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Esposito P, Cappadona F, Marengo M, Fiorentino M, Fabbrini P, Quercia AD, Garzotto F, Castellano G, Cantaluppi V, Viazzi F. Recognition patterns of acute kidney injury in hospitalized patients. Clin Kidney J 2024; 17:sfae231. [PMID: 39157067 PMCID: PMC11328729 DOI: 10.1093/ckj/sfae231] [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: 02/09/2024] [Indexed: 08/20/2024] Open
Abstract
Background Acute kidney injury (AKI) during hospitalization is associated with increased complications and mortality. Despite efforts to standardize AKI management, its recognition in clinical practice is limited. Methods To assess and characterize different patterns of AKI diagnosis, we collected clinical data, serum creatinine (sCr) levels, comorbidities and outcomes from adult patients using the Hospital Discharge Form (HDF). AKI diagnosis was based on administrative data and according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria by evaluating sCr variations during hospitalization. Additionally, patients were categorized based on the timing of AKI onset. Results Among 56 820 patients, 42 900 (75.5%) had no AKI, 1893 (3.3%) had AKI diagnosed by sCr changes and coded in the HDF (full-AKI), 2529 (4.4%) had AKI reported on the HDF but not meeting sCr-based criteria (HDF-AKI) and 9498 (16.7%) had undetected AKI diagnosed by sCr changes but not coded in the HDF (KDIGO-AKI). Overall, AKI incidence was 24.5%, with a 68% undetection rate. Patients with KDIGO-AKI were younger and had a higher proportion of females, lower comorbidity burden, milder AKI stages, more frequent admissions to surgical wards and lower mortality compared with full-AKI patients. All AKI groups had worse outcomes than those without AKI, and AKI, even if undetected, was independently associated with mortality risk. Patients with AKI at admission had different profiles and better outcomes than those developing AKI later. Conclusions AKI recognition in hospitalized patients is highly heterogeneous, with a significant prevalence of undetection. This variability may be affected by patients' characteristics, AKI-related factors, diagnostic approaches and in-hospital patient management. AKI remains a major risk factor, emphasizing the importance of ensuring proper diagnosis for all patients.
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Affiliation(s)
- Pasquale Esposito
- Department of Internal Medicine, University of Genova, Genova, Italy
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Cappadona
- Department of Internal Medicine, University of Genova, Genova, Italy
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marita Marengo
- Nephrology and Dialysis Unit, Department of Specialist Medicine, Azienda Sanitaria Locale CN1, Cuneo, Italy
| | - Marco Fiorentino
- Department of Precision and Regenerative Medicine and Ionian Area, Nephrology Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, Italy
| | - Paolo Fabbrini
- Nephrology and Dialysis Unit, ASST Nord Milano, Milan, Italy
| | | | - Francesco Garzotto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Castellano
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Vincenzo Cantaluppi
- Nephrology and Kidney Transplantation Unit, Department of Translational Medicine, SCDU Nefrologia e Trapianto Renale, University of Piemonte Orientale, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Francesca Viazzi
- Department of Internal Medicine, University of Genova, Genova, Italy
- Division of Nephrology, Dialysis and Transplantation, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Meersch M, Weiss R, Strauß C, Albert F, Booke H, Forni L, Pittet JF, Kellum JA, Rosner M, Mehta R, Bellomo R, Rosenberger P, Zarbock A. Acute kidney disease beyond day 7 after major surgery: a secondary analysis of the EPIS-AKI trial. Intensive Care Med 2024; 50:247-257. [PMID: 38285051 PMCID: PMC10907445 DOI: 10.1007/s00134-023-07314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE Acute kidney disease (AKD) is a significant health care burden worldwide. However, little is known about this complication after major surgery. METHODS We conducted an international prospective, observational, multi-center study among patients undergoing major surgery. The primary study endpoint was the incidence of AKD (defined as new onset of estimated glomerular filtration rate (eCFR) < 60 ml/min/1.73 m2 present on day 7 or later) among survivors. Secondary endpoints included the relationship between early postoperative acute kidney injury (AKI) (within 72 h after major surgery) and subsequent AKD, the identification of risk factors for AKD, and the rate of chronic kidney disease (CKD) progression in patients with pre-existing CKD. RESULTS We studied 9510 patients without pre-existing CKD. Of these, 940 (9.9%) developed AKD after 7 days of whom 34.1% experiencing an episode of early postoperative-AKI. Rates of AKD after 7 days significantly increased with the severity (19.1% Kidney Disease Improving Global Outcomes [KDIGO] 1, 24.5% KDIGO2, 34.3% KDIGO3; P < 0.001) and duration (15.5% transient vs 38.3% persistent AKI; P < 0.001) of early postoperative-AKI. Independent risk factors for AKD included early postoperative-AKI, exposure to perioperative nephrotoxic agents, and postoperative pneumonia. Early postoperative-AKI carried an independent odds ratio for AKD of 2.64 (95% confidence interval [CI] 2.21-3.15). Of 663 patients with pre-existing CKD, 42 (6.3%) had worsening CKD at day 90. In patients with CKD and an episode of early AKI, CKD progression occurred in 11.6%. CONCLUSION One in ten major surgery patients developed AKD beyond 7 days after surgery, in most cases without an episode of early postoperative-AKI. However, early postoperative-AKI severity and duration were associated with an increased rate of AKD and early postoperative-AKI was strongly associated with AKD independent of all other potential risk factors.
