kidney disease, dialysis initiation, and death. ANALYTICAL APPROACH Multivariable logistic regression analysis to test the association between CA-AKI and measured outcomes. RESULTS For all encounters, 10.4% of patients met the criteria for any stage of AKI on arrival to the ED. 16.6% of patients admitted to the hospital from the ED had CA-AKI on arrival to the ED. The likelihood of AKI recovery was inversely related to CA-AKI stage on arrival to the ED. Among encounters for hospitalized patients, CA-AKI was associated with in-hospital dialysis initiation (OR, 6.2; 95% CI, 5.1-7.5), ICU admission (OR, 1.9; 95% CI, 1.7-2.0), and death (OR, 2.2; 95% CI, 2.0-2.5) compared with patients without CA-AKI. Among all encounters, CA-AKI was associated with new or progressive chronic kidney disease (OR, 6.0; 95% CI, 5.6-6.4), dialysis initiation (OR, 5.1; 95% CI, 4.5-5.7), subsequent hospitalization (OR, 1.1; 95% CI, 1.1-1.2) including ICU admission (OR, 1.2; 95% CI, 1.1-1.4), and death (OR, 1.6; 95% CI, 1.5-1.7) during the subsequent 180 days. LIMITATIONS Residual confounding. Study implemented at a single university-based health system. Potential selection bias related to exclusion of patients without an available baseline Scr measurement. Potential ascertainment bias related to limited repeat Scr data during follow-up after an ED visit. CONCLUSIONS CA-AKI is a common and important entity that is associated with serious adverse clinical consequences during the 6-month period after diagnosis. PLAIN-LANGUAGE SUMMARY Acute kidney injury (AKI) is a condition characterized by a rapid decline in kidney function. There are many causes of AKI, but few studies have examined how often AKI is already present when patients first arrive to an emergency department seeking medical attention for any reason. We analyzed approximately 175,000 visits to Johns Hopkins emergency departments and found that AKI is common on presentation to the emergency department and that patients with AKI have increased risks of hospitalization, intensive care unit admission, development of chronic kidney disease, requirement of dialysis, and death in the first 6 months after diagnosis. AKI is an important condition for health care professionals to recognize and is associated with serious adverse outcomes.
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Affiliation(s)
- Michael R Ehmann
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Center for Disease Dynamics, Economics & Policy, Washington, District of Columbia
| | - Xihan Zhao
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jonathon Mitchell
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Steven Menez
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Malone Center for Engineering in Healthcare, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland; Beckman Coulter, Brea, California
| | - Jeremiah S Hinson
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland; Malone Center for Engineering in Healthcare, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland; Beckman Coulter, Brea, California
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He T, Xiong L, Zhang Y, Yan R, Yu M, Liu M, Liu L, Duan C, Li X, Zhang J. Mice kidney biometabolic process analysis after cantharidin exposure using widely-targeted metabolomics combined with network pharmacology. Food Chem Toxicol 2022; 171:113541. [PMID: 36464109 DOI: 10.1016/j.fct.2022.113541] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/01/2022] [Accepted: 11/27/2022] [Indexed: 12/05/2022]
Abstract
Cantharidin (CTD) is a principal bioactive component of traditional Chinese medicine Mylabris used in cancer treatment. However, CTD clinical application is limited due to nephrotoxicity, and the mechanism is unknown. The present study used widely-targeted metabolomics, network pharmacology, and cell experiments to investigate the nephrotoxicity mechanism after CTD exposure. In mice exposed to CTD, serum creatinine and urea nitrogen levels increased with renal injury. Then, 74 differential metabolites were detected, including 51 up-regulated and 23 down-regulated metabolites classified as amino acids, small peptides, fatty acyl, arachidonic acid metabolite, organic acid, and nucleotides. Sixteen metabolic pathways including tyrosine, sulfur, and pyrimidine metabolism were all disrupted in the kidney. Furthermore, network pharmacology revealed that 258 metabolic targets, and pathway enrichment indicated that CTD could activate oxidative phosphorylation and oxidative stress (OS). Subsequently, HK-2 cell experiments demonstrated that CTD could reduce superoxide dismutase while increasing malondialdehyde levels. In conclusion, after CTD exposure, biometabolic processes may be disrupted with renal injury in mice, resulting in oxidative phosphorylation and OS.
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Affiliation(s)
- Tianmu He
- School of Basic Medicine, Guizhou Medical University, Guiyang, 550025, China; School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China
| | - Lijuan Xiong
- School of Pharmacy and Key Laboratory of Basic Pharmacology Ministry Education, Joint International Research Laboratory of Ethnomedicine Ministry of Education, Zunyi Medical University, Zunyi, 563000, China
| | - Yixin Zhang
- School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China
| | - Rong Yan
- School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China
| | - Ming Yu
- School of Pharmacy and Key Laboratory of Basic Pharmacology Ministry Education, Joint International Research Laboratory of Ethnomedicine Ministry of Education, Zunyi Medical University, Zunyi, 563000, China
| | - Meichen Liu
- School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China
| | - Liu Liu
- School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China
| | - Cancan Duan
- School of Pharmacy and Key Laboratory of Basic Pharmacology Ministry Education, Joint International Research Laboratory of Ethnomedicine Ministry of Education, Zunyi Medical University, Zunyi, 563000, China
| | - Xiaofei Li
- School of Basic Medicine, Guizhou Medical University, Guiyang, 550025, China; School of Basic Medicine, Zunyi Medical University, Zunyi, 563000, China.
| | - Jianyong Zhang
- School of Pharmacy and Key Laboratory of Basic Pharmacology Ministry Education, Joint International Research Laboratory of Ethnomedicine Ministry of Education, Zunyi Medical University, Zunyi, 563000, China.
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Zhou L, Li Y, Gao Q, Lin Y, Su L, Chen R, Cao Y, Xu R, Luo F, Gao P, Zhang X, Li P, Nie S, Tang Y, Xu X. Loop Diuretics Are Associated with Increased Risk of Hospital-Acquired Acute Kidney Injury in Adult Patients: A Retrospective Study. J Clin Med 2022; 11:jcm11133665. [PMID: 35806949 PMCID: PMC9267783 DOI: 10.3390/jcm11133665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The association between loop diuretics and acute kidney injury (AKI) remains unclear. Methods: The population studied was selected from the Epidemiology of AKI in Chinese Hospitalized patients (EACH) study. Exposure to loop diuretics was defined as any filled prescription prior to the date when AKI was detected in patients with HA-AKI, and prior to the last date of SCr testing in those without AKI. The outcome was AKI, defined by the Kidney Disease Improving Global Outcomes criteria. Associations between loop diuretics and HA-AKI were examined by Cox proportional hazards models adjusted for baseline and time-dependent covariates. Results: Of the 150,020 patients, 16,437 (11.0%) were prescribed loop diuretics, and 5717 (3.8%) experienced HA-AKI events. The crude rates of HA-AKI in patients who were and were not prescribed loop diuretics were 1632 (9.9%) and 3262 (2.8%), respectively. A multivariate cox proportional hazards analysis showed that exposure to loop diuretics was associated with significantly increased risks of HA-AKI compared with non-users (hazard ratio (HR), 1.61; 95% CI (confidence interval), 1.55–1.67), other diuretics (HR, 1.09; 95% CI, 1.03–1.15), and osmotic diuretics (HR, 1.30; 95% CI, 1.20–1.42). Compared with other diuretics, the use of loop diuretics was associated with higher risks of HA-AKI in women, in patients without hypertension, in patients without heart failure, in patients without liver cirrhosis, and in patients not requiring surgery. Conclusions: Loop diuretics are widely used and are associated with increased risks of HA-AKI in hospitalized adults. Renal function should be more closely monitored during the use of loop diuretics.
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Affiliation(s)
- Liping Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yanqin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Qi Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yuxin Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Licong Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruixuan Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yue Cao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruqi Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Fan Luo
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Peiyan Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Xiaodong Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Pingping Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ying Tang
- Division of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510515, China
- Correspondence: (Y.T.); (X.X.)
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
- Correspondence: (Y.T.); (X.X.)
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He T, Wang Q, Ao J, Chen K, Li X, Zhang J, Duan C. Endoplasmic reticulum stress contributes to autophagy and apoptosis in cantharidin-induced nephrotoxicity. Food Chem Toxicol 2022; 163:112986. [PMID: 35398186 DOI: 10.1016/j.fct.2022.112986] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/22/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
Abstract
Mylabris, as a natural product of traditional Chinese medicine (TCM), exhibiting typical antitumor activity, and cantharidin (CTD) is the major bioactive component. However, drug-induced nephrotoxicity (DIN) extremely limited its clinical application. In this study, we proved that activation of the endoplasmic reticulum (ER) stress-dependent PERK/CHOP pathway exerts a toxic role in rats and HK-2 cells through inducing autophagy and apoptosis. Results showed that CTD could cause renal function damage, cytotoxicity, and apoptosis. The ER dilatation and autolysosomes were observed after CTD treatment. Furthermore, the distribution of LC3, ATF4, and CHOP proteins was observed in the nucleus and cytoplasm. In addition, the mRNA levels of ER stress-regulated genes (PERK, eIF2α, CHOP, and ATF4) were increased, and the expression levels of GRP78, ATF4, CHOP, LC3, Beclin-1, Atg3, Atg7, Caspase 3, and Bax/Bcl-2 proteins were increased both in vitro and in vivo. Consistently, this upregulation could be inhibited by an ER stress inhibitor 4-Phenylbutyric acid (4-PBA), indicating that ER stress is partly responsible for activation of autophagy and apoptosis in CTD-induced DIN. In conclusion, CTD could induce DIN by triggering ER stress, further activating autophagy and apoptosis both in vivo and in vitro.
