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Sun Q, Pan Y, Li Z. Acute kidney injury in hospitalized children in 20 hospitals of China's Hunan Province: a cross-sectional survey. Ren Fail 2024; 46:2379003. [PMID: 39082671 PMCID: PMC11293263 DOI: 10.1080/0886022x.2024.2379003] [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: 08/01/2023] [Revised: 06/26/2024] [Accepted: 07/07/2024] [Indexed: 08/03/2024] Open
Abstract
OBJECTIVE The incidence of acute kidney injury (AKI) in pediatric patients has been increasing over the years, and AKI significantly impacts children's health and quality of life. This article reviews the current epidemiological research on pediatric AKI. METHODS The clinical data of hospitalized children aged 0 to 14 years from 20 different hospitals in Hunan Province, China, collected from December 2017 to February 2018, were analyzed. The incidence rate, misdiagnosis rate, main causes, and medical costs of AKI in hospitalized children were examined. RESULTS A total of 29,639 patients were included, with an AKI incidence rate of 4.34% (1286/29,639). Among the 1286 AKI patients, 863 (67.11%) were classified as AKI stage 1324 (25.19%) as AKI stage 2, and 99 (7.7%) as AKI stage 3. AKI patients had significantly longer hospital stays [6.0 (4.0, 10) days vs. 6.0 (4.0, 8.0) days, p < 0.001] and higher hospitalization costs [3375.22 (1600, 6083.83) yuan vs. 2729.4 (1659.45, 8216.65) yuan, p = 0.003] than non-AKI patients. The mortality rate (1.2% vs. 0.1%, p < 0.001), intensive care unit (ICU) transfer rate (8.7% vs. 5.97%, p < 0.001), and use of invasive mechanical ventilation (3.6% vs. 1%, p < 0.001) were significantly greater in patients with AKI than in those without AKI patients. The etiology of AKI varied among different age groups, and dehydration, diarrhea, and shock were the main causes of pre-renal AKI. CONCLUSION The incidence and missed diagnosis rates of AKI in hospitalized children were high. AKI prolongs hospital stays, increases hospitalization costs, and increases the risk of mortality in children.
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Affiliation(s)
- Qianliang Sun
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Nephrology and Rheumatology, Changsha, China
| | - Ying Pan
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Rehabilitation Center, Changsha, China
| | - Zhihui Li
- The Affiliated Children’s Hospital of Xiangya School of Medicine, Central South University (Hunan Children’s Hospital), Nephrology and Rheumatology, Changsha, China
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2
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Li J, Zhu M, Yan L. Predictive models of sepsis-associated acute kidney injury based on machine learning: a scoping review. Ren Fail 2024; 46:2380748. [PMID: 39082758 PMCID: PMC11293267 DOI: 10.1080/0886022x.2024.2380748] [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: 03/30/2024] [Revised: 06/27/2024] [Accepted: 07/11/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND With the development of artificial intelligence, the application of machine learning to develop predictive models for sepsis-associated acute kidney injury has made potential breakthroughs in early identification, grading, diagnosis, and prognosis determination. METHODS Here, we conducted a systematic search of the PubMed, Cochrane Library, Embase (Ovid), Web of Science, and Scopus databases on April 28, 2023, and screened relevant literature. Then, we comprehensively extracted relevant data related to machine learning algorithms, predictors, and predicted objectives. We subsequently performed a critical evaluation of research quality, data aggregation, and analyses. RESULTS We screened 25 studies on predictive models for sepsis-associated acute kidney injury from a total of originally identified 2898 studies. The most commonly used machine learning algorithm is traditional logistic regression, followed by eXtreme gradient boosting. We categorized these predictive models into early identification models (60%), prognostic prediction models (32%), and subtype identification models (8%) according to their predictive purpose. The five most commonly used predictors were serum creatinine levels, lactate levels, age, blood urea nitrogen concentration, and diabetes mellitus. In addition, a single data source, insufficient assessment of clinical utility, lack of model bias assessment, and hyperparameter adjustment may be the main reasons for the low quality of the current research. CONCLUSIONS However, studies on the nondeath prognostic outcomes, the long-term clinical outcomes, and the subtype identification models are insufficient. Additionally, the poor quality of the research and the insufficient practicality of the model are problems that need to be addressed urgently.
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Affiliation(s)
- Jie Li
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manli Zhu
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Yan
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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3
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Henedak NT, El-Abhar HS, Soubh AA, Abdallah DM. NLRP3 Inflammasome: A central player in renal pathologies and nephropathy. Life Sci 2024; 351:122813. [PMID: 38857655 DOI: 10.1016/j.lfs.2024.122813] [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: 02/12/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
The cytoplasmic oligomer NLR Family Pyrin Domain Containing 3 (NLRP3) inflammasome has been implicated in most inflammatory and autoimmune diseases. Here, we highlight the significance of NLRP3 in diverse renal disorders, demonstrating its activation in macrophages and non-immune tubular epithelial and mesangial cells in response to various stimuli. This activation leads to the release of pro-inflammatory cytokines, contributing to the development of acute kidney injury (AKI), chronic renal injury, or fibrosis. In AKI, NLRP3 inflammasome activation and pyroptotic renal tubular cell death is driven by contrast and chemotherapeutic agents, sepsis, and rhabdomyolysis. Nevertheless, inflammasome is provoked in disorders such as crystal and diabetic nephropathy, obesity-related renal fibrosis, lupus nephritis, and hypertension-induced renal damage that induce chronic kidney injury and/or fibrosis. The mechanisms by which the inflammatory NLRP3/ Apoptosis-associated Speck-like protein containing a Caspase recruitment domain (ASC)/caspase-1/interleukin (IL)-1β & IL-18 pathway can turn on renal fibrosis is also comprehended. This review further outlines the involvement of dopamine and its associated G protein-coupled receptors (GPCRs), including D1-like (D1, D5) and D2-like (D2-D4) subtypes, in regulating this inflammation-linked renal dysfunction pathway. Hence, we identify D-related receptors as promising targets for renal disease management by inhibiting the functionality of the NLRP3 inflammasome.
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Affiliation(s)
- Nada T Henedak
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ahram Canadian University, 6(th) of October City, Giza, Egypt
| | - Hanan S El-Abhar
- Department of Pharmacology, Toxicology, and Biochemistry, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
| | - Ayman A Soubh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ahram Canadian University, 6(th) of October City, Giza, Egypt
| | - Dalaal M Abdallah
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt.
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4
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Katerelos M, Gleich K, Harley G, Loh K, Oakhill JS, Kemp BE, de Souza DP, Narayana VK, Coughlan MT, Laskowski A, Ling NXY, Murray-Segal L, Brink R, Lee M, Power DA, Mount PF. The AMPK activator ATX-304 alters cellular metabolism to protect against cisplatin-induced acute kidney injury. Biomed Pharmacother 2024; 175:116730. [PMID: 38749175 DOI: 10.1016/j.biopha.2024.116730] [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: 01/05/2024] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 06/03/2024] Open
Abstract
Acute kidney injury (AKI) disrupts energy metabolism. Targeting metabolism through AMP-activated protein kinase (AMPK) may alleviate AKI. ATX-304, a pan-AMPK activator, was evaluated in C57Bl/6 mice and tubular epithelial cell (TEC) cultures. Mice received ATX-304 (1 mg/g) or control chow for 7 days before cisplatin-induced AKI (CI-AKI). Primary cultures of tubular epithelial cells (TECs) were pre-treated with ATX-304 (20 µM, 4 h) prior to exposure to cisplatin (20 µM, 23 h). ATX-304 increased acetyl-CoA carboxylase phosphorylation, indicating AMPK activation. It protected against CI-AKI measured by serum creatinine (control 0.05 + 0.03 mM vs ATX-304 0.02 + 0.01 mM, P = 0.03), western blot for neutrophil gelatinase-associated lipocalin (NGAL) (control 3.3 + 1.8-fold vs ATX-304 1.2 + 0.55-fold, P = 0.002), and histological injury (control 3.5 + 0.59 vs ATX-304 2.7 + 0.74, P = 0.03). In TECs, pre-treatment with ATX-304 protected against cisplatin-mediated injury, as measured by lactate dehydrogenase release, MTS cell viability, and cleaved caspase 3 expression. ATX-304 protection against cisplatin was lost in AMPK-null murine embryonic fibroblasts. Metabolomic analysis in TECs revealed that ATX-304 (20 µM, 4 h) altered 66/126 metabolites, including fatty acids, tricarboxylic acid cycle metabolites, and amino acids. Metabolic studies of live cells using the XFe96 Seahorse analyzer revealed that ATX-304 increased the basal TEC oxygen consumption rate by 38%, whereas maximal respiration was unchanged. Thus, ATX-304 protects against cisplatin-mediated kidney injury via AMPK-dependent metabolic reprogramming, revealing a promising therapeutic strategy for AKI.
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Affiliation(s)
- Marina Katerelos
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia
| | - Kurt Gleich
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia
| | - Geoff Harley
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia
| | - Kim Loh
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
| | - Jonathan S Oakhill
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
| | - Bruce E Kemp
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
| | - David P de Souza
- Metabolomics Australia, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Vinod K Narayana
- Metabolomics Australia, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Melinda T Coughlan
- Glycation, Nutrition and Metabolism Laboratory, Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia; Drug Discovery Biology, Monash Institute of Pharmaceutical Sciences, Monash University Parkville Campus, Parkville, Victoria 3052, Australia
| | - Adrienne Laskowski
- Glycation, Nutrition and Metabolism Laboratory, Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria 3004, Australia
| | - Naomi X Y Ling
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
| | - Lisa Murray-Segal
- St. Vincent's Institute of Medical Research, Fitzroy, Victoria 3065, Australia
| | - Robert Brink
- Immunology Division, Garvan Institute of Medical Research, Darlinghurst, New South Wales 2010, Australia; St. Vincent's Clinical School, University of New South Wales, St. Vincent's Hospital, Darlinghurst, New South Wales 2010, Australia
| | - Mardiana Lee
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia
| | - David A Power
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia; Department of Medicine (Austin), The University of Melbourne, Heidelberg ,Victoria 3084, Australia
| | - Peter F Mount
- Department of Nephrology, Austin Health, Heidelberg, Victoria 3084, Australia; Kidney Laboratory, The Institute for Breathing and Sleep (IBAS), Austin Health, Heidelberg, Victoria 3084, Australia; Department of Medicine (Austin), The University of Melbourne, Heidelberg ,Victoria 3084, Australia.
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5
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Wang JY, Song QL, Wang YL, Jiang ZM. Urinary oxygen tension and its role in predicting acute kidney injury: A narrative review. J Clin Anesth 2024; 93:111359. [PMID: 38061226 DOI: 10.1016/j.jclinane.2023.111359] [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: 04/22/2023] [Revised: 11/12/2023] [Accepted: 12/01/2023] [Indexed: 01/14/2024]
Abstract
Acute kidney injury occurs frequently in the perioperative setting. The renal medulla often endures hypoxia or hypoperfusion and is susceptible to the imbalance between oxygen supply and demand due to the nature of renal blood flow distribution and metabolic rate in the kidney. The current available evidence demonstrated that the urine oxygen pressure is proportional to the variations of renal medullary tissue oxygen pressure. Thus, urine oxygenation can be a candidate for reflecting the change of oxygen in the renal medulla. In this review, we discuss the basic physiology of acute kidney injury, as well as techniques for monitoring urine oxygen tension, confounding factors affecting the reliable measurement of urine oxygen tension, and its clinical use, highlighting its potential role in early detection and prevention of acute kidney injury.
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Affiliation(s)
- Jing-Yan Wang
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Qi-Liang Song
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Yu-Long Wang
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China
| | - Zong-Ming Jiang
- Department of Anesthesia, Shaoxing People's Hospital, Shaoxing 312000, Zhejiang Province, China.
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Xiong Y, Zhong J, Chen W, Li X, Liu H, Li Y, Xiong W, Li H. Neferine alleviates acute kidney injury by regulating the PPAR-α/NF-κB pathway. Clin Exp Nephrol 2024:10.1007/s10157-024-02504-8. [PMID: 38658442 DOI: 10.1007/s10157-024-02504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
Acute kidney injury (AKI) is a cluster of clinical syndromes with diverse etiologies that ultimately result in a swift decline in kidney function. Regrettably, AKI lacks effective therapeutic agents at present. Neferine, a bioactive alkaloid derived from Lotus Plumule, has been reported to alleviate AKI triggered by cisplatin, ischemia/reperfusion (I/R), and sepsis by inhibiting inflammatory pathways. However, the precise molecular mechanisms underpinning its renoprotective effects remain elusive. Peroxisome proliferator-activated receptor alpha (PPAR-α), a regulator of lipid metabolism with anti-inflammatory properties, was investigated in this study to examine its role in neferine's renoprotective effects in cellular and mouse models of AKI. We found that neferine pretreatment in both I/R- or lipopolysaccharide (LPS)-induced AKI models inhibited the activation of the NF-κB inflammatory pathway and reversed PPAR-α deficiency. In NRK-52E cells exposed to hypoxia/reoxygenation (H/R) or LPS, overexpression of PPAR-α resulted in inhibition of the NF-κB pathway and TNF-α production, while PPAR-α silencing via siRNA transfection negated neferine's anti-inflammatory effects. Furthermore, pretreatment with neferine not only reduced lipid accumulation but also reversed the downregulation of FAO-related enzymes induced by LPS. Our findings suggest that neferine's renoprotective effects against AKI are partially mediated through the reversal of renal PPAR-α deficiency and subsequent inhibition of the inflammatory NF-κB pathway. Therefore, regulating renal PPAR-α expression by neferine could represent a promising therapeutic strategy for AKI.
