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Birkelo BC, Koyner JL, Ostermann M, Bhatraju PK. The Road to Precision Medicine for Acute Kidney Injury. Crit Care Med 2024; 52:1127-1137. [PMID: 38869385 PMCID: PMC11250999 DOI: 10.1097/ccm.0000000000006328] [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] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Acute kidney injury (AKI) is a common form of organ dysfunction in the ICU. AKI is associated with adverse short- and long-term outcomes, including high mortality rates, which have not measurably improved over the past decade. This review summarizes the available literature examining the evidence of the need for precision medicine in AKI in critical illness, highlights the current evidence for heterogeneity in the field of AKI, discusses the progress made in advancing precision in AKI, and provides a roadmap for studying precision-guided care in AKI. DATA SOURCES Medical literature regarding topics relevant to precision medicine in AKI, including AKI definitions, epidemiology, and outcomes, novel AKI biomarkers, studies of electronic health records (EHRs), clinical trial design, and observational studies of kidney biopsies in patients with AKI. STUDY SELECTION English language observational studies, randomized clinical trials, reviews, professional society recommendations, and guidelines on areas related to precision medicine in AKI. DATA EXTRACTION Relevant study results, statements, and guidelines were qualitatively assessed and narratively synthesized. DATA SYNTHESIS We synthesized relevant study results, professional society recommendations, and guidelines in this discussion. CONCLUSIONS AKI is a syndrome that encompasses a wide range of underlying pathologies, and this heterogeneity has hindered the development of novel therapeutics for AKI. Wide-ranging efforts to improve precision in AKI have included the validation of novel biomarkers of AKI, leveraging EHRs for disease classification, and phenotyping of tubular secretory clearance. Ongoing efforts such as the Kidney Precision Medicine Project, identifying subphenotypes in AKI, and optimizing clinical trials and endpoints all have great promise in advancing precision medicine in AKI.
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Affiliation(s)
- Bethany C Birkelo
- Division of Nephrology, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Jay L Koyner
- Section of Nephrology, Department of Medicine, University of Chicago, Chicago, IL
| | - Marlies Ostermann
- Department of Critical Care and Nephrology, King's College London, Guy's and St. Thomas' Hospital, London, United Kingdom
| | - Pavan K Bhatraju
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA
- Kidney Research Institute, University of Washington, Seattle, WA
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2
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Jeong R, Haines R, Ostermann M. Outcomes after acute kidney injury and critical illness. Curr Opin Crit Care 2024:00075198-990000000-00191. [PMID: 39092636 DOI: 10.1097/mcc.0000000000001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) in critical illness is common, and survivors are faced with a host of adverse outcomes. In this article, we review the current landscape of outcomes and care in survivors of AKI and critical illness. RECENT FINDINGS Follow-up care of survivors of AKI and critical illness is prudent to monitor for and mitigate the risk of adverse outcomes. Observational data have suggested improvement in outcomes with nephrology-based follow-up care, and recent interventional studies demonstrate similar findings. However, current post-AKI care is suboptimal with various challenges, such as breakdowns in the transition of care during hospital episodes and into the community, barriers for patients in follow-up, and lack of identification of high-risk patients for nephrology-based follow-up. Tools predictive of renal nonrecovery and long-term outcomes may help to identify high-risk patients who may benefit the most from nephrology-based care post-AKI. SUMMARY Follow-up care of survivors of AKI and critical illness may improve outcomes and there is a need to prioritize transitions of care into the community. Further research is needed to elucidate the best ways to risk-stratify and manage post-AKI survivors to improve outcomes.
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Affiliation(s)
- Rachel Jeong
- Division of Nephrology, Department of Medicine
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Ryan Haines
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, King's College London, London, UK
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, King's College London, London, UK
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3
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McNicholas B, Akcan Arikan A, Ostermann M. Quality of life after acute kidney injury. Curr Opin Crit Care 2023; 29:566-579. [PMID: 37861184 DOI: 10.1097/mcc.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW Deciphering the effect of acute kidney injury (AKI) during critical illness on long-term quality of life versus the impact of conditions that brought on critical illness is difficult. RECENT FINDINGS Reports on patient-centred outcomes such as health-related quality of life (HRQOL) have provided insight into the long-lasting impact of critical illness complicated by AKI. However, these data stem from observational studies and randomized controlled trials, which have been heterogeneous in their patient population, timing, instruments used for assessment and reporting. Recent studies have corroborated these findings including lack of effect of renal replacement therapy compared to severe AKI on outcomes and worse physical compared to cognitive dysfunction. SUMMARY In adults, more deficits in physical than mental health domains are found in survivors of AKI in critical care, whereas memory deficits and learning impairments have been noted in children. Further study is needed to understand and develop interventions that preserve or enhance the quality of life for individual patients who survive AKI following critical illness, across all ages.
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Affiliation(s)
- Bairbre McNicholas
- Department of Anaesthesia and Intensive Care Medicine, Galway University Hospital
- School of Medicine, University of Galway, Galway, Ireland
| | - Ayse Akcan Arikan
- Department of Pediatrics, Divisions of Critical Care Medicine and Nephrology, Baylor College of Medicine, Houston, Texas, USA
| | - Marlies Ostermann
- King's College London, Guy's & St Thomas' Hospital, Department of Critical Care, Westminster Bridge Road, London, UK
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McNicholas BA, Haines R, Ostermann M. Survive or thrive after ICU: what's the score? Ann Intensive Care 2023; 13:43. [PMID: 37202549 DOI: 10.1186/s13613-023-01140-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Affiliation(s)
- Bairbre A McNicholas
- Department of Anaesthesia and Intensive Care Medicine, School of Medicine, University of Galway, Galway, H91 YR71, Ireland.