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Affiliation(s)
- Tianmu He
- School of Basic Medical Sciences, Zunyi Medical University, Zunyi, 563000, China; School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550025, China
| | - Qiyi Wang
- School of Pharmacy, Zunyi Medical University, Zunyi, 563000, China
| | - Jingwen Ao
- School of Pharmacy, Zunyi Medical University, Zunyi, 563000, China
| | - Kuan Chen
- School of Pharmacy, Zunyi Medical University, Zunyi, 563000, China
| | - Xiaofei Li
- School of Basic Medical Sciences, Zunyi Medical University, Zunyi, 563000, China; School of Basic Medical Sciences, Guizhou Medical University, Guiyang, 550025, China
| | - Jianyong Zhang
- School of Pharmacy, Zunyi Medical University, Zunyi, 563000, China.
| | - Cancan Duan
- School of Pharmacy, Zunyi Medical University, Zunyi, 563000, China.
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Worakajit N, Thipboonchoo N, Chaturongakul S, Jutabha P, Soontornniyomkij V, Tuchinda P, Soodvilai S. Nephroprotective potential of Panduratin A against colistin-induced renal injury via attenuating mitochondrial dysfunction and cell apoptosis. Biomed Pharmacother 2022; 148:112732. [PMID: 35217281 DOI: 10.1016/j.biopha.2022.112732] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/10/2022] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
Colistin is a last-resort polypeptide antibiotic widely used to treat against multidrug-resistant Gram-negative bacterial infections. However, this treatment is associated with nephrotoxicity. The aim of this study was to examine the potential protective effect of panduratin A, a bioactive compound of Boesenbergia rotunda, on colistin-induced nephrotoxicity in both in vivo and in vitro models. Intraperitoneal injection of 15 mg/kg colistin for 7 days markedly promoted renal tubular degeneration, increased blood urea nitrogen (BUN) levels, and upregulated the expression of renal injury biomarker and apoptosis proteins. In addition, treatment with colistin increased oxidative stress and apoptosis in mice kidney tissues. Interestingly, these defects were attenuated when co-administered of colistin with panduratin A (2.5 or 25 mg/kg). The underlying mechanisms of panduratin A attenuating colistin toxicity was investigated in human renal proximal tubular cells (RPTEC/TERT1). The mechanisms by which colistin-triggered cytotoxicity was determined by analysis of cell death, reactive oxygen species (ROS) levels, mitochondria function as well as the expression of proteins related to apoptosis pathway. Colistin treatment (200 µg/ml) significantly increased cell apoptosis, elevated ROS production, reduced mitochondrial membrane potential, and decreased anti-apoptotic protein (Bcl-2) expression. These effects were notably suppressed by co-treatment with panduratin A (5 μM). Collectively, panduratin A exerts as a novel nephroprotective agent to protect against colistin-induced renal injury by attenuating mitochondrial damage and renal cell apoptosis.
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Affiliation(s)
- Nichakorn Worakajit
- Research Center of Transporter Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Natechanok Thipboonchoo
- Research Center of Transporter Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Soraya Chaturongakul
- Institute of Molecular Biosciences, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Promsuk Jutabha
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bang Phli, Samut Prakan 10540, Thailand
| | - Virawudh Soontornniyomkij
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bang Phli, Samut Prakan 10540, Thailand
| | | | - Sunhapas Soodvilai
- Research Center of Transporter Protein for Medical Innovation, Department of Physiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand; Excellent Center for Drug Discovery, Mahidol University, Bangkok 10400, Thailand.
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Jaryal A, Vikrant S, Gupta D. Epidemiology and outcomes of dialysis requiring acute kidney injury: A single-center study. Ther Apher Dial 2021; 26:594-600. [PMID: 34538021 DOI: 10.1111/1744-9987.13739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common diagnosis in hospitalized patients. Dialysis requiring AKI (AKI-D) is associated with adverse outcomes. This study aims to know the clinical profile and short-term outcomes at 3 months, in patients with AKI-D, at our center. METHODS A prospective observational study was done of all the patients admitted with AKI-D for 2 years, from July 2018 to June 2020. We recorded clinical parameters at baseline and postdischarge follow-up at 3 months. RESULTS One hundred twenty-eight patients had AKI-D over 2 years. Then, 116 (90.6%) patients had community-acquired AKI (CAAKI), and 12 (9.4%) patients had hospital-acquired AKI. The underlying causes of AKI-D were: toxins in 48 (37.5%), sepsis in 31 (24.2%), acute kidney disease in 15 (11.7%), acute gastroenteritis (AGE) in 9 (7%), and cardiogenic shock in 7 (5.5%) patients. The mean values of intact parathyroid hormone (available in 32% of patients) were 268 pg/mL. Intermittent hemodialysis was the commonest mode of dialysis (85.2%). A kidney biopsy was done in 23 (18%) patients. The most common diagnosis on kidney biopsy was glomerulonephritis (GN) in 12 patients (crescentic GN-9 and IgA nephropathy-3), followed by acute tubule-interstitial nephritis in 6 patients. In-hospital mortality was 29.7%. Overall, 39% regained serum creatinine in the normal range at 3 months, 36.7% died, 14.1% reached chronic kidney disease (CKD), 7.8% lost to follow-up, and 2.3% had reached end-stage renal disease. CONCLUSION The majority of AKI-D at our center was CAAKI. A significant chunk of AKI-D (68.7%) was caused by preventable causes like toxins, sepsis, and AGE. Dysregulation of mineral metabolism was conspicuous. In chemical toxin vs. biological toxins and undifferentiated sepsis vs. the identifiable cause of sepsis, formers had significantly more in-hospital mortality than the latter ones. AKI-D is associated with high in-hospital mortality, total mortality, and risk of progression to CKD at 3 months.
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Affiliation(s)
- Ajay Jaryal
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Sanjay Vikrant
- Department of Nephrology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Dalip Gupta
- Department of Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Liu C, Yan S, Wang Y, Wang J, Fu X, Song H, Tong R, Dong M, Ge W, Wang J, Yang H, Wang C, Xia P, Zhao L, Shen S, Xie J, Xu Y, Ma P, Li H, Lu S, Ding Y, Jiang L, Lin Y, Wang M, Qiu F, Feng W, Yang L. Drug-Induced Hospital-Acquired Acute Kidney Injury in China: A Multicenter Cross-Sectional Survey. KIDNEY DISEASES (BASEL, SWITZERLAND) 2021; 7:143-155. [PMID: 33824870 PMCID: PMC8010232 DOI: 10.1159/000510455] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/24/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Drug-induced acute kidney injury (D-AKI) is one of the important types of AKI. The incidence of D-AKI in China has rarely been studied. OBJECTIVE This study aims to explore the disease burden, related drugs, and risk factors of D-AKI. METHODS A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in China. Suspected AKI was screened based on serum creatinine changes in accordance with the 2012 Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI, patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. Suspected AKI was firstly evaluated for the possibility of D-AKI by pharmacists using the Naranjo Scale and finally defined as D-AKI by nephrologists through reviewing AKI clinical features. RESULTS Altogether 280,255 hospitalized patients were screened and 1,960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as having D-AKI (37.50%, 735/1,960) with an in-hospital mortality rate of 13.88% and 54.34% of the survivors did not achieve full renal recovery. 1,642 drugs were related to AKI in these patients. Anti-infectives, diuretics, and proton pump inhibitors were the top 3 types of drugs relevant to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitute, and carbapenem related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. CONCLUSION In China, D-AKI has caused a substantial medical burden. Efforts should be made to pursue nephrotoxic drug stewardship to minimize attributable risk and improve the prevention, diagnosis, and treatment of D-AKI.
