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Palmowski L, Lindau S, Henk LC, Marko B, Witowski A, Nowak H, Stoll SE, Zacharowski K, Böttiger BW, Peters J, Adamzik M, Dusse F, Rahmel T. Predictive enrichment for the need of renal replacement in sepsis-associated acute kidney injury: combination of furosemide stress test and urinary biomarkers TIMP-2 and IGFBP-7. Ann Intensive Care 2024; 14:111. [PMID: 39002065 PMCID: PMC11246358 DOI: 10.1186/s13613-024-01349-4] [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: 04/22/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND In sepsis, initial resuscitation with fluids is followed by efforts to achieve a negative fluid balance. However, patients with sepsis-associated acute kidney injury (SA-AKI) often need diuretic or renal replacement therapy (RRT). The dilemma is to predict whether early RRT might be advantageous or diuretics will suffice. Both the Furosemide Stress Test (FST) and measurements of the urinary biomarkers TIMP-2*IGFBP-7, if applied solely, do not provide sufficient guidance. We tested the hypothesis that a combination of two tests, i.e., an upstream FST combined with downstream measurements of urinary TIMP-2*IGFBP-7 concentrations improves the accuracy in predicting RRT necessity. METHODS In this prospective, multicenter study 100 patients with sepsis (diagnosed < 48h), AKI stage ≥ 2, and an indication for negative fluid balance were included between 02/2020 and 12/2022. All patients received a standardized FST and urinary biomarkers TIMP-2*IGFBP-7 were serially measured immediately before and up to 12 h after the FST. The primary outcome was the RRT requirement within 7 days after inclusion. RESULTS 32% (n = 32/99) of SA-AKI patients eventually required RRT within 7 days. With the FST, urine TIMP-2*IGFBP-7 decreased within 2 h from 3.26 ng2/mL2/1000 (IQR: 1.38-5.53) to 2.36 ng2/mL2/1000 (IQR: 1.61-4.87) in RRT and 1.68 ng2/mL2/1000 (IQR: 0.56-2.94) to 0.27 ng2/mL2/1000 (IQR: 0.12-0.89) and non-RRT patients, respectively. While TIMP-2*IGFBP-7 concentrations remained low for up to 12 h in non-RRT patients, we noted a rebound in RRT patients after 6 h. TIMP-2*IGFBP-7 before FST (accuracy 0.66; 95%-CI 0.55-0.78) and the FST itself (accuracy 0.74; 95%-CI: 0.64-0.82) yielded moderate test accuracies in predicting RRT requirement. In contrast, a two-step approach, utilizing FST as an upstream screening tool followed by TIMP-2*IGFBP-7 quantification after 2 h improved predictive accuracy (0.83; 95%-CI 0.74-0.90, p = 0.03) compared to the FST alone, resulting in a positive predictive value of 0.86 (95%-CI 0.64-0.97), and a specificity of 0.96 (95%-CI 0.88-0.99). CONCLUSIONS The combined application of an upstream FST followed by urinary TIMP-2*IGFBP-7 measurements supports highly specific identification of SA-AKI patients requiring RRT. Upcoming interventional trials should elucidate if this high-risk SA-AKI subgroup, identified by our predictive enrichment approach, benefits from an early RRT initiation.
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Affiliation(s)
- Lars Palmowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Simone Lindau
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Laura Contreras Henk
- Center for Children and Adolescent Medicine, Sana Hospital Duisburg, Duisburg, Germany
| | - Britta Marko
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Andrea Witowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Hartmuth Nowak
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
- Center for Artificial Intelligence, Medical Informatics and Data Science, University Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Sandra E Stoll
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University of Cologne, Cologne, Germany
- Department of Anesthesiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University of Cologne, Cologne, Germany
| | | | - Michael Adamzik
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, Medical Faculty and University of Cologne, Cologne, Germany
| | - Tim Rahmel
- Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
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Liu L, Hu Z. When to start renal replacement therapy in acute kidney injury: What are we waiting for? JOURNAL OF INTENSIVE MEDICINE 2024; 4:341-346. [PMID: 39035622 PMCID: PMC11258500 DOI: 10.1016/j.jointm.2023.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 07/23/2024]
Abstract
Acute kidney injury remains a serious condition with a high mortality risk. In the absence of any new drugs, renal replacement therapy (RRT) is the most important treatment option. Randomized controlled trials have concluded that in critically ill patients without an emergency indication for RRT, a watchful waiting strategy is safe; however, further delays in RRT did not seem to confer any benefit, rather was associated with potential harm. During this process, balancing the risks of complications due to an unnecessary intervention with the risk of not correcting a potentially life-threatening complication remains a challenge. Dynamic renal function assessment, especially dynamic assessment of renal demand-capacity matching, combined with renal biomarkers such as neutrophil gelatinase-associated lipocalin and furosemide stress test, is helpful to identify which patients and when the patients may benefit from RRT.
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Affiliation(s)
- Lixia Liu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenjie Hu
- Department of Critical Care Medicine, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Su Y, Wang P, Hu Y, Liu WJ, Zhang YJ, Chen JQ, Deng YZ, Lin S, Qiu Y, Li JK, Chen C, Tu GW, Luo Z. AKI-Pro score for predicting progression to severe acute kidney injury or death in patients with early acute kidney injury after cardiac surgery. J Transl Med 2024; 22:571. [PMID: 38879493 PMCID: PMC11180399 DOI: 10.1186/s12967-024-05279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/07/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND No reliable clinical tools exist to predict acute kidney injury (AKI) progression. We aim to explore a scoring system for predicting the composite outcome of progression to severe AKI or death within seven days among early AKI patients after cardiac surgery. METHODS In this study, we used two independent cohorts, and patients who experienced mild/moderate AKI within 48 h after cardiac surgery were enrolled. Eventually, 3188 patients from the MIMIC-IV database were used as the derivation cohort, while 499 patients from the Zhongshan cohort were used as external validation. The primary outcome was defined by the composite outcome of progression to severe AKI or death within seven days after enrollment. The variables identified by LASSO regression analysis were entered into logistic regression models and were used to construct the risk score. RESULTS The composite outcome accounted for 3.7% (n = 119) and 7.6% (n = 38) of the derivation and validation cohorts, respectively. Six predictors were assembled into a risk score (AKI-Pro score), including female, baseline eGFR, aortic surgery, modified furosemide responsiveness index (mFRI), SOFA, and AKI stage. And we stratified the risk score into four groups: low, moderate, high, and very high risk. The risk score displayed satisfied predictive discrimination and calibration in the derivation and validation cohort. The AKI-Pro score discriminated the composite outcome better than CRATE score, Cleveland score, AKICS score, Simplified renal index, and SRI risk score (all P < 0.05). CONCLUSIONS The AKI-Pro score is a new clinical tool that could assist clinicians to identify early AKI patients at high risk for AKI progression or death.