| | - Ryan Haines
- Adult Critical Care Unit, The Royal London Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Marlies Ostermann
- Department of Intensive Care, King's College London, Guy's and St Thomas' Hospital, London, UK
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5
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Hirano Y, Hanajima W, Yamauchi K. Kidney Disease After Allogeneic Hematopoietic Stem Cell Transplantation Is Associated With Decreased Physical Function. Transplant Proc 2022; 54:2352-2356. [DOI: 10.1016/j.transproceed.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
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Castro I, Relvas M, Gameiro J, Lopes JA, Monteiro-Soares M, Coentrão L. The impact of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury on mortality and clinical outcomes: a meta-analysis. Clin Kidney J 2022; 15:1932-1945. [PMID: 36158157 PMCID: PMC9494521 DOI: 10.1093/ckj/sfac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Indexed: 11/24/2022] Open
Abstract
Background Renal replacement therapy (RRT) is essential in the presence of life-threatening complications associated with acute kidney injury (AKI). In the absence of urgent indications, the optimal timing for RRT initiation is still under debate. This meta-analysis aims to compare the benefits between early and late RRT initiation strategies in critically ill patients with AKI. Methods Studies were obtained from three databases [Medical Literature Analysis and Retrieval System Online (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus], searched from inception to May 2021. The selected primary outcome was 28-day mortality. Secondary outcomes included overall mortality, recovery of renal function (RRF) and RRT-associated adverse events. A random-effects model was used for summary measures. Heterogeneity was assessed through Cochrane I2 test statistics. Potential sources of heterogeneity for the primary outcome were sought using sensitivity analyses. Further subgroup analyses were conducted based on RRT modality and study population. Results A total of 13 randomized controlled trials including 5193 participants were analysed. No significant differences were found between early and late RRT initiation regarding 28-day mortality [risk ratio (RR) 1.00;
95% confidence interval (CI) 0.89–1.12, I² = 30%], overall mortality (RR 1.00; 95% CI 0.90–1.12, I² = 42%) and RRF (RR 1.02; 95% CI 0.92–1.13, I² = 53%). However, early RRT initiation was associated with a significantly higher incidence of hypotensive (RR 1.34; 95% CI 1.17–1.53, I² = 6%) and infectious events (RR 1.83; 95% CI 1.11–3.02, I² = 0%). Conclusions Early RRT initiation does not improve the 28-day and overall mortality, nor the likelihood of RRF, and increases the risk for RRT-associated adverse events, namely hypotension and infection.
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Affiliation(s)
- Inês Castro
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal
| | - Miguel Relvas
- Nephrology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Gameiro
- Department of Medicine, Division of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - José António Lopes
- Department of Medicine, Division of Nephrology and Renal Transplantation, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Matilde Monteiro-Soares
- Community Medicine Department, Information and Decision in Health (MEDCIDS), University of Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), University of Porto, Portugal
| | - Luís Coentrão
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal
- Nephrology Department, Centro Hospitalar Universitário São João, Porto, Portugal
- Nephrology & Infectious Diseases R&D, i3S - Institute for Research & Innovation in Health, Porto, Portugal
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Birkelo BC, Pannu N, Siew ED. Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient. Clin J Am Soc Nephrol 2022; 17:717-735. [PMID: 35292532 PMCID: PMC9269585 DOI: 10.2215/cjn.14181021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since the description ischuria renalis by William Heberden (1), AKI has remained a prominent complication of critical illness. Beyond KRT, treatment has been limited by the capacity to phenotype this condition. Here, we chronicle the evolution of attempts to classify AKI, including the adoption of consensus definitions, the expansion of diagnosis and prognosis with novel biomarkers, and emerging tools such as artificial intelligence (AI).
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Affiliation(s)
- Bethany C. Birkelo
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for Acute Kidney Injury Research (VIP-AKI), Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Edward D. Siew
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for Acute Kidney Injury Research (VIP-AKI), Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
- Health Services Research and Development, Veterans Affairs Tennessee Valley, Nashville, Tennessee
- Veterans Affairs Geriatrics Research Education and Clinical Center (GRECC), Tennessee Valley Health System (THVS), Veteran’s Health Administration, Nashville, Tennessee
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8
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Mayer KP, Ortiz-Soriano VM, Kalantar A, Lambert J, Morris PE, Neyra JA. Acute kidney injury contributes to worse physical and quality of life outcomes in survivors of critical illness. BMC Nephrol 2022; 23:137. [PMID: 35392844 PMCID: PMC8991933 DOI: 10.1186/s12882-022-02749-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/18/2022] [Indexed: 12/31/2022] Open
Abstract
Objectives Survivors of critical illness and acute kidney injury (AKI) are at risk of increased morbidity. The purpose of this study was to compare physical, emotional, and cognitive health in survivors of critical illness with and without AKI. Methods Retrospective cohort study of adult (≥ 18 years old) survivors of critical illness due to sepsis and/or acute respiratory failure who attended follow-up in a specialized ICU Recovery Clinic. Outcomes were evaluated during 3-month visit and comprised validated tests for evaluation of physical function, muscle strength, cognitive and emotional health, and self-reported health-related quality of life (HRQOL). Descriptive statistics and group comparisons were performed. Results A total of 104 patients with median age of 55 [49-64] years, 54% male, and median SOFA score of 10 [8-12] were analyzed. Incidence of AKI during ICU admission was 61 and 19.2% of patients required renal replacement therapy (RRT). Patients with AKI stage 2 or 3 (vs. those with AKI stage 1 or no AKI) walked less on the 6-min walk test (223 ± 132 vs. 295 ± 153 m, p = 0.059) and achieved lower of the predicted walk distance (38% vs. 58%, p = 0.041). Similar patterns of worse physical function and more significant muscle weakness were observed in multiple tests, with overall worse metrics in patients that required RRT. Patients with AKI stage 2 or 3 also reported lower HRQOL scores when compared to their counterparts, including less ability to return to work or hobby, or reengage in driving. There were no significant differences in cognitive function or emotional health between groups. Conclusions Survivors of critical illness and AKI stage 2 or 3 have increased physical debility and overall lower quality of life, with more impairment in return to work, hobby, and driving when compared to their counterparts without AKI or AKI stage 1 at 3 months post-discharge. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02749-z.