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Affiliation(s)
- Chen Liu
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Suying Yan
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuqin Wang
- Department of Pharmacy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinwei Wang
- Renal Division, Peking University First Hospital, Peking University, Beijing, China
| | - Xiujuan Fu
- Department of Pharmacy, The Second Hospital of Jilin University, Changchun, China
| | - Hongtao Song
- Department of Pharmacy, 900 Hospital of the Joint Logistic Team, Fuzhou, China
| | - Rongsheng Tong
- Department of Pharmacy, Sichuan Provincial People's Hospital, Chengdu, China
| | - Mei Dong
- Department of Pharmacy, Affiliated Tumor Hospital Harbin Medical University, Harbin, China
| | - Weihong Ge
- Department of Pharmacy, Nanjing Drum Tower Hospital, Nanjing, China
| | - Jiawei Wang
- Department of Pharmacy, Beijing Tongren Hospital, Beijing, China
| | - Hui Yang
- Department of Pharmacy, Qinghai University Affiliated Hospital, Xining, China
| | - Changlian Wang
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Peiyuan Xia
- Department of Pharmacy, The First Hospital Affiliated to Army Medical University, Chongqing, China
| | - Limei Zhao
- Department of Pharmacy, Shengjing Hospital of China Medical University, Shenyang, China
| | - Sijing Shen
- Department of Pharmacy, Peking University Shougang Hospital, Beijing, China
| | - Juan Xie
- Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yangui Xu
- Department of Pharmacy, Tianjin First Center Hospital, Tianjin, China
| | - Peizhi Ma
- Department of Pharmacy, Henan Provincial Peoples' Hospital, Zhengzhou, China
| | - Hongjian Li
- Department of Pharmacy, Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Shegui Lu
- Department of Pharmacy, The Second Hospital of Nanchang University, Nanchang, China
| | - Yufeng Ding
- Department of Pharmacy, The Tongji Affiliated Hospital of Tongji Medical College, Huazhong University of science, Wuhan, China
| | - Ling Jiang
- Department of Pharmacy, Anhui Provincial Hospital, Hefei, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Beijing, China
| | - Maoyi Wang
- Department of Pharmacy, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Feng Qiu
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wanyu Feng
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Li Yang
- Renal Division, Peking University First Hospital, Peking University, Beijing, China
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8
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Iram H, Ali M, Kumar V, Ejaz A, Solangi SA, Junejo AM, Solangi SA, Un Nisa N. Frequency of Risk Factors and Outcome of Hospital-Acquired Acute Kidney Injury. Cureus 2020; 12:e12001. [PMID: 33457112 PMCID: PMC7797606 DOI: 10.7759/cureus.12001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the frequencies of risk factors and the ultimate outcomes of ccute kidney injury (AKI) among hospitalized patients. MATERIALS AND METHODOLOGY This prospective, observational study was carried out from September 15, 2018, to March 14, 2019. All admitted patients, both male and female, with AKI, were included. Those with chronic kidney disease (CKD), small size echogenic kidneys (on ultrasonography, performed on admission), and recent history of urological intervention were excluded from the study. All patients were assessed for etiological factors (sepsis, gastroenteritis, surgical, and obstetrical) and outcome (improved, progression to CKD, or expired). RESULTS Out of a total of 230, most patients were aged between 20-50 years with a mean age of 38.99 ± 7.61 years. Males were 144 (62.61%) and females were 86 (37.39%). About 78 (33.91%) patients were hypertensive while 65 (28.26%) were diabetic. The cause of hospital-acquired AKI was found to be sepsis in most (71.73%, n=165) of the cases, followed by gastroenteritis (10.00%, n=23), surgical (9.56%, n=22), and obstetric (8.69%, n=20) causes. When the outcome was assessed, 10 (4.35%) patients expired, 154 (66.96%) improved completely, while 66 (28.69%) progressed to CKD. CONCLUSION This study has shown that sepsis is the most common cause of AKI in patients admitted to the hospital. So we recommend that proper steps should be taken to ensure adequate hospital care for avoiding such outcomes in hospitalized patients, and further decrease mortality.
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Affiliation(s)
- Hina Iram
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Muhammad Ali
- Department of Nephrology, Fazaia Ruth Pfau Medical College, Karachi, PAK
| | - Vinod Kumar
- Department of Medicine, Sir Syed College of Medical Sciences for Girls, Karachi, PAK
| | - Ayesha Ejaz
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Shafique A Solangi
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Abdul Manan Junejo
- Department of Nephrology, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | | | - Noor Un Nisa
- Physiology, Jinnah Sindh Medical University, Karachi, PAK
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9
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Bell S, James MT, Farmer CKT, Tan Z, de Souza N, Witham MD. Development and external validation of an acute kidney injury risk score for use in the general population. Clin Kidney J 2020; 13:402-412. [PMID: 33149901 PMCID: PMC7596889 DOI: 10.1093/ckj/sfaa072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/01/2020] [Indexed: 12/23/2022] Open
Abstract
Background Improving recognition of patients at increased risk of acute kidney injury (AKI) in the community may facilitate earlier detection and implementation of proactive prevention measures that mitigate the impact of AKI. The aim of this study was to develop and externally validate a practical risk score to predict the risk of AKI in either hospital or community settings using routinely collected data. Methods Routinely collected linked datasets from Tayside, Scotland, were used to develop the risk score and datasets from Kent in the UK and Alberta in Canada were used to externally validate it. AKI was defined using the Kidney Disease: Improving Global Outcomes serum creatinine–based criteria. Multivariable logistic regression analysis was performed with occurrence of AKI within 1 year as the dependent variable. Model performance was determined by assessing discrimination (C-statistic) and calibration. Results The risk score was developed in 273 450 patients from the Tayside region of Scotland and externally validated into two populations: 218 091 individuals from Kent, UK and 1 173 607 individuals from Alberta, Canada. Four variables were independent predictors for AKI by logistic regression: older age, lower baseline estimated glomerular filtration rate, diabetes and heart failure. A risk score including these four variables had good predictive performance, with a C-statistic of 0.80 [95% confidence interval (CI) 0.80–0.81] in the development cohort and 0.71 (95% CI 0.70–0.72) in the Kent, UK external validation cohort and 0.76 (95% CI 0.75–0.76) in the Canadian validation cohort. Conclusion We have devised and externally validated a simple risk score from routinely collected data that can aid both primary and secondary care physicians in identifying patients at high risk of AKI.
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Affiliation(s)
- Samira Bell
- Renal Unit, Ninewells Hospital, Dundee, UK.,Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Matthew T James
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute of Public Health, Libin Cardiovascular Institute of Alberta, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chris K T Farmer
- Centre for Health Services Studies, University of Kent, Canterbury, Kent, UK
| | - Zhi Tan
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicosha de Souza
- Division of Population Health and Genomics, Medical Research Institute, University of Dundee, Dundee, UK
| | - Miles D Witham
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle University and Newcastle-upon-Tyne Hospitals Trust, Newcastle, UK.,Ageing and Health, Division of Molecular & Clinical Medicine, School of Medicine, Ninewells Hospital, Dundee, UK
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10
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Heinjoki M, Karjalainen M, Saltevo J, Tiihonen M, Haanpää M, Kautiainen H, Mäntyselkä P. Kidney function and nephrotoxic drug use among older home-dwelling persons with or without diabetes in Finland. BMC Nephrol 2020; 21:11. [PMID: 31924175 PMCID: PMC6954600 DOI: 10.1186/s12882-020-1684-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/03/2020] [Indexed: 01/13/2023] Open
Abstract
Background Due to these changes in kidney function, aging kidneys are more prone to drug-induced impairments in renal properties. Diabetes has been associated with the declined kidney function and an elevated risk of renal failure. The aim of this study is to compare kidney function and potentially nephrotoxic drug use among home-dwelling older persons with or without diabetes. Methods A total of 259 persons with and 259 persons without diabetes and aged ≥65 years were randomly selected to participate in a health examination with complete data gathered from 363 individuals (187 with diabetes and 176 without diabetes). The estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation. Each participant was categorized based on the nephrotoxic profile of their medications. Results There were no differences in mean eGFR values (77.5 ± 18.8 vs. 80.5 ± 14.8 ml/min/1.73m2, p = 0.089) or in the proportion of participants with eGFR < 60 ml/min/1.73m2 among persons with diabetes (16% vs. 10%, p = 0.070), compared to persons without diabetes. Potentially nephrotoxic drug use was similar between the groups. The mean number of potentially nephrotoxic drugs was 1.06 ± 0.88 in those with and 0.97 ± 1.05 in those without diabetes (p = 0.39). Conclusions The kidney function of older persons with diabetes does not differ from that of older persons without diabetes and furthermore potentially nephrotoxic drug use seem to play only a minor role in the decline in kidney function among home-dwelling persons in the Inner-Savo district.