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Affiliation(s)
- Ying Su
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Peng Wang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yan Hu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wen-Jun Liu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yi-Jie Zhang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jia-Qi Chen
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yi-Zhi Deng
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Shuang Lin
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Yue Qiu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Jia-Kun Li
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Chen Chen
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Guo-Wei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Zhe Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
- Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China.
- Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China.
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Wang R, Lin Z, Quan S, Yang X, Zhao K, Sui X, Kong H, Wang X, Su T. Evaluation of renal tubular function by multiparametric functional MRI in early diabetes. Magn Reson Imaging 2024; 109:100-107. [PMID: 38494095 DOI: 10.1016/j.mri.2024.03.016] [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: 04/06/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/19/2024]
Abstract
Purpose To evaluate the tubular function in an alloxan-induced type 1 diabetes mellitus (DM) rabbit model measured by renal oxygenation (R2*), oxygen extraction fraction (OEF), and renal blood flow (RBF) using blood oxygenation level dependent, asymmetric spin echo, and arterial spin labeling MRI. Methods Twenty-six rabbits were randomized into the 3-day DM group (n = 13) and the 7-day DM group (n = 13). We performed pairs of multiparametric MRIs (before and after furosemide injection) at baseline and 3/7 days post-DM, and scored pathological kidney injury. We performed statistical analyses using non-parametric, chi-square, and Spearman correlation tests. Results At baseline, medullary R2* significantly decreased by 24.97% and 16.74% in the outer and inner stripes of the outer medulla (OS and IS, p = 0.006 and 0.003, respectively) after furosemide administration. While the corresponding OEF decreased by 15.91% for OS and 16.67% for IS (both p = 0.003), and no significant change in medullary RBF was observed (p > 0.05). In the 3-day DM group, the decrease of medullary R2* and OEF post-furosemide became unremarkable, suggesting tubular dysfunction. We noticed similar changes in the 7-day DM group. Correlation analysis showed pathological tubular injury score significantly correlated with medullary ∆R2* (post-furosemide - pre-furosemide difference, r = 0.82 for OS and 0.82 for IS) and ∆OEF (r = 0.82 for OS and 0.82 for IS) (p < 0.001, respectively). Conclusion: The combination of medullary OEF and R2* in response to furosemide could detect renal tubular dysfunction in early DM.
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Affiliation(s)
- Rui Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Zhiyong Lin
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Shuo Quan
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xuedong Yang
- Department of Radiology, China Academy of Chinese Medical Sciences Guanganmen Hospital, Beijing, China
| | - Kai Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xueqing Sui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hanjing Kong
- UIH Group, Beijing United Imaging Research Institute of Intelligent Imaging, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China.
| | - Tao Su
- Department of Nephrology, Peking University First Hospital, Beijing, China.
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Krishnasamy S, Sinha A, Lodha R, Sankar J, Tarik M, Ramakrishnan L, Bagga A, Hari P. Furosemide stress test to predict acute kidney injury progression in critically ill children. Pediatr Nephrol 2024:10.1007/s00467-024-06387-5. [PMID: 38691152 DOI: 10.1007/s00467-024-06387-5] [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: 01/31/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Furosemide stress test (FST) is a novel functional biomarker for predicting severe acute kidney injury (AKI); however, pediatric studies are limited. METHODS Children 3 months to 18 years of age admitted to the intensive care unit (ICU) of a tertiary care hospital from Nov 2019 to July 2021 were screened and those who developed AKI stage 1 or 2 within 7 days of admission underwent FST (intravenous furosemide 1 mg/kg). Urine output was measured hourly for the next 6 h; a value > 2 ml/kg within the first 2 h was deemed furosemide responsive. Other biomarkers like plasma neutrophil gelatinase-associated lipocalin (NGAL) and proenkephalin (PENK) were also evaluated. RESULTS Of the 480 admitted patients, 51 developed AKI stage 1 or 2 within 7 days of admission and underwent FST. Nine of these patients were furosemide non-responsive. Thirteen (25.5%) patients (eight of nine from FST non-responsive group) developed stage 3 AKI within 7 days of FST, nine (17.6%) of whom (seven from non-responsive group) required kidney support therapy (KST). FST emerged as a good biomarker for predicting stage 3 AKI and need for KST with area-under-the-curve (AUC) being 0.93 ± 0.05 (95% CI 0.84-1.0) and 0.96 ± 0.03 (95% CI 0.9-1.0), respectively. FST outperformed NGAL and PENK in predicting AKI stage 3 and KST; however, the combination did not improve the diagnostic accuracy. CONCLUSIONS Furosemide stress test is a simple, inexpensive, and robust biomarker for predicting stage 3 AKI and KST need in critically ill children. Further research is required to identify the best FST cut-off in children.