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Affiliation(s)
- Yanying Xiong
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Jin Zhong
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Wenhang Chen
- Department of Nephropathy, Xiangya Hospital Central-South University, Changsha, Hunan, China
| | - Xuan Li
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Hong Liu
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Ying Li
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Weijian Xiong
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China
| | - Huihui Li
- Department of Nephropathy, Chongqing Hospital of Traditional Chinese Medicine, Jiangbei District, Chongqing, China.
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7
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Wang TH, Kao CC, Chang TH. Ensemble Machine Learning for Predicting 90-Day Outcomes and Analyzing Risk Factors in Acute Kidney Injury Requiring Dialysis. J Multidiscip Healthc 2024; 17:1589-1602. [PMID: 38628614 PMCID: PMC11020304 DOI: 10.2147/jmdh.s448004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/24/2024] [Indexed: 04/19/2024] Open
Abstract
Purpose Our objectives were to (1) employ ensemble machine learning algorithms utilizing real-world clinical data to predict 90-day prognosis, including dialysis dependence and mortality, following the first hospitalized dialysis and (2) identify the significant factors associated with overall outcomes. Patients and Methods We identified hospitalized patients with Acute kidney injury requiring dialysis (AKI-D) from a dataset of the Taipei Medical University Clinical Research Database (TMUCRD) from January 2008 to December 2020. The extracted data comprise demographics, comorbidities, medications, and laboratory parameters. Ensemble machine learning models were developed utilizing real-world clinical data through the Google Cloud Platform. Results The Study Analyzed 1080 Patients in the Dialysis-Dependent Module, Out of Which 616 Received Regular Dialysis After 90 Days. Our Ensemble Model, Consisting of 25 Feedforward Neural Network Models, Demonstrated the Best Performance with an Auroc of 0.846. We Identified the Baseline Creatinine Value, Assessed at Least 90 Days Before the Initial Dialysis, as the Most Crucial Factor. We selected 2358 patients, 984 of whom were deceased after 90 days, for the survival module. The ensemble model, comprising 15 feedforward neural network models and 10 gradient-boosted decision tree models, achieved superior performance with an AUROC of 0.865. The pre-dialysis creatinine value, tested within 90 days prior to the initial dialysis, was identified as the most significant factor. Conclusion Ensemble machine learning models outperform logistic regression models in predicting outcomes of AKI-D, compared to existing literature. Our study, which includes a large sample size from three different hospitals, supports the significance of the creatinine value tested before the first hospitalized dialysis in determining overall prognosis. Healthcare providers could benefit from utilizing our validated prediction model to improve clinical decision-making and enhance patient care for the high-risk population.
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Affiliation(s)
- Tzu-Hao Wang
- Division of General Medicine, Department of Medical Education, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan, Republic of China
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Chih-Chin Kao
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
- Taipei Medical University-Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei, Taiwan, Republic of China
| | - Tzu-Hao Chang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan, Republic of China
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City, Taiwan, Republic of China
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8
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Cavada-Bustamante AM, Sanz García C, Menéndez García N, Gago Fraile M, Vivanco Allende B, Bande Fernández J. A renal failure related to the feline world. Nefrologia 2024; 44:308-310. [PMID: 38582744 DOI: 10.1016/j.nefroe.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Affiliation(s)
- Adriana M Cavada-Bustamante
- Nefrología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain; Nefrología, Hospital Universitario de Navarra, Pamplona.
| | - Clara Sanz García
- Nefrología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | | | - María Gago Fraile
- Nefrología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
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9
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Lu J, Xu X, Sun X, Du Y. Protein and peptide-based renal targeted drug delivery systems. J Control Release 2024; 366:65-84. [PMID: 38145662 DOI: 10.1016/j.jconrel.2023.12.036] [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: 07/27/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 12/27/2023]
Abstract
Renal diseases have become an increasingly concerned public health problem in the world. Kidney-targeted drug delivery has profound transformative potential on increasing renal efficacy and reducing extra-renal toxicity. Protein and peptide-based kidney targeted drug delivery systems have garnered more and more attention due to its controllable synthesis, high biocompatibility and low immunogenicity. At the same time, the targeting methods based on protein/peptide are also abundant, including passive renal targeting based on macromolecular protein and active targeting mediated by renal targeting peptide. Here, we review the application and the drug loading strategy of different proteins or peptides in targeted drug delivery, including the ferritin family, albumin, low molecular weight protein (LMWP), different peptide sequence and antibodies. In addition, we summarized the factors influencing passive and active targeting in drug delivery system, the main receptors related to active targeting in different kidney diseases, and a variety of nano forms of proteins based on the controllable synthesis of proteins.
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Affiliation(s)
- Jingyi Lu
- Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, Zhejiang 310014, China; College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China
| | - Xiaoling Xu
- College of Medical Sciences, Zhejiang Shuren University, 8 Shuren Street, Hangzhou, Zhejiang 310015, China.
| | - Xuanrong Sun
- Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, Zhejiang 310014, China.
| | - Yongzhong Du
- Collaborative Innovation Center of Yangtza River Delta Region Green Pharmaceuticals, Zhejiang University of Technology, 18 Chaowang Road, Hangzhou, Zhejiang 310014, China; College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou, Zhejiang 310058, China; Innovation Center of Translational Pharmacy, Jinhua Institute of Zhejiang University, Jinhua 321299, China.
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10
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Pevzner IB, Brezgunova AA, Popkov VA, Sintsov MY, Andrianova NV, Zorova LD, Silachev DN, Burov AA, Podurovskaya YL, Zorov DB, Plotnikov EY, Sukhikh GT. The effects of antibiotic therapy on neonatal sepsis-associated acute kidney injury. Life Sci 2024; 338:122359. [PMID: 38135115 DOI: 10.1016/j.lfs.2023.122359] [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: 08/24/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
AIM Neonatal sepsis remains one of the most dangerous conditions in the neonatal intensive care units. One of the organs affected by sepsis is the kidney, making acute kidney injury (AKI) a common complication of sepsis. Treatment of sepsis almost always involves antibiotic therapy, which by itself may cause some adverse effects, including nephrotoxicity. We analyzed the mutual effect of antibiotic therapy and sepsis on AKI in an experimental and clinical study in infants and neonatal rats. MATERIALS AND METHODS We evaluated the influence of therapy with different antibiotics on the appearance of AKI markers (blood urea nitrogen (BUN), neutrophil gelatinase-associated lipocalin (NGAL), clusterin, interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), monocyte chemoattractant protein 1 (MCP-1), calbindin, glutation-S-transferase subtype π (GST-π)) and liver injury markers in newborns with or without clinical signs of sepsis in the intensive care unit. In parallel, we analyzed the development of AKI in experimental lipopolysaccharide (LPS)-induced systemic inflammation in newborn rats accompanied by antibiotic therapy. KEY FINDINGS We showed that therapy with metronidazole or ampicillin in combination with sulbactam had a beneficial effect in children with suspected sepsis, resulting in a decrease in AKI markers levels. However, treatment of newborns with netilmicin, cefepime, linezolid, or imipenem in combination with cilastatin worsened kidney function in these patients. SIGNIFICANCE This prospective study indicates which antibiotics are preferable in neonatal sepsis and which should be used with caution in view of the risk of AKI development.
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Affiliation(s)
- Irina B Pevzner
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Anna A Brezgunova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia
| | - Vasily A Popkov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | | | - Nadezda V Andrianova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Ljubava D Zorova
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Denis N Silachev
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Artem A Burov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Yulia L Podurovskaya
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Dmitry B Zorov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Egor Y Plotnikov
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia.
| | - Gennady T Sukhikh
- V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
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Mongkolpathumrat P, Pikwong F, Phutiyothin C, Srisopar O, Chouyratchakarn W, Unnajak S, Nernpermpisooth N, Kumphune S. The secretory leukocyte protease inhibitor (SLPI) in pathophysiology of non-communicable diseases: Evidence from experimental studies to clinical applications. Heliyon 2024; 10:e24550. [PMID: 38312697 PMCID: PMC10835312 DOI: 10.1016/j.heliyon.2024.e24550] [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: 04/22/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Non-communicable diseases (NCDs) are a worldwide health issue because of their prevalence, negative impacts on human welfare, and economic costs. Protease enzymes play important roles in viral and NCD diseases. Slowing disease progression by inhibiting proteases using small-molecule inhibitors or endogenous inhibitory peptides appears to be crucial. Secretory leukocyte protease inhibitor (SLPI), an inflammatory serine protease inhibitor, maintains protease/antiprotease balance. SLPI is produced by host defense effector cells during inflammation to prevent proteolytic enzyme-induced tissue damage. The etiology of noncommunicable illnesses is linked to SLPI's immunomodulatory and tissue regeneration roles. Disease phases are associated with SLPI levels and activity changes in regional tissue and circulation. SLPI has been extensively evaluated in inflammation, but rarely in NCDs. Unfortunately, the thorough evaluation of SLPI's pathophysiological functions in NCDs in multiple research models has not been published elsewhere. In this review, data from PubMed from 2014 to 2023 was collected, analysed, and categorized into in vitro, in vivo, and clinical studies. According to the review, serine protease inhibitor (SLPI) activity control is linked to non-communicable diseases (NCDs) and other illnesses. Overexpression of the SLPI gene and protein may be a viable diagnostic and therapeutic target for non-communicable diseases (NCDs). SLPI is also cytoprotective, making it a unique treatment. These findings suggest that future research should focus on these pathways using advanced methods, reliable biomarkers, and therapy approaches to assess susceptibility and illness progression. Implications from this review will help pave the way for a new therapeutic target and diagnosis marker for non-communicable diseases.
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Affiliation(s)
- Podsawee Mongkolpathumrat
- Cardiovascular and Thoracic Technology Program, Chulabhorn International College of Medicine (CICM), Thammasat University (Rangsit Center), Pathumthani 12120, Thailand
| | - Faprathan Pikwong
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Mueang Chiang Mai District, Chiang Mai, 50200 Thailand
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Chayanisa Phutiyothin
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Mueang Chiang Mai District, Chiang Mai, 50200 Thailand
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Onnicha Srisopar
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Mueang Chiang Mai District, Chiang Mai, 50200 Thailand
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Wannapat Chouyratchakarn
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Mueang Chiang Mai District, Chiang Mai, 50200 Thailand
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Sasimanas Unnajak
- Department of Biochemistry, Faculty of Science, Kasetsart University, Bangkok, 10900 Thailand
| | - Nitirut Nernpermpisooth
- Department of Cardio-Thoracic Technology, Faculty of Allied Health Sciences, Naresuan University, Phitsanulok, 65000 Thailand
| | - Sarawut Kumphune
- Biomedical Engineering and Innovation Research Center, Chiang Mai University, Mueang Chiang Mai District, Chiang Mai, 50200 Thailand
- Biomedical Engineering Institute (BMEI), Chiang Mai University, Chiang Mai, 50200 Thailand
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12
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Musolino M, D’Agostino M, Zicarelli M, Andreucci M, Coppolino G, Bolignano D. Spice Up Your Kidney: A Review on the Effects of Capsaicin in Renal Physiology and Disease. Int J Mol Sci 2024; 25:791. [PMID: 38255865 PMCID: PMC10815060 DOI: 10.3390/ijms25020791] [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: 12/10/2023] [Revised: 12/31/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Capsaicin, the organic compound which attributes the spicy flavor and taste of red peppers and chili peppers, has been extensively studied for centuries as a potential natural remedy for the treatment of several illnesses. Indeed, this compound exerts well-known systemic pleiotropic effects and may thus bring important benefits against various pathological conditions like neuropathic pain, rhinitis, itching, or chronic inflammation. Yet, little is known about the possible biological activity of capsaicin at the kidney level, as this aspect has only been addressed by sparse experimental investigations. In this paper, we aimed to review the available evidence focusing specifically on the effects of capsaicin on renal physiology, as well as its potential benefits for the treatment of various kidney disorders. Capsaicin may indeed modulate various aspects of renal function and renal nervous activity. On the other hand, the observed experimental benefits in preventing acute kidney injury, slowing down the progression of diabetic and chronic kidney disease, ameliorating hypertension, and even delaying renal cancer growth may set the stage for future human trials of capsaicin administration as an adjuvant or preventive therapy for different, difficult-to-treat renal diseases.