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Affiliation(s)
- Kirby P Mayer
- Department of Physical Therapy, College of Health Sciences, University of Kentucky, 900 Rose Street, Lexington, KY, 40536, USA. .,Center for Muscle Biology, College of Health Sciences, University of Kentucky, Lexington, KY, USA. .,Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY, USA.
| | - Victor M Ortiz-Soriano
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY, 40536, USA
| | - Alborz Kalantar
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, 800 Rose Street, MN668, Lexington, KY, 40536, USA
| | - Joshua Lambert
- School of Medicine, University of Louisville, Louisville, KY, USA
| | - Peter E Morris
- Kentucky Research Alliance for Lung Disease, College of Medicine, University of Kentucky, Lexington, KY, USA.,College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Javier A Neyra
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, University of Kentucky, Lexington, KY, USA.
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9
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Li Q, Cai X, Li G, Ju H, Li D, Zhou F. Association Between the Severity of Early Acute Kidney Injury and Subsequent in-Hospital Complications and 90-Day Mortality in Geriatric Patients Receiving Invasive Mechanical Ventilation. Healthc Policy 2022; 15:793-804. [PMID: 35502444 PMCID: PMC9056073 DOI: 10.2147/rmhp.s361598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose Acute kidney injury (AKI) in elderly patients is associated with higher hospital mortality. However, the relationship between AKI and peri-intubation complications is unclear. Methods This retrospective, observational, multicenter cohort study enrolled 3271 consecutive elderly patients (≥75 years) who received invasive mechanical ventilation (MV) in four medical centers of Chinese PLA General Hospital from 2008 to 2020. AKI was diagnosed according to the 2012 KDIGO criteria by an absolute increase in serum creatinine of ≥26.5 µmol/L within the first 48 hours of MV. We recorded subsequent in-hospital complications, including incident gastrointestinal bleeding, new-onset electrolyte imbalances, severe hypoxemia, hypoalbuminemia, cardiovascular instability and all-cause 90-day mortality. Results A total of 1292 patients were included in the final evaluation, with 29.1% presenting AKI (stage 1: 31.4%, stage 2: 35.1%, stage 3: 33.5%). Multiple regression analyses show that more advanced AKI increased the risk of MAP <65 mmHg (stage 1: OR=1.833, P=0.002; stage 2: OR= 4.653, P<0.001; stage 3: OR=4.834, P<0.001) and SBP <90 mmHg (stage 1: OR=1.644, P=0.014; stage 2: OR=3.701, P<0.001; stage 3: OR=5.750, P<0.001), a new need for or requiring an increased dose of vasopressors (stage 1: OR=1.623, P=0.014; stage 2: OR=3.250, P<0.001; stage 3: OR=12.132, P<0.001), gastrointestinal bleeding (stage 1: OR=1.102, P=0.669; stage 2: OR=1.471, P=0.060; stage 3: OR=2.377, P<0.001), severe hypoxia (stage 1: OR=1.213, P=0.399; stage 2: OR=1.449, P=0.077; stage 3: OR=2.214, P<0.001) and all-cause 90-day mortality (stage 1: OR =0.935; P=0.741; stage 2: OR=1.888; P=0.001; stage 3: OR=12.584; P<0.001). Conclusion Our study suggests that the presence of AKI within the first 48 hours of MV in geriatric patients is associated with a higher risk for postintubation complications and 90-day mortality. Moreover, the risk of complications was greater for patients with more severe AKI.
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Affiliation(s)
- Qinglin Li
- Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Xiaoyan Cai
- Department of Nephrology, the Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Guanggang Li
- Department of Critical Care Medicine, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, 100700, People’s Republic of China
| | - Hongyan Ju
- Department of Critical Care Medicine, the Seventh Medical Center, Chinese PLA General Hospital, Beijing, 100700, People’s Republic of China
| | - Dawei Li
- Department of Critical Care Medicine, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, 100048, People’s Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
- Chinese PLA General Hospital National Clinical Research Center for Geriatric Diseases, Beijing, 100853, People’s Republic of China
- Correspondence: Feihu Zhou, Department of Critical Care Medicine, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China, Tel +86–10–66938148, Fax +86–10–88219862, Email
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10
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Association of serum potassium level with early and late mortality in very elderly patients with acute kidney injury. JOURNAL OF INTENSIVE MEDICINE 2022; 2:50-55. [PMID: 36789231 PMCID: PMC9923985 DOI: 10.1016/j.jointm.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/28/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022]
Abstract
Background The kidneys play a central role in serum potassium (K +) homeostasis, and their dysfunction leads to electrolyte disorders. We aimed to examine the relationship between different levels of K + and mortality among very elderly patients with acute kidney injury (AKI). Methods We retrospectively enrolled very elderly patients (≥75 years) with AKI from the hospital information system of the Chinese PLA General Hospital from January 1, 2007 to December 31, 2018. All-cause mortality was examined according to six predefined K + levels: <3.50 mmol/L, 3.50-3.79 mmol/L, 3.80-4.09 mmol/L, 4.10-4.79 mmol/L, 4.80-5.49 mmol/L, and ≥5.50 mmol/L. We estimated the risk of all-cause mortality using the multivariable adjusted Cox proportional hazard model with the normal K + level at 3.50-3.79 mmol/L as a reference. Results In total, 747 patients were deemed suitable for the final evaluation. The median age of the 747 participants was 88 (84-91) years. After 90 days, the mortality rates in the six strata were 28.3%, 21.9%, 30.1%, 35.4%, 45.2%, and 58.3%, respectively. In the multivariable adjusted analysis, patients with K + levels of 4.10-4.79 mmol/L (hazard ratio [HR]: 1.638; 95% confidence interval [CI]: 1.016-2.642), 4.80-5.49 mmol/L (HR: 2.585; 95% CI: 1.524-4.384), and ≥5.50 mmol/L (HR: 2.587; 95% CI: 1.495-4.479) had an increased risk of all-cause mortality. After 1 year, the mortality rates in the six strata were 44.8%, 41.1%, 45.1%, 51.8%, 63.1%, and 76.3%, respectively. In the multivariable adjusted analysis, patients with K + levels of 4.10-4.79 mmol/L (HR: 1.452; 95% CI: 1.014-2.079), 4.80-5.49 mmol/L (HR: 2.151; 95% CI: 1.427-3.241), and ≥5.50 mmol/L (HR: 2.341; 95% CI: 1.514-3.620) had an increased risk of all-cause mortality. Conclusion Increased serum K + levels, including levels of 4.10-5.49 mmol/L and ≥5.50 mmol/L, were associated with a significantly increased short- and long-term risk of death. Serum K + has the potential to be a marker of disease severity among very elderly patients with AKI.