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Affiliation(s)
- Sudarsan Krishnasamy
- Pediatric Nephrology Services, Department of Paediatrics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Rakesh Lodha
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Jhuma Sankar
- Division of Pediatric Pulmonology and Intensive Care, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Mohamad Tarik
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arvind Bagga
- Director Paediatrics and Senior Consultant Pediatric Nephrology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Pankaj Hari
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Su Y, Zhang YJ, Tu GW, Hou JY, Ma GG, Hao GW, Xu RH, Luo Z. Furosemide Responsiveness Predicts Acute Kidney Injury Progression After Cardiac Surgery. Ann Thorac Surg 2024; 117:432-438. [PMID: 37488003 DOI: 10.1016/j.athoracsur.2023.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND As patients with acute kidney injury (AKI) progress to a higher stage, the risk for poor outcomes dramatically rises. Early identification of patients at high risk for AKI progression remains a major challenge. This study aimed to evaluate the value of furosemide responsiveness (FR) for predicting AKI progression in patients with initial mild and moderate AKI after cardiac surgery. METHODS We performed 2 separate exploratory analyses. The Zhongshan cohort was a single-center, prospective, observational cohort, whereas the Beth Israel Deaconess Medical Center cohort was a single-center, retrospective cohort. We calculated 2 FR parameters for each patient, namely the FR index and modified FR index, defined as 2-hour urine output divided by furosemide dose (FR index, mL/mg/2 h) and by furosemide dose and body weight (modified FR index, mL/[mg·kg]/2 h), respectively. The primary outcome was AKI progression within 7 days. RESULTS AKI progression occurred in 80 (16.0%) and 359 (11.3%) patients in the Zhongshan and Beth Israel Deaconess Medical Center cohorts, respectively. All FR parameters (considered continuously or in quartiles) were inversely associated with risk of AKI progression in both cohorts (all adjusted P < .01). The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models involving C-index, net reclassification improvement, and integrated discrimination improvement index in both cohorts (all P < .01). CONCLUSIONS FR parameters were inversely associated with risk of AKI progression in patients with mild and moderate AKI after cardiac surgery. The addition of FR parameters significantly improved prediction for AKI progression based on baseline clinical models.
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Affiliation(s)
- Ying Su
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi-Jie Zhang
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Wei Tu
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun-Yi Hou
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Guang Ma
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guang-Wei Hao
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Rong-Hui Xu
- Department of Mathematics, Halicioglu Data Science Institute, University of California, San Diego, La Jolla, California
| | - Zhe Luo
- Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Key Laboratory of Lung Inflammation and Injury, Shanghai, China; Department of Critical Care Medicine, Shanghai Xuhui Central Hospital, Zhongshan-Xuhui Hospital, Fudan University, Shanghai, China.
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Gist KM, Penk J, Wald EL, Kitzmiller L, Webb TN, Krallman K, Brinton J, Soranno DE, Goldstein SL, Basu RK. Urine Quantification Following Furosemide for Severe Acute Kidney Injury Prediction in Critically Ill Children. J Pediatr Intensive Care 2023; 12:289-295. [PMID: 37970140 PMCID: PMC10631834 DOI: 10.1055/s-0041-1732447] [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: 04/14/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022] Open
Abstract
A standardized, quantified assessment of furosemide responsiveness predicts acute kidney injury (AKI) in children after cardiac surgery and AKI progression in critically ill adults. The purpose of this study was to determine if response to furosemide is predictive of severe AKI in critically ill children outside of cardiac surgery. We performed a multicenter retrospective study of critically ill children. Quantification of furosemide response was based on urine flow rate (normalized for weight) measurement 0 to 6 hours after the dose. The primary outcome was presence of creatinine defined severe AKI (Kidney Disease Improving Global Outcomes stage 2 or greater) within 7 days of furosemide administration. Secondary outcomes included mortality, duration of mechanical ventilation and length of stay. A total of 110 patients were analyzed. Severe AKI occurred in 20% ( n = 22). Both 2- and 6-hour urine flow rate were significantly lower in those with severe AKI compared with no AKI ( p = 0.002 and p < 0.001). Cutoffs for 2- and 6-hour urine flow rate for prediction of severe AKI were <4 and <3 mL/kg/hour, respectively. The adjusted odds of developing severe AKI for 2-hour urine flow rate of <4 mL/kg/hour was 4.3 (95% confidence interval [CI]: 1.33-14.15; p = 0.02). The adjusted odds of developing severe AKI for 6-hour urine flow rate of <3 mL/kg/hour was 6.19 (95% CI: 1.85-20.70; p = 0.003). Urine flow rate in response to furosemide is predictive of severe AKI in critically ill children. A prospective assessment of urine flow rate in response to furosemide for predicting subsequent severe AKI is warranted.
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Affiliation(s)
- Katja M. Gist
- Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Jamie Penk
- Department of Pediatrics, Division of Pediatric Critical Care, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, United States
| | - Eric L. Wald
- Department of Pediatrics, Division of Pediatric Critical Care, Northwestern University, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, United States
| | - Laura Kitzmiller
- Pediatric Critical Care, Department of Pediatrics, Essentia Health St Mary's Medical Center, Duluth, Minnesota, United States
| | - Tennille N. Webb
- Division of Pediatric Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama, United States
| | - Kelli Krallman
- Section of Pediatric Critical Care Medicine, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, United States
| | - John Brinton
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Danielle E. Soranno
- Department of Pediatrics, Division of Pediatric Nephrology, University of Colorado, Children's Hospital Colorado, Aurora, Colorado, United States
| | - Stuart L. Goldstein
- Department of Pediatrics, University of Cincinnati, Center for Acute Care Nephrology, Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio, United States
| | - Rajit K. Basu
- Department of Pediatrics, Division of Critical Care Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
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Samoni S, De Rosa S, Ronco C, Castellano G. Update on persistent acute kidney injury in critical illnesses. Clin Kidney J 2023; 16:1813-1823. [PMID: 37915904 PMCID: PMC10616499 DOI: 10.1093/ckj/sfad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Indexed: 11/03/2023] Open
Abstract
Acute kidney injury (AKI) affects about half of patients admitted to the intensive care unit (ICU), and worsens their short- and long-term outcomes. Apparently self-limiting AKI episodes initiate a progression toward chronic kidney disease (CKD) through cellular and molecular mechanisms that are yet to be explained. In particular, persistent AKI, defined in 2016 by the Acute Dialysis Quality Initiative as an AKI which lasts more than 48 h from its onset, has been correlated with higher morbidity and mortality, and with a higher progression to acute kidney disease (AKD) and CKD than transient AKI (i.e. AKI with a reversal within 48 h). This classification has been also used in the setting of solid organ transplantation, demonstrating similar outcomes. Due to its incidence and poor prognosis and because prompt interventions seem to change its course, persistent AKI should be recognized early and followed-up also after its recovery. However, while AKI and CKD are well-described syndromes, persistent AKI and AKD are relatively new entities. The purpose of this review is to highlight the key phases of persistent AKI in ICU patients in terms of both clinical and mechanistic features in order to offer to clinicians and researchers an updated basis from which to start improving patients' care and direct future research.