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Affiliation(s)
- Michela Musolino
- Nephrology and Dialysis Unit, Magna Graecia University Hospital, 88100 Catanzaro, Italy; (M.M.); (M.D.); (M.A.); (G.C.)
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Mario D’Agostino
- Nephrology and Dialysis Unit, Magna Graecia University Hospital, 88100 Catanzaro, Italy; (M.M.); (M.D.); (M.A.); (G.C.)
| | | | - Michele Andreucci
- Nephrology and Dialysis Unit, Magna Graecia University Hospital, 88100 Catanzaro, Italy; (M.M.); (M.D.); (M.A.); (G.C.)
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Giuseppe Coppolino
- Nephrology and Dialysis Unit, Magna Graecia University Hospital, 88100 Catanzaro, Italy; (M.M.); (M.D.); (M.A.); (G.C.)
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Davide Bolignano
- Nephrology and Dialysis Unit, Magna Graecia University Hospital, 88100 Catanzaro, Italy; (M.M.); (M.D.); (M.A.); (G.C.)
- Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy
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13
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Ohlmeier C, Schuchhardt J, Bauer C, Brinker M, Kong SX, Scott C, Vaitsiakhovich T. Risk of chronic kidney disease in patients with acute kidney injury following a major surgery: a US claims database analysis. Clin Kidney J 2023; 16:2461-2471. [PMID: 38046015 PMCID: PMC10689184 DOI: 10.1093/ckj/sfad148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Acute kidney injury (AKI) is a common complication after major surgery. This study assessed the risk of developing or worsening of chronic kidney disease (CKD) and other clinical outcomes in patients experiencing AKI after major surgery. Methods This retrospective observational study used Optum's de-identified Clinformatics Data Mart Database to investigate cardiorenal outcomes in adult patients at the first AKI event following major surgery. The primary outcome was CKD stage ≥3; secondary outcomes included myocardial infarction (MI), stroke, heart failure, all-cause hospitalization, end-stage kidney disease, need for dialysis or kidney transplant and composite measures. Follow-up was up to 3 years. Additionally, the effect of intercurrent events on the risk of clinical outcomes was assessed. Results Of the included patients (N = 31 252), most were male (61.9%) and White (68.9%), with a median age of 72 years (interquartile range 64-79). The event rates were 25.5 events/100 patient-years (PY) for CKD stage ≥3, 3.1 events/100 PY for end-stage kidney disease, 3.0 events/100 PY for dialysis and 0.1 events/100 PY for kidney transplants. Additionally, there were 6.9 events/100 PY for MI, 8.7 events/100 PY for stroke and 49.8 events/100 PY for all-cause hospitalization during follow-up. Patients with AKI relapses as intercurrent events were more likely to develop CKD stage ≥3 than those with just one AKI event after major surgery. Conclusion This analysis demonstrated that patients experiencing AKI following major surgery are at high risk of developing severe CKD or worsening of pre-existing CKD and other cardiorenal clinical outcomes such as MI and stroke.
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Affiliation(s)
- Christoph Ohlmeier
- Medical Affairs & Pharmacovigilance, Pharmaceuticals, Bayer AG, Berlin, Germany
| | | | | | - Meike Brinker
- Research & Development, Pharmaceuticals, Bayer AG, Wuppertal, Germany
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14
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Yasrebi-de Kom IAR, Dongelmans DA, Abu-Hanna A, Schut MC, de Lange DW, van Roon EN, de Jonge E, Bouman CSC, de Keizer NF, Jager KJ, Klopotowska JE. Acute kidney injury associated with nephrotoxic drugs in critically ill patients: a multicenter cohort study using electronic health record data. Clin Kidney J 2023; 16:2549-2558. [PMID: 38045998 PMCID: PMC10689186 DOI: 10.1093/ckj/sfad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Indexed: 12/05/2023] Open
Abstract
Background Nephrotoxic drugs frequently cause acute kidney injury (AKI) in adult intensive care unit (ICU) patients. However, there is a lack of large pharmaco-epidemiological studies investigating the associations between drugs and AKI. Importantly, AKI risk factors may also be indications or contraindications for drugs and thereby confound the associations. Here, we aimed to estimate the associations between commonly administered (potentially) nephrotoxic drug groups and AKI in adult ICU patients whilst adjusting for confounding. Methods In this multicenter retrospective observational study, we included adult ICU admissions to 13 Dutch ICUs. We measured exposure to 44 predefined (potentially) nephrotoxic drug groups. The outcome was AKI during ICU admission. The association between each drug group and AKI was estimated using etiological cause-specific Cox proportional hazard models and adjusted for confounding. To facilitate an (independent) informed assessment of residual confounding, we manually identified drug group-specific confounders using a large drug knowledge database and existing literature. Results We included 92 616 ICU admissions, of which 13 492 developed AKI (15%). We found 14 drug groups to be associated with a higher hazard of AKI after adjustment for confounding. These groups included established (e.g. aminoglycosides), less well established (e.g. opioids) and controversial (e.g. sympathomimetics with α- and β-effect) drugs. Conclusions The results confirm existing insights and provide new ones regarding drug associated AKI in adult ICU patients. These insights warrant caution and extra monitoring when prescribing nephrotoxic drugs in the ICU and indicate which drug groups require further investigation.
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Affiliation(s)
- Izak A R Yasrebi-de Kom
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Dave A Dongelmans
- Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
| | - Ameen Abu-Hanna
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martijn C Schut
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Laboratory Medicine, Amsterdam, The Netherlands
| | - Dylan W de Lange
- Department of Intensive Care and Dutch Poison Information Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eric N van Roon
- Department of Clinical Pharmacy and Pharmacology, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Evert de Jonge
- Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Catherine S C Bouman
- Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
| | - Nicolette F de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Kitty J Jager
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Joanna E Klopotowska
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
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15
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Chen X, Guo J, Mahmoud S, Vanga G, Liu T, Xu W, Xiong Y, Xiong W, Abdel-Razek O, Wang G. Regulatory roles of SP-A and exosomes in pneumonia-induced acute lung and kidney injuries. Front Immunol 2023; 14:1188023. [PMID: 37256132 PMCID: PMC10225506 DOI: 10.3389/fimmu.2023.1188023] [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: 03/16/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction Pneumonia-induced sepsis can cause multiple organ dysfunction including acute lung and kidney injury (ALI and AKI). Surfactant protein A (SP-A), a critical innate immune molecule, is expressed in the lung and kidney. Extracellular vesicles like exosomes are involved in the processes of pathophysiology. Here we tested one hypothesis that SP-A regulates pneumonia-induced AKI through the modulation of exosomes and cell death. Methods Wild-type (WT), SP-A knockout (KO), and humanized SP-A transgenic (hTG, lung-specific SP-A expression) mice were used in this study. Results After intratracheal infection with Pseudomonas aeruginosa, KO mice showed increased mortality, higher injury scores, more severe inflammation in the lung and kidney, and increased serum TNF-α, IL-1β, and IL-6 levels compared to WT and hTG mice. Infected hTG mice exhibited similar lung injury but more severe kidney injury than infected WT mice. Increased renal tubular apoptosis and pyroptosis in the kidney of KO mice were found when compared with WT and hTG mice. We found that serum exosomes from septic mice cause ALI and AKI through mediating apoptosis and proptosis when mice were injected intravenously. Furthermore, primary proximal tubular epithelial cells isolated from KO mice showed more sensitivity than those from WT mice after exposure to septic serum exosomes. Discussion Collectively, SP-A attenuates pneumonia-induced ALI and AKI by regulating inflammation, apoptosis and pyroptosis; serum exosomes are important mediators in the pathogenesis of AKI.
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Affiliation(s)
- Xinghua Chen
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
- Department of Nephrology, Wuhan University, Renmin Hospital, Wuhan, Hubei, China
| | - Junping Guo
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Salma Mahmoud
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Gautam Vanga
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Tianyi Liu
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Wanwen Xu
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Yunhe Xiong
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Weichuan Xiong
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Osama Abdel-Razek
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Guirong Wang
- Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, United States
- Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, NY, United States
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16
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Bravo-Santibáñez E, Hernández-González MA, López-Briones S, Contreras-Chávez M. [Association of neutrophil, lymphocyte, platelet ratio with acute kidney injury in sepsis]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:342-347. [PMID: 37216673 PMCID: PMC10441577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/30/2022] [Indexed: 05/24/2023]
Abstract
Background Acute kidney injury (AKI) is frequent in sepsis (25 to 51%), with high mortality (40 to 80%) and long-term complications. Despite its importance we do not have accessible markers in intensive care. In other entities (post-surgical and COVID-19) the neutrophil/lymphocyte and platelet (N/LP) ratio has been associated with acute kidney injury; however, this relationship has not been studied in a pathology with a severe inflammatory response such as sepsis. Objective To demonstrate the association between N/LP with AKI secondary to sepsis in intensive care. Material and methods Ambispective cohort study in patients over 18 years who were admitted to intensive care with a diagnosis of sepsis. The N/LP ratio was calculated from admission up to the seventh day and up to the diagnosis of AKI and outcome. Statistical analysis was performed with chi squared test, Cramer's V and multivariate logistic regression. Results Out of the 239 patients studied, the incidence of AKI developed in 70%. 80.9% of patients with N/LP ratio > 3 had AKI (p < 0.0001, Cramer's V 0.458, OR 3.05, 95% CI 1.602-5.8) and increased renal replacement therapy (21.1 vs. 11.1%, p = 0.043). Conclusion N/LP ratio > 3 has a moderate association with AKI secondary to sepsis in the intensive care unit.
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Affiliation(s)
- Edgar Bravo-Santibáñez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Departamento de Enseñanza. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Martha Alicia Hernández-González
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Departamento de Enseñanza. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Sergio López-Briones
- Universidad de Guanajuato, División Ciencias de la Salud, Laboratorio de Biología Molecular. León, Guanajuato, MéxicoUniversidad de GuanajuatoMéxico
| | - Marisol Contreras-Chávez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Unidad de Cuidados Intensivos. León, Guanajuato, MéxicoInstituto Mexicano del Seguro SocialMéxico
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Karaaslan T, Ayaloglu J, Kocaaslan C, Uysal O, Kuzgun GS, Odabas AR, Ecder ST, Ecder SA. Learning Curve for Temporary Hemodialysis Catheter Placement. Transplant Proc 2023:S0041-1345(23)00159-8. [PMID: 37088615 DOI: 10.1016/j.transproceed.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/05/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Training is essential for the safe and uncomplicated placement of hemodialysis catheters. This study explores the learning curve of this procedure. METHODS In this prospective study, 60 patients who needed emergency hemodialysis without vascular access were included. All catheters were placed under ultrasound guidance. One nephrologist was included in each two groups, one to be consisted of a junior, and one to be consisted of a senior. Learning curves were created using the cumulative total methodology and receiver operating characteristic curve analyses. RESULTS The patients' mean age was 67.92 ± 14.23 years. The mean catheter insertion time of the senior nephrologist was significantly shorter than that of the junior. According to cumulative total analysis, the junior group's maximum learning point overlaps with patient 22. When the confidence intervals of the study durations of both groups were examined, they overlapped in the 95% confidence interval starting from the 19th patient. When the mean catheter insertion time of the senior and the mean of the last 12 patients of the junior were compared, there was no significant difference between them (F = 15.827, P = .092). The receiver operating characteristic curve analysis showed a cutoff value of 320 seconds for the junior group compared with the senior group, indicating an overlap in case 22 for the junior nephrologist. CONCLUSION This study suggests that 22 catheter insertions under the supervision of a senior nephrologist are needed to complete the learning curve for a junior nephrologist. If the number of nephrologists at the center is limited, safe catheter insertion may be allowed after 19 insertions.