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Affiliation(s)
- Marjo Heinjoki
- School of Pharmacy, University of Eastern Finland, P.O. BOX 1627, FI-70211, Kuopio, Finland
| | - Merja Karjalainen
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland.,Inner Savo Health Center, Suonenjoki, Finland
| | - Juha Saltevo
- Central Finland Central Hospital, Jyväskylä, Finland
| | - Miia Tiihonen
- School of Pharmacy, University of Eastern Finland, P.O. BOX 1627, FI-70211, Kuopio, Finland.
| | - Maija Haanpää
- Ilmarinen Mutual Pension Insurance Company, Helsinki, Finland.,Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Hannu Kautiainen
- Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, General Practice, University of Eastern Finland, Kuopio, Finland.,Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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11
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Yeh HC, Ting IW, Huang HC, Chiang HY, Kuo CC. Acute Kidney Injury in the Outpatient Setting Associates with Risk of End-Stage Renal Disease and Death in Patients with CKD. Sci Rep 2019; 9:17658. [PMID: 31776433 PMCID: PMC6881443 DOI: 10.1038/s41598-019-54227-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/04/2019] [Indexed: 01/02/2023] Open
Abstract
Current acute kidney injury (AKI) diagnostic criteria are restricted to the inpatient setting. We proposed a new AKI diagnostic algorithm for the outpatient setting and evaluate whether outpatient AKI (AKIOPT) modifies the disease course among patients with chronic kidney disease (CKD) enrolled in the national predialysis registry. AKIOPT was detected when a 50% increase in serum creatinine level or 35% decline in eGFR was observed in the 180-day period prior to enrollment in the predialysis care program. Outcomes were progression to end-stage renal disease (ESRD) and all-cause mortality. Association analyses were performed using multiple Cox regression and coarsened exact matching (CEM) analysis. Among 6,046 patients, 31.5% (1,905 patients) had developed AKIOPT within the 180-day period before enrollment. The adjusted hazard ratios of the 1-year and overall risk of ESRD among patients with preceding AKIOPT compared with those without AKIOPT were 2.61 (95% CI: 2.15-3.18) and 1.97 (1.72-2.26), respectively. For 1-year and overall risk of all-cause mortality, patients with AKIOPT had respectively a 141% (95% CI: 89-209%) and 84% (56-117%) higher risk than those without AKIOPT. This statistical inference remained robust in CEM analysis. We also discovered a complete reversal in the eGFR slope before and after the AKIOPT from -10.61 ± 0.32 to 0.25 ± 0.30 mL/min/1.73 m2 per year; however, the loss of kidney function is not recovered. The new AKIOPT diagnostic algorithm provides prognostic insight in patients with CKD.
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Affiliation(s)
- Hung-Chieh Yeh
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - I-Wen Ting
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Han-Chun Huang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiu-Yin Chiang
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan
| | - Chin-Chi Kuo
- AKI-CARE (Clinical Advancement, Research and Education) Center, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
- Division of Nephrology, Department of Internal Medicine, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
- Big Data Center, China Medical University Hospital and College of Medicine, China Medical University, Taichung, Taiwan.
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
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12
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Bamoulid J, Philippot H, Kazory A, Yannaraki M, Crepin T, Vivet B, Devillard N, Roubiou C, Bresson-Vautrin C, Chalopin JM, Courivaud C, Ducloux D. Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score. BMC Nephrol 2019; 20:419. [PMID: 31752723 PMCID: PMC6868787 DOI: 10.1186/s12882-019-1610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/29/2019] [Indexed: 01/05/2023] Open
Abstract
Background Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units. Methods We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC. Results Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/− 0.297 (p < 0.001) after validation in the VC. Conclusions Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.
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Affiliation(s)
- Jamal Bamoulid
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France. .,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France. .,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France. .,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France.
| | - Hélène Philippot
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.
| | - Amir Kazory
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maria Yannaraki
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Thomas Crepin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Bérengère Vivet
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Nadège Devillard
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Caroline Roubiou
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Catherine Bresson-Vautrin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Jean-Marc Chalopin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Cécile Courivaud
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Didier Ducloux
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
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13
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Huang L, Xue C, Kuai J, Ruan M, Yang B, Chen X, Zhang Y, Qian Y, Wu J, Zhao X, Mei C, Xu J, Mao Z. Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired Acute Kidney Injury: A Meta-Analysis. Kidney Blood Press Res 2019; 44:879-896. [PMID: 31553972 DOI: 10.1159/000502546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The different clinical characteristics of community-acquired acute kidney injury (CA-AKI) versus hospital-acquired AKI (HA-AKI) have remained inconclusive, and thus, a meta-analysis was conducted to summarize and quantify the clinical significance distinguishing the 2 types of AKI. METHODS We identified observational studies reporting the clinical characteristics and prognosis of HA-AKI and CA-AKI. ORs and mean differences (MDs) were extracted for each outcome and the results aggregated. The primary outcome was defined as the mortality rate; renal recovery, oliguria incidence, dialysis, intensive care unit (ICU) requirement, and length of hospital stay were secondary outcomes. RESULTS Fifteen eligible studies involving 46,157 patients (22,791 CA-AKI patients and 23,366 HA-AKI patients) were included. Mortality was significantly lower in CA-AKI than in HA-AKI patients, with an OR of 0.43 (95% CI 0.35-0.53). The incidence of oliguria and need for ICU were also lower in CA-AKI patients (OR 0.58, 95% CI 0.38-0.88; OR 0.24, 95% CI 0.14-0.40, respectively). CA-AKI patients had a shorter hospital stay (MD -9.42, 95% CI -13.73 to -5.12). The renal recovery rate and dialysis need between CA- and HA-AKI were similar (OR 1.27, 95% CI 0.53-3.02; OR 1.05, 95% CI 0.82-1.34, respectively). CONCLUSIONS CA-AKI showed better clinical manifestations with a lower incidence of oliguria, reduced risk of ICU treatment, and shorter hospital stay. Mortality associated with CA-AKI was lower compared with HA-AKI, indicating a better prognosis. The rate of renal recovery and need for dialysis showed no significant difference between the 2 groups.
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Affiliation(s)
- Linxi Huang
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Cheng Xue
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jianke Kuai
- Third Hospital of Xi'an, Department of Anesthesiology, Xi'an, China
| | - Mengna Ruan
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Yang
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xujiao Chen
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu Zhang
- Medical team of 32120 troop of PLA, Dalian, China
| | - Yixin Qian
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jun Wu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuezhi Zhao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Changlin Mei
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Xu
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhiguo Mao
- Division of Nephrology, Kidney Institute of CPLA, Changzheng Hospital, Second Military Medical University, Shanghai, China,
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14
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Jackson AR, Hoff ML, Li B, Ching CB, McHugh KM, Becknell B. Krt5 + urothelial cells are developmental and tissue repair progenitors in the kidney. Am J Physiol Renal Physiol 2019; 317:F757-F766. [PMID: 31322419 DOI: 10.1152/ajprenal.00171.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Congenital urinary tract obstruction (UTO) is the leading cause of chronic kidney disease in children; however, current management strategies do not safeguard against progression to end-stage renal disease, highlighting the need for interventions to limit or reverse obstructive nephropathy. Experimental UTO triggers renal urothelial remodeling that culminates in the redistribution of basal keratin 5-positive (Krt5+) renal urothelial cells (RUCs) and the generation of uroplakin-positive (Upk)+ RUCs that synthesize a protective apical urothelial plaque. The cellular source of Upk+ RUCs is currently unknown, limiting the development of strategies to promote renal urothelial remodeling as a therapeutic approach. In the present study, we traced the origins of adult Upk+ RUCs during normal development and in response to UTO. Fate mapping analysis demonstrated that adult Upk+ RUCs derive from embryonic and neonatal Krt5+ RUCs, whereas Krt5+ RUCs lose this progenitor capacity and become lineage restricted by postnatal day 14. However, in response to UTO, postnatal day 14-labeled adult Krt5+ RUCs break their lineage restriction and robustly differentiate into Upk+ RUCs. Thus, Krt5+ RUCs drive renal urothelial formation during normal ontogeny and after UTO by differentiating into Upk+ RUCs in a temporally restricted manner.
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Affiliation(s)
- Ashley R Jackson
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Monica L Hoff
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Birong Li
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Christina B Ching
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Division of Pediatric Urology, Department of Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Kirk M McHugh
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Anatomy, The Ohio State University College of Medicine, Columbus, Ohio
| | - Brian Becknell
- Nephrology Urology Research Affinity Group, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio.,Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio
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15
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. RENAL REPLACEMENT THERAPY 2018. [DOI: 10.1186/s41100-018-0177-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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16
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Yang B, Xie Y, Guo M, Rosner MH, Yang H, Ronco C. Nephrotoxicity and Chinese Herbal Medicine. Clin J Am Soc Nephrol 2018; 13:1605-1611. [PMID: 29615394 PMCID: PMC6218812 DOI: 10.2215/cjn.11571017] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Chinese herbal medicine has been practiced for the prevention, treatment, and cure of diseases for thousands of years. Herbal medicine involves the use of natural compounds, which have relatively complex active ingredients with varying degrees of side effects. Some of these herbal medicines are known to cause nephrotoxicity, which can be overlooked by physicians and patients due to the belief that herbal medications are innocuous. Some of the nephrotoxic components from herbs are aristolochic acids and other plant alkaloids. In addition, anthraquinones, flavonoids, and glycosides from herbs also are known to cause kidney toxicity. The kidney manifestations of nephrotoxicity associated with herbal medicine include acute kidney injury, CKD, nephrolithiasis, rhabdomyolysis, Fanconi syndrome, and urothelial carcinoma. Several factors contribute to the nephrotoxicity of herbal medicines, including the intrinsic toxicity of herbs, incorrect processing or storage, adulteration, contamination by heavy metals, incorrect dosing, and interactions between herbal medicines and medications. The exact incidence of kidney injury due to nephrotoxic herbal medicine is not known. However, clinicians should consider herbal medicine use in patients with unexplained AKI or progressive CKD. In addition, exposure to herbal medicine containing aristolochic acid may increase risk for future uroepithelial cancers, and patients require appropriate postexposure screening.