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Affiliation(s)
- Sara Samoni
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia De Rosa
- Centre for Medical Sciences – CISMed, University of Trento, Trento, Italy
- Anesthesia and Intensive Care, Santa Chiara Regional Hospital, APSS Trento, Trento, Italy
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy
- International Renal Research Institute of Vicenza (IRRIV), Vicenza, Italy
- Department of Nephrology, Dialysis and Renal Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Giuseppe Castellano
- Department of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
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To A, Davila C, Stroope S, Walton R. Case report: Resolution of oligo-anuric acute kidney injury with furosemide administration in a cat following lily toxicity. Front Vet Sci 2023; 10:1195743. [PMID: 37476822 PMCID: PMC10354244 DOI: 10.3389/fvets.2023.1195743] [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: 03/28/2023] [Accepted: 06/05/2023] [Indexed: 07/22/2023] Open
Abstract
Objective To describe the successful outcome of a case of oligo-anuric acute kidney injury in a cat secondary to lily ingestion. Case summary A 12-week-old intact male domestic short-hair cat weighing 1.64 kg (3.6 lb) presented with a 12-h duration of vomiting and lethargy after exposure to lilies of the genera Lilium species 24 h prior to presentation. Severe azotemia (Creatinine 5.8 mg/dL, BUN > 100 mg/dL) and hyperkalemia (9.36 mmol/L) were noted on the day of presentation. Treatment of hyperkalemia was instituted with calcium gluconate, lactated ringers solution, dextrose, regular short-acting insulin, albuterol, and sodium bicarbonate, Oliguria to anuria was highly suspected based on a lack of urine production 21 h after hospitalization with intravenous fluid administration and a static bladder size. The cat was administered 4 mg/kg of furosemide, and urinated at 6 h following administration and continued to produce over 6 ml/kg/h of urine in the next 24 h. Two days following furosemide administration, the cat's hyperkalemia and azotemia resolved. The cat was discharged after 4 days of hospitalization, and a recheck revealed no persistent azotemia or hyperkalemia. Unique information Anuric acute kidney injury secondary to lily toxicity is associated with a poor prognosis, and the only treatment modality previously described is hemodialysis. The cat in this report was successfully managed with medical intervention and furosemide administration, with complete resolution of the acute kidney injury.
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Affiliation(s)
- An To
- Department of Emergency and Critical Care, Veterinary Centers of America (VCA) West Los Angeles Animal Hospital, Los Angeles, CA, United States
| | - Claudia Davila
- Department of Emergency and Critical Care, Veterinary Centers of America (VCA) West Los Angeles Animal Hospital, Los Angeles, CA, United States
| | - Sarah Stroope
- Department of Emergency and Critical Care, Veterinary Centers of America (VCA) West Los Angeles Animal Hospital, Los Angeles, CA, United States
| | - Rebecca Walton
- Department of Emergency and Critical Care, Veterinary Centers of America (VCA) West Los Angeles Animal Hospital, Los Angeles, CA, United States
- Department of Emergency and Critical Care, Iowa State University, Ames, IA, United States
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10
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Cai L, Shu L, Yujun Z, Ke C, Qiang W. Lack of furosemide responsiveness predict severe acute kidney injury after liver transplantation. Sci Rep 2023; 13:4978. [PMID: 36973328 PMCID: PMC10042839 DOI: 10.1038/s41598-023-31757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
Acute kidney injury (AKI) remains to be a common but severe complication after liver transplantation (LT). However, there are still few clinically validated biomarkers. A total of 214 patients who underwent routine furosemide (1-2 mg/kg) after LT were retrospectively included. The urine output during the first 6 h was recorded to evaluate the predictive value of AKI stage 3 and renal replacement therapy (RRT). 105 (49.07%) patients developed AKI, including 21 (9.81%) progression to AKI stage 3 and 10 (4.67%) requiring RRT. The urine output decreased with the increasing severity of AKI. The urine output of AKI stage 3 did not significantly increase after the use of furosemide. The area under the receiver operator characteristic (ROC) curves for the total urine output in the first hour to predict progression to AKI stage 3 was 0.94 (p < 0.001). The ideal cutoff for predicting AKI progression during the first hour was a urine volume of less than 200 ml with a sensitivity of 90.48% and specificity of 86.53%. The area under the ROC curves for the total urine output in the six hours to predict progression to RRT was 0.944 (p < 0.001). The ideal cutoff was a urine volume of less than 500 ml with a sensitivity of 90% and specificity of 90.91%. Severe AKI after liver transplantation seriously affects the outcome of patients. Lack of furosemide responsiveness quickly and accurately predict AKI stage 3, and patients requiring RRT after the operation.
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Affiliation(s)
- Li Cai
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liu Shu
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhao Yujun
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Ke
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China.
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China.
| | - Wang Qiang
- Department of Transplantation, The Third Xiangya Hospital, Central South University, Changsha, China.
- Engineering and Technology Research Center for Transplantation Medicine of National Health Comission, The Third Xiangya Hospital, Central South University, Changsha, China.