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Affiliation(s)
- Melanie Meersch
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Raphael Weiss
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Christian Strauß
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Felix Albert
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Hendrik Booke
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
| | - Lui Forni
- School of Medicine, University of Surrey, Kate Granger Building, Guildford, UK
- Intensive Care Unit, Royal Surrey Hospital, Guildford, UK
| | - Jean-Francois Pittet
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mitchell Rosner
- Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Ravindra Mehta
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Rinaldo Bellomo
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
- Department of Intensive Care, Royal Melbourne Hospital, Parkville, VIC, Australia
- Department of Intensive Care, Austin Health, Heidelberg, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
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La Rosa R, Grechi B, Ragazzi R, Alvisi V, Montanari G, Marangoni E, Volta CA, Spadaro S, Scaramuzzo G. Incidence and Determinants of Acute Kidney Injury after Prone Positioning in Severe COVID-19 Acute Respiratory Distress Syndrome. Healthcare (Basel) 2023; 11:2903. [PMID: 37958047 PMCID: PMC10647784 DOI: 10.3390/healthcare11212903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/26/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Background: Acute kidney injury (AKI) is common among critically ill COVID-19 patients, but its temporal association with prone positioning (PP) is still unknown, and no data exist on the possibility of predicting PP-associated AKI from bedside clinical variables. (2) Methods: We analyzed data from 93 COVID-19-related ARDS patients who underwent invasive mechanical ventilation (IMV) and at least one PP cycle. We collected hemodynamic variables, respiratory mechanics, and circulating biomarkers before, during, and after the first PP cycle. PP-associated AKI (PP-AKI) was defined as AKI diagnosed any time from the start of PP to 48 h after returning to the supine position. A t-test for independent samples was used to test for the differences between groups, while binomial logistical regression was performed to assess variables independently associated with PP-associated AKI. (3) Results: A total of 48/93 (52%) patients developed PP-AKI, with a median onset at 24 [13.5-44.5] hours after starting PP. No significant differences in demographic characteristics between groups were found. Before starting the first PP cycle, patients who developed PP-AKI had a significantly lower cumulative fluid balance (CFB), even when normalized for body weight (p = 0.006). Central venous pressure (CVP) values, measured before the first PP (OR 0.803, 95% CI [0.684-0.942], p = 0.007), as well as BMI (OR 1.153, 95% CI = [1.013-1.313], p = 0.031), were independently associated with the development of PP-AKI. In the multivariable regression analysis, a lower CVP before the first PP cycle was independently associated with ventilator-free days (OR 0.271, 95% CI [0.123-0.936], p = 0.011) and with ICU mortality (OR:0.831, 95% CI [0.699-0.989], p = 0.037). (4) Conclusions: Acute kidney injury occurs frequently in invasively ventilated severe COVID-19 ARDS patients undergoing their first prone positioning cycle. Higher BMI and lower CVP before PP are independently associated with the occurrence of AKI during prone positioning.
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Affiliation(s)
- Riccardo La Rosa
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
| | - Benedetta Grechi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
| | - Riccardo Ragazzi
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Valentina Alvisi
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Giacomo Montanari
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Elisabetta Marangoni
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Carlo Alberto Volta
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
| | - Gaetano Scaramuzzo
- Department of Translational Medicine and for Romagna, University of Ferrara, 44124 Ferrara, Italy; (R.L.R.); (B.G.); (R.R.); (C.A.V.); (S.S.)