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Affiliation(s)
- Tahsin Karaaslan
- Department of Nephrology, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Jale Ayaloglu
- Department of Nephrology, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Cemal Kocaaslan
- Department of Cardiovascular Surgery, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Omer Uysal
- Department of Medical Statistics and Informatics, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey
| | - Gulsah Sasak Kuzgun
- Department of Nephrology, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Ali Rıza Odabas
- Department of Nephrology, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - S Tevfik Ecder
- Department of Nephrology, Istinye University Faculty of Medicine Vadi Liv Hospital, Istanbul, Turkey
| | - Sabahat Alisir Ecder
- Department of Nephrology, Medeniyet University, Goztepe Prof Dr Suleyman Yalcin City Hospital, Istanbul, Turkey
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Embaby EM, Saleh RM, Marghani BH, Barakat N, Awadin W, Elshal MF, Ali IS, Abu-Heakal N. The combined effect of zinc oxide nanoparticles and milrinone on acute renal ischemia/reperfusion injury in rats: Potential underlying mechanisms. Life Sci 2023; 323:121435. [PMID: 37068707 DOI: 10.1016/j.lfs.2023.121435] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/11/2023] [Accepted: 01/20/2023] [Indexed: 04/19/2023]
Abstract
AIM To investigate the efficacy of zinc oxide nanoparticles (ZnO-NPs) and/or milrinone (MIL) on renal ischemia/reperfusion injury (I/RI) in rats and their possible underlying mechanisms. MATERIALS AND METHODS Forty-eight adult male Sprague-Dawley albino rats were randomly assigned into six equal-sized groups (n = 8): normal control, sham-operated, I/R group (45 min/24 h), ZnO-NPs group (10 mg/Kg i.p.), MIL group (0.5 mg/Kg i.p.), and ZnO-NPs + MIL group in the same previous doses. KEY FINDINGS In comparison to the I/R-operated group, administration of either ZnO-NPs or MIL significantly decreased serum creatinine and urea concentrations, and renal vascular permeability (p < 0.05). The oxidative stress was significantly declined, as evidenced by increased GPx, CAT, and SOD activities and decreased MDA and NO concentrations. Renal expressions of TNF-α, NF-κB, KIM-1, NGAL, and caspase-3 decreased significantly, while Nrf2 increased significantly. Histopathology investigation revealed improvement with minimal renal lesions and fibrosis after ZnO-NPs or MIL treatments. The combined treatments synergistically improved the studied parameters more than either treatment alone. These findings were validated by molecular modeling, which revealed that MIL inhibited TNF-α, NF-kB, caspase-3, KIM-1 and NGAL. SIGNIFICANCE Both ZnO-NPs and MIL exerted cytoprotective effects against acute renal I/RI, and a combination of both was found to be even more effective. This renoprotective effect is suggested to be mediated through activation of Nrf2 and the prevention of the NF-κB activation-induced oxidative stress and inflammation, which may strengthen the potential role of ZnO-NPs or MIL in renal I/RI protection during surgical procedures.
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Affiliation(s)
- Eman M Embaby
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Rasha M Saleh
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Basma H Marghani
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt; Department of Biochemistry, Physiology and Pharmacology, Faculty of Veterinary Medicine, King Salman International University, Ras Sudr, South of Sinaa 46612, Egypt
| | - Nashwa Barakat
- Urology and Nephrology Center, Mansoura University, Mansoura 35516, Egypt
| | - Walaa Awadin
- Department of Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Mohamed F Elshal
- Molecular Biology Department, Genetic Engineering and Biotechnology Institute, University of Sadat City, Sadat City, Egypt
| | - Islam S Ali
- Basic Science Department, Delta University for Science and Technology, Gamasa, Dakahlia, Egypt
| | - Nabil Abu-Heakal
- Department of Physiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt
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Murphy RM, Dongelmans DA, Kom IYD, Calixto I, Abu-Hanna A, Jager KJ, de Keizer NF, Klopotowska JE. Drug-related causes attributed to acute kidney injury and their documentation in intensive care patients. J Crit Care 2023; 75:154292. [PMID: 36959015 DOI: 10.1016/j.jcrc.2023.154292] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE To investigate drug-related causes attributed to acute kidney injury (DAKI) and their documentation in patients admitted to the Intensive Care Unit (ICU). METHODS This study was conducted in an academic hospital in the Netherlands by reusing electronic health record (EHR) data of adult ICU admissions between November 2015 to January 2020. First, ICU admissions with acute kidney injury (AKI) stage 2 or 3 were identified. Subsequently, three modes of DAKI documentation in EHR were examined: diagnosis codes (structured data), allergy module (semi-structured data), and clinical notes (unstructured data). RESULTS n total 8124 ICU admissions were included, with 542 (6.7%) ICU admissions experiencing AKI stage 2 or 3. The ICU physicians deemed 102 of these AKI cases (18.8%) to be drug-related. These DAKI cases were all documented in the clinical notes (100%), one in allergy module (1%) and none via diagnosis codes. The clinical notes required the highest time investment to analyze. CONCLUSIONS Drug-related causes comprise a substantial part of AKI in the ICU patients. However, current unstructured DAKI documentation practice via clinical notes hampers our ability to gain better insights about DAKI occurrence. Therefore, both automating DAKI identification from the clinical notes and increasing structured DAKI documentation should be encouraged.
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Affiliation(s)
- Rachel M Murphy
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - Dave A Dongelmans
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Izak Yasrebi-de Kom
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands
| | - Iacer Calixto
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Methodology, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands
| | - Kitty J Jager
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam Public Health, Aging & Later Life, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Pulmonary hypertension & thrombosis, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Joanna E Klopotowska
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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Kim KN, Shin MK, Lim YH, Bae S, Kim JH, Hwang SS, Kim MJ, Oh J, Lim H, Choi J, Kwon HJ. Associations of cold exposure with hospital admission and mortality due to acute kidney injury: A nationwide time-series study in Korea. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 863:160960. [PMID: 36528107 DOI: 10.1016/j.scitotenv.2022.160960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/28/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Emerging evidence supports an association between heat exposure and acute kidney injury (AKI). However, there is a paucity of studies on the association between cold exposure and AKI. OBJECTIVE We aimed to investigate the associations of cold exposure with hospital admission and mortality due to AKI and to explore whether these associations were influenced by age and sex. METHODS Information on daily counts of hospital admission and mortality due to AKI in 16 regions of Korea during the cold seasons (2010-2019) was obtained from the National Health Insurance Service (a single national insurer providing universal health coverage) and Statistics Korea. Daily mean temperature and relative humidity were calculated from hourly data obtained from 94 monitoring systems operated by the Korean Meteorological Administration. Associations of low temperatures (<10th percentile of daily mean temperature) and cold spells (≥2 consecutive days with <5th percentile of daily mean temperature) up to 21 days with AKI were estimated using quasi-Poisson regression models adjusted for potential confounders (e.g., relative humidity and air pollutants) with distributed lag models and univariate meta-regression models. RESULTS Low temperatures were associated with hospital admission due to AKI [relative risk (RR) = 1.12, 95 % confidence interval (CI): 1.09, 1.16]. Cold spells were associated with hospital admission (RR = 1.87, 95 % CI: 1.46, 2.39) and mortality due to AKI (RR = 4.84, 95 % CI: 1.30, 17.98). These associations were stronger among individuals aged ≥65 years than among those aged <65 years. CONCLUSION Our results underscore the need for the general population, particularly the elderly, physicians, and other healthcare providers to be more vigilant to cold exposure, given the risk of AKI. Government agencies need to develop specific strategies for the prevention and early detection of cold exposure-related AKI.
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Affiliation(s)
- Kyoung-Nam Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Moon-Kyung Shin
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanghyuk Bae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Seung-Sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Mi-Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jongmin Oh
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyungryul Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jonghyuk Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
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Brezgunova AA, Andrianova NV, Popkov VA, Tkachev SY, Manskikh VN, Pevzner IB, Zorova LD, Timashev PS, Silachev DN, Zorov DB, Plotnikov EY. New experimental model of kidney injury: Photothrombosis-induced kidney ischemia. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166622. [PMID: 36526237 DOI: 10.1016/j.bbadis.2022.166622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/04/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Acute kidney injury (AKI) is a frequent pathology with a high mortality rate after even a single AKI episode and a great risk of chronic kidney disease (CKD) development. To get insight into mechanisms of the AKI pathogenesis, there is a need to develop diverse experimental models of the disease. Photothrombosis is a widely used method for inducing ischemia in the brain. In this study, for the first time, we described photothrombosis-induced kidney ischemia as an appropriate model of AKI and obtained comprehensive characteristics of the photothrombotic lesion using micro-computed tomography (micro-CT) and histological techniques. In the ischemic area, we observed destruction of tubules, the loss of brush border and nuclei, connective tissue fibers disorganization, leukocyte infiltration, and hyaline casts formation. In kidney tissue and urine, we revealed increased levels in markers of proliferation and injury. The explicit long-term consequence of photothrombosis-induced kidney ischemia was renal fibrosis. Thus, we establish a new low invasive experimental model of AKI, which provides a reproducible local ischemic injury lesion. We propose our model of photothrombosis-induced kidney ischemia as a useful approach for investigating AKI pathogenesis, studying the mechanisms of kidney regeneration, and development of therapy against AKI and CKD.
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Affiliation(s)
- Anna A Brezgunova
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, Moscow, Russia; A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Nadezda V Andrianova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Vasily A Popkov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Sergey Y Tkachev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Vasily N Manskikh
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia
| | - Irina B Pevzner
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Ljubava D Zorova
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Peter S Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Denis N Silachev
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia
| | - Dmitry B Zorov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia.
| | - Egor Y Plotnikov
- A.N. Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, Russia; V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Moscow, Russia.
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22
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Enevoldsen FC, Christiansen CF, Jensen SK. Twenty-Three-Year Trends in the Use of Potentially Nephrotoxic Drugs in Denmark. Clin Epidemiol 2023; 15:275-287. [PMID: 36915868 PMCID: PMC10008004 DOI: 10.2147/clep.s397415] [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: 11/13/2022] [Accepted: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
Background The occurrence of acute and chronic kidney diseases has been rising in the last decades. Although drug use is a common risk factor for impaired kidney function, changes in utilization of potential nephrotoxic drugs have received little attention. Purpose To describe temporal trends in the utilization of potentially nephrotoxic drugs in Denmark between 1999 and 2021. Methods Specific drugs known or suspected to be nephrotoxic were identified in the literature. Data on the sold defined daily doses (DDDs) of potentially nephrotoxic drugs between 1999 and 2021 were retrieved using the Danish Register of Medical Product Statistics. Trends in sales of DDDs per 1000 inhabitants per day were tabulated and illustrated graphically. Results From 1999 to 2021, the total sale of all selected drugs increased from 286 to 457 DDDs per 1000 inhabitants per day. The overall sale reached a preliminary peak in 2012 with 449 DDDs per 1000 inhabitants per day and remained relatively stable thereafter until reaching an all-time high in 2021 with 457 DDDs per 1000 inhabitants per day. Contributing with the majority in volume, sales of drugs inhibiting the renin-angiotensin-aldosterone system (RAAS) increased dramatically throughout the period. The same was observed for acetaminophen, methotrexate, tacrolimus, and iodinated contrast dye. In contrast, the sales of diuretics, acetylsalicylic acid, and ciclosporin decreased during the last decade of the study period. Conclusion From 1999-2021 considerable changes in sales of potentially nephrotoxic drugs were observed. In general, the sales increased, in volume predominated by RAAS inhibiting drugs. This increase in sales of potential nephrotoxins could contribute to an increasing occurrence of kidney diseases.
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Affiliation(s)
| | - Christian Fynbo Christiansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Simon Kok Jensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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23
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Stergiannis P, Christoforaki M, Platis C, Lahana E, Oikonomou AN, Intas G. Assessment of Burden in Family Caregivers of Chronic Hemodialysis and Peritoneal Dialysis Patients During the Pandemic Period of COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1425:283-290. [PMID: 37581802 DOI: 10.1007/978-3-031-31986-0_27] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
INTRODUCTION In Greece, patients undergoing hemodialysis (HD) usually go to dialysis centers two or three times a week for three/four hours per session because the treatment for home is unavailable; therefore, caregivers should perform supportive transportation and care functions. PURPOSE This study was designed to assess the burden and quality of life in caregivers of patients undergoing hemodialysis and peritoneal dialysis (PD) and to record their attitude toward Coronavirus Disease-2019 (COVID-19). METHODOLOGY We studied caregivers of patients undergoing hemodialysis and peritoneal dialysis. A total of 80 caregivers took part (30 caregivers of patients of PD and 50 caregivers of patients of HD). The final form of the questionnaire was based on the Quality-of-Life Scale (SF-12) and the Zarit Scale, in order to record the scale of burden and the effect on them throughout the process. The Fear Due to COVID-19 Scale (FCV-19S) contributed to recording the caregivers' fear toward the pandemic of COVID-19. RESULTS Most of the caregivers were women with an average age of about 60 years and 6-10 were the patient's wife or partners. The prevalence of the moderate or severe burden of the patients was found at 18.7%, and the few or no burden at all at 33.8%. The prevalence of fear toward COVID-19 was at very high levels, reaching 82.5% in all caregivers. CONCLUSIONS During the pandemic period of COVID-19, the role of the caregivers of the patients, both who follow the PD method and those who have joined the HD, is particularly important. Their quality of life has been partially affected in all dimensions.
