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Lee MY, Heo KN, Lee S, Ah YM, Shin J, Lee JY. Development and validation of a medication-based risk prediction model for acute kidney injury in older outpatients. Arch Gerontol Geriatr 2024; 120:105332. [PMID: 38382232 DOI: 10.1016/j.archger.2024.105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/06/2024] [Accepted: 01/13/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Older adults are at an increased risk of acute kidney injury (AKI), particularly in community settings, often due to medications. Effective prevention hinges on identifying high-risk patients, yet existing models for predicting AKI risk in older outpatients are scarce, particularly those incorporating medication variables. We aimed to develop an AKI risk prediction model that included medication-related variables for older outpatients. METHODS We constructed a cohort of 2,272,257 outpatients aged ≥65 years using a national claims database. This cohort was split into a development (70%) and validation (30%) groups. Our primary goal was to identify newly diagnosed AKI within one month of cohort entry in an outpatient context. We screened 170 variables and developed a risk prediction model using logistic regression. RESULTS The final model integrated 12 variables: 2 demographic, 4 comorbid, and 6 medication-related. It showed good performance with acceptable calibration. In the validation cohort, the area under the receiver operating characteristic curve value was 0.720 (95% confidence interval, 0.692-0.748). Sensitivity and specificity were 69.9% and 61.9%, respectively. Notably, the model identified high-risk patients as having a 27-fold increased AKI risk compared with low-risk individuals. CONCLUSION We have developed a new AKI risk prediction model for older outpatients, incorporating critical medication-related variables with good discrimination. This tool may be useful in identifying and targeting patients who may require interventions to prevent AKI in an outpatient setting.
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Affiliation(s)
- Mee Yeon Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Kyu-Nam Heo
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Suhyun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Young-Mi Ah
- College of Pharmacy, Yeungnam University, Gyeongsan, Republic of Korea
| | - Jaekyu Shin
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, CA, United States
| | - Ju-Yeun Lee
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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Sawhney S, Ball W, Bell S, Black C, Christiansen CF, Heide-Jørgensen U, Jensen SK, Lambourg E, Ronksley PE, Tan Z, Tonelli M, James MT. Recovery of kidney function after acute kidney disease-a multi-cohort analysis. Nephrol Dial Transplant 2024; 39:426-435. [PMID: 37573145 PMCID: PMC10899778 DOI: 10.1093/ndt/gfad180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND There are no consensus definitions for evaluating kidney function recovery after acute kidney injury (AKI) and acute kidney disease (AKD), nor is it clear how recovery varies across populations and clinical subsets. We present a federated analysis of four population-based cohorts from Canada, Denmark and Scotland, 2011-18. METHODS We identified incident AKD defined by serum creatinine changes within 48 h, 7 days and 90 days based on KDIGO AKI and AKD criteria. Separately, we applied changes up to 365 days to address widely used e-alert implementations that extend beyond the KDIGO AKI and AKD timeframes. Kidney recovery was based on resolution of AKD and a subsequent creatinine measurement below 1.2× baseline. We evaluated transitions between non-recovery, recovery and death up to 1 year; within age, sex and comorbidity subgroups; between subset AKD definitions; and across cohorts. RESULTS There were 464 868 incident cases, median age 67-75 years. At 1 year, results were consistent across cohorts, with pooled mortalities for creatinine changes within 48 h, 7 days, 90 days and 365 days (and 95% confidence interval) of 40% (34%-45%), 40% (34%-46%), 37% (31%-42%) and 22% (16%-29%) respectively, and non-recovery of kidney function of 19% (15%-23%), 30% (24%-35%), 25% (21%-29%) and 37% (30%-43%), respectively. Recovery by 14 and 90 days was frequently not sustained at 1 year. Older males and those with heart failure or cancer were more likely to die than to experience sustained non-recovery, whereas the converse was true for younger females and those with diabetes. CONCLUSION Consistently across multiple cohorts, based on 1-year mortality and non-recovery, KDIGO AKD (up to 90 days) is at least prognostically similar to KDIGO AKI (7 days), and covers more people. Outcomes associated with AKD vary by age, sex and comorbidities such that older males are more likely to die, and younger females are less likely to recover.
