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Lin WC, Peng PS, Lin SL. Feasibility of Short-Term Use of Ivabradine in Critical Ill Patients Who Have Atrial Fibrillation and Tachycardia. ACTA CARDIOLOGICA SINICA 2024; 40:373-382. [PMID: 39045379 PMCID: PMC11261355 DOI: 10.6515/acs.202407_40(4).20240411a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/11/2024] [Indexed: 07/25/2024]
Abstract
Background Ivabradine is approved for heart rate reduction in patients with stable symptomatic heart failure (HF). The United States Food and Drug Administration and Taiwan Central Health Insurance Agency approved the use of ivabradine for patients with chronic stable HF with sinus rhythm, but it has not yet been approved for patients with acute decompensated HF or with atrial fibrillation (AF). Objectives To investigate whether short-term ivabradine use is feasible in critically ill patients with AF and rapid ventricular response (RVR). Methods This study retrospectively analyzed 23 patients admitted to an intensive care unit with acute HF and AF-RVR who received ivabradine. All patients initially received a slow IV of amiodarone. Other medications for HF were prescribed according to current HF guidelines. The time taken for ivabradine to reduce HR to 80 beats per minute, referred to as "Time to 80," was measured in each patient. Results Overall, 69.6 % (16/23) of the patients had New York Heart Association functional class IV HF. In addition, 60.9% (14/23) of the patients required endotracheal intubation and ventilatory support, with more than half receiving vasopressor treatment to manage hypotension. Five patients died during the study period. The surviving patients had a significantly shorter "Time to 80" compared to those who did not survive (p = 0.037). Conclusions Adding ivabradine to standard treatment might be feasible for critically ill patients with AF and tachycardia. The finding that surviving patients had a shorter "Time to 80" duration than those who did not survive may have clinical implications. However, further investigations are needed to assess its clinical utility.
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Affiliation(s)
- Wei-Cheng Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Yuan’s General Hospital
| | - Po-Sen Peng
- Division of Cardiology, Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung
- School of Medicine, National Defense Medical Center, Taipei
| | - Shoa-Lin Lin
- Coronary Care Unit, Division of Cardiology, Department of Internal Medicine, Kaohsiung Yuan’s General Hospital, Kaohsiung, Taiwan
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Fedi M, Bobot M, Torrents J, Gobert P, Magnant É, Knefati Y, Verhelst D, Lebrun G, Masson V, Giaime P, Santini J, Bataille S, Brunet P, Dussol B, Burtey S, Mancini J, Daniel L, Jourde-Chiche N. Kidney biopsy in very elderly patients: indications, therapeutic impact and complications. BMC Nephrol 2021; 22:362. [PMID: 34727880 PMCID: PMC8561868 DOI: 10.1186/s12882-021-02559-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few data is available on the risk/benefit balance of native kidney biopsy (KB) in very elderly patients. METHODS Multicenter retrospective cohort study in the Aix-Marseille area: the results of KB and medical charts of all patients over 85 years biopsied between January 2010 and December 2018 were reviewed. RESULTS 104 patients were included. Median age was 87 years. Indications for KB were: acute kidney injury (AKI) in 69.2% of patients, nephrotic syndrome (NS) with AKI in 13.5%, NS without AKI in 12.5%, and proteinuria in 4.8%. Median serum creatinine was 262 μmol/L, 21% of patients required dialysis at the time of KB. Significant bleeding occurred in 7 (6.7%) patients, requiring blood cell transfusion in 4 (3.8%), and radiological embolization in 1 (1%). The most frequent pathological diagnoses were: non-diabetic glomerular diseases (29.8%, including pauci-immune crescentic glomerulonephritis in 9.6%), hypertensive nephropathy (27.9%), acute interstitial nephritis (16.3%), renal involvement of hematological malignancy (8.7%), and acute tubular necrosis (6.7%). After KB, 51 (49%) patients received a specific treatment: corticosteroids (41.3%), cyclophosphamide (6.7%), rituximab (6.7%), bortezomib (3.8%), other chemotherapies (3.8%). Median overall survival was 31 months. CONCLUSIONS KB can reveal a diagnosis with therapeutic impact even in very elderly patients. Severe bleeding was not frequent in this cohort, but KB may have not been performed in more vulnerable patients.