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11
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Krishnasamy S, Sinha A, Bagga A. Management of Acute Kidney Injury in Critically Ill Children. Indian J Pediatr 2023; 90:481-491. [PMID: 36859513 PMCID: PMC9977639 DOI: 10.1007/s12098-023-04483-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
Abstract
Acute kidney injury (AKI) is common in critically ill patients, affecting almost one in four critically ill children and one in three neonates. Higher stages of AKI portend worse outcomes. Identifying AKI timely and instituting appropriate measures to prevent and manage severe AKI is important, since it is independently associated with mortality. Methods to predict severe AKI should be applied to all critically ill patients. Assessment of volume status to prevent the development of fluid overload is useful to prevent adverse outcomes. Patients with metabolic or clinical complications of AKI need prompt kidney replacement therapy (KRT). Various modes of KRT are available, and the choice of modality depends most on the technical competence of the center, patient size, and hemodynamic stability. Given the significant risk of chronic kidney disease, patients with AKI require long-term follow-up. It is important to focus on improving awareness about AKI, incorporate AKI prevention as a quality initiative, and improve detection, prevention, and management of AKI with the aim of reducing acute and long-term morbidity and mortality.
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Affiliation(s)
- Sudarsan Krishnasamy
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Aditi Sinha
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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12
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Acute Kidney Injury and Renal Replacement Therapy: A Review and Update for the Perioperative Physician. Anesthesiol Clin 2023; 41:211-230. [PMID: 36872000 DOI: 10.1016/j.anclin.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Post-operative acute kidney injury is a devastating complication with significant morbidity and mortality associated with it. The perioperative anesthesiologist is in a unique position to potentially mitigate the risk of postoperative AKI, however, understanding the pathophysiology, risk factors and preventative strategies is paramount. There are also certain clinical scenarios, where renal replacement therapy may be indicated intraoperatively including severe electrolyte abnormalities, metabolic acidosis and massive volume overload. A multidisciplinary approach including the nephrologist, critical care physician, surgeon and anesthesiologist is necessary to determine the optimal management of these critically ill patients.
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13
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Fox HM, DeCleene JH. Relationship Between Mean Arterial Pressure and Furosemide Stress Test Success Rates: A Retrospective Cohort Study. Ann Pharmacother 2023; 57:44-50. [PMID: 35570799 DOI: 10.1177/10600280221096466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The furosemide stress test (FST) is a safe and easy assessment of renal tubular function. Other factors, such as mean arterial pressure (MAP), which may influence the success rates of the FST, have not been well defined. OBJECTIVE To evaluate the relationship between MAP and success rates of the FST in critically ill patients. METHODS Retrospective, single-center, institutional review board (IRB)-approved cohort study. Critically ill adult patients given at least one dose of intravenous (IV) furosemide (≥1-1.5 mg/kg) were included. Primary outcome was whether a MAP ≥ 75 mm Hg would equate to a higher FST success rate. Secondary outcome was the success rates of patient on one or more vasopressors. RESULTS Of 225 patients, 88 (39.1%) had a successful FST. In patients with a MAP ≥ 75 mm Hg, 60 out of 104 (57.7%) had a successful FST compared to 28 out of 121 (23.1%) of patients who had a MAP < 75 mm Hg (odds ratio [OR], 4.53, 95% CI, 2.55-8.74, P < 0.001). Patients on vasopressors at the time of the furosemide dose had lower rates of success compared to those not on vasoactive agents (30.4% versus 68.2%, p = 0.026). Limitations of this study include its retrospective design and reliance on documented urine output. CONCLUSION AND RELEVANCE Patients with a MAP ≥ 75 mm Hg were significantly more likely to have a successful FST compared to those with a MAP < 75 mm Hg. This represents the first report of factors that may influence FST success rates.
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Affiliation(s)
- Haley M Fox
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Acute Care Pharmacy, Iowa City, IA, USA
| | - Jacob H DeCleene
- Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Acute Care Pharmacy, Iowa City, IA, USA
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14
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Weaver LJ, Travers CP, Ambalavanan N, Askenazi D. Neonatal fluid overload-ignorance is no longer bliss. Pediatr Nephrol 2023; 38:47-60. [PMID: 35348902 PMCID: PMC10578312 DOI: 10.1007/s00467-022-05514-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/26/2022] [Accepted: 02/21/2022] [Indexed: 01/10/2023]
Abstract
Excessive accumulation of fluid may result in interstitial edema and multiorgan dysfunction. Over the past few decades, the detrimental impact of fluid overload has been further defined in adult and pediatric populations. Growing evidence highlights the importance of monitoring, preventing, managing, and treating fluid overload appropriately. Translating this knowledge to neonates is difficult as they have different disease pathophysiologies, and because neonatal physiology changes rapidly postnatally in many of the organ systems (i.e., skin, kidneys, and cardiovascular, pulmonary, and gastrointestinal). Thus, evaluations of the optimal targets for fluid balance need to consider the disease state as well as the gestational and postmenstrual age of the infant. Integration of what is known about neonatal fluid overload with individual alterations in physiology is imperative in clinical management. This comprehensive review will address what is known about the epidemiology and pathophysiology of neonatal fluid overload and highlight the known knowledge gaps. Finally, we provide clinical recommendations for monitoring, prevention, and treatment of fluid overload.