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Affiliation(s)
- Simon Sawhney
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Renal Medicine, NHS Grampian, Aberdeen, UK
| | - William Ball
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Samira Bell
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Department of Renal Medicine, NHS Grampian, Aberdeen, UK
| | - Christian F Christiansen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Simon K Jensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Emilie Lambourg
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Paul E Ronksley
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Zhi Tan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Matthew T James
- Department of Community Health Sciences, O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Acute Kidney Injury after Endoscopic Retrograde Cholangiopancreatography-A Hospital-Based Prospective Observational Study. Biomedicines 2022; 10:biomedicines10123166. [PMID: 36551921 PMCID: PMC9775076 DOI: 10.3390/biomedicines10123166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Endoscopic retrograde cholangiopancreatography (ERCP) represents a major pivotal point in gastrointestinal endoscopy. Little is known about acute kidney injury (AKI) post-ERCP. This study analyses the incidence, risk factors, and prognosis of post-ERCP AKI. Methods: A total of 396 patients were prospectively studied. AKI was defined by an increase in serum creatinine (SCr) ≥ 0.3 mg/dL or by an increase in SCr ≥ 50% in the first 48 h post-ERCP. Logistic regression analysis was used to identify the predictors of AKI and in-hospital mortality. A two-tailed p value < 0.05 was considered significant. Results: One hundred and three patients (26%) developed post-ERCP AKI. Estimated glomerular filtration rate (adjusted odds ratio (aOR) = 0.95, 95% confidence interval (CI): 0.94−0.96, p < 0.001), nonrenal Charlson Comorbidity Index (Aor = 1.19, 95% CI: 1.05−1.35, p = 0.006), choledocholithiasis (aOR = 4.05, 95% CI: 1.98−8.29, p < 0.001), and bilirubin (aOR = 1.1, 95% CI: 1.05−1.15, p < 0.001) were associated with post-ERCP AKI. Post-ERCP AKI was associated with longer hospital stay (p < 0.001) and with increased in-hospital mortality (7.76% versus 0.36%, p < 0.001). Moderate-to-severe (stage 2 and 3) AKI was independently associated with in-hospital mortality (aOR = 6.43, 95% CI: 1.48−27.88, p < 0.013). Conclusions: Post-ERCP AKI represented an important complication associated with longer hospital stay. Moderate-to-severe post-ERCP AKI was an independent risk factor for in-hospital mortality.
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Bajaj T, Koyner JL. Artificial Intelligence in Acute Kidney Injury Prediction. Adv Chronic Kidney Dis 2022; 29:450-460. [PMID: 36253028 PMCID: PMC10259199 DOI: 10.1053/j.ackd.2022.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/20/2022] [Accepted: 07/27/2022] [Indexed: 01/25/2023]
Abstract
The use of artificial intelligence (AI) in nephrology and its associated clinical research is growing. Recent years have seen increased interest in utilizing AI to predict the development of hospital-based acute kidney injury (AKI). Several AI techniques have been employed to improve the ability to detect AKI across a variety of hospitalized settings. This review discusses the evolutions of AKI risk prediction discussing the static risk assessment models of yesteryear as well as the more recent trend toward AI and advanced learning techniques. We discuss the relative improvement in AKI detection as well as the relative dearth of data around the clinical implementation and patient outcomes using these models. The use of AI for AKI detection and clinical care is in its infancy, and this review describes how we arrived at our current position and hints at the promise of the future.
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Affiliation(s)
- Tushar Bajaj
- Section of Nephrology, Department of Medicine University of Chicago, Chicago, IL, USA
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine University of Chicago, Chicago, IL, USA.
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5
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Zhuo M, Paik JM, Wexler DJ, Bonventre JV, Kim SC, Patorno E. SGLT2 Inhibitors and the Risk of Acute Kidney Injury in Older Adults With Type 2 Diabetes. Am J Kidney Dis 2022; 79:858-867.e1. [PMID: 34762974 PMCID: PMC9079190 DOI: 10.1053/j.ajkd.2021.09.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Abstract
RATIONALE & OBJECTIVE Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been found to have many benefits for patients with type 2 diabetes. However, whether SGLT2 inhibitors increase the risk of acute kidney injury (AKI) remains unknown. We examined the association of AKI hospitalization with prior initiation of an SGLT2 inhibitor compared with initiation of a dipeptidyl peptidase 4 (DPP-4) inhibitor or a glucagon-like peptide 1 receptor agonist (GLP-1RA) among older adults with type 2 diabetes in routine practice. STUDY DESIGN Population-based cohort study. SETTING & PARTICIPANTS Older adults aged at least 66 years with type 2 diabetes enrolled in Medicare fee-for-service and who were new users of SGLT2 inhibitor, DPP-4 inhibitor, or GLP-1RA agents in the interval from March 2013 to December 2017. EXPOSURES New use of an SGLT2 inhibitor versus new use of a DPP-4 inhibitor or GLP-1RA. OUTCOME The primary outcome was hospitalization for AKI, defined as a discharge diagnosis of AKI in the primary or secondary position. ANALYTICAL APPROACH New users of SGLT2 inhibitors were matched at a 1:1 ratio to new users of DPP-4 inhibitors or GLP-1RAs using propensity scores in 2 pairwise comparisons. Cox proportional hazards regression models generated hazard ratios (HRs) with 95% CIs in propensity score-matched groups. RESULTS Totals of 68,130 and 71,477 new users of SGLT2 inhibitors were matched to new users of DPP-4 inhibitors or GLP-1RAs, respectively. Overall, the mean age of study participants was 72 years. The risk of AKI was lower in the SGLT2 inhibitor group than in the DPP-4 inhibitor group (HR, 0.71 [95% CI, 0.65-0.76]) or the GLP-1RA group (HR, 0.81 [95% CI, 0.75-0.87]). LIMITATIONS Residual confounding and lack of laboratory data. CONCLUSIONS Among older adults with type 2 diabetes, initiation of an SGLT2 inhibitor was associated with a reduced risk of AKI compared with initiation of a DPP-4 inhibitor or a GLP-1RA.