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Affiliation(s)
- Bo Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- International Renal Research Institute of Vicenza and
| | - Yun Xie
- International Renal Research Institute of Vicenza and
- Department of Nephrology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maojuan Guo
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; and
| | - Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
| | - Hongtao Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Claudio Ronco
- International Renal Research Institute of Vicenza and
- Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
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17
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese clinical practice guideline for acute kidney injury 2016. Clin Exp Nephrol 2018; 22:985-1045. [PMID: 30039479 PMCID: PMC6154171 DOI: 10.1007/s10157-018-1600-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention is necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
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Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Department of Surgery, Kidney Center, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa, Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
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18
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Doi K, Nishida O, Shigematsu T, Sadahiro T, Itami N, Iseki K, Yuzawa Y, Okada H, Koya D, Kiyomoto H, Shibagaki Y, Matsuda K, Kato A, Hayashi T, Ogawa T, Tsukamoto T, Noiri E, Negi S, Kamei K, Kitayama H, Kashihara N, Moriyama T, Terada Y. The Japanese Clinical Practice Guideline for acute kidney injury 2016. J Intensive Care 2018; 6:48. [PMID: 30123509 PMCID: PMC6088399 DOI: 10.1186/s40560-018-0308-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/22/2018] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) is a syndrome which has a broad range of etiologic factors depending on different clinical settings. Because AKI has significant impacts on prognosis in any clinical settings, early detection and intervention are necessary to improve the outcomes of AKI patients. This clinical guideline for AKI was developed by a multidisciplinary approach with nephrology, intensive care medicine, blood purification, and pediatrics. Of note, clinical practice for AKI management which was widely performed in Japan was also evaluated with comprehensive literature search.
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Affiliation(s)
- Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | | | - Tomohito Sadahiro
- Department of Emergency and Critical Care Medicine, Tokyo Women’s Medical University Yachiyo Medical Center, Chiba, Japan
| | - Noritomo Itami
- Kidney Center, Department of Surgery, Nikko Memorial Hospital, Hokkaido, Japan
| | - Kunitoshi Iseki
- Clinical Research Support Center, Tomishiro Central Hospital, Okinawa, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi Japan
| | - Hirokazu Okada
- Department of Nephrology and General Internal Medicine, Saitama Medical University, Saitama, Japan
| | - Daisuke Koya
- Division of Anticipatory Molecular Food Science and Technology, Department of Diabetology and Endocrinology, Kanazawa Medical University, Kanawaza, Ishikawa Japan
| | - Hideyasu Kiyomoto
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, St. Marianna University School of Medicine, Kawasaki, Kanagawa Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, University of Yamanashi School of Medicine, Yamanashi, Japan
| | - Akihiko Kato
- Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan
| | - Terumasa Hayashi
- Department of Kidney Disease and Hypertension, Osaka General Medical Center, Osaka, Japan
| | - Tomonari Ogawa
- Nephrology and Blood Purification, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Tatsuo Tsukamoto
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eisei Noiri
- Department of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan
| | - Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Okayama, Japan
| | - Toshiki Moriyama
- Health Care Division, Health and Counseling Center, Osaka University, Osaka, Japan
| | - Yoshio Terada
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505 Japan
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19
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Negi S, Koreeda D, Kobayashi S, Yano T, Tatsuta K, Mima T, Shigematsu T, Ohya M. Acute kidney injury: Epidemiology, outcomes, complications, and therapeutic strategies. Semin Dial 2018; 31:519-527. [PMID: 29738093 DOI: 10.1111/sdi.12705] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is one of the most common serious complications for all hospital admissions, with its incidence increasing among hospitalized patients, particularly those in the intensive care unit. Despite significant improvements in critical care and dialysis technology, AKI is associated with an increased risk of short- and long-term mortality, prolonged hospital stays, and dialysis dependence. These risks are particularly relevant for critically ill patients with AKI severe enough to require renal replacement therapy (RRT). No specific pharmacologic treatment has been established to treat AKI. Hence, the mainstay treatment for patients with AKI is RRT even though there are still several problematic issues regarding its use including RRT modality, dose, and timing. Recently, the impact of AKI on an increased risk of progression to chronic kidney disease (CKD) and end-stage renal disease requiring dialysis or transplantation is attracting increased attention.
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Affiliation(s)
- Shigeo Negi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Koreeda
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Sou Kobayashi
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Takuro Yano
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Koichi Tatsuta
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | - Toru Mima
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
| | | | - Masaki Ohya
- Department of Nephrology, Wakayama Medical University, Wakayama, Japan
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20
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Du B, Dai XM, Li S, Qi GL, Cao GX, Zhong Y, Yin PD, Yang XS. MiR-30c regulates cisplatin-induced apoptosis of renal tubular epithelial cells by targeting Bnip3L and Hspa5. Cell Death Dis 2017; 8:e2987. [PMID: 28796263 PMCID: PMC5596565 DOI: 10.1038/cddis.2017.377] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 06/18/2017] [Accepted: 07/06/2017] [Indexed: 12/19/2022]
Abstract
As a common anticancer drug, cisplatin has been widely used for treating tumors in the clinic. However, its side effects, especially its nephrotoxicity, noticeably restrict the application of cisplatin. Therefore, it is imperative to investigate the mechanism of renal injury and explore the corresponding remedies. In this study, we showed the phenotypes of the renal tubules and epithelial cell death as well as elevated cleaved-caspase3- and TUNEL-positive cells in rats intraperitoneally injected with cisplatin. Similar cisplatin-induced cell apoptosis was found in HK-2 and NRK-52E cells exposed to cisplatin as well. In both models of cisplatin-induced apoptosis in vivo and in vitro, quantitative PCR data displayed reductions in miR-30a-e expression levels, indicating that miR-30 might be involved in regulating cisplatin-induced cell apoptosis. This was further confirmed when the effects of cisplatin-induced cell apoptosis were found to be closely correlated with alterations in miR-30c expression, which were manipulated by transfection of either the miR-30c mimic or miR-30c inhibitor in HK-2 and NRK-52E cells. Using bioinformatics tools, including TargetScan and a gene expression database (Gene Expression Omnibus), Adrb1, Bnip3L, Hspa5 and MAP3K12 were predicted to be putative target genes of miR-30c in cisplatin-induced apoptosis. Subsequently, Bnip3L and Hspa5 were confirmed to be the target genes after determining the expression of these putative genes following manipulation of miR-30c expression levels in HK-2 cells. Taken together, our current experiments reveal that miR-30c is certainly involved in regulating the renal tubular cell apoptosis induced by cisplatin, which might supply a new strategy to minimize cisplatin-induced nephrotoxicity.
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Affiliation(s)
- Bin Du
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Xiao-Meng Dai
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Shuang Li
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Guo-Long Qi
- Division of Medical Informatics, Medical School, Jinan University, Guangzhou 510632, China
| | - Guang-Xu Cao
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Ying Zhong
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Pei-di Yin
- Department of Pathology, Medical School, Jinan University, Guangzhou 510632, China
| | - Xue-Song Yang
- Division of Histology and Embryology, Key Laboratory for Regenerative Medicine of the Ministry of Education, Medical School, Jinan University, Guangzhou 510632, China
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21
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Hodgson LE, Dimitrov BD, Roderick PJ, Venn R, Forni LG. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS). BMJ Open 2017; 7:e013511. [PMID: 28274964 PMCID: PMC5353262 DOI: 10.1136/bmjopen-2016-013511] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). DESIGN, SETTING AND PARTICIPANTS External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). METHODS Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. RESULTS HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). CONCLUSIONS On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate risk prediction.
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Affiliation(s)
- L E Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - B D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - P J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - R Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - L G Forni
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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22
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Wang Y, Wang J, Su T, Qu Z, Zhao M, Yang L. Community-Acquired Acute Kidney Injury: A Nationwide Survey in China. Am J Kidney Dis 2017; 69:647-657. [PMID: 28117208 DOI: 10.1053/j.ajkd.2016.10.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/29/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND This study aimed to describe the burden of community-acquired acute kidney injury (AKI) in China based on a nationwide survey about AKI. STUDY DESIGN Cross-sectional and retrospective study. SETTING & PARTICIPANTS A national sample of 2,223,230 hospitalized adult patients from 44 academic/local hospitals in Mainland China was used. AKI was defined according to the 2012 KDIGO AKI creatinine criteria or an increase or decrease in serum creatinine level of 50% during the hospital stay. Community-acquired AKI was identified when a patient had AKI that could be defined at hospital admission. PREDICTORS The rate, cause, recognition, and treatment of community-acquired AKI were stratified according to hospital type, latitude, and economic development of the regions in which the patients were admitted. OUTCOMES All-cause in-hospital mortality and recovery of kidney function at hospital discharge. RESULTS 4,136 patients with community-acquired AKI were identified during the 2 single-month snapshots (January 2013 and July 2013). Of these, 2,020 (48.8%) had cases related to decreased kidney perfusion; 1,111 (26.9%), to intrinsic kidney disease; and 499 (12.1%), to urinary tract obstruction. In the north versus the south, more patients were exposed to nephrotoxins or had urinary tract obstructions. 536 (13.0%) patients with community-acquired AKI had indications for renal replacement therapy (RRT), but only 347 (64.7%) of them received RRT. Rates of timely diagnosis and appropriate use of RRT were higher in regions with higher per capita gross domestic product. All-cause in-hospital mortality was 7.3% (295 of 4,068). Delayed AKI recognition and being located in northern China were independent risk factors for in-hospital mortality, and referral to nephrology providers was an independent protective factor. LIMITATIONS Possible misclassification of AKI and community-acquired AKI due to nonstandard definitions and missing data for serum creatinine. CONCLUSIONS The features of community-acquired AKI varied substantially in different regions of China and were closely linked to the environment, economy, and medical resources.