- Anesthesia and Intensive Care Unit, Emergency Department, Azienda Ospedaliera Universitaria Ferrara, 44124 Ferrara, Italy; (V.A.); (G.M.); (E.M.)
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See CY, Pan HC, Chen JY, Wu CY, Liao HW, Huang YT, Liu JH, Wu VC, Ostermann M. Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis. Crit Care 2023; 27:390. [PMID: 37814334 PMCID: PMC10563300 DOI: 10.1186/s13054-023-04641-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/06/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Various approaches have been suggested to identify acute kidney injury (AKI) early and to initiate kidney-protective measures in patients at risk or with AKI. The objective of this study was to evaluate whether care bundles improve kidney outcomes in these patients. METHODS We conducted a systematic review of the literature to evaluate the clinical effectiveness of AKI care bundles with or without urinary biomarkers in the recognition and management of AKI. The main outcomes were major adverse kidney events (MAKEs) consisting of moderate-severe AKI, receipt of renal replacement therapy (RRT), and mortality. RESULTS Out of 7434 abstracts screened, 946 published studies were identified. Thirteen studies [five randomized controlled trials (RCTs) and eight non-RCTs] including 16,540 patients were eligible for inclusion in the meta-analysis. Meta-analysis showed a lower incidence of MAKE in the AKI care bundle group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.66-0.81] with differences in all 3 individual outcomes [moderate-severe AKI (OR 0.65, 95% CI 0.51-0.82), RRT (OR 0.63, 95% CI = 0.46-0.88) and mortality]. Subgroup analysis of the RCTs, all adopted biomarker-based approach, decreased the risk of MAKE (OR 0.55, 95% CI 0.41-0.74). Network meta-analysis could reveal that the incorporation of biomarkers in care bundles carried a significantly lower risk of MAKE when compared to care bundles without biomarkers (OR = 0.693, 95% CI = 0.50-0.96), while the usual care subgroup had a significantly higher risk (OR = 1.29, 95% CI = 1.09-1.52). CONCLUSION Our meta-analysis demonstrated that care bundles decreased the risk of MAKE, moderate-severe AKI and need for RRT in AKI patients. Moreover, the inclusion of biomarkers in care bundles had a greater impact than care bundles without biomarkers.
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Affiliation(s)
- Chun Yin See
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
| | - Heng-Chih Pan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
- Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
- College of Medicine, Chang Gung University, Taoyüan, 333, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Jui-Yi Chen
- Division of Nephrology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chun-Yi Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
| | - Hung-Wei Liao
- Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, 11696, Taiwan
- Division of Nephrology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Hua Liu
- Department of Communication, National Chung Cheng University, Chiayi, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, Clinical Research Building, National Taiwan University Hospital, 7 Chung-Shan South Road, Room 1555, Taipei, Taiwan.
- NSARF (National Taiwan University Hospital Study Group on Acute Renal Failure), Taipei, Taiwan.
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St. Thomas' Foundation Trust, Westminster Bridge, London, SE1 7EH, UK.