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Hirano Y, Kono K, Yamauchi K, Yasuda H. Rehabilitation of a Patient With Minimal Change Nephrotic Syndrome and Acute Kidney Injury: A Case Report. J UOEH 2022; 44:257-262. [PMID: 36089343 DOI: 10.7888/juoeh.44.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with minimal change nephrotic syndrome (MCNS) are prone to loss of motor skills due to urinary protein leakage, steroid myopathy, and other factors. Acute kidney injury (AKI) is a common complication that contributes to the loss of physical function. Rehabilitation is crucial, but its efficacy and safety are unknown. Here we present a case of a patient with MCNS complicated by AKI, who commenced rehabilitation after dialysis was discontinued and experienced improved mobility. The patient, a woman in her 70s, was admitted to our hospital with bilateral lower limb edema and decreased urine output for approximately 5 days. Treatment with prednisolone and furosemide was initiated, but then dialysis was initiated due to AKI. Rehabilitation was started after dialysis was discontinued. The patient's muscle strength and physical activity improved, and her exercise capacity and exercise tolerance improved without adverse effects. Rehabilitation may contribute to the improvement of exercise capacity without worsening renal function and urinary protein in patients with MCNS complicated by AKI.
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Affiliation(s)
- Yuma Hirano
- Department of Rehabilitation Medicine, Hamamatsu University Hospital
| | - Kenichi Kono
- Department of Physical Therapy, International University of Health and Welfare, School of Health Sciences at Narita
| | - Katsuya Yamauchi
- Department of Rehabilitation Medicine, Hamamatsu University Hospital
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University Hospital
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Timing of renal-replacement therapy in intensive care unit-related acute kidney injury. Curr Opin Crit Care 2021; 27:573-581. [PMID: 34757994 DOI: 10.1097/mcc.0000000000000891] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW The optimal timing of renal-replacement therapy (RRT) initiation for the management of acute kidney injury (AKI) in the intensive care unit (ICU) is frequently controversial. An earlier-strategy has biological rationale, even in the absence of urgent indications; however, a delayed-strategy may prevent selected patients from receiving RRT and avoid complications related to RRT. RECENT FINDINGS Previous studies assessing the optimal timing of RRT initiation found conflicting results, contributing to variation in clinical practice. The recent multinational trial, standard vs. accelerated initiation of renal replacement therapy in acute kidney injury (STARRT-AKI) found no survival benefit and a higher risk of RRT dependence with an accelerated compared to a standard RRT initiation strategy in critically ill patients with severe AKI. Nearly 40% of patients allocated to the standard-strategy group did not receive RRT. The Artificial Kidney Initiation in Kidney Injury-2 (AKIKI-2) trial further assessed delayed compared to more-delayed strategies for RRT initiation. The more-delayed strategy did not confer an increase in RRT-free days and was associated with a higher risk of death. SUMMARY Early preemptive initiation of RRT in critically ill patients with AKI does not confer clear clinical benefits. However, protracted delays in RRT initiation may be harmful.
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Abstract
Acute kidney injury (AKI) is a syndrome of impaired kidney function associated with reduced survival and increased morbidity. International consensus criteria were developed based on changes in serum creatinine and urine output. Based on these definitions, epidemiologic studies have shown strong associations with clinical outcomes including death and dialysis. However, numerous limitations exist for creatinine and urine volume as markers of AKI and novel biomarkers have been developed to detect cellular stress or damage. Persistent AKI and acute kidney disease are relatively new concepts that explore the idea of AKI as a continuum with chronic kidney disease.
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Affiliation(s)
- Siddharth Verma
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15213, USA; Center for Critical Care Nephrology, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15213, USA
| | - John A Kellum
- Center for Critical Care Nephrology, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15213, USA; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Center for Critical Care Nephrology, 3347 Forbes Avenue, Suite 220, Pittsburgh, PA 15213, USA.
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14
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Chuang YC, Tung TH, Chen JY, Chien CW, Shen KY. Exploration of the Relationship Among Key Risk Factors of Acute Kidney Injury for Elderly Patients Considering Covid-19. Front Med (Lausanne) 2021; 8:639250. [PMID: 34368176 PMCID: PMC8339321 DOI: 10.3389/fmed.2021.639250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/10/2021] [Indexed: 01/31/2023] Open
Abstract
Background: Previous systematic reviews and meta-analyses supported the relationship between frailty and risk of acute kidney injury (AKI) in elderly patients. However, few studies evaluated proactive management to wear down AKI risk in such frail populations. Purpose: To understand how AKI risk factors might influence each other and to identify the source factors for clinical decision aids. Methods: This study uses the decision-making trial and evaluation laboratory (DEMATEL) method to establish influential network-relationship diagrams (INRDs) to form the AKI risk assessment model for the elderly. Results: Based on the DEMATEL approach, the results of INRD identified the six key risk factors: comorbidity, malignancy, diabetes, creatinine, estimated glomerular filtration rate, and nutritional assessment. (The statistical significance confidence is 98.423%, which is higher than 95%; the gap error is 1.577%, which is lower than 5%). After considering COVID-19 as an additional risk factor in comorbidity, the INRD revealed a similar influential relationship among the essential aspects. Conclusion: While evaluating the geriatric population, physicians need to pay attention to patients' comorbidities and nutritional assessment; also, they should note patients' creatinine values and glomerular filtration rate. Physicians could establish a preliminary observation index and then design a series of preventive guidelines to reduce the incidence of AKI risk for the elderly.