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Affiliation(s)
- Yafang Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
| | - Tao Su
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
| | - Zhen Qu
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China.
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- Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, PR China
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23
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Mesropian PD, Othersen J, Mason D, Wang J, Asif A, Mathew RO. Community-acquired acute kidney injury: A challenge and opportunity for primary care in kidney health. Nephrology (Carlton) 2016; 21:729-35. [DOI: 10.1111/nep.12751] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 01/25/2016] [Accepted: 02/11/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Paul Der Mesropian
- Division of Nephrology, Department of Medicine; Stratton Veterans Affairs Medical Center; Albany New York USA
| | - Jennifer Othersen
- Division of Nephrology, Department of Medicine; William Jennings Bryan Dorn Veterans Affairs Medical Center; Columbia South Carolina USA
| | - Darius Mason
- Department of Research Stratton Veterans Affairs Medical Center; Albany New York USA
- Department of Pharmacy Practice; Albany College of Pharmacy and Health Sciences; Albany New York USA
- Division of Nephrology and Hypertension; Albany Medical College; Albany New York USA
| | - Jeffrey Wang
- Division of Nephrology and Hypertension; Albany Medical College; Albany New York USA
- Division of Nephrology and Hypertension, Department of Medicine; Hennepin County Medical Center; Minneapolis Minnesota USA
| | - Arif Asif
- Department of Medicine; Jersey Shore University Medical Center, Meridian Health; Neptune NJ
| | - Roy O Mathew
- Division of Nephrology, Department of Medicine; William Jennings Bryan Dorn Veterans Affairs Medical Center; Columbia South Carolina USA
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24
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Cronin RM, VanHouten JP, Siew ED, Eden SK, Fihn SD, Nielson CD, Peterson JF, Baker CR, Ikizler TA, Speroff T, Matheny ME. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury. J Am Med Inform Assoc 2015; 22:1054-71. [PMID: 26104740 PMCID: PMC5009929 DOI: 10.1093/jamia/ocv051] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. MATERIALS AND METHODS A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. RESULTS The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. CONCLUSIONS This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant.
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Affiliation(s)
- Robert M Cronin
- Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Jacob P VanHouten
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Edward D Siew
- Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Svetlana K Eden
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Stephan D Fihn
- Office of Analytics and Business Intelligence, VA Central Office, Veterans Health Administration, Seattle, WA, USA Division of General Internal Medicine, University of Washington, Seattle, WA, USA
| | - Christopher D Nielson
- Office of Analytics and Business Intelligence, VA Central Office, Veterans Health Administration, Seattle, WA, USA Division of Pulmonary Medicine and Critical Care, University of Nevada, Reno, NV, USA
| | - Josh F Peterson
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Clifton R Baker
- Office of Analytics and Business Intelligence, VA Central Office, Veterans Health Administration, Seattle, WA, USA
| | - T Alp Ikizler
- Division of Nephrology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Theodore Speroff
- Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, TN, USA Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Michael E Matheny
- Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, TN, USA Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
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25
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Xu X, Nie S, Liu Z, Chen C, Xu G, Zha Y, Qian J, Liu B, Han S, Xu A, Xu X, Hou FF. Epidemiology and Clinical Correlates of AKI in Chinese Hospitalized Adults. Clin J Am Soc Nephrol 2015; 10:1510-8. [PMID: 26231194 DOI: 10.2215/cjn.02140215] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/16/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in the cohort was estimated using a novel two-step approach with adjustment for the frequency of serum creatinine tests and other potential confounders. Risk factor profiles for hospital-acquired (HA) and community-acquired (CA) AKI were examined. The in-hospital outcomes of AKI, including mortality, renal recovery, length of stay, and daily cost, were assessed. RESULTS The incidence of CA-AKI and HA-AKI was 2.5% and 9.1%, respectively, giving rise to an overall incidence of 11.6%. Although the risk profiles for CA-AKI and HA-AKI differed, preexisting CKD was a major risk factor for both, contributing to 20% of risk in CA-AKI and 12% of risk in HA-AKI. About 40% of AKI cases were possibly drug-related and 16% may have been induced by Chinese traditional medicines or remedies. The in-hospital mortality of AKI was 8.8%. The risk of in-hospital death was higher among patients with more severe AKI. Preexisting CKD and need for intensive care unit admission were associated with higher death risk in patients at any stage of AKI. Transiency of AKI did not modify the risk of in-hospital death. AKI was associated with longer length of stay and higher daily costs, even after adjustment for confounders. CONCLUSION AKI is common in hospitalized adults in China and is associated with significantly higher in-hospital mortality and resource utilization.
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Affiliation(s)
- Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhangsuo Liu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Chunbo Chen
- Guangdong General Hospital, Guangzhou, China
| | - Gang Xu
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Zha
- Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China
| | - Jing Qian
- Guizhou Provincial People's Hospital, Guiyang Medical University, Guiyang, China
| | - Bicheng Liu
- Zhongda Hospital, Southeast University, Nanjing, China
| | - Shuai Han
- The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, China; and
| | - Anping Xu
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xing Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fan Fan Hou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China;
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Bouchard J, Acharya A, Cerda J, Maccariello ER, Madarasu RC, Tolwani AJ, Liang X, Fu P, Liu ZH, Mehta RL. A Prospective International Multicenter Study of AKI in the Intensive Care Unit. Clin J Am Soc Nephrol 2015. [PMID: 26195505 DOI: 10.2215/cjn.04360514] [Citation(s) in RCA: 183] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES AKI is frequent and is associated with poor outcomes. There is limited information on the epidemiology of AKI worldwide. This study compared patients with AKI in emerging and developed countries to determine the association of clinical factors and processes of care with outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This prospective observational study was conducted among intensive care unit patients from nine centers in developed countries and five centers in emerging countries. AKI was defined as an increase in creatinine of ≥0.3 mg/dl within 48 hours. RESULTS Between 2008 and 2012, 6647 patients were screened, of whom 1275 (19.2%) developed AKI. A total of 745 (58% of those with AKI) agreed to participate and had complete data. Patients in developed countries had more sepsis (52.1% versus 38.0%) and higher Acute Physiology and Chronic Health Evaluation (APACHE) scores (mean±SD, 61.1±27.5 versus 51.1±25.2); those from emerging countries had more CKD (54.3% versus 38.3%), GN (6.3% versus 0.9%), and interstitial nephritis (7.0% versus 0.6%) (all P<0.05). Patients from developed countries were less often treated with dialysis (15.5% versus 30.2%; P<0.001) and started dialysis later after AKI diagnosis (2.0 [interquartile range, 0.75-5.0] days versus 0 [interquartile range, 0-5.0] days; P=0.02). Hospital mortality was 22.0%, and 13.3% of survivors were dialysis dependent at discharge. Independent risk factors associated with hospital mortality included older age, residence in an emerging country, use of vasopressors (emerging countries only), dialysis and mechanical ventilation, and higher APACHE score and cumulative fluid balance (developed countries only). A lower probability of renal recovery was associated with residence in an emerging country, higher APACHE score (emerging countries only) and dialysis, while mechanical ventilation was associated with renal recovery (developed countries only). CONCLUSIONS This study contrasts the clinical features and management of AKI and demonstrates worse outcomes in emerging than in developed countries. Differences in variations in care may explain these findings and should be considered in future trials.