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Affiliation(s)
- Min Zhuo
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Julie M Paik
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts
| | - Deborah J Wexler
- Diabetes Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph V Bonventre
- Division of Renal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Elisabetta Patorno
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Harmonization of epidemiology of acute kidney injury and acute kidney disease produces comparable findings across four geographic populations. Kidney Int 2022; 101:1271-1281. [DOI: 10.1016/j.kint.2022.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/25/2022] [Accepted: 02/18/2022] [Indexed: 12/24/2022]
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Carpio JD, Marco MP, Martin ML, Ramos N, de la Torre J, Prat J, Torres MJ, Montoro B, Ibarz M, Pico S, Falcon G, Canales M, Huertas E, Romero I, Nieto N, Gavaldà R, Segarra A. Development and Validation of a Model to Predict Severe Hospital-Acquired Acute Kidney Injury in Non-Critically Ill Patients. J Clin Med 2021; 10:3959. [PMID: 34501406 PMCID: PMC8432169 DOI: 10.3390/jcm10173959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/13/2021] [Accepted: 08/24/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The current models developed to predict hospital-acquired AKI (HA-AKI) in non-critically ill fail to identify the patients at risk of severe HA-AKI stage 3. OBJECTIVE To develop and externally validate a model to predict the individual probability of developing HA-AKI stage 3 through the integration of electronic health databases. METHODS Study set: 165,893 non-critically ill hospitalized patients. Using stepwise logistic regression analyses, including demography, chronic comorbidities, and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI stage 3. This model was then externally validated in 43,569 non-critical patients admitted to the validation center. RESULTS The incidence of HA-AKI stage 3 in the study set was 0.6%. Among chronic comorbidities, the highest odds ratios were conferred by ischemic heart disease, ischemic cerebrovascular disease, chronic congestive heart failure, chronic obstructive pulmonary disease, chronic kidney disease and liver disease. Among acute complications, the highest odd ratios were associated with acute respiratory failure, major surgery and exposure to nephrotoxic drugs. The model showed an AUC of 0.906 (95% CI 0.904 to 0.908), a sensitivity of 89.1 (95% CI 87.0-91.0) and a specificity of 80.5 (95% CI 80.2-80.7) to predict HA-AKI stage 3, but tended to overestimate the risk at low-risk categories with an adequate goodness-of-fit for all risk categories (Chi2: 16.4, p: 0.034). In the validation set, incidence of HA-AKI stage 3 was 0.62%. The model showed an AUC of 0.861 (95% CI 0.859-0.863), a sensitivity of 83.0 (95% CI 80.5-85.3) and a specificity of 76.5 (95% CI 76.2-76.8) to predict HA-AKI stage 3 with an adequate goodness of fit for all risk categories (Chi2: 15.42, p: 0.052). CONCLUSIONS Our study provides a model that can be used in clinical practice to obtain an accurate dynamic assessment of the individual risk of HA-AKI stage 3 along the hospital stay period in non-critically ill patients.
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Affiliation(s)
- Jacqueline Del Carpio
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Maria Paz Marco
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Maria Luisa Martin
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
| | - Natalia Ramos
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
| | - Judith de la Torre
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
- Department of Nephrology, Althaia Foundation, 08243 Manresa, Spain
| | - Joana Prat
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Development, Parc Salut Hospital, 08019 Barcelona, Spain
| | - Maria J. Torres
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Information, Southern Metropolitan Territorial Management, 08028 Barcelona, Spain
| | - Bruno Montoro
- Department of Hospital Pharmacy, Vall d’Hebron University Hospital, 08035 Barcelona, Spain;
| | - Mercedes Ibarz
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
- Laboratory Department, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Silvia Pico
- Institute of Biomedical Research (IRBLleida), 25198 Lleida, Spain; (M.I.); (S.P.)