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Affiliation(s)
- Yen-Ching Chuang
- Institute of Public Health & Emergency Management, Taizhou University, Taizhou, China
| | - Tao-Hsin Tung
- Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Jau-Yuan Chen
- Department of Family Medicine, Linkou Chang-Gung Memorial Hospital and Chang-Gung University, Taoyuan, Taiwan
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Kao-Yi Shen
- Department of Banking and Finance, Chinese Culture University, Taipei, Taiwan
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15
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Bagshaw SM, Hoste EA, Wald R. When should we start renal-replacement therapy in critically ill patients with acute kidney injury: do we finally have the answer? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:179. [PMID: 34039373 PMCID: PMC8152190 DOI: 10.1186/s13054-021-03600-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, 2-124E Clinical Science Building, 8440-112 Street NW, Edmonton, AB, T6G2B7, Canada.
| | - Eric A Hoste
- Intensive Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
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16
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Bernardi MH, Wagner L, Ryz S, Puchinger J, Nixdorf L, Edlinger-Stanger M, Geilen J, Kainz M, Hiesmayr MJ, Lassnigg A. Urinary neprilysin for early detection of acute kidney injury after cardiac surgery: A prospective observational study. Eur J Anaesthesiol 2021; 38:13-21. [PMID: 32941200 DOI: 10.1097/eja.0000000000001321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) predicts adverse outcomes after cardiac surgery. The accuracy of using changes in serum creatinine for diagnosis and grading of AKI is limited in the peri-operative cardiac surgical setting and AKI may be underdiagnosed due to haemodilution from cardiopulmonary bypass priming and the need for intra-operative and postoperative volume resuscitation. OBJECTIVES To determine whether the urinary biomarker neprilysin can be used as a marker for the early detection of AKI after cardiac surgery. DESIGN Prospective, observational cohort study. SETTING Austrian tertiary referral centre. PATIENTS 96 Patients undergoing elective cardiac surgery with cardiopulmonary bypass. MAIN OUTCOME MEASURES Differences and discriminatory power of neprilysin levels early after cardiac surgery and on postoperative day 1 between patients with or without AKI, as defined by the Kidney Disease Improving Global Outcomes Group. RESULTS AKI was found in 27% (n=26). The median neprilysin levels on postoperative day 1 were significantly higher in the AKI than in the non-AKI group, 4.0 [interquartile range (IQR): 2 to 6.25] vs. 2.0 ng ml [IQR: 1.0 to 4.5], P = 0.0246, respectively. In addition, the median neprilysin levels at the end of surgery were significantly different between both groups, 5.0 [IQR: 2.0 to 9.0] vs. 2.0 ng ml [IQR: 1.0 to 4.0], P = 0.0055, respectively. The discriminatory power of neprilysin for detecting early AKI corresponded to an area under the curve of 0.77 (95% confidence interval, 0.65 to 0.90). CONCLUSION Urinary neprilysin has potential as a biomarker for the early detection of AKI after cardiac surgery and has comparable discriminatory power to recently studied AKI biomarkers. TRIAL REGISTRATION The trial was registered at ClinicalTrials.gov (NCT03854825, https://clinicaltrials.gov/ct2/show/NCT03854825).
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Affiliation(s)
- Martin H Bernardi
- From the Division of Cardiac Thoracic Vascular Anaesthesia and Intensive Care Medicine (MHB, SR, JP, ME-S, JG, MK, MJH, AL), Division for Nephrology and Dialysis, Department of Internal Medicine III (LW) and Department of Surgery, Medical University of Vienna, Vienna, Austria (LN)
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17
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Beaubien-Souligny W, Yang A, Lebovic G, Wald R, Bagshaw SM. Frailty status among older critically ill patients with severe acute kidney injury. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:84. [PMID: 33632288 PMCID: PMC7908639 DOI: 10.1186/s13054-021-03510-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. METHODS This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. RESULTS Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3-5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11-2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03-1.13, p = 0.003). CONCLUSIONS Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.
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Affiliation(s)
| | - Alan Yang
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - Gerald Lebovic
- Applied Health Research Centre, St. Michael's Hospital, Toronto, Canada
| | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, School of Public Health, University of Alberta, 2-124 Clinical Science Building, 8440-112 Street, Edmonton, AB, T6G2B7, Canada.
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18
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Li Q, Wang Y, Mao Z, Kang H, Zhou F. Serum Sodium Levels Predict Mortality in Elderly Acute Kidney Injury Patients: A Retrospective Observational Study. Int J Gen Med 2021; 14:603-612. [PMID: 33658833 PMCID: PMC7920587 DOI: 10.2147/ijgm.s294644] [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: 12/03/2020] [Accepted: 01/18/2021] [Indexed: 12/29/2022] Open
Abstract
Purpose We examined the relationship between different levels of serum sodium and mortality among elderly patients with acute kidney injury (AKI). Methods We retrospectively enrolled elderly patients from Chinese PLA General Hospital from 2007, to 2018. All-cause mortality was examined according to eight predefined sodium levels: <130.0 mmol/L, 130.0–134.9 mmol/L, 135.0–137.9 mmol/L, 138.0–141.9 mmol/L, 142.0–144.9 mmol/L, 145.0–147.9 mmol/L, 148.0–151.9 mmol/L, and ≥152.0 mmol/L. We estimated the risk of all-cause mortality using a multivariable adjusted Cox analysis, with a normal sodium level of 135.0–137.9 mmol/L as a reference. Results In total, 744 patients were suitable for the final evaluation. After 90 days, the mortality rates in the eight strata were 36.1, 27.8, 19.6, 24.4, 30.7, 48.6, 52.8, and 57.7%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L (HR: 2.247; 95% CI: 1.117–4.521), from 142.0 to 144.9 mmol/L (HR: 1.964; 95% CI: 1.100–3.508), from 145.0 to 147.9 mmol/L (HR: 2.942; 95% CI: 1.693–5.114), from 148.0 to 151.9 mmol/L (HR: 3.455; 95% CI: 2.009–5.944), and ≥152.0 mmol/L (HR: 3.587; 95% CI: 2.151–5.983) had an increased risk of all-cause mortality. After 1 year, the mortality rates in the eight strata were 58.3, 47.8, 33.7, 38.9, 45.5, 64.3, 69.4, and 78.4%, respectively. Patients with sodium levels <130.0 mmol/L (HR: 1.944; 95% CI: 1.125–3.360), from 142.0 to 144.9 mmol/L (HR: 1.681; 95% CI: 1.062–2.660), from 145.0 to 147.9 mmol/L (HR: 2.631; 95% CI: 1.683–4.112), from 148.0 to 151.9 mmol/L (HR: 2.411; 95% CI: 1.552–3.744), and ≥152.0 mmol/L (HR: 3.037; 95% CI: 2.021–4.563) had an increased risk of all-cause mortality. Conclusion Sodium levels outside the interval of 130.0–141.9 mmol/L were associated with increased risks of 90-day mortality and 1-year mortality in elderly AKI patients.