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von Groote T, Meersch M, Romagnoli S, Ostermann M, Ripollés-Melchor J, Schneider AG, Vandenberghe W, Monard C, De Rosa S, Cattin L, Rahmel T, Adamzik M, Parise D, Candela-Toha A, Haaker JG, Göbel U, Bernard A, Lumlertgul N, Fernández-Valdes-Bango P, Romero Bhathal I, Suarez-de-la-Rica A, Larmann J, Villa G, Spadaro S, Wulf H, Arndt C, Putensen C, García-Álvarez R, Brandenburger T, Siniscalchi A, Ellerkmann R, Espeter F, Porschen C, Sadjadi M, Saadat-Gilani K, Weiss R, Gerss J, Kellum J, Zarbock A. Biomarker-guided intervention to prevent acute kidney injury after major surgery (BigpAK-2 trial): study protocol for an international, prospective, randomised controlled multicentre trial. BMJ Open 2023; 13:e070240. [PMID: 36972972 PMCID: PMC10069589 DOI: 10.1136/bmjopen-2022-070240] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Previous studies demonstrated that the implementation of the Kidney Disease Improving Global Outcomes (KDIGO) guideline-based bundle, consisting of different supportive measures in patients at high risk for acute kidney injury (AKI), might reduce rate and severity of AKI after surgery. However, the effects of the care bundle in broader population of patients undergoing surgery require confirmation. METHODS AND ANALYSIS The BigpAK-2 trial is an international, randomised, controlled, multicentre trial. The trial aims to enrol 1302 patients undergoing major surgery who are subsequently admitted to the intensive care or high dependency unit and are at high-risk for postoperative AKI as identified by urinary biomarkers (tissue inhibitor of metalloproteinases 2*insulin like growth factor binding protein 7 (TIMP-2)*IGFBP7)). Eligible patients will be randomised to receive either standard of care (control) or a KDIGO-based AKI care bundle (intervention). The primary endpoint is the incidence of moderate or severe AKI (stage 2 or 3) within 72 hours after surgery, according to the KDIGO 2012 criteria. Secondary endpoints include adherence to the KDIGO care bundle, occurrence and severity of any stage of AKI, change in biomarker values during 12 hours after initial measurement of (TIMP-2)*(IGFBP7), number of free days of mechanical ventilation and vasopressors, need for renal replacement therapy (RRT), duration of RRT, renal recovery, 30-day and 60-day mortality, intensive care unit length-of-stay and hospital length-of-stay and major adverse kidney events. An add-on study will investigate blood and urine samples from recruited patients for immunological functions and kidney damage. ETHICS AND DISSEMINATION The BigpAK-2 trial was approved by the Ethics Committee of the Medical Faculty of the University of Münster and subsequently by the corresponding Ethics Committee of the participating sites. A study amendment was approved subsequently. In the UK, the trial was adopted as an NIHR portfolio study. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and will guide patient care and further research. TRIAL REGISTRATION NUMBER NCT04647396.
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Affiliation(s)
- Thilo von Groote
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Melanie Meersch
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Stefano Romagnoli
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK
| | | | | | - Wim Vandenberghe
- Department of Intensive Care Medicine, Universiteit Gent, Gent, Belgium
| | - Céline Monard
- Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Lyon, Rhône-Alpes, France
| | - Silvia De Rosa
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
- Department of Intensive Care Medicine, Centre for Medical Sciences, CISMed, University of Trento, Trento, Trentino-Alto Adige, Italy
| | - Lucia Cattin
- Department of Anesthesiology and Intensive Care Medicine, San Bortolo Hospital of Vicenza, Vicenza, Veneto, Italy
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Nordrhein-Westfalen, Germany
| | - Diego Parise
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Angel Candela-Toha
- Department of Anesthesiology and Critical Care, Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
| | - Jan Gerrit Haaker
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
| | - Ulrich Göbel
- Department of Anesthesiology and Intensive Care, St Franziskus-Hospital Münster GmbH, Munster, Nordrhein-Westfalen, Germany
| | - Alice Bernard
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, University of Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Nuttha Lumlertgul
- Department of Critical Care, King's College London, Guy's and St Thomas' Hospitals NHS Trust, London, London, UK
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Bangkok, Thailand
| | | | - Irene Romero Bhathal
- Department of Anaesthesiology and Intensive Care Medicine, Consorci Parc de Salut MAR de Barcelona, Barcelona, Catalunya, Spain
| | - A Suarez-de-la-Rica
- Department of Anesthesiology and Critical Care, Hospital Universitario Marques de Valdecilla, Santander, Spain
- Department of Anaesthesiology, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | - Jan Larmann
- Department of Anaesthesia, Heidelberg University Hospital, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Gianluca Villa