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Affiliation(s)
- Pantelis Stergiannis
- Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | - George Intas
- General Hospital of Nikaia "Agios Panteleimon", Nikaia, Greece
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24
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Al-Yassiri AK, Hadi NR, Altemimi M, Qassam H, Hameed AMA. NEPHROPROTECTIVE EFFECT OF OLMESARTAN ON RENAL ISCHEMIA REPERFUSION INJURY IN MALE RATS: THE ROLE OF NRF2/HO-1 SIGNALING PATHWAY. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2791-2803. [PMID: 36591770 DOI: 10.36740/wlek202211213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim: To investigate the Nephroprotective potential of Olmesartan in RIRI via modulation of the Nrf2/OH-1 signaling pathway. PATIENTS AND METHODS Materials and methods: Thirty male rats were equally divided into four groups. The sham group was exposed to surgical conditions without induction of RIRI. The control group was exposed to ischemia by clamping the renal pedicles for 30 min, followed by 2h of blood restoration. The vehicle-treated group was received dimethyl sulfoxide (DMSO) by intraperitoneal injection (IP) 30 min before clamping. RESULTS Results: Olmesartan-treated group was pretreated with Olmesartan a dose of 10 mg/kg IP; 30 min prior to induction of ischemia. Following 30 min of ischemia, the clamps were released and allowed to the reperfusion for 2 h. Blood samples were collected to examine the levels of serum urea and creatinine. Kidney tissue was used to measure the levels of cytokines (TNFα, IL6, MCP, BAX, BCL2 and isoprostane F2. Immunohistochemistry was used to assess the levels of Nrf2 and HO-1. Histological analyses were used to detect the tubular damage in the kidney. CONCLUSION Conclusions: The results showed that Olmesartan alleviates renal tissue damage through activating the antioxidant effect mediated by Nrf2 signaling.
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Affiliation(s)
- Alaa K Al-Yassiri
- DEPARTMENT OF PHARMACOLOGY & THERAPEUTICS, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Najah R Hadi
- DEPARTMENT OF PHARMACOLOGY & THERAPEUTICS, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Murooj Altemimi
- DEPARTMENT OF PHARMACOLOGY & THERAPEUTICS, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Heider Qassam
- DEPARTMENT OF PHARMACOLOGY & THERAPEUTICS, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
| | - Ahmed M Abdul Hameed
- DEPARTMENT OF PHARMACOLOGY & THERAPEUTICS, FACULTY OF MEDICINE, UNIVERSITY OF KUFA, NAJAF, IRAQ
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25
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Peng X, Chen S, Wang Y, Jin M, Mei F, Bao Y, Liao X, Chen Y, Gong W. SGLT2i reduces renal injury by improving mitochondrial metabolism and biogenesis. Mol Metab 2022:101613. [PMID: 36241142 DOI: 10.1016/j.molmet.2022.101613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Despite advances in treatment, an effective therapeutic strategy for acute kidney injury (AKI) is still lacking. Considering the widely reported clinical benefits of canagliflozin in the kidneys, we assessed the effects of canagliflozin on AKI. METHODS Lipopolysaccharide was used to induce AKI in the presence of canagliflozin. RESULTS Canagliflozin treatment reduced blood urea nitrogen and serum creatinine levels and improved the renal tubular structure in mice with lipopolysaccharide-induced septic AKI. Canagliflozin also suppressed the inflammatory response, oxidative stress and tubular cell death in the kidneys during septic AKI. In vitro, canagliflozin supplementation maintained mitochondrial function in lipopolysaccharide-treated HK-2 cells by restoring the mitochondrial membrane potential, inhibiting mitochondrial reactive oxygen species production and normalizing mitochondrial respiratory complex activity. In HK-2 cells, canagliflozin stimulated the adenosine monophosphate-activated protein kinase catalytic subunit alpha 1 (AMPKα1)/peroxisome proliferator-activated receptor-gamma coactivator 1 alpha (PGC1α)/nuclear respiratory factor 1 (NRF1) pathway, thus elevating the number of live and healthy mitochondria following lipopolysaccharide treatment. Inhibition of the AMPKα1/PGC1α/NRF1/mitochondrial biogenesis pathway abolished the protective effects of canagliflozin on renal cell mitochondria and tubular viability. Similarly, the protective effects of canagliflozin on kidney function and tubular structure were abrogated in AMPKα1-knockout mice. CONCLUSIONS Canagliflozin could be used to treat septic AKI by activating the AMPKα1/PGC1α/NRF1/mitochondrial biogenesis pathway.
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Affiliation(s)
- Xiaojie Peng
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; The Third School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China; Department of Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou city, Guangdong province, China
| | - Shuze Chen
- Department of Gastroenterology, Nanfang Hospital, Southern Medical University Guangzhou city, Guangdong province, China
| | - Ying Wang
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Ming Jin
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; Integrative Microecology Center, Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Fen Mei
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou city, Guangdong province, China
| | - Yun Bao
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou city, Guangdong province, China
| | - Xixian Liao
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou city, Guangdong province, China
| | - Ye Chen
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; Department of Gastroenterology, Nanfang Hospital, Southern Medical University Guangzhou city, Guangdong province, China; Integrative Microecology Center, Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China.
| | - Wei Gong
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China; The Third School of Clinical Medicine, Southern Medical University, Shenzhen, Guangdong, China.
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Li Q, Zhang Z, Yin M, Cui C, Zhang Y, Wang Y, Liu F. What do we actually know about exosomal microRNAs in kidney diseases? Front Physiol 2022; 13:941143. [PMID: 36105281 PMCID: PMC9464820 DOI: 10.3389/fphys.2022.941143] [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: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
There are several types of kidney diseases with complex causes. If left untreated, these diseases irreversibly progress to end-stage renal disease. Thus, their early diagnosis and targeted treatment are important. Exosomes—extracellular vesicles released by a variety of cells—are ideal carriers for DNA, RNA, proteins, and other metabolites owing to their bilayer membranes. Studies have shown that almost all renal cells can secrete exosomes. While research on exosomal microRNAs in the context of renal diseases begun only recently, rapid progress has been achieved. This review summarizes the changes in exosomal microRNA expression in different kidney diseases. Thus, it highlights the diagnostic and prognostic value of these exosomal microRNAs. Further, this review analyzes their roles in the development of different kidney diseases, guiding research on molecular mechanisms and therapeutic strategies.
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Affiliation(s)
- Qianyu Li
- Department of Nephrology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Zhiping Zhang
- Department of Nephrology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Min Yin
- Department of Nephrology, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Cancan Cui
- Clinical Laboratory, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Yucheng Zhang
- Scientific Research Center, China–Japan Union Hospital of Jilin University, Changchun, China
| | - Yali Wang
- Department of Blood Transfusion, China–Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Feng Liu, ; Yali Wang,
| | - Feng Liu
- Department of Nephrology, China–Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Feng Liu, ; Yali Wang,
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Expression of MicroRNAs in Sepsis-Related Organ Dysfunction: A Systematic Review. Int J Mol Sci 2022; 23:ijms23169354. [PMID: 36012630 PMCID: PMC9409129 DOI: 10.3390/ijms23169354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
Sepsis is a critical condition characterized by increased levels of pro-inflammatory cytokines and proliferating cells such as neutrophils and macrophages in response to microbial pathogens. Such processes lead to an abnormal inflammatory response and multi-organ failure. MicroRNAs (miRNA) are single-stranded non-coding RNAs with the function of gene regulation. This means that miRNAs are involved in multiple intracellular pathways and thus contribute to or inhibit inflammation. As a result, their variable expression in different tissues and organs may play a key role in regulating the pathophysiological events of sepsis. Thanks to this property, miRNAs may serve as potential diagnostic and prognostic biomarkers in such life-threatening events. In this narrative review, we collect the results of recent studies on the expression of miRNAs in heart, blood, lung, liver, brain, and kidney during sepsis and the molecular processes in which they are involved. In reviewing the literature, we find at least 122 miRNAs and signaling pathways involved in sepsis-related organ dysfunction. This may help clinicians to detect, prevent, and treat sepsis-related organ failures early, although further studies are needed to deepen the knowledge of their potential contribution.
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Li B, Huo Y, Zhang K, Chang L, Zhang H, Wang X, Li L, Hu Z. Development and validation of outcome prediction models for acute kidney injury patients undergoing continuous renal replacement therapy. Front Med (Lausanne) 2022; 9:853989. [PMID: 36059833 PMCID: PMC9433572 DOI: 10.3389/fmed.2022.853989] [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: 01/24/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Object This study aimed to develop and validate a set of practical predictive tools that reliably estimate the 28-day prognosis of acute kidney injury patients undergoing continuous renal replacement therapy. Methods The clinical data of acute kidney injury patients undergoing continuous renal replacement therapy were extracted from the Medical Information Mart for Intensive Care IV database with structured query language and used as the development cohort. An all-subset regression was used for the model screening. Predictive models were constructed via a logistic regression, and external validation of the models was performed using independent external data. Results Clinical prediction models were developed with clinical data from 1,148 patients and validated with data from 121 patients. The predictive model based on seven predictors (age, vasopressor use, red cell volume distribution width, lactate, white blood cell count, platelet count, and phosphate) exhibited good predictive performance, as indicated by a C-index of 0.812 in the development cohort, 0.811 in the internal validation cohort and 0.768 in the external validation cohort. Conclusions The model reliably predicted the 28-day prognosis of acute kidney injury patients undergoing continuous renal replacement therapy. The predictive items are readily available, and the web-based prognostic calculator (https://libo220284.shinyapps.io/DynNomapp/) can be used as an adjunctive tool to support the management of patients.
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Zhao YB, Wei W, Lin XX, Chai YF, Jin H. The Role of Histone H3 Methylation in Acute Kidney Injury. Drug Des Devel Ther 2022; 16:2453-2461. [PMID: 35941926 PMCID: PMC9356748 DOI: 10.2147/dddt.s376673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/27/2022] [Indexed: 12/28/2022] Open
Abstract
Acute kidney injury (AKI) is a clinical syndrome in which kidney function declines sharply due to various reasons. Although the morbidity and mortality of AKI are high, the mechanism of occurrence and development of AKI has not been fully elucidated, and precise prevention and treatment measures are lacking. Epigenetics is a branch of genetics that provides a new perspective to explore the pathophysiology of AKI and renal repair. A large amount of literature shows that the methylation mechanism of H3 in histones is closely related to the development of kidney diseases. The sorting out of histone H3 methylation mechanism in AKI and kidney repair can help understand the pathophysiological process of the disease more deeply. It may also provide new ideas for diagnosing and treating of the disease.
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Affiliation(s)
- Yi-Bo Zhao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China
| | - Wei Wei
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China
| | - Xiao-Xi Lin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China
| | - Yan-Fen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China
| | - Heng Jin
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China
- Correspondence: Heng Jin; Yan-Fen Chai, Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, People’s Republic of China, Email ;
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Inhibition of Homeobox D10 Alleviates Acute Kidney Injury by Upregulating PI3K/AKT Signaling Proteins. Cell Microbiol 2022. [DOI: 10.1155/2022/2955546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. To observe the protective effect of homeobox D10 (HOXD10) on acute kidney injury (AKI) by regulating PI3K/AKT signaling pathway is the purpose of this study.Methods. 30 rats were randomly divided into three groups: blank control group, model group, and HOXD10 interference group. The kidney function indexes, HOXD10 protein expression, histopathological features, tubulointerstitial injury, and PI3K and AKT protein expression levels of the three groups were analyzed. Results. Compared with the blank control group, the kidney weight, BUN and SCr in model group increased significantly, and TIL score was higher (
). The expression of HOXD10 in model group and HOXD10 interference group were higher than blank control group, and the expression of HOXD10 in HOXD10 interference group was lower than model group (
). After we administered HOXD10 blocker to AKI rats, pathological sections by HE staining showed that the kidney tissue damage was significantly reduced compared with the model group, and the expression levels of BUN and SCr in kidney tissue decreased, and the TIL score decreased. The expression of p-PI3K and p-AKT decreased after kidney injury. Compared with the model group, the phosphorylation levels of PI3K and AKT in HOXD10 interference group were significantly increased (
). Conclusion. Downregulation of HOXD10 can play a protective role on AKI by activating PI3K/AKT signaling pathway, which can reduce tubulointerstitial injury and improve kidney function.
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Wajda-Pokrontka M, Nadziakiewicz P, Krauchuk A, Ochman M, Zawadzki F, Przybyłowski P. Incidence and Perioperative Risk Factors of Acute Kidney Injury Among Lung Transplant Recipients. Transplant Proc 2022; 54:1120-1123. [PMID: 35422319 DOI: 10.1016/j.transproceed.2022.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant burden in an early postoperative period after lung transplantation (LT). The development of severe AKI, including a need for continuous renal replacement therapy (CRRT), is associated with increased mortality among lung transplant recipients. Evaluation of AKI incidence and predictive factors related to the development of severe AKI and with the use of CRRT in the early postoperative period after LT. METHODS Retrospective study of 73 consecutive patients after LT operated between 2015 and 2018 in our center. We noted the stage of AKI according to KDIGO guidelines in the 7 postoperative days. RESULTS We noted AKI among 62 lung transplant recipients (84.9%). We recognized the first and second stages of AKI in 21 patients (28.8%) and 19 patients 26%, respectively (group A). We identified severe AKI (group C) in 22 recipients (30.1%), 9 of whom needed CRRT postoperatively. There was a nonsignificant difference between groups in baseline serum creatinine (0.69 ± 0.22 mg/dL vs 0.84 ± 0.34; P = .073). Group C subjects statistically more often suffered from pulmonary hypertension (P < .001) and diabetes (P < .001). In both groups, the duration of the procedure was comparable, but, among patients with severe AKI, procedures were performed more often with the use of extracorporeal circulation (50% vs 68%; P = .194) CONCLUSIONS: Pulmonary hypertension and diabetes could be significant risk factors of high-grade AKI development after LT. Identification of factors modifying renal insufficiency development in lung transplant recipients needs further investigations.