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Affiliation(s)
- Qinglin Li
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yan Wang
- Department of Health Care, The Second Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Hongjun Kang
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China.,Chinese PLA General Hospital National Clinical Research Center for Geriatric Diseases, Beijing, 100853, People's Republic of China
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19
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Shen KY, Chuang YC, Tung TH. Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041607. [PMID: 33567671 PMCID: PMC7915995 DOI: 10.3390/ijerph18041607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 11/16/2022]
Abstract
From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice.
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Affiliation(s)
- Kao-Yi Shen
- Department of Banking & Finance, Chinese Culture University, Taipei 11114, Taiwan
- Correspondence:
| | - Yen-Ching Chuang
- Taiwan Association of Health Industry Management and Development, Taipei 10351, Taiwan;
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China;
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20
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Sohaney R, Heung M. Care of the Survivor of Critical Illness and Acute Kidney Injury: A Multidisciplinary Approach. Adv Chronic Kidney Dis 2021; 28:105-113. [PMID: 34389131 DOI: 10.1053/j.ackd.2021.01.001] [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: 08/02/2020] [Revised: 10/19/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Acute kidney injury (AKI) is a common complication of critical illness and is associated with adverse short- and long-term health consequences. Survivors of critical illness and AKI experience poor kidney, cardiovascular and quality of life outcomes, along with increased mortality. Yet, many patients surviving AKI are unaware that there is a problem with their kidney health, and post-AKI nephrology follow-up occurs at very low rates. Although there is a paucity of evidence-based studies to guide post-AKI care, attention to risk factors such as hypertension and albuminuria are requisite. There are several ongoing or planned studies which are expected to help inform specific management in the future. Until then, a multidisciplinary approach is warranted to address areas such as quality of life, physical rehabilitation, dietary modifications, and medication reconciliation.
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21
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Siew ED, Liu KD, Bonn J, Chinchilli V, Dember LM, Girard TD, Greene T, Hernandez AF, Ikizler TA, James MT, Kampschroer K, Kopp JB, Levy M, Palevsky PM, Pannu N, Parikh CR, Rocco MV, Silver SA, Thiessen-Philbrook H, Wald R, Xie Y, Kimmel PL, Star RA. Improving Care for Patients after Hospitalization with AKI. J Am Soc Nephrol 2020; 31:2237-2241. [PMID: 32912935 DOI: 10.1681/asn.2020040397] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee .,Department is Medical Service, Tennessee Valley Health Systems, Nashville Veterans Affairs Hospital, Nashville, Tennessee
| | - Kathleen D Liu
- Division of Nephrology, University of California, San Francisco, California
| | - John Bonn
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Vernon Chinchilli
- Division of Biostatistics and Bioinformatics, Penn State University, Hershey, Pennsylvania
| | - Laura M Dember
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Timothy D Girard
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Tom Greene
- Division of Biostatistics, Health University of Utah School of Medicine, Salt Lake City, Utah
| | - Adrian F Hernandez
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | - T Alp Ikizler
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee.,Department is Medical Service, Tennessee Valley Health Systems, Nashville Veterans Affairs Hospital, Nashville, Tennessee
| | - Matthew T James
- Department of Medicine, O'Brien Institute of Public Health, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department Community Health Sciences, O'Brien Institute of Public Health, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeffrey B Kopp
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marla Levy
- Division of Nephrology, University of California, San Francisco, California
| | - Paul M Palevsky
- Renal Section, Veterans Affairs Pittsburgh Healthcare System and Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Neesh Pannu
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Chirag R Parikh
- Division of Nephrology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael V Rocco
- Division of Nephrology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | | | - Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
| | - Yining Xie
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L Kimmel
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A Star
- National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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22
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Nagata S, Kato A, Isobe S, Fujikura T, Ohashi N, Miyajima H, Yasuda H. Regular exercise and branched-chain amino acids prevent ischemic acute kidney injury-related muscle wasting in mice. Physiol Rep 2020; 8:e14557. [PMID: 32845566 PMCID: PMC7448801 DOI: 10.14814/phy2.14557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 12/20/2022] Open
Abstract
Acute kidney injury (AKI) causes glucose and protein metabolism abnormalities that result in muscle wasting, thereby affecting the long-term prognosis of critical illness survivors. Here, we examined whether early intervention with treadmill exercise and branched-chain amino acids (BCAA) can prevent AKI-related muscle wasting and reduced physical performance in mice. Unilateral 15 min ischemia-reperfusion injury was induced in contralateral nephrectomized mice, and muscle histological and physiological changes were assessed and compared with those of pair-fed control mice, since AKI causes severe anorexia. Mice exercised for 30 min each day and received oral BCAA for 7 days after AKI insult. By day 7, ischemic AKI significantly decreased wet weight, myofiber cross-sectional area, and central mitochondrial volume density of the anterior tibialis muscle, and significantly reduced maximal exercise time. Regular exercise and BCAA prevented AKI-related muscle wasting and low physical performance by suppressing myostatin and atrogin-1 mRNA upregulation, and restoring reduced phosphorylated Akt and PGC-1α mRNA expression in the muscle. Ischemic AKI induces muscle wasting by accelerating muscle protein degradation and reducing protein synthesis; however, we found that regular exercise and BCAA prevented AKI-related muscle wasting without worsening kidney damage, suggesting that early rehabilitation with nutritional support could prevent AKI-related muscle wasting.