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Affiliation(s)
| | - Colm P Travers
- University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - David Askenazi
- University of Alabama at Birmingham, Birmingham, AL, USA
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15
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Alfieri F, Ancona A, Tripepi G, Randazzo V, Paviglianiti A, Pasero E, Vecchi L, Politi C, Cauda V, Fagugli RM. External validation of a deep-learning model to predict severe acute kidney injury based on urine output changes in critically ill patients. J Nephrol 2022; 35:2047-2056. [PMID: 35554875 PMCID: PMC9585008 DOI: 10.1007/s40620-022-01335-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to externally validate algorithms (previously developed and trained in two United States populations) aimed at early detection of severe oliguric AKI (stage 2/3 KDIGO) in intensive care units patients. METHODS The independent cohort was composed of 10'596 patients from the university hospital ICU of Amsterdam (the "AmsterdamUMC database") admitted to their intensive care units. In this cohort, we analysed the accuracy of algorithms based on logistic regression and deep learning methods. The accuracy of investigated algorithms had previously been tested with electronic intensive care unit (eICU) and MIMIC-III patients. RESULTS The deep learning model had an area under the ROC curve (AUC) of 0,907 (± 0,007SE) with a sensitivity and specificity of 80% and 89%, respectively, for identifying oliguric AKI episodes. Logistic regression models had an AUC of 0,877 (± 0,005SE) with a sensitivity and specificity of 80% and 81%, respectively. These results were comparable to those obtained in the two US populations upon which the algorithms were previously developed and trained. CONCLUSION External validation on the European sample confirmed the accuracy of the algorithms, previously investigated in the US population. The models show high accuracy in both the European and the American databases even though the two cohorts differ in a range of demographic and clinical characteristics, further underlining the validity and the generalizability of the two analytical approaches.
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Affiliation(s)
- Francesca Alfieri
- Department of Applied Science and Technology, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Andrea Ancona
- Department of Applied Science and Technology, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Giovanni Tripepi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Nefrologia-Ospedali Riuniti, 89100, Reggio Calabria, Italy
| | - Vincenzo Randazzo
- Department of Electronics and Telecommunications, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Annunziata Paviglianiti
- Department of Electronics and Telecommunications, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Eros Pasero
- Department of Electronics and Telecommunications, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Luigi Vecchi
- S.C. Nefrologia e Dialisi, Azienda Ospedaliera di Terni, viale Tristano di Joannuccio, 05100, Terni, Italy
| | - Cristina Politi
- CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Nefrologia-Ospedali Riuniti, 89100, Reggio Calabria, Italy
| | - Valentina Cauda
- Department of Applied Science and Technology, Politecnico di Torino, C.so Duca degli Abruzzi 24, 10129, Turin, Italy.
| | - Riccardo Maria Fagugli
- S.C. Nefrologia e Dialisi, Azienda Ospedaliera di Terni, viale Tristano di Joannuccio, 05100, Terni, Italy.
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16
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Sitbon A, Darmon M, Geri G, Jaubert P, Lamouche-Wilquin P, Monet C, Le Fèvre L, Baron M, Harlay ML, Bureau C, Joannes-Boyau O, Dupuis C, Contou D, Lemiale V, Simon M, Vinsonneau C, Blayau C, Jacobs F, Zafrani L. Accuracy of clinicians' ability to predict the need for renal replacement therapy: a prospective multicenter study. Ann Intensive Care 2022; 12:95. [PMID: 36242651 PMCID: PMC9569012 DOI: 10.1186/s13613-022-01066-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Identifying patients who will receive renal replacement therapy (RRT) during intensive care unit (ICU) stay is a major challenge for intensivists. The objective of this study was to evaluate the performance of physicians in predicting the need for RRT at ICU admission and at acute kidney injury (AKI) diagnosis. METHODS Prospective, multicenter study including all adult patients hospitalized in 16 ICUs in October 2020. Physician prediction was estimated at ICU admission and at AKI diagnosis, according to a visual Likert scale. Discrimination, risk stratification and benefit of physician estimation were assessed. Mixed logistic regression models of variables associated with risk of receiving RRT, with and without physician estimation, were compared. RESULTS Six hundred and forty-nine patients were included, 270 (41.6%) developed AKI and 77 (11.8%) received RRT. At ICU admission and at AKI diagnosis, a model including physician prediction, the experience of the physician, SOFA score, serum creatinine and diuresis to determine need for RRT performed better than a model without physician estimation with an area under the ROC curve of 0.90 [95% CI 0.86-0.94, p < 0.008 (at ICU admission)] and 0.89 [95% CI 0.83-0.93, p = 0.0014 (at AKI diagnosis)]. In multivariate analysis, physician prediction was strongly associated with the need for RRT, independently of creatinine levels, diuresis, SOFA score and the experience of the doctor who made the prediction. CONCLUSION As physicians are able to stratify patients at high risk of RRT, physician judgement should be taken into account when designing new randomized studies focusing on RRT initiation during AKI.
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Affiliation(s)
- Alexandre Sitbon
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France. .,Sorbonne Université, Paris, France.
| | - Michael Darmon
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université Paris Cité, Paris, France
| | - Guillaume Geri
- Médecine Intensive et Réanimation, Hôpital Ambroise Paré, Assistance Publique-Hôpitaux de Paris (AP-HP) Sud, Boulogne Billancourt, France
| | - Paul Jaubert
- Médecine Intensive et Réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP) Sud, Paris, France
| | | | - Clément Monet
- Département d'Anesthésie-Réanimation, Hôpital St-Eloi, CHRU, Montpellier, France
| | - Lucie Le Fèvre
- Médecine Intensive et Réanimation, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, Paris, France
| | - Marie Baron
- Réanimation Polyvalente, Centre Hospitalier du Sud-Francilien, Corbeil-Essonnes, France
| | - Marie-Line Harlay
- Médecine Intensive et Réanimation, CHU Hautepierre, Strasbourg, France
| | - Côme Bureau
- Médecine Intensive et Réanimation, Hôpital de La Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Olivier Joannes-Boyau
- Département d'Anesthésie-Réanimation Sud, Centre Médico-Chirurgical Magellan, Bordeaux, France
| | - Claire Dupuis
- Médecine Intensive et Réanimation, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Damien Contou
- Réanimation Polyvalente, CH Victor Dupouy, Argenteuil, France
| | - Virginie Lemiale
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Marie Simon
- Médecine Intensive et Réanimation, CHU Edouard Herriot, Lyon, France
| | | | - Clarisse Blayau
- Médecine Intensive et Réanimation, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Paris, France
| | - Frederic Jacobs
- Médecine Intensive et Réanimation, Hôpital Antoine Béclère, Assistance Publique-Hôpitaux de Paris (AP-HP), Clamart, France
| | - Lara Zafrani
- Médecine Intensive et Réanimation, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP) Nord, 1 Avenue Claude Vellefaux, 75010, Paris, France.,Université Paris Cité, Paris, France
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17
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Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, Govil D, Savio RD, Subbarayan B, Arora N, Chatterjee R, Chacko J, Khasne RW, Chakravarthi RM, George N, Ahmed A, Javeri Y, Chhallani AK, Khanikar RG, Margabandhu S, Lopa AJ, Chaudhry D, Samavedam S, Kar A, Dixit SB, Gopal P. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022; 26:S13-S42. [PMID: 36896356 PMCID: PMC9989875 DOI: 10.5005/jp-journals-10071-24109] [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: 10/03/2021] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is a complex syndrome with a high incidence and considerable morbidity in critically ill patients. Renal replacement therapy (RRT) remains the mainstay of treatment for AKI. There are at present multiple disparities in uniform definition, diagnosis, and prevention of AKI and timing of initiation, mode, optimal dose, and discontinuation of RRT that need to be addressed. The Indian Society of Critical Care Medicine (ISCCM) AKI and RRT guidelines aim to address the clinical issues pertaining to AKI and practices to be followed for RRT, which will aid the clinicians in their day-to-day management of ICU patients with AKI. How to cite this article Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13-S42.