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Affiliation(s)
- Marta Wajda-Pokrontka
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Paweł Nadziakiewicz
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alena Krauchuk
- Medical University of Silesia, Doctoral School, Katowice, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Fryderyk Zawadzki
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Medical University of Silesia, Katowice, Poland
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Therapeutic effect of quercetin polymeric nanoparticles on ischemia/reperfusion-induced acute kidney injury in mice. Biochem Biophys Res Commun 2022; 608:122-127. [PMID: 35397424 DOI: 10.1016/j.bbrc.2022.03.159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 11/22/2022]
Abstract
Acute kidney injury (AKI) is known as a sudden episode of kidney injury, which happens suddenly within a few hours or a few days. Quercetin (3,3',4',5,7-pentahydroxyflavone) is a flavonoid found in plants. Quercetin is known to have several biological activities, such as anti-oxidant, anti-inflammatory, and anti-carcinogenic effects. However, low water solubility and bioavailability are the limitations of quercetin for its clinical applications. Moreover, ischemia/reperfusion (I/R) injury is a common cause of AKI. There are no satisfactory strategies for I/R-induced AKI. Developing suitable preventive or therapeutic intervention for AKI is an important and urgent issue. We investigated the benefit effect of synthesized polyethylene glycol (PEG) conjugated polyethyleneimine (PEI) nanoparticles for targeted delivery of quercetin on AKI in a mouse model. An I/R-induced AKI mouse model was used to evaluate the therapeutic effect of quercetin polymeric nanoparticles by intravenous injection. Biochemical changes for renal function in blood samples were analyzed. Histological and immunohistochemical changes were also analyzed. The biochemical changes of blood urea nitrogen (BUN), creatinine, and cystatin C were significantly increased in I/R-induced AKI mice, which could be significantly reversed by quercetin polymeric nanoparticles. Quercetin polymeric nanoparticles could also significantly decrease the histological lesions, positive staining for 3-nitrotyrosine and cyclooxygenase-2, and lipid peroxidation in the kidneys of I/R-induced AKI mice. These results demonstrate for the first time that quercetin polymeric nanoparticles possess therapeutic potential for the treatment of I/R-induced AKI in vivo.
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Maragkos GA, Cho LD, Legome E, Wedderburn R, Margetis K. Prognostic Factors for Stage 3 Acute Kidney Injury in Isolated Serious Traumatic Brain Injury. World Neurosurg 2022; 161:e710-e722. [PMID: 35257954 DOI: 10.1016/j.wneu.2022.02.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stage 3 acute kidney injury (AKI) has been observed to develop following serious traumatic brain injury (TBI) and is associated with worse outcomes, though its incidence is not consistently established. This study aims to report the incidence of stage 3 AKI in serious isolated TBI in a large, national trauma database, and explore associated predictive factors. METHODS This was a retrospective cohort study using 2015-2018 data from the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP), a national database of trauma patients. Adult trauma patients admitted to the hospital with isolated serious TBI were included. Variables relating to demographics, comorbidities, vitals, hospital presentation, and course of stay were assessed. Imputed multivariable logistic regression assessed factors predictive of stage 3 AKI development. RESULTS A total of 342,675 patients with isolated serious TBI were included, 1,585 (0.5%) of whom developed stage 3 AKI. Variables associated with stage 3 AKI in multivariable analysis were older age, male sex, Black race, higher BMI, history of hypertension, diabetes, peripheral artery disease, chronic kidney disease, higher injury severity score, higher heart rate on arrival, lower oxygen saturation and motor Glasgow coma scale (GCS), admission to the intensive care unit (ICU) or operating room, development of catheter-associated urinary tract infections (CAUTI) or acute respiratory distress syndrome (ARDS), longer ICU stay and ventilation duration. CONCLUSIONS Stage 3 AKI occurred in 0.5% of serious TBI cases. Complications of ARDS and CAUTI are more likely to co-occur with stage 3 AKI in serious TBI patients.
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Affiliation(s)
- Georgios A Maragkos
- Department of Neurosurgery, Mount Sinai Morningside Hospital, Icahn School of Medicine, New York, NY
| | - Logan D Cho
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eric Legome
- Department of Emergency Medicine, Mount Sinai West and Mount Sinai Morningside Hospitals, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Raymond Wedderburn
- Department of Surgery, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Konstantinos Margetis
- Department of Neurosurgery, Mount Sinai Morningside Hospital, Icahn School of Medicine at Mount Sinai, New York, NY.
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Ghorbani F, Movassaghpour AA, Talebi M, Yousefi M, Abbaszadeh H. Renoprotective effects of extracellular vesicles: A systematic review. GENE REPORTS 2022. [DOI: 10.1016/j.genrep.2021.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sears SM, Dupre TV, Shah PP, Davis DL, Doll MA, Sharp CN, Vega AA, Megyesi J, Beverly LJ, Snider AJ, Obeid LM, Hannun YA, Siskind LJ. Neutral ceramidase deficiency protects against cisplatin-induced acute kidney injury. J Lipid Res 2022; 63:100179. [PMID: 35151662 PMCID: PMC8953688 DOI: 10.1016/j.jlr.2022.100179] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Cisplatin is a commonly used chemotherapeutic for the treatment of many solid organ cancers; however, its effectiveness is limited by the development of acute kidney injury (AKI) in 30% of patients. AKI is driven by proximal tubule cell death, leading to rapid decline in renal function. It has previously been shown that sphingolipid metabolism plays a role in regulating many of the biological processes involved in cisplatin-induced AKI. For example, neutral ceramidase (nCDase) is an enzyme responsible for converting ceramide into sphingosine, which is then phosphorylated to become sphingosine-1-phosphate, and our lab previously demonstrated that nCDase knockout (nCDase-/-) in mouse embryonic fibroblasts led to resistance to nutrient and energy deprivation-induced cell death via upregulation of autophagic flux. In this study, we further characterized the role of nCDase in AKI by demonstrating that nCDase-/- mice are resistant to cisplatin-induced AKI. nCDase-/- mice display improved kidney function, reduced injury and structural damage, lower rates of apoptosis, and less ER stress compared to wild-type mice following cisplatin treatment. Although the mechanism of protection is still unknown, we propose that it could be mediated by increased autophagy, as chloroquine treatment resensitized nCDase-/- mice to AKI development. Taken together, we conclude that nCDase may represent a novel target to prevent cisplatin-induced nephrotoxicity.
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Affiliation(s)
- Sophia M Sears
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA
| | - Tess V Dupre
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA
| | - Parag P Shah
- Department of Medicine, University of Louisville, Louisville, KY, USA; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Deanna L Davis
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA
| | - Mark A Doll
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA
| | - Cierra N Sharp
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA
| | - Alexis A Vega
- Department of Biochemistry & Molecular Genetics, University of Louisville, Louisville, KY, USA
| | - Judit Megyesi
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences and Central Arkansas, Veterans Healthcare System, Little Rock, AR, USA
| | - Levi J Beverly
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA; Department of Medicine, University of Louisville, Louisville, KY, USA; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Ashley J Snider
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, USA
| | - Lina M Obeid
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA; Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; Northport Veteran Affairs Medical Center, Northport, NY, USA
| | - Yusuf A Hannun
- Department of Medicine, Stony Brook University, Stony Brook, NY, USA; Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA; Northport Veteran Affairs Medical Center, Northport, NY, USA
| | - Leah J Siskind
- Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY, USA; James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA.
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Wehedy E, Shatat IF, Al Khodor S. The Human Microbiome in Chronic Kidney Disease: A Double-Edged Sword. Front Med (Lausanne) 2022; 8:790783. [PMID: 35111779 PMCID: PMC8801809 DOI: 10.3389/fmed.2021.790783] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/20/2021] [Indexed: 12/13/2022] Open
Abstract
Chronic kidney disease (CKD) is an increasing global health burden. Current treatments for CKD include therapeutics to target factors that contribute to CKD progression, including renin–angiotensin–aldosterone system inhibitors, and drugs to control blood pressure and proteinuria control. Recently, associations between chronic disease processes and the human microbiota and its metabolites have been demonstrated. Dysbiosis—a change in the microbial diversity—has been observed in patients with CKD. The relationship between CKD and dysbiosis is bidirectional; gut-derived metabolites and toxins affect the progression of CKD, and the uremic milieu affects the microbiota. The accumulation of microbial metabolites and toxins is linked to the loss of kidney functions and increased mortality risk, yet renoprotective metabolites such as short-chain fatty acids and bile acids help restore kidney functions and increase the survival rate in CKD patients. Specific dietary interventions to alter the gut microbiome could improve clinical outcomes in patients with CKD. Low-protein and high-fiber diets increase the abundance of bacteria that produce short-chain fatty acids and anti-inflammatory bacteria. Fluctuations in the urinary microbiome are linked to increased susceptibility to infection and antibiotic resistance. In this review, we describe the potential role of the gut, urinary and blood microbiome in CKD pathophysiology and assess the feasibility of modulating the gut microbiota as a therapeutic tool for treating CKD.
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Affiliation(s)
- Eman Wehedy
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Souhaila Al Khodor
- College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
- Research Department, Sidra Medicine, Doha, Qatar
- *Correspondence: Souhaila Al Khodor
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Ma M, Luo Q, Fan L, Li W, Li Q, Meng Y, Yun C, Wu H, Lu Y, Cui S, Liu F, Hu B, Guan B, Liu H, Huang S, Liang W, Morgera S, Krämer B, Luan S, Yin L, Hocher B. The urinary exosomes derived from premature infants attenuate cisplatin-induced acute kidney injury in mice via microRNA-30a-5p/ mitogen-activated protein kinase 8 (MAPK8). Bioengineered 2022; 13:1650-1665. [PMID: 35001794 PMCID: PMC8805886 DOI: 10.1080/21655979.2021.2021686] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/03/2021] [Indexed: 11/24/2022] Open
Abstract
Acute kidney injury (AKI) is a susceptible factor for chronic kidney disease (CKD). There is still a lack of effective prevention methods in clinical practice. This study investigated the protective effect of the urinary exosomes from premature infants on cisplatin-induced acute kidney injury. Here we isolated exosomes from the fresh urine of premature infants. A C57BL/6 mice model of cisplatin-induced acute kidney injury was given 100 ug urinary exosomes 24 hours after model establishment. The kidneys were collected for pathological examination and the evaluation of renal tubular damage and apoptosis. In the in vitro experiment, human renal cortex/proximal tubular cells (HK-2) were induced by cisplatin to assess the effect of the urine exosomes from premature infants. Exosome microRNA (miRNA) sequencing technology was applied to investigate the miRNAs enriched in exosomes and the dual-luciferase gene reporter system to examine the targeting relationship of the miRNA with target genes. The results indicated that the urinary exosomes could decrease the serum creatinine level and the apoptosis of renal tubular cells, and reduce mice mortality. In addition, miR-30a-5p was the most abundant miRNA in the exosomes. It protected HK-2 cells from cisplatin-induced apoptosis by targeting and down-regulating the mitogen-activated protein kinase 8 (MAPK8). Together, our findings identified that the urinary exosomes derived from premature infants alleviated cisplatin-induced acute kidney injury and inhibited the apoptosis of HK-2 via miR-30a-5p, which could target MAPK8. These findings implied that urinary exosomes from premature infants riched in miR-30a-5p might become a potential treatment for AKI.
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Affiliation(s)
- Mingming Ma
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Qiao Luo
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Lijing Fan
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Weilong Li
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Guangdong, China
| | - Qiang Li
- Department of Nephrology, Dongguan Hospital of Traditional Chinese Medicine, Dongguan, China
| | - Yu Meng
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Chen Yun
- Charité -Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Hongwei Wu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Charité -Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Yongping Lu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Charité -Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Shuang Cui
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Fanna Liu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Bo Hu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Baozhang Guan
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Huanhuan Liu
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Shengling Huang
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Wenxue Liang
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | | | - Bernhard Krämer
- Fifth Department of Medicine (Nephrology/endocrinology/rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Shaodong Luan
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Guangdong, China
| | - Lianghong Yin
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
| | - Berthold Hocher
- Institute of Nephrology and Blood Purification, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, China
- Charité -Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Fifth Department of Medicine (Nephrology/endocrinology/rheumatology), University Medical Centre Mannheim, University of Heidelberg, Heidelberg, Germany
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Wang J, Jiao P, Wei X, Zhou Y. Silencing Long Non-coding RNA Kcnq1ot1 Limits Acute Kidney Injury by Promoting miR-204-5p and Blocking the Activation of NLRP3 Inflammasome. Front Physiol 2021; 12:721524. [PMID: 34858199 PMCID: PMC8632456 DOI: 10.3389/fphys.2021.721524] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Acute kidney injury (AKI) is a critical clinical disease characterized by an acute decrease in renal function. Long non-coding RNAs (LncRNAs) are important in AKI. This study aimed to explore the mechanism of lncRNA Kcnq1ot1 in AKI by sponging microRNA (miR)-204-5p as a competitive endogenous RNA (ceRNA). AKI mouse model and hypoxia/reoxygenation (H/R) model of human kidney (HK) cells were established. Kcnq1ot1 expression, cell proliferation, and apoptosis were measured. Binding relations among Kcnq1ot1, miR-204-5p, and NLRP3 were verified. Pathological changes and cell apoptosis were detected. The results showed that Kcnq1ot1 was highly expressed in the AKI model in vivo and in vitro. Kcnq1ot1 knockdown promoted cell proliferation and prevented apoptosis and inflammation. Furthermore, Kcnq1ot1 inhibited miR-204-5p expression by competitively binding to miR-204-5p in HK-2 cells. miR-204-5p targeted NLRP3 and NLRP3 overexpression averted the inhibiting effect of miR-204-5p on apoptosis and inflammation in HK-2 cells in vitro. Kcnq1ot1 knockdown in vivo promoted miR-204-5p expression, inhibited NLRP3 inflammasome activation, reduced levels of SCr, BUN, and KIM-1, and thus alleviated AKI and reduced apoptosis. In summary, silencing lncRNA Kcnq1ot1 inhibited AKI by promoting miR-204-5p and inhibiting NLRP3 inflammasome activation.