- Department of Health Sciences, Section of Anesthesiology, Intensive Care and Pain Medicine, University of Florence; Department of Anesthesia and Intensive Care, Section of Oncological Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Savino Spadaro
- Department of Translational Medicine and for Romagna, St. Anne's Archbishop Hospital, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Hinnerk Wulf
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | - Christian Arndt
- Anesthesiology and Intensive Care Medicine, Philipps-Universitat Marburg Fachbereich Medizin, Marburg, Germany
| | - Christian Putensen
- Department of Anesthesiology and Surgical Intensive Care Medicine, Division of Intensive Care Medicine, Universitätsklinikum Bonn, Bonn, Germany
| | - Raquel García-Álvarez
- Department of Anesthesia and Intensive Care, Hospital Universitario 12 de Octubre, Madrid, Comunidad de Madrid, Spain
| | - Timo Brandenburger
- Anesthesiology and Critical Care Medicine, Heinrich Heine University Düsseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
| | - Antonio Siniscalchi
- Postoperative and Abdominal Organ Transplant Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola, Bologna, Emilia-Romagna, Italy
| | - Richard Ellerkmann
- Department of Anesthesiology, Intensive Care, Pain Medicine and Palliative Care Medicine, Hospital Dortmund, Dortmund, Germany
| | - Florian Espeter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Christian Porschen
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Mahan Sadjadi
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Khaschayar Saadat-Gilani
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Raphael Weiss
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Munster, Nordrhein-Westfalen, Germany
| | - John Kellum
- Center for Critical Care Nephrology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alexander Zarbock
- Department of Anaesthesiology, Intensive Care and Pain Medicine, University Hospital Münster, Munster, North Rhine-Westphalia, Germany
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Xia H, Shanshan X, Sumeng L, Fang X, Tao Z, Cheng C. LncRNA RMRP aggravates LPS-induced HK-2 cell injury and AKI mice kidney injury by upregulating COX2 protein via targeting ELAVL1. Int Immunopharmacol 2023; 116:109676. [PMID: 36764281 DOI: 10.1016/j.intimp.2022.109676] [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: 11/11/2022] [Revised: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 02/11/2023]
Abstract
OBJECTIVES There is emerging evidence that long non-coding RNA component of mitochondrial RNA processing endoribonuclease (lncRNA RMRP) is involved in acute kidney injury (AKI) progression, but the specific mechanism of action still requires further investigation. METHODS The lipopolysaccharide (LPS)-treated HK-2 cells were transfected with pcDNA-RMRP or si-RMRP, or transfected with pcDNA-ELAV like RNA binding protein 1 (ELAVL1) or si-ELAVL1, and cell viability, apoptosis, inflammatory factor secretion and oxidative stress were detected. The LPS-treated HK-2 cells were transfected with si-RMRP alone or together with pcDNA-ELAVL1, and cell behaviors were examined. The LPS-treated HK-2 cells were transfected with si-ELAVL1 alone or together with pcDNA- cyclooxygenase-2 (COX2), and the cellular changes were observed. The LPS-treated HK-2 cells were transfected with si-RMRP alone or together with pcDNA-ELAVL1, or together with pcDNA-ELAVL1 and si-COX2, and cell behaviors were examined. A mouse model of AKI was constructed using male C57BL/6 mice by the method of cecal ligation and puncture and intraperitoneal injection of LPS to explore the effect of RMRP silencing on renal injury in vivo. RESULTS RMRP and ELAVL1 was upregulated in LPS-treated HK-2 cells, and RMRP or ELAVL1 overexpression inhibited cell viability and promoted cell apoptosis, inflammatory factor secretion and oxidative stress, and RMRP knockdown showed the opposite effects. ELAVL1 upregulated COX2 protein expression and overexpression of COX2 reversed the promoting effects of RMRP knockdown on cell viability, as well as the inhibitory effects on cell apoptosis, inflammatory factor secretion and oxidative stress. Mechanistic findings suggested that RMRP aggravates LPS induced cell injury by activating prostaglandin E (PGE)/janus kinase-2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signaling pathway. We observed that knockdown of RMRP expression significantly alleviated renal tissue apoptosis, inflammatory factor secretion, and oxidative stress with AKI mice. CONCLUSIONS Our findings may provide a new reference for the treatment of AKI.
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Affiliation(s)
- Huang Xia
- Department of Laboratory Medicine, Taizhou People Hospital, Taizhou 225300, China
| | - Xue Shanshan
- Department of Laboratory Medicine, Taizhou People Hospital, Taizhou 225300, China
| | - Li Sumeng
- Department of Laboratory Medicine, Taizhou People Hospital, Taizhou 225300, China
| | - Xu Fang
- Department of Laboratory Medicine, Taizhou People Hospital, Taizhou 225300, China
| | - Zhou Tao
- Department of Medicine, Taizhou Polytechnic College, Taizhou 225300, China
| | - Cheng Cheng
- Department of Laboratory Medicine, Taizhou People Hospital, Taizhou 225300, China.
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