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Affiliation(s)
- Soichiro Nagata
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
| | - Akihiko Kato
- Blood Purification UnitHamamatsu University HospitalHamamatsuJapan
| | - Shinsuke Isobe
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
| | - Tomoyuki Fujikura
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
| | - Naro Ohashi
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
| | - Hiroaki Miyajima
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
| | - Hideo Yasuda
- Internal Medicine 1Hamamatsu University School of MedicineHamamatsuJapan
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23
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Jiesisibieke ZL, Tung TH, Xu QY, Chen PE, Hsu SY, Liu Y, Chien CW. Association of acute kidney injury with frailty in elderly population: a systematic review and meta-analysis. Ren Fail 2020; 41:1021-1027. [PMID: 31809623 PMCID: PMC6913666 DOI: 10.1080/0886022x.2019.1679644] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: The objective of this study was to assess whether an elderly patient's frailty was associated with acute kidney injury (AKI) and to examine whether severe frailty group had an increased risk of AKI than mild-moderate group.Methods: We searched The Cochrane Library, PubMed, and EMBASE for relevant studies without language limitations before 1 March 2019 with a priori defined inclusion and exclusion criteria. Five population-based cohort studies were included for systematic review and meta-analysis.Results: Compared with the control group, the frailty group is significantly associated AKI (Odds Ratio = 2.05; 95% CI: 1.23-3.43). The moderate-severe frailty group has an increased risk of AKI than mild frailty group (Hazard Ratio = 2.87; 95% CI: 1.60-5.17.Conclusion: In conclusion, the available best evidence support an association between frailty and AKI among elder patients, thus relevant interventions should be taken among elderly under potential risk of AKI.
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Affiliation(s)
| | - Tao-Hsin Tung
- Hechi Third People's Hospital, Guangxi, China.,Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Qin-Yi Xu
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
| | - Pei-En Chen
- Taiwan Association of Health Industry Management and Development, Taiwan
| | - Shih-Yung Hsu
- Department of Emergency Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yongguang Liu
- Zhujiang Hospital, Southern Medical University Guangzhou, Guangzhou, China
| | - Ching-Wen Chien
- Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China
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24
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James MT, Bhatt M, Pannu N, Tonelli M. Long-term outcomes of acute kidney injury and strategies for improved care. Nat Rev Nephrol 2020; 16:193-205. [PMID: 32051567 DOI: 10.1038/s41581-019-0247-z] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2019] [Indexed: 12/19/2022]
Abstract
Acute kidney injury (AKI), once viewed predominantly as a self-limited and reversible condition, is now recognized as a growing problem associated with significant risks of adverse long-term health outcomes. Many cohort studies have established important relationships between AKI and subsequent risks of recurrent AKI, hospital re-admission, morbidity and mortality from cardiovascular disease and cancer, as well as the development of chronic kidney disease and end-stage kidney disease. In both high-income countries (HICs) and low-income or middle-income countries (LMICs), several challenges exist in providing high-quality, patient-centered care following AKI. Despite advances in our understanding about the long-term risks following AKI, large gaps in knowledge remain about effective interventions that can improve the outcomes of patients. Therapies for high blood pressure, glycaemic control (for patients with diabetes), renin-angiotensin inhibition and statins might be important in improving long-term cardiovascular and kidney outcomes after AKI. Novel strategies that incorporate risk stratification approaches, educational interventions and new models of ambulatory care following AKI have been described, and some of these are now being implemented and evaluated in clinical studies in HICs. Care for AKI in LMICs must overcome additional barriers due to limited resources for diagnosis and management.
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Affiliation(s)
- Matthew T James
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Meha Bhatt
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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25
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Vanmassenhove J, Van Biesen W, Lameire N. The interplay and interaction between frailty and acute kidney injury. Nephrol Dial Transplant 2020; 35:911-915. [PMID: 32025721 DOI: 10.1093/ndt/gfz275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/07/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
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26
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Maxwell D, Rhee P, Drake M, Hodge J, Ingram W, Williams R. Development of the Burn Frailty Index: A prognostication index for elderly patients sustaining burn injuries. Am J Surg 2019; 218:87-94. [DOI: 10.1016/j.amjsurg.2018.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/01/2018] [Indexed: 01/19/2023]
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27
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Under-recognized post-stroke acute kidney injury: risk factors and relevance for stroke outcome of a frequent comorbidity. Int Urol Nephrol 2019; 51:1597-1604. [PMID: 31250340 DOI: 10.1007/s11255-019-02203-4] [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] [Received: 12/17/2018] [Accepted: 06/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is emerging as a predictor of poor stroke outcome, however, it is often not recognized. The aim of our study was to evaluate post-stroke AKI burden, AKI risk factors and their influence in post-stroke outcome. METHODS From 2013 to 2016, 440 individuals with stroke diagnosis admitted in Stroke Unit, Foundation IRCCS Policlinico San Matteo (Pavia, Italy), were retrospectively enrolled. AKI cases identified by KDIGO criteria through the electronic database and hospital chart review were compared with the ones reported in discharge letters or in administrative hospital data base. Mortality data were provided by Agenzia Tutela della Salute of Pavia. RESULTS We included 430 patients in the analysis. Median follow-up was 19.2 months. We identified 79 AKI cases (18% of the enrolled patients, 92% classified as AKI stage 1), a fivefold higher number of cases than the ones reported at discharge. 37 patients had AKI at the admission in the hospital, while 42 developed AKI during the hospitalization. Cardioembolic (p = 0.01) and hemorrhagic (p = 0.01) stroke types were associated with higher AKI risk. Admission National Institutes of Health Stroke Scale (NIHSS, p < 0.05) and Charlson Comorbidity Index (p < 0.01) were independently associated with overall AKI, while admission NIHSS (p < 0.05) and eGFR (p < 0.005) were independently associated with AKI developed during the hospitalization. AKI was associated to longer in-hospital stay (p = 0.01), worse Rankin Neurologic Disability Score at discharge (p < 0.0001) and discharge disposition other than home (p = 0.03). AKI was also independently associated to higher in-hospital mortality (OR 3.9 95% CI 1.2-12.9 p = 0.023) but not with long-term survival. CONCLUSIONS Post-stroke AKI diagnosis needs to be improved by strictly monitoring individuals with cardioembolic or hemorrhagic stroke, reduced kidney function, higher Charlson Comorbidity Index and worse NIHSS at presentation.