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Affiliation(s)
- JunTao Wang
- Department of Nephrology, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Peng Jiao
- Department of Emergency, The First People's Hospital of Shangqiu, Shangqiu, China
| | - XiaoYing Wei
- Department of Nephrology, The First People's Hospital of Shangqiu, Shangqiu, China
| | - Yun Zhou
- Institute of Nephrology Eastern Theater General Hospital, Nanjing, China
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Utility of bedside ultrasound derived hepatic and renal parenchymal flow patterns to guide management of acute kidney injury. Curr Opin Crit Care 2021; 27:587-592. [PMID: 34636777 DOI: 10.1097/mcc.0000000000000899] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Ideal fluid management of critically ill patients is maintaining an adequate perfusion pressure but avoiding venous congestion. Venous excess ultrasound score (VExUS) quantifies venous congestion to guide the management of fluid balance. RECENT FINDINGS VExUS of abdominal veins measures fluid tolerance and helps clinicians avoid congestion. VExUS scoring predicts the development of acute kidney injury (AKI) that is a common hospital problem resulting in higher mortality and morbidity. VExUS can predict patients at risk of developing AKI post cardiac surgery. VExUS has been associated with an increase in adverse outcomes in a general intensive care population. Hepatic vein ultrasound can manifest as a sequela of right heart failure and pulmonary hypertension. Intrarenal congestion suggests poorer prognosis in heart failure patients. VExUS score has been used in decision-making to remove fluid in patients with cardiorenal syndrome. VExUS scoring may help curtail overly aggressive fluid resuscitation for patients with septic shock and help avoid iatrogenic 'salt water drowning'. SUMMARY We summarize the technique and clinical practice of VExUS to help guide fluid balance across different populations of critically ill patients.
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Biomarkers of persistent renal vulnerability after acute kidney injury recovery. Sci Rep 2021; 11:21183. [PMID: 34707157 PMCID: PMC8551194 DOI: 10.1038/s41598-021-00710-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/18/2021] [Indexed: 02/01/2023] Open
Abstract
Acute kidney injury (AKI) is a risk factor for new AKI episodes, chronic kidney disease, cardiovascular events and death, as renal repair may be deficient and maladaptive, and activate proinflammatory and profibrotic signals. AKI and AKI recovery definitions are based on changes in plasma creatinine, a parameter mostly associated to glomerular filtration, but largely uncoupled from renal tissue damage. The evolution of structural and functional repair has been incompletely described. We thus aimed at identifying subclinical sequelae persisting after recovery from cisplatin-induced AKI in rats. Compared to controls, after plasma creatinine recovery, post-AKI kidneys showed histological alterations and attendant susceptibility to new AKI episodes. Tubular function (assessed by the furosemide stress test, FST) also remained affected. Lingering parenchymal and functional subclinical alterations were paralleled by tapering, but abnormally high levels of urinary albumin, transferrin, insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and, especially, the [TIMP-2]*[IGFBP7] product. As subclinical surrogates of incomplete renal recovery, the FST and the urinary [TIMP-2]*[IGFBP7] product provide two potential diagnostic tools to monitor the sequelae and kidney vulnerability after the apparent recovery from AKI.
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Gao X, Han L, Yao X, Ma L. Gremlin1 and TGF-β1 protect kidney tubular epithelial cells from ischemia-reperfusion injury through different pathways. Int Urol Nephrol 2021; 54:1311-1321. [PMID: 34633599 DOI: 10.1007/s11255-021-03010-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 10/04/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Gremlin1 belongs to the superfamily members of transforming growth factor (TGF)-β1, playing a profibrotic role in chronic kidney diseases (CKD) and the transition from the late stage of acute kidney injury (AKI) to CKD, but the effect it plays in the early stage of AKI is unclear. This study aimed to investigate the role of Gremlin1on apoptosis in renal tubular epithelial cells under ischemia-reperfusion (I/R) induction. METHODS We detected Gremlin1 and TGF-β1 expression in the kidneys of mice undergoing renal ischemia-reperfusion injury bilaterally. We induced apoptosis through depletion and reperfusion of oxygen and serum in human kidney tubular epithelial cells (HKCs), mimicking I/R injury in vivo, and detected the role and pathways of Gremlin1 and TGF-β1on HKCs injury. RESULTS Mice undergoing bilateral I/R surgery presented AKI with a significant increase in serum creatinine, obvious renal tubular injuries, and increased macrophage cell and T-cell infiltration in interstitial areas. Gremlin1 expression was significantly increased along with TGF-β1 in the kidneys of AKI mice compared to sham mice. Exogenous Gremlin1 inhibited I/R-induced caspase3 expression in HKCs, which was blocked by a VEGFR2 kinase inhibitor III (SU5416). TGF-β1 also inhibited I/R-induced cell apoptosis in HKCs but had no synergic effect with Gremlin1. The TGF-β1's inhibitory effect could be blocked by the TGF-β1 type I receptor (activin receptor-like kinase 5, and ALK5)-specific inhibitor SB431542. CONCLUSIONS Gremlin1 and TGF- β1 protect kidney tubular epithelial cells from ischemia-reperfusion-induced apoptosis through VEGFR2 and Smad2 signaling pathways.
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Affiliation(s)
- Xuxia Gao
- Department of General Internal Medicine, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chao Yang District, Beijing, 100029, People's Republic of China.
| | - Liyuan Han
- Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinbao Yao
- Department of Pharmaceutical Affairs, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liping Ma
- Department of General Internal Medicine, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chao Yang District, Beijing, 100029, People's Republic of China.
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Mortality Prediction in Patients with Severe Acute Kidney Injury Requiring Renal Replacement Therapy. MEDICINA-LITHUANIA 2021; 57:medicina57101076. [PMID: 34684113 PMCID: PMC8537734 DOI: 10.3390/medicina57101076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 10/05/2021] [Indexed: 01/18/2023]
Abstract
Background and Objective: Acute kidney injury (AKI) remains a serious health condition around the world, and is related to high morbidity, mortality, longer hospitalization duration and worse long-term outcomes. The aim of our study was to estimate the significant related factors for poor outcomes of patients with severe AKI requiring renal replacement therapy (RRT). Materials and Methods: We retrospectively analyzed data from patients (n = 573) with severe AKI requiring RRT within a 5-year period and analyzed the outcomes on discharge from the hospital. We also compared the clinical data of the surviving and non-surviving patients and examined possible related factors for poor patient outcomes. Logistic regression was used to analyze the odds ratio for patient mortality and its related factors. Results: In 32.5% (n = 186) of the patients, the renal function improved and RRT was stopped, 51.7% (n = 296) of the patients died, and 15.9% (n = 91) of the patients remained dialysis-dependent on the day of discharge from the hospital. During the period of 5 years, the outcomes of the investigated patients did not change statistically significantly. Administration of vasopressors, aminoglycosides, sepsis, pulmonary edema, oliguria, artificial pulmonary ventilation (APV), patient age ≥ 65 y, renal cause of AKI, AKI after cardiac surgery, a combination of two or more RRT methods, dysfunction of three or more organs, systolic blood pressure (BP) ≤ 120 mmHg, diastolic BP ≤ 65 mmHg, and Sequential Organ Failure Assessment (SOFA) score on the day of the first RRT procedure ≥ 7.5 were related factors for lethal patient outcome. Conclusions: The mortality rate among patients with severe AKI requiring RRT is very high—52%. Patient death was significantly predicted by the causes of AKI (sepsis, cardiac surgery), clinical course (oliguria, pulmonary edema, hypotension, acidosis, lesion of other organs) and the need for a continuous renal replacement therapy.
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Ding C, Hu T. Development and External Verification of a Nomogram for Patients with Persistent Acute Kidney Injury in the Intensive Care Unit. Int J Gen Med 2021; 14:5005-5015. [PMID: 34511984 PMCID: PMC8412828 DOI: 10.2147/ijgm.s325904] [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: 06/25/2021] [Accepted: 08/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background We aimed to identify the affecting features of persistent acute kidney injury (pAKI) for patients in intensive care units (ICU). Methods The Medical Information Mart for Intensive Care IV (MIMIC-IV) database and eICU Collaborative Research Database (eICU-CRD) were used to identify AKI patients with and without duration of more than 48 hours. Least absolute shrinkage and selection operator (LASSO) regression and support vector machine (SVM-RFE) were utilized to screen for the significant clinical indexes associated with pAKI. Predictive nomogram was created based on the above informative parameters to predict the probability of pAKI. Results LASSO regression and SVM-RFE revealed that serum albumin, chronic kidney disease, AKI stage, sequential organ failure assessment score, lactate and renal replacement therapy during the first day were significantly associated with pAKI in the training cohort. The predictive nomogram based on the six predictors exhibited good predictive performance as calculated by C-index 0.730 (95% CI 0.710-0.749) in the training group, 0.702 (95% CI 0.672-0.722) in the internal validation set and 0.704 (0.677-0.731) in the external validation cohort for the prediction of pAKI. Moreover, the predictive nomogram exhibited not only encouraging calibration ability, but also great clinical utility in the training group, in the internal validation group as well as in the external validation cohort. Conclusion Serum albumin, CKD, AKI stage, SOFA score, lactate, RRT during the first day were closely associated with pAKI in patients in ICU. The predictive nomogram for pAKI manifested good predictive ability for the identification of ICU patients with pAKI.
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Affiliation(s)
- Chao Ding
- Department of Hematology, Suining Central Hospital, An Affiliated Hospital of Chongqing Medical University, Suining, Sichuan Province, People's Republic of China
| | - Tianyang Hu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
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Ying F, Chen S, Pan G, He Z. Artificial Intelligence Pulse Coupled Neural Network Algorithm in the Diagnosis and Treatment of Severe Sepsis Complicated with Acute Kidney Injury under Ultrasound Image. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6761364. [PMID: 34336164 PMCID: PMC8315850 DOI: 10.1155/2021/6761364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/17/2022]
Abstract
The objective of this study was to explore the diagnosis of severe sepsis complicated with acute kidney injury (AKI) by ultrasonic image information based on the artificial intelligence pulse coupled neural network (PCNN) algorithm. In this study, an algorithm of ultrasonic image information enhancement based on the artificial intelligence PCNN was constructed and compared with the histogram equalization algorithm and linear transformation algorithm. After that, it was applied to the ultrasonic image diagnosis of 20 cases of severe sepsis combined with AKI in hospital. The condition of each patient was diagnosed by ultrasound image performance, change of renal resistance index (RRI), ultrasound score, and receiver operator characteristic curve (ROC) analysis. It was found that the histogram distribution of this algorithm was relatively uniform, and the information of each gray level was obviously retained and enhanced, which had the best effect in this algorithm; there was a marked individual difference in the values of RRI. Overall, the values of RRI showed a slight upward trend after admission to the intensive care unit (ICU). The RRI was taken as the dependent variable, time as the fixed-effect model, and patients as the random effect; the parameter value of time was between 0.012 and 0.015, p=0.000 < 0.05. Besides, there was no huge difference in the ultrasonic score among different time measurements (t = 1.348 and p=0.128 > 0.05). The area under the ROC curve of the RRI for the diagnosis of AKI at the 2nd day, 4th day, and 6th day was 0.758, 0.841, and 0.856, respectively, which was all greater than 0.5 (p < 0.05). In conclusion, the proposed algorithm in this study could significantly enhance the amount of information in ultrasound images. In addition, the change of RRI values measured by ultrasound images based on the artificial intelligence PCNN was associated with AKI.