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Affiliation(s)
- Mathilde Fedi
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
| | - Mickaël Bobot
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julia Torrents
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Pierre Gobert
- Rhône Durance Clinic, Medicine Department Avignon, Avignon, France
| | - Éric Magnant
- Private Hospital of Provence, Nephrology Department, Aix-en-Provence, France
| | - Yannick Knefati
- Hospital of Sainte Musse, Nephrology Department, Toulon, France
| | - David Verhelst
- Hospital Général Henri Duffaut, Nephrology Department, Avignon, France
| | - Gaëtan Lebrun
- Hospital of Aix en Provence, Nephrology Department, Aix-en-Provence, France
| | - Valérie Masson
- Polyclinic "des fleurs", Nephrology Department, Ollioules, France
| | - Philippe Giaime
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Julien Santini
- Saint-Joseph Hospital, Nephrology Department, Marseille, France
| | - Stanislas Bataille
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- Phocaean Institute of Nephrology, Bouchard Clinic, ELSAN, Marseille, France
| | - Philippe Brunet
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Bertrand Dussol
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Stéphane Burtey
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
| | - Julien Mancini
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, University Hospital of la Timone, BIOSTIC Service, Marseille, France
| | - Laurent Daniel
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France
- AP-HM, University Hospital of La Timone, Anatomical Pathology Laboratory, Marseille, France
| | - Noémie Jourde-Chiche
- AP-HM, University Hospital of la Conception, Nephrology and Kidney Transplant Centre, Marseille, France.
- Aix-Marseille Univ, C2VN, INSERM, INRAE, Marseille, France.
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Peng JC, Wu T, Wu X, Yan P, Kang YX, Liu Y, Zhang NY, Liu Q, Wang HS, Deng YH, Wang M, Luo XQ, Duan SB. Development of mortality prediction model in the elderly hospitalized AKI patients. Sci Rep 2021; 11:15157. [PMID: 34312443 PMCID: PMC8313696 DOI: 10.1038/s41598-021-94271-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/30/2021] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) correlates with increased health-care costs and poor outcomes in older adults. However, there is no good scoring system to predict mortality within 30-day, 1-year after AKI in older adults. We performed a retrospective analysis screening data of 53,944 hospitalized elderly patients (age > 65 years) from multi-centers in China. 944 patients with AKI (acute kidney disease) were included and followed up for 1 year. Multivariable regression analysis was used for developing scoring models in the test group (a randomly 70% of all the patients). The established models have been verified in the validation group (a randomly 30% of all the patients). Model 1 that consisted of the risk factors for death within 30 days after AKI had accurate discrimination (The area under the receiver operating characteristic curves, AUROC: 0.90 (95% CI 0.875–0.932)) in the test group, and performed well in the validation groups (AUROC: 0.907 (95% CI 0.865–0.949)). The scoring formula of all-cause death within 1 year (model 2) is a seven-variable model including AKI type, solid tumor, renal replacement therapy, acute myocardial infarction, mechanical ventilation, the number of organ failures, and proteinuria. The area under the receiver operating characteristic (AUROC) curves of model 2 was > 0.80 both in the test and validation groups. Our newly established risk models can well predict the risk of all-cause death in older hospitalized AKI patients within 30 days or 1 year.
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Affiliation(s)
- Jing-Cheng Peng
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ting Wu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xi Wu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ping Yan
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yi-Xin Kang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Yu Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ning-Ya Zhang
- Information Center, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qian Liu
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Hong-Shen Wang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Ying-Hao Deng
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Mei Wang
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xiao-Qin Luo
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Shao-Bin Duan
- Hunan Key Laboratory of Kidney Disease and Blood Purification, Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China.