- Laboratory Department, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | - Gloria Falcon
- Technical Secretary and Territorial Management of Lleida-Pirineus, 25198 Lleida, Spain; (G.F.); (M.C.)
| | - Marina Canales
- Technical Secretary and Territorial Management of Lleida-Pirineus, 25198 Lleida, Spain; (G.F.); (M.C.)
| | - Elisard Huertas
- Informatic Unit of the Catalonian Institute of Health—Territorial Management, 25198 Lleida, Spain;
| | - Iñaki Romero
- Territorial Management Information Systems, Catalonian Institute of Health, 25198 Lleida, Spain;
| | - Nacho Nieto
- Department of Informatics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (J.P.); (M.J.T.); (N.N.)
- Department of Information, Southern Metropolitan Territorial Management, 08028 Barcelona, Spain
| | | | - Alfons Segarra
- Department of Nephrology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain; (M.P.M.); (M.L.M.); (A.S.)
- Department of Nephrology, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (N.R.); (J.d.l.T.)
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Yu C, Guo D, Yao C, Zhu Y, Liu S, Kong X. Development and Validation of a Nomogram for Predicting Drug-Induced Acute Kidney Injury in Hospitalized Patients: A Case-Control Study Based on Propensity-Score Matching. Front Pharmacol 2021; 12:657853. [PMID: 34194322 PMCID: PMC8238493 DOI: 10.3389/fphar.2021.657853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Drug-induced acute kidney injury (D-AKI) is associated with increased mortality and longer hospital stays. This study aims to establish a nomogram to predict the occurrence of D-AKI in hospitalized patients in a multi-drug environment. Methods: A single center retrospective study among adult hospitalized patients was conducted from July 2019 to September 2019 based on the Adverse Drug Events Active Surveillance and Assessment System-2 developed by our hospital. According to the propensity score matching algorithm, four controls per case were matched to eliminate the confounding bias caused by individual baseline variables. The predictors for D-AKI were obtained by logistic regression equation and used to establish the nomogram. Results: Among 51,772 hospitalized patients, 332 were diagnosed with D-AKI. After matching, 288 pairs and 1,440 patients were included in the study, including 1,005 cases in the development group and 435 cases in the validation group. Six variables were independent predictors for D-AKI: alcohol abuse, the concurrent use of nonsteroidal anti-inflammatory drugs or diuretics, chronic kidney disease, lower baseline red blood cell count and neutrophil count ≥7 × 109/L. The area under the curve (AUC) of the prediction model in the development group and validation group were 0.787 (95%CI, 0.752–0.823) and 0.788 (95%CI, 0.736–0.840), respectively. The GiViTI calibration belts showed that the model had a good prediction accuracy for the occurrence of D-AKI (p > 0.05). Conclusion: This nomogram can help identify patients at high risk of D-AKI, which was useful in preventing the progression of D-AKI and treating it in the early stages.
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Affiliation(s)
- Chengxuan Yu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Daihong Guo
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Chong Yao
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China
| | - Yu Zhu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Siyuan Liu
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,Graduate School, Chinese PLA General Hospital, Beijing, China
| | - Xianghao Kong
- Pharmacy Department, Medical Security Center, Chinese PLA General Hospital, Beijing, China.,College of Pharmacy, Chongqing Medical University, Chongqing, China
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9
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Mistry NS, Koyner JL. Artificial Intelligence in Acute Kidney Injury: From Static to Dynamic Models. Adv Chronic Kidney Dis 2021; 28:74-82. [PMID: 34389139 DOI: 10.1053/j.ackd.2021.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 12/21/2022]
Abstract
Artificial intelligence (AI) is the development of computer systems that normally require human intelligence. In the field of acute kidney injury (AKI) AI has led to an evolution of risk prediction models. In the past, static prediction models were developed using baseline (eg, preoperative) data to evaluate AKI risk. Newer models which incorporated baseline as well as evolving data collected during a hospital admission have shown improved predicative abilities. In this review, we will summarize the advances made in AKI risk prediction over the last several years, including a shift toward more dynamic, real-time, electronic medical record-based models. In addition, we will be discussing the role of electronic AKI alerts and decision support tools. Recent studies have demonstrated improved patient outcomes through the use of these tools which monitor for nephrotoxin medication exposures as well as provide kidney focused care bundles for patients at high risk for severe AKI. Finally, we will briefly discuss the pitfalls and implications of implementing these scores, alerts, and support tools.
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