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Affiliation(s)
- Rajesh C Mishra
- EPIC Hospital, Sanjivani Super Speciality Hospital, Ahmedabad, Gujarat, India
| | | | | | - Niraj Tyagi
- Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Rajeev A Annigeri
- Department of Nephrology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Deepak Govil
- Institute of Critical Care and Anaesthesiology, Medanta, Gurugram, Haryana, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | | | - Nitin Arora
- Department of Intensive Care, University Hospitals Birmingham, Birmingham, West Midlands, United Kingdom
| | - Ranajit Chatterjee
- Department of Anaesthesiology and Critical Care, Swami Dayanand Hospital, New Delhi, India
| | - Jose Chacko
- Narayana Health City, Bengaluru, Karnataka, India
| | - Ruchira W Khasne
- Department of Critical Care Medicine, SMBT Institute of Medical Sciences and Research Centre, Nashik, Maharashtra, India
| | | | - Nita George
- VPS Lakeshore Hospital, Kochi, Kerala, India
| | - Ahsan Ahmed
- KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Yash Javeri
- Department of Critical Care, Anesthesia and Emergency Medicine, Regency Super Speciality Hospital, Lucknow, Uttar Pradesh, India
| | | | - Reshu G Khanikar
- Department of Critical Care Medicine, Health City Hospital, Guwahati, Assam, India
| | | | - Ahsina J Lopa
- Intensive Care Unit, MH Samorita Hospital and Medical College, Tejgaon, Dhaka, Bangladesh
| | | | - Srinivas Samavedam
- Department of Critical Care, Vrinchi Hospital, Hyderabad, Telangana, India
| | - Arindam Kar
- Reliance Hospital, Mumbai, Maharashtra, India
| | - Subhal B Dixit
- Department of Critical Care, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Palepu Gopal
- Department of Critical Care Medicine, Continental Hospitals, Hyderabad, Telangana, India
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18
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Wald R, Beaubien-Souligny W, Chanchlani R, Clark EG, Neyra JA, Ostermann M, Silver SA, Vaara S, Zarbock A, Bagshaw SM. Delivering optimal renal replacement therapy to critically ill patients with acute kidney injury. Intensive Care Med 2022; 48:1368-1381. [PMID: 36066597 DOI: 10.1007/s00134-022-06851-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Critical illness is often complicated by acute kidney injury (AKI). In patients with severe AKI, renal replacement therapy (RRT) is deployed to address metabolic dysfunction and volume excess until kidney function recovers. This review is intended to provide a comprehensive update on key aspects of RRT prescription and delivery to critically ill patients. Recently completed trials have enhanced the evidence base regarding several RRT practices, most notably the timing of RRT initiation and anticoagulation for continuous therapies. Better evidence is still needed to clarify several aspects of care including optimal targets for ultrafiltration and effective strategies for RRT weaning and discontinuation.
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Affiliation(s)
- Ron Wald
- Division of Nephrology, St. Michael's Hospital and the University of Toronto, 61 Queen Street East, 9-140, Toronto, ON, M5C 2T2, Canada. .,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | | | - Rahul Chanchlani
- Division of Pediatric Nephrology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Javier A Neyra
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marlies Ostermann
- Department of Critical Care Medicine, Guys and St. Thomas Hospital, London, UK
| | - Samuel A Silver
- Division of Nephrology, Kingston Health Sciences Center, Queen's University, Kingston, ON, Canada
| | - Suvi Vaara
- Division of Intensive Care Medicine, Department of Anesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alexander Zarbock
- Department of Anesthesiology, Intensive Care and Pain Medicine, Muenster, Germany
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
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19
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Schanz M, Ketteler M. [62/m-Oliguria and increasing retention values after cardiopulmonary resuscitation : Preparation course anesthesiological intensive care medicine: case 7]. DIE ANAESTHESIOLOGIE 2022; 71:36-41. [PMID: 35925163 DOI: 10.1007/s00101-022-01145-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Moritz Schanz
- Zentrum für Innere Medizin, Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland
| | - Markus Ketteler
- Zentrum für Innere Medizin, Abteilung für Allgemeine Innere Medizin und Nephrologie, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Deutschland.