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Chandiraseharan VK, Kalimuthu M, Prakash TV, George T, Rajenesh A, Jayaseelan V, Sudarsanam TD. Acute kidney injury is an independent predictor of in-hospital mortality in a general medical ward: A retrospective study from a tertiary care centre in south India. Indian J Med Res 2021; 152:386-392. [PMID: 33380703 PMCID: PMC8061603 DOI: 10.4103/ijmr.ijmr_1685_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background & objectives: Acute kidney injury (AKI) has been identified as an independent risk factor for mortality in intensive care units. This retrospective study was conducted to determine the effect of AKI on in-hospital mortality in a general medical ward of a tertiary care hospital and risk factors for mortality in patients with AKI. Methods: Demographic and clinical details, and outcome data were collected from case records of patients. In all hospitalized patients, factors associated with increased in-hospital mortality, such as AKI, inotrope requirement, mechanical ventilation and primary disease were compared between patients who died during their hospital stay and those who were discharged alive. Among the hospitalized patients, who had AKI, likely predictors of in-hospital mortality were compared between dead and alive patients at discharge. Factors that were significant in univariate analysis were tested by multivariate regression analysis to identify those that independently predicted poor outcomes. Results: Of the 1150 patients admitted in a general medical ward in a year, 220 patients were identified to have AKI. In-hospital mortality rate among patients with AKI was 19.09 per cent as compared to 1.8 per cent without AKI [adjusted odds ratio (OR) 5.7 (95% CI: 1.56-20.74)]. The presence of AKI was an independent risk factor for death, with an adjusted OR of 6.0 [95% CI: 1.67-21.6]. Among patients with AKI, the presence of haematological malignancy, adjusted OR 25.86 (95% CI: 1.81-369.58), requirement of inotrope, adjusted OR 126.5 (95% CI: 19.39-825.93) and serum creatinine at admission (P<0.001) were found to be independent predictors of death. The presence of underlying chronic kidney disease and hospital-acquired AKI were not found to have an association with mortality. Interpretation & conclusions: The study showed the in-hospital mortality rate among patients with AKI in a general medical ward was 19.09 per cent. The occurrence of AKI was an independent risk factor for death, with haematological malignancy, use of vasopressors and higher serum creatinine at admission, significantly associated with death among patients with AKI. Large prospective studies need to be done to better understand the outcomes in AKI and the ways to present and manage AKI.
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Affiliation(s)
| | - Murugabharathy Kalimuthu
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Turaka Vijay Prakash
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Tina George
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Ashwin Rajenesh
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Visalakshi Jayaseelan
- Department of Biostatistics, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Thambu David Sudarsanam
- Department of Internal Medicine, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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Oweis AO, Alshelleh SA. Incidence and outcomes of acute kidney injury in octogenarians in Jordan. BMC Res Notes 2018; 11:279. [PMID: 29739428 PMCID: PMC5941475 DOI: 10.1186/s13104-018-3397-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/03/2018] [Indexed: 12/18/2022] Open
Abstract
Objective Improvements in the health care system, resulted in a greater number of geriatric patients diagnosed with acute kidney injury (AKI). We evaluated the incidence and outcome of AKI in octogenarians, as studies in the Middle-East region are few; moreover, treatment approaches, in addition to medical decisions, may require special consideration for advanced age to improve the outcomes. Results At King Abdullah II teaching and referral hospital, we recruited patients aged 80–90 years who were admitted to the medical floor between January 2010 and December 2013. Patients were followed-up for at least 1 year after discharge.850 patients were admitted during the study period. Of these, 135 were excluded from our analysis. The most common admission diagnoses were uncontrolled diabetes mellitus and acute coronary syndrome. AKI occurred in 216 patients (30.2%). Using the acute kidney injury network classification; stage 1, stage 2, and stage 3 disease were present in 59, 17.5, and 23.5% of patients, respectively. Of the 115 patients who died before discharge (16.1%), 87 (75.6%) had developed AKI. Hypertension, the use of angiotensin receptor blockers and non-steroidal anti-inflammatory drugs, heart failure, and exposure to radiologic contrast media were significant risk factors for AKI.
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Affiliation(s)
- Ashraf O Oweis
- Division of Nephrology, Department of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sameeha A Alshelleh
- Division of Nephrology, Department of Medicine, University of Jordan, Amman, Jordan
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