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Affiliation(s)
- Josée Bouchard
- Department of Medicine, University of Montreal, Montréal, Québec, Canada
| | - Anjali Acharya
- Department of Medicine, Jacobi Medical Center, New York, New York
| | | | | | | | - Ashita J Tolwani
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Xinling Liang
- Department of Medicine, Guangdong General Hospital, Guangzhou, China
| | - Ping Fu
- Department of Medicine, West China School of Medicine Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Hong Liu
- Department of Medicine, Jinling Hospital, Nanjing University, Nanjing, China; and
| | - Ravindra L Mehta
- Department of Medicine, University of California at San Diego, San Diego, California
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Pang CL, Chanouzas D, Baharani J. Timing of acute kidney injury--does it matter? A single-centre experience from the United Kingdom. Eur J Intern Med 2014; 25:669-73. [PMID: 24961157 DOI: 10.1016/j.ejim.2014.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 05/23/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with high mortality and long-term dependence on RRT. However, there is limited information about the difference in outcome between patients who develop AKI in the community (c-AKI), and those who develop AKI in hospital (h-AKI). AIM Identify differences in short- and long-term outcomes between patients admitted with c-AKI and h-AKI who require intermittent haemodialysis, and to identify factors that predict poor outcome. DESIGN & METHODS Single-centre, retrospective analysis of 306 patients with AKI who received intermittent haemodialysis between 2009 and 2011. FOLLOW-UP six months. Primary endpoints: patient and renal survival. Secondary endpoints: time on dialysis, length of hospital stay, and admission to the intensive care unit (ICU). RESULTS Survival for patients in the h-AKI group was significantly lower, at 42.9% (compared to 72%). They had a significantly longer length of stay. However, at 6-month follow-up, the survival benefit of the c-AKI group was no longer significant. Patients with h-AKI were more likely to be dialysis independent at discharge and six months although this result did not reach statistical significance. Independent predictors of survival to discharge within the entire group included: renal/post-renal causes of AKI, younger age, pre-existing diabetes, and c-AKI. The only independent predictor for RRT dependence at discharge and six months was pre-existing chronic kidney disease. CONCLUSIONS h-AKI is associated with high mortality and longer hospital stays during the acute admission. However, h-AKI patients who survive are more likely to be independent of RRT at discharge and follow-up.
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Abstract
China has a large population and bears a heavy burden of kidney diseases. Acute kidney injury (AKI) is increasingly prevalent in China and is associated with severe morbidity and mortality. The inadequacies of early diagnosis and management remain the major challenges to Chinese nephrologists. There is an urgent need for a nationwide, or even a global effort to increase an awareness of the devastating effects of AKI, to develop professional preventive strategies, as well as to achieve early diagnosis and early intervention. In this article, we review the increasing incidence of AKI and complexity behind prevention and management, focusing on differences in various clinical settings in China.
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Affiliation(s)
- Yi Fang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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29
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Lewington AJP, Cerdá J, Mehta RL. Raising awareness of acute kidney injury: a global perspective of a silent killer. Kidney Int 2013; 84:457-67. [PMID: 23636171 PMCID: PMC3758780 DOI: 10.1038/ki.2013.153] [Citation(s) in RCA: 470] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/05/2013] [Accepted: 02/07/2013] [Indexed: 12/15/2022]
Abstract
Worldwide, acute kidney injury (AKI) is associated with poor patient outcomes. Over the last few years, collaborative efforts, enabled by a common definition of AKI, have provided a description of the epidemiology, natural history, and outcomes of this disease and improved our understanding of the pathophysiology. There is increased recognition that AKI is encountered in multiple settings and in all age groups, and that its course and outcomes are influenced by the severity and duration of the event. The effect of AKI on an individual patient and the resulting societal burden that ensues from the long-term effects of the disease, including development of chronic kidney disease (CKD) and end-stage renal disease (ESRD), is attracting increasing scrutiny. There is evidence of marked variation in the management of AKI, which is, to a large extent, due to a lack of awareness and an absence of standards for prevention, early recognition, and intervention. These emerging data point to an urgent need for a global effort to highlight that AKI is preventable, its course is modifiable, and its treatment can improve outcomes. In this article, we provide a framework of reference and propose specific strategies to raise awareness of AKI globally, with the goal to ultimately improve outcomes from this devastating disease.
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Affiliation(s)
| | - Jorge Cerdá
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Ravindra L Mehta
- Department of Medicine, University of California San Diego, San Diego CA, USA
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Schissler MM, Zaidi S, Kumar H, Deo D, Brier ME, McLeish KR. Characteristics and outcomes in community-acquired versus hospital-acquired acute kidney injury. Nephrology (Carlton) 2013; 18:183-7. [DOI: 10.1111/nep.12036] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
| | - Syed Zaidi
- Department of Medicine; University of Louisville School of Medicine
| | - Haresh Kumar
- Department of Medicine; University of Louisville School of Medicine
| | - Datinder Deo
- Department of Medicine; University of Louisville School of Medicine
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31
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Luyckx VA. Nephrotoxicity of alternative medicine practice. Adv Chronic Kidney Dis 2012; 19:129-41. [PMID: 22578672 DOI: 10.1053/j.ackd.2012.04.005] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Revised: 04/06/2012] [Accepted: 04/09/2012] [Indexed: 11/11/2022]
Abstract
The use of alternative medicine is highly prevalent around the world; in many areas, this is so because of lack of access to, or trust in, Western medicine, and also because they are considered "natural" and therefore safe. The kidney is an organ vulnerable to toxic insults by virtue of its anatomy and function. Reports of nephrotoxicity associated with alternative medicine use encompass all forms of renal dysfunction, ranging from electrolyte abnormalities and proteinuria to acute and CKD, renal failure, and death. In countries where intensive care and dialysis support are not available, mortality is high. Mechanisms of alternative medicine-associated kidney injury include direct nephrotoxicity, which may be augmented by underlying predisposing conditions such as dehydration; contamination, or adulteration of remedies; inappropriate use or preparation of a remedy; or interactions with other medications. The use of alternative medicines is underreported to clinicians. Because many patients strongly believe in the powers of alternative medicines, it is important that alternative medicines not be demonized as a whole, but that their use and consequences be closely observed and reported to build a more comprehensive understanding of their impact in our clinical practice and to foster research on the potential harm or, in some cases, possible benefits.
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Matheny ME, Miller RA, Ikizler TA, Waitman LR, Denny JC, Schildcrout JS, Dittus RS, Peterson JF. Development of inpatient risk stratification models of acute kidney injury for use in electronic health records. Med Decis Making 2010; 30:639-50. [PMID: 20354229 DOI: 10.1177/0272989x10364246] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with hospital-acquired acute kidney injury (AKI) are at risk for increased mortality and further medical complications. Evaluating these patients with a prediction tool easily implemented within an electronic health record (EHR) would identify high-risk patients prior to the development of AKI and could prevent iatrogenically induced episodes of AKI and improve clinical management. METHODS The authors used structured clinical data acquired from an EHR to identify patients with normal kidney function for admissions from 1 August 1999 to 31 July 2003. Using administrative, computerized provider order entry and laboratory test data, they developed a 3-level risk stratification model to predict each of 2 severity levels of in-hospital AKI as defined by RIFLE criteria. The severity levels were defined as 150% or 200% of baseline serum creatinine. Model discrimination and calibration were evaluated using 10-fold cross-validation. RESULTS Cross-validation of the models resulted in area under the receiver operating characteristic (AUC) curves of 0.75 (150% elevation) and 0.78 (200% elevation). Both models were adequately calibrated as measured by the Hosmer-Lemeshow goodness-of-fit test chi-squared values of 9.7 (P = 0.29) and 12.7 (P = 0.12), respectively. CONCLUSIONS The authors generated risk prediction models for hospital-acquired AKI using only commonly available electronic data. The models identify patients at high risk for AKI who might benefit from early intervention or increased monitoring.
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Affiliation(s)
- Michael E Matheny
- Geriatric Research Education Clinical Center, Tennessee Valley Health System, Veterans Health Administration, Nashville, TN, USA.
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Li JH, Wang NS, Wang F, Xiang HY, Wu HL, Wu QM. Acute renal failure in hospitalized patients in China: a prospective study. Ren Fail 2010; 31:431-7. [PMID: 19839819 DOI: 10.1080/08860220902963574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Acute renal failure (ARF) is a common complication in hospitalized patients, but little is known about the epidemiology of ARF in China. In this study, we performed a prospective examination of the cause, prognosis, and risk factors associated with ARF at a hospital in Shanghai, China. We considered all ARF patients who were admitted to our hospital from December 2003 to December 2006. Among the 320 ARF patients, 135 (42.2%) were over the age of 60. Sepsis, heart failure, and nephrotoxic drug use were the leading causes of ARF. The overall mortality rate was 31.9%, and mortality rate was significantly higher among the elderly. Logistic regression indicated that heart failure, respiratory failure, and malignant cancer were risk factors independently associated with poor prognosis. In this Shanghai hospital, there was a high incidence and mortality rate of patients hospitalized with ARF. The prognosis of patients who underwent renal replacement therapy was better than those who were treated more conservatively.