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Affiliation(s)
- Fu Ying
- Department of Emergency Medicine, Changzhou Cancer Hospital, Changzhou 213000, Jiangsu, China
| | - Shuhua Chen
- Department of Intensive Care Unit, Changzhou Cancer Hospital, Changzhou 213000, Jiangsu, China
| | - Guojun Pan
- Department of Intensive Care Unit, Changzhou Cancer Hospital, Changzhou 213000, Jiangsu, China
| | - Zemin He
- Department of Emergency Medicine, Changzhou Cancer Hospital, Changzhou 213000, Jiangsu, China
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Viñas JL, Spence M, Porter CJ, Douvris A, Gutsol A, Zimpelmann JA, Campbell PA, Burns KD. micro-RNA-486-5p protects against kidney ischemic injury and modifies the apoptotic transcriptome in proximal tubules. Kidney Int 2021; 100:597-612. [PMID: 34181969 DOI: 10.1016/j.kint.2021.05.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 02/08/2023]
Abstract
Acute kidney injury (AKI) carries high morbidity and mortality, and effective treatments are lacking. Preclinical models support involvement of micro-RNAs (miRs) in AKI pathogenesis, although effects on the kidney transcriptome are unclear. We previously showed that injection of cord blood endothelial colony forming cell-derived exosomes, enriched in miR-486-5p, prevented ischemic AKI in mice. To further define this, we studied direct effects of miR-486-5p in mice with kidney ischemia-reperfusion injury. RNA-Seq was used to compare the impact of miR-486-5p and exosomes on the transcriptome of proximal tubules and kidney endothelial cells 24 hours after ischemia-reperfusion. In mice with AKI, injection of miR-486-5p mimic increased its levels in proximal tubules and endothelial cells, and improved plasma creatinine, histological injury, neutrophil infiltration, and apoptosis. Additionally, miR-486-5p inhibited expression of its target phosphatase and tensin homolog, and activated protein kinase B. In proximal tubules, miR-486-5p or exosomes reduced expression of genes associated with ischemic injury and the tumor necrosis factor (TNF) pathway, and altered distinct apoptotic genes. In endothelial cells, genes associated with metabolic processes were altered by miR-486-5p or exosomes, although TNF pathway genes were not affected. Thus, our results suggest that miR-486-5p may have therapeutic potential in AKI.
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Affiliation(s)
- Jose L Viñas
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew Spence
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher J Porter
- Ottawa Bioinformatics Core Facility, the Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Adrianna Douvris
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alex Gutsol
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph A Zimpelmann
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pearl A Campbell
- Regenerative Medicine Program, the Sprott Centre for Stem Cell Research, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
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Hu Y, Zhou J, Cao Q, Wang H, Yang Y, Xiong Y, Zhou Q. Utilization of Echocardiography After Acute Kidney Injury Was Associated with Improved Outcomes in Patients in Intensive Care Unit. Int J Gen Med 2021; 14:2205-2213. [PMID: 34113152 PMCID: PMC8183456 DOI: 10.2147/ijgm.s310445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to investigate the association between usage of transthoracic echocardiography (TTE) within 24 hours after acute kidney injury (AKI) and the prognosis of patients in intensive care unit (ICU). Methods The Medical Information Mart for Intensive Care III (MIMIC-III) database was used to identify AKI patients with and without TTE administration. The primary outcome was 28-day mortality. Multivariable regression was used to clarify the association between TTE and clinical outcomes and propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to validate our findings. Results Among 23,945 eligible AKI patients, 3361 patients who received TTE and 3361 who did not conduct TTE had similar propensity scores which were included in this study. After matching, the TTE group had a significantly lower 28-day mortality (OR 0.80, 95% CI 0.72–0.88, P<0.001). Patients in the TTE group received more fluid on day 1 and day 2 and had a more urine volume on day 1 and day 3, and the reduction in serum creatinine was greater than that in the no TTE group. The mediating effect of creatinine reduction was remarkable for the whole cohort (P=0.02 for the average causal mediation effect). Conclusion TTE utilization was associated with decreased risk-adjusted 28-day mortality for AKI patients in ICU and was proportionally mediated through creatinine reduction.
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Affiliation(s)
- Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Jia Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Ye Xiong
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430061, People's Republic of China
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Dahlerus C, Segal JH, He K, Wu W, Chen S, Shearon TH, Sun Y, Pearson A, Li X, Messana JM. Acute Kidney Injury Requiring Dialysis and Incident Dialysis Patient Outcomes in US Outpatient Dialysis Facilities. Clin J Am Soc Nephrol 2021; 16:853-861. [PMID: 34045300 PMCID: PMC8216606 DOI: 10.2215/cjn.18311120] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/23/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES About 30% of patients with AKI may require ongoing dialysis in the outpatient setting after hospital discharge. A 2017 Centers for Medicare & Medicaid Services policy change allows Medicare beneficiaries with AKI requiring dialysis to receive outpatient treatment in dialysis facilities. Outcomes for these patients have not been reported. We compare patient characteristics and mortality among patients with AKI requiring dialysis and patients without AKI requiring incident dialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We used a retrospective cohort design with 2017 Medicare claims to follow outpatients with AKI requiring dialysis and patients without AKI requiring incident dialysis up to 365 days. Outcomes are unadjusted and adjusted mortality using Kaplan-Meier estimation for unadjusted survival probability, Poisson regression for monthly mortality, and Cox proportional hazards modeling for adjusted mortality. RESULTS In total, 10,821 of 401,973 (3%) Medicare patients requiring dialysis had at least one AKI claim, and 52,626 patients were Medicare patients without AKI requiring incident dialysis. Patients with AKI requiring dialysis were more likely to be White (76% versus 70%), non-Hispanic (92% versus 87%), and age 60 or older (82% versus 72%) compared with patients without AKI requiring incident dialysis. Unadjusted mortality was markedly higher for patients with AKI requiring dialysis compared with patients without AKI requiring incident dialysis. Adjusted mortality differences between both cohorts persisted through month 4 of the follow-up period (all P=0.01), then, they declined and were no longer statistically significant. Adjusted monthly mortality stratified by Black and other race between patients with AKI requiring dialysis and patients without AKI requiring incident dialysis was lower throughout month 4 (1.5 versus 0.60, 1.20 versus 0.84, 1.00 versus 0.80, and 0.95 versus 0.74; all P<0.001), which persisted through month 7. Overall adjusted mortality risk was 22% higher for patients with AKI requiring dialysis (1.22; 95% confidence interval, 1.17 to 1.27). CONCLUSIONS In fully adjusted analyses, patients with AKI requiring dialysis had higher early mortality compared with patients without AKI requiring incident dialysis, but these differences declined after several months. Differences were also observed by age, race, and ethnicity within both patient cohorts.
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Affiliation(s)
- Claudia Dahlerus
- Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan,Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Jonathan H. Segal
- Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan,Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
| | - Kevin He
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Wenbo Wu
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Shu Chen
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Tempie H. Shearon
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Yating Sun
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Aaron Pearson
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Xiang Li
- Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan,Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Joseph M. Messana
- Division of Nephrology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan,Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan
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Harnessing the Physiological Functions of Cellular Prion Protein in the Kidneys: Applications for Treating Renal Diseases. Biomolecules 2021; 11:biom11060784. [PMID: 34067472 PMCID: PMC8224798 DOI: 10.3390/biom11060784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 12/16/2022] Open
Abstract
A cellular prion protein (PrPC) is a ubiquitous cell surface glycoprotein, and its physiological functions have been receiving increased attention. Endogenous PrPC is present in various kidney tissues and undergoes glomerular filtration. In prion diseases, abnormal prion proteins are found to accumulate in renal tissues and filtered into urine. Urinary prion protein could serve as a diagnostic biomarker. PrPC plays a role in cellular signaling pathways, reno-protective effects, and kidney iron uptake. PrPC signaling affects mitochondrial function via the ERK pathway and is affected by the regulatory influence of microRNAs, small molecules, and signaling proteins. Targeting PrPC in acute and chronic kidney disease could help improve iron homeostasis, ameliorate damage from ischemia/reperfusion injury, and enhance the efficacy of mesenchymal stem/stromal cell or extracellular vesicle-based therapeutic strategies. PrPC may also be under the influence of BMP/Smad signaling and affect the progression of TGF-β-related renal fibrosis. PrPC conveys TNF-α resistance in some renal cancers, and therefore, the coadministration of anti-PrPC antibodies improves chemotherapy. PrPC can be used to design antibody-drug conjugates, aptamer-drug conjugates, and customized tissue inhibitors of metalloproteinases to suppress cancer. With preclinical studies demonstrating promising results, further research on PrPC in the kidney may lead to innovative PrPC-based therapeutic strategies for renal disease.
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Nasu T, Ueda K, Kawashima S, Okishio Y, Kunitatsu K, Iwasaki Y, Kato S. Prehospital Blood Pressure and Lactate are Early Predictors of Acute Kidney Injury After Trauma. J Surg Res 2021; 265:180-186. [PMID: 33940241 DOI: 10.1016/j.jss.2021.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this study is to report the prevalence of acute kidney injury (AKI) after trauma in our center, describe the risk factors associated with AKI, and determine whether these risk factors help avoid AKI. MATERIALS AND METHODS We retrospectively analyzed the data which were prospectively collected from a single center trauma registry from January 2017 to December 2018. Patients who were <16 years of age, patients with burns, and patients with chronic kidney disease were excluded from the present study. AKI was defined according to the risk, injury, failure, loss of the kidney function, and end-stage kidney disease (RIFLE) classification from serum creatinine alone. A logistic regression analysis was performed to identify prehospital and early hospital risk factors for AKI. RESULTS There were 806 trauma patients recorded in the database. One hundred thirty cases were excluded based on the abovementioned exclusion criteria. Six hundred seventy-six patients were included in the analysis. The prevalence of AKI in the overall population was 14.5% including 10.5% of patients with stage R, 3.0% of patients with stage I and 1.0% with stage F. The incidence of AKI increased to 36.3%, 12.1% and 3.3% in the subgroup of patients with hemorrhagic shock. The multivariate analysis revealed that the minimum prehospital systolic blood pressure and arterial lactate level were independent predictors of AKI. The model showed good discrimination with an area under the receiver operating characteristic curve (AUC-ROC) of 0.867 and 0.852 in the prediction of AKI stage I or F. The cutoff values were ≤126 mmHg and ≥2.5 mmol/L, respectively. CONCLUSION These parameters showed good performance in the early prediction of AKI after trauma. They are associated with the early onset of AKI after trauma and may be an early predictor of the effects of treatment to prevent AKI.
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Affiliation(s)
- Toru Nasu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan.
| | - Kentaro Ueda
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Shuji Kawashima
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Yuko Okishio
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Kosei Kunitatsu
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Yasuhiro Iwasaki
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan; Department of Emergency and Critical Care Medicine, Wakayama Rosai Hospital, Wakayama, Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, School of Medicine, Wakayama, Japan
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Yuan ZN, Wang HJ, Gao Y, Qu SN, Huang CL, Wang H, Zhang H, Yang QH, Xing XZ. The effect of the underlying malignancy on short- and medium-term survival of critically ill patients admitted to the intensive care unit: a retrospective analysis based on propensity score matching. BMC Cancer 2021; 21:417. [PMID: 33858357 PMCID: PMC8051069 DOI: 10.1186/s12885-021-08152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/06/2021] [Indexed: 11/20/2022] Open
Abstract
Background Advances in oncology led to a substantial increase in the number of patients requiring admission to the ICU. It is significant to confirm which cancer critical patients can benefit from the ICU care like noncancer patients. Methods An observational retrospective cohort study using intensive care unit (ICU) admissions of Medical Information Mart for Intensive Care III from the Beth Israel Deaconess Medical Center in Boston, MA, USA between 2001 and 2012 was conducted. Propensity score matching was used to reduce the imbalance between two matched cohorts. ICU patients with cancer were compared with those without cancer in terms of patients’ characteristics and survival. Results There were 38,508 adult patients admitted to ICUs during the period. The median age was 65 years (IQR, 52–77) and 8308 (21.6%) had an underlying malignancy diagnosis. The noncancer group had a significant survive advantage at the point of 28-day, 90-day, 365-day and 1095-day after ICU admission compared with cancer group (P < 0.001 for all) after PSM. Subgroup analysis showed that the diagnosis of malignancy didn’t decrease 28-day and 90-day survive when patients’ age ≥ 65-year, patients in surgical intensive care unit or cardiac surgery recovery unit or traumatic surgical intensive care unit, elective admissions, patients with renal replacement therapy or vasopressor support (P > 0.05 for all). Conclusions Malignancy is a common diagnosis among ICU patients. Patients without cancer have a survive advantage compared with patients with cancer in the short- and medium-term. However, in selected groups, cancer critical patients can benefit from the ICU care service like noncancer patients in the short-term.
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Affiliation(s)
- Zhen-Nan Yuan
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hai-Jun Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Yong Gao
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Shi-Ning Qu
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Chu-Lin Huang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Wang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Quan-Hui Yang
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China
| | - Xue-Zhong Xing
- Department of Intensive Care Unit, National Cancer Center / National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100021, China.
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