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28
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Wang JC, Chien WC, Chu P, Chung CH, Lin CY, Tsai SH. The association between heat stroke and subsequent cardiovascular diseases. PLoS One 2019; 14:e0211386. [PMID: 30759128 PMCID: PMC6373898 DOI: 10.1371/journal.pone.0211386] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/24/2018] [Indexed: 12/13/2022] Open
Abstract
Background Recent studies have indicated that several critical illnesses are associated with an increased risk of cardiovascular diseases (CVDs). Nonetheless, studies of the association between heat-related illnesses (HRIs) and subsequent CVDs are still limited. We sought to evaluate whether heat stroke (HS) was associated with an increased CVD incidence. Methods The data from the nationwide, population-based, retrospective, cohort study described herein were obtained from the National Health Insurance Research Database in Taiwan. The outcome evaluated in this study was the cumulative incidence of CVDs, which was compared between patients with HS, patients with other HRIs and a control group during a 14-year follow-up period. Results Our analyses included 150 HS cases, 150 patients with other HRIs and 150 patients without HRIs. The HS patients had a significantly higher incidence of developing CVDs than the other HRI and control patients (32.67% vs. 23.33% vs. 16.67%, p = 0.005). Patients with HS had an increased incidence of acute myocardial infarction (AMI) compared with that of the controls (6% vs. 2.67%, p = 0.042) and an increased incidence of acute ischemic stroke (AIS) compared with those of the other HRI and control patients (12% vs. 6% vs. 4.67%, p = 0.038). An increased risk of chronic kidney disease (CKD) was also found in the patients with HS and other HRIs compared to that in the controls (17.33% vs. 14.67% vs. 6.67%, p = 0.016). Conclusion Prior HS was associated with an increased incidence of CVDs, particularly AMI and AIS, and an increased incidence of CKD.
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Affiliation(s)
- Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- * E-mail: (SHT); (W-CC)
| | - Pauling Chu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chih-Yuan Lin
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (SHT); (W-CC)
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29
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Ortiz-Soriano V, Neyra JA. The impact of acute kidney injury on frailty status in critical illness survivors-is there enough evidence? ACTA ACUST UNITED AC 2018; 2. [PMID: 30662978 DOI: 10.21037/jeccm.2018.10.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Victor Ortiz-Soriano
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, USA
| | - Javier A Neyra
- Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky Medical Center, Lexington, USA
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30
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Irina G, Refaela C, Adi B, Avia D, Liron H, Chen A, Gad S. Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department. J Clin Med 2018; 7:jcm7110386. [PMID: 30366377 PMCID: PMC6262457 DOI: 10.3390/jcm7110386] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 10/17/2018] [Accepted: 10/24/2018] [Indexed: 01/24/2023] Open
Abstract
Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.
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Affiliation(s)
- Gringauz Irina
- Department of Internal Medicine and Geriatrics "C", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Cohen Refaela
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Brom Adi
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Davidi Avia
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Hofstetter Liron
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Avaki Chen
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
| | - Segal Gad
- Department of Internal Medicine "T", The Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Ramat-Gan 5265601, Israel.
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31
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Schosserer M, Banks G, Dogan S, Dungel P, Fernandes A, Marolt Presen D, Matheu A, Osuchowski M, Potter P, Sanfeliu C, Tuna BG, Varela-Nieto I, Bellantuono I. Modelling physical resilience in ageing mice. Mech Ageing Dev 2018; 177:91-102. [PMID: 30290161 PMCID: PMC6445352 DOI: 10.1016/j.mad.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/12/2018] [Accepted: 10/01/2018] [Indexed: 02/06/2023]
Abstract
Geroprotectors, a class of drugs targeting multiple deficits occurring with age, necessitate the development of new animal models to test their efficacy. The COST Action MouseAGE is a European network whose aim is to reach consensus on the translational path required for geroprotectors, interventions targeting the biology of ageing. In our previous work we identified frailty and loss of resilience as a potential target for geroprotectors. Frailty is the result of an accumulation of deficits, which occurs with age and reduces the ability to respond to adverse events (physical resilience). Modelling frailty and physical resilience in mice is challenging for many reasons. There is no consensus on the precise definition of frailty and resilience in patients or on how best to measure it. This makes it difficult to evaluate available mouse models. In addition, the characterization of those models is poor. Here we review potential models of physical resilience, focusing on those where there is some evidence that the administration of acute stressors requires integrative responses involving multiple tissues and where aged mice showed a delayed recovery or a worse outcome then young mice in response to the stressor. These models include sepsis, trauma, drug- and radiation exposure, kidney and brain ischemia, exposure to noise, heat and cold shock.
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Affiliation(s)
- Markus Schosserer
- University of Natural Resources and Life Sciences, Vienna, Department of Biotechnology, Vienna, Austria
| | - Gareth Banks
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, United Kingdom
| | - Soner Dogan
- Department of Medical Biology, School of Medicine, Yeditepe University, Istanbul, Turkey
| | - Peter Dungel
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Adelaide Fernandes
- Neuron-Glia Biology in Health and Disease, iMed.ULisboa, Research Institute for Medicines, Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Lisboa, Portugal
| | - Darja Marolt Presen
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Ander Matheu
- Oncology Department, Biodonostia Research Institute, San Sebastián, Spain
| | - Marcin Osuchowski
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research Center, Vienna, Austria
| | - Paul Potter
- Mammalian Genetics Unit, MRC Harwell Institute, Harwell Campus, Oxfordshire, OX11 0RD, United Kingdom
| | - Coral Sanfeliu
- Institute of Biomedical Research of Barcelona (IIBB) CSIC, IDIBAPS, CIBERESP, Barcelona, Spain
| | - Bilge Guvenc Tuna
- Department of Medical Biophysics, School of Medicine, Yeditepe University, Istanbul, Turkey
| | | | - Ilaria Bellantuono
- MRC/Arthritis Research-UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, The Medical School, Beech Hill Road, Sheffield, S10 2RX, United Kingdom.
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