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Affiliation(s)
- Jun-Hui Li
- Department of Nephrology, The Sixth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, PR China
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Acute kidney injury in the intensive care unit: An update and primer for the intensivist. Crit Care Med 2010; 38:261-75. [PMID: 19829099 DOI: 10.1097/ccm.0b013e3181bfb0b5] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Yilmaz R, Erdem Y. Acute kidney injury in the elderly population. Int Urol Nephrol 2009; 42:259-71. [PMID: 19707882 DOI: 10.1007/s11255-009-9629-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Accepted: 07/29/2009] [Indexed: 12/22/2022]
Abstract
The elderly population is more prone to acute kidney injury (AKI) than younger populations. Older patients have less renal reserve because of reduced glomerular filtration rates due to anatomic/functional changes, and concomitant diseases such as hypertension, diabetes, atherosclerosis, heart failure, ischemic renal disease, and obstructive uropathy. The risk of AKI may also increase as a result of aggressive diagnostic and therapeutic procedures, which include medical agents, radiology, and surgical intervention. AKI in the elderly has a multifactorial physiopathology due to different etiologies. Studies that have specifically compared prognosis of AKI in elderly versus young over the recent years suggest that age is a predictor of long-term outcome. In most cases, the treatment of AKI is similar for all age groups. The majority of critically ill patients with AKI will eventually need renal replacement therapy (RRT). The influence of RRT on renal outcome remains a subject of intense investigation and debate. Avoiding situations that could damage the kidney is an important strategy to prevent AKI development in the elderly, besides medical and interventional therapeutics.
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Affiliation(s)
- Rahmi Yilmaz
- School of Medicine, Nephrology Department, Hacettepe University, 06100, Ankara, Turkey
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36
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Barrantes F, Feng Y, Ivanov O, Yalamanchili HB, Patel J, Buenafe X, Cheng V, Dijeh S, Amoateng-Adjepong Y, Manthous CA. Acute kidney injury predicts outcomes of non-critically ill patients. Mayo Clin Proc 2009; 84:410-6. [PMID: 19411437 PMCID: PMC2676123 DOI: 10.1016/s0025-6196(11)60559-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate whether acute kidney injury (AKI), defined as an increase in the serum creatinine level of 0.3 mg/dL or more within 48 hours, predicts outcomes of non-critically ill patients. PATIENTS AND METHODS Among the adults admitted from June 1, 2005, to June 30, 2007, to the medical wards of a community teaching hospital, 735 patients with AKI and 5089 controls were identified. Demographic and health information, serum creatinine values, and outcomes were abstracted from patients' computerized medical records. Outcomes of patients with AKI were compared with those of controls. In an additional case-control analysis, more detailed clinical information was abstracted from the medical records of 282 pairs of randomly selected, age-matched AKI cases and controls. Conditional multivariate logistic regression analyses were used to adjust for potential confounders of AKI effect on outcomes. RESULTS Overall, patients with AKI had higher in-hospital mortality (14.8% vs 1.5%; P<.001), longer lengths of stay (median 7.9 vs 3.7 days; P<.001), and higher rates of transfer to critical care areas (28.6% vs 4.3%; P<.001); survivors were more likely to be discharged to an extended care facility (43.1% vs 20.3%; P<.001). Conditional multivariate logistic regression analyses of the 282 pairs of cases and controls showed that patients with AKI were 8 times more likely to die in hospital (odds ratio [OR], 7.9; 95% CI [confidence interval], 2.9-15.3) and were 5 times more likely to have prolonged (>or=7 days) hospital stays (OR, 5.2; 95% CI, 3.5-7.9) and require intensive care (OR, 4.7; 95% CI, 2.7-8.1), after adjustment for age, comorbidities, and other potential confounders. CONCLUSION In this study, AKI was associated with adverse outcomes in non-critically ill patients.
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Tian J, Barrantes F, Amoateng-Adjepong Y, Manthous CA. Rapid reversal of acute kidney injury and hospital outcomes: a retrospective cohort study. Am J Kidney Dis 2009; 53:974-81. [PMID: 19362401 DOI: 10.1053/j.ajkd.2009.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 02/12/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute kidney injury (AKI), defined as an increment in serum creatinine level of 0.3 mg/dL or greater in 48 hours, is associated with poor outcomes. The prognosis associated with an increased creatinine level, either on admission or that develops in the hospital (ie, AKI), that rapidly returns to normal is not known. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS 6,033 patients admitted to medical wards of a community teaching hospital between 2005 and 2007. PREDICTOR AKI was defined as an increase in serum creatinine level of 0.3 mg/dL or greater within 48 hours. Increased serum creatinine level on admission was defined as serum creatinine greater than1.2 mg/dL on hospital admission in patients who did not subsequently meet criteria for AKI. Patients with a serum creatinine level of 1.2 mg/dL or less who had no increase of 0.3 mg/dL or greater within 48 hours during their hospital stay served as controls. OUTCOMES & MEASUREMENTS Mortality, length of stay, intensive care unit transfer, and discharge destination were outcomes of interest. RESULTS Of 6,033 patients, 735 had AKI. Of these, 443 (60%) had serum creatinine levels that subsequently decreased by 0.3 mg/dL or greater within 48 hours and 197 returned to normal levels within 48 hours. Overall, patients with AKI had significantly greater mortality rates (14.8%) than patients without AKI with increased serum creatinine levels on admission (2.5%) and controls (1.3%; P < 0.001). Patients with AKI with a serum creatinine level that returned to normal within 48 hours had substantially greater mortality rates (14.2%) than those who initially presented with an increased serum creatinine level on admission and subsequent serum creatinine level decrease of 0.3 mg/dL or greater to normal within 48 hours (2.5%; P < 0.01). LIMITATIONS Sample sizes of subgroups were small. Causes of AKI and increases in serum creatinine levels on admission were not assessed. CONCLUSIONS An increase in serum creatinine level of 0.3 mg/dL or greater during 48 hours of hospitalization predicts outcomes even if the value returns to normal. Patients who present to the hospital with an increased creatinine level that returns rapidly to normal have outcomes approaching those with serum creatinine levels consistently in the normal range.
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Affiliation(s)
- Jianmin Tian
- Bridgeport Hospital and Yale University School of Medicine, Bridgeport, CT 06610, USA
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38
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Abstract
Asia, the largest continent in the world, is heterogeneous in the ethnic, socioeconomic, and developmental status of its populations. A vast majority of it is poor with no adequate access to modern health care, making an accurate estimation of the nature and extent of acute kidney injury (AKI) difficult. Community-acquired AKI in otherwise healthy individuals is common, and the population developing AKI is younger compared with its counterparts in Europe or North America. The etiologic spectrum varies in different geographic regions of Asia depending on environmental, cultural, and socioeconomic factors. Some of the etiologic factors include AKI in relation to infectious diseases, intravascular hemolysis caused by glucose 6-phosphate dehydrogenase deficiency, poisonings caused by industrial chemicals or copper sulphate, animal venoms, natural medicines, heat stroke, and after complications of pregnancy. Preventive opportunities are missed because of failure to recognize the risk factors and early signs of AKI. Patients often present late for treatment, leading to multi-organ involvement and increased mortality. The exact etiologic diagnosis cannot be established in many instances because of a lack of appropriate laboratory support. Modern methods of renal replacement therapy are not universally available; and intermittent peritoneal dialysis is still widely practiced in many areas.
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Affiliation(s)
- Vivekanand Jha
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirpal S Chugh
- Postgraduate Institute of Medical Education and Research, Chandigarh, India..
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Luyckx VA, Naicker S. Acute kidney injury associated with the use of traditional medicines. ACTA ACUST UNITED AC 2008; 4:664-71. [PMID: 18838981 DOI: 10.1038/ncpneph0970] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Accepted: 09/01/2008] [Indexed: 01/10/2023]
Abstract
The use of traditional medicine is common worldwide, with rates of use of over 80% in some populations. Considering the large number of people using traditional remedies throughout the world, it does seem that most do so without major adverse effects. Nevertheless, many folk medicines can cause kidney injury. Drug-induced nephrotoxicity reportedly contributes to up to 26% of cases of hospital-acquired acute kidney injury (AKI) and 18% of cases of community-acquired AKI globally, and folk remedies account for up to 35% of cases of AKI in the developing world. The kidney is highly susceptible to toxic insults because its intrinsic functions expose it to exceptionally high concentrations of any particular toxic substance. Clinical syndromes of nephrotoxicity can be defined according to the predominant regions of the kidney affected by the toxin, and reversibility of the injury is likely related to the severity and nature of the injury and also to the duration of toxin exposure. In countries with well-developed health-care systems, a large proportion of patients with nephrotoxicity will recover at least some renal function with adequate supportive care and dialysis. Health-care practitioners in all countries should be aware of the high prevalence of the use of alternative therapies and should be proactive in obtaining this information from patients. In poorer countries, where large proportions of the population rely on traditional medicine, attempts should be made to integrate traditional healers into the health-care system.
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Affiliation(s)
- Valerie A Luyckx
- Division of Nephrology and Immunology, University of Alberta, Edmonton, AB, Canada
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40
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Cerdá J, Lameire N, Eggers P, Pannu N, Uchino S, Wang H, Bagga A, Levin A. Epidemiology of Acute Kidney Injury. Clin J Am Soc Nephrol 2008; 3:881-6. [DOI: 10.2215/cjn.04961107] [Citation(s) in RCA: 184] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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The contrasting characteristics of acute kidney injury in developed and developing countries. ACTA ACUST UNITED AC 2008; 4:138-53. [DOI: 10.1038/ncpneph0722] [Citation(s) in RCA: 157] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 10/31/2007] [Indexed: 01/07/2023]
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