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20
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Ojo B, Campbell CH. Perioperative acute kidney injury: impact and recent update. Curr Opin Anaesthesiol 2022; 35:215-223. [PMID: 35102042 DOI: 10.1097/aco.0000000000001104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Acute kidney injury (AKI) is common in hospitalized patients and is a major risk factor for increased length of stay, morbidity, and mortality in postoperative patients. There are multiple barriers to reducing perioperative AKI - the etiology is multi-factorial and the diagnosis is fraught with issues. We review the recent literature on perioperative AKI and some considerations for anesthesiologists that examine the far-reaching effects of AKI on multiple organ systems. RECENT FINDINGS This review will discuss recent literature that addresses the epidemiology, use of novel biomarkers in risk stratification, and therapeutic modalities for AKI in burn, pediatrics, sepsis, trauma, cardiac, and liver disease, contrast-induced AKI, as well as the evidence assessing goal-directed fluid therapy. SUMMARY Recent studies address the use of risk stratification models and biomarkers, more sensitive than creatinine, in the preoperative identification of patients at risk for AKI. Although exciting, these scores and models need validation. There is a need for research assessing whether early AKI detection improves outcomes. Enhanced recovery after surgery utilizing goal-directed fluid therapy has not been shown to make an appreciable difference in the incidence of AKI. Reducing perioperative AKI requires a multi-pronged and possibly disease-specific approach.
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Affiliation(s)
- Bukola Ojo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA
| | - Cedric H Campbell
- Department of Anesthesiology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Diuretics and the kidney. BJA Educ 2022; 22:216-223. [DOI: 10.1016/j.bjae.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/22/2022] Open
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Acute Kidney Injury: Biomarker-Guided Diagnosis and Management. Medicina (B Aires) 2022; 58:medicina58030340. [PMID: 35334515 PMCID: PMC8953384 DOI: 10.3390/medicina58030340] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 12/23/2022] Open
Abstract
Acute kidney injury (AKI) is a common clinical syndrome that is characterized by abnormal renal function and structure. The Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference in 2019 reviewed the stages of AKI and the definitions of AKI-related terminologies, and discussed the advances in the last decade. Along with serum creatinine level and urine output, more accurate novel biomarkers for predicting AKI are being applied for the early detection of renal dysfunction. A literature search was conducted in PubMed, Scopus, Medline, and ClinicalTrials.gov using the terms AKI and biomarker, combined with diagnosis, management, or prognosis. Because of the large volume of data (160 articles) published between 2005 and 2022, representative literature was chosen. A number of studies have demonstrated that new biomarkers are more sensitive in detecting AKI in certain populations than serum creatinine and urine output according to the recommendations from the Acute Disease Quality Initiative Consensus Conference. To be specific, there is a persistently unresolved need for earlier detection of patients with AKI before AKI progresses to a need for renal replacement therapy. Biomarker-guided management may help to identify a high-risk group of patients in progression to severe AKI, and decide the initiation time to renal replacement therapy and optimal follow-up period. However, limitations such as biased data to certain studied populations and absence of cutoff values need to be solved for worldwide clinical use of biomarkers in the future. Here, we provide a comprehensive review of biomarker-based AKI diagnosis and management and highlight recent developments.
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Wei C, Zhang L, Feng Y, Ma A, Kang Y. Machine learning model for predicting acute kidney injury progression in critically ill patients. BMC Med Inform Decis Mak 2022; 22:17. [PMID: 35045840 PMCID: PMC8772216 DOI: 10.1186/s12911-021-01740-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
Background Acute kidney injury (AKI) is a serve and harmful syndrome in the intensive care unit. Comparing to the patients with AKI stage 1/2, the patients with AKI stage 3 have higher in-hospital mortality and risk of progression to chronic kidney disease. The purpose of this study is to develop a prediction model that predict whether patients with AKI stage 1/2 will progress to AKI stage 3. Methods Patients with AKI stage 1/2, when they were first diagnosed with AKI in the Medical Information Mart for Intensive Care, were included. We used the Logistic regression and machine learning extreme gradient boosting (XGBoost) to build two models which can predict patients who will progress to AKI stage 3. Established models were evaluated by cross-validation, receiver operating characteristic curve, and precision–recall curves. Results We included 25,711 patients, of whom 2130 (8.3%) progressed to AKI stage 3. Creatinine, multiple organ failure syndromes were the most important in AKI progression prediction. The XGBoost model has a better performance than the Logistic regression model on predicting AKI stage 3 progression. Thus, we build a software based on our data which can predict AKI progression in real time. Conclusions The XGboost model can better identify patients with AKI progression than Logistic regression model. Machine learning techniques may improve predictive modeling in medical research.
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Fuhrman D. The use of diagnostic tools for pediatric AKI: applying the current evidence to the bedside. Pediatr Nephrol 2021; 36:3529-3537. [PMID: 33492454 PMCID: PMC8813176 DOI: 10.1007/s00467-021-04940-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 12/17/2022]
Abstract
Given the known deleterious consequences of acute kidney injury (AKI), exciting recent research efforts have focused on developing strategies for the earlier recognition of AKI in the pediatric population. Recognizing the limitations of serum creatinine, investigators have focused on the study of novel biomarkers and practical bedside tools for identifying patients at risk for AKI prior to a rise in serum creatinine. In PubMed, there are presently over 30 original research papers exploring the use of pediatric AKI risk prediction tools in just the last 2 years. The following review highlights the most recent advances in the literature regarding opportunities to refine our ability to detect AKI early. Importantly, this review discusses how prediction tools including novel urine and serum biomarkers, practical risk stratification tests, renal functional reserve, and electronic medical record alerts may ultimately be applied to routine clinical practice.
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Affiliation(s)
- Dana Fuhrman
- Department of Critical Care Medicine, Department of Pediatrics, Division of Nephrology, The Center for Critical Care Nephrology, University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA, 15224, USA.
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Neutrophil-to-lymphocyte ratio is a marker for acute kidney injury progression and mortality in critically ill populations: a population-based, multi-institutional study. J Nephrol 2021; 35:911-920. [PMID: 34623629 PMCID: PMC8498757 DOI: 10.1007/s40620-021-01162-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
Backgrounds Neutrophil-to-lymphocyte ratio (NLR), a surrogate marker of systemic response to physiological stress, is used for prognosis prediction in many diseases. However, the usefulness of this marker for predicting acute kidney injury (AKI) progression is unclear. Methods This retrospective study was based on the Chang Gung Research Database. Patients admitted to the intensive care unit with a diagnosis of stage 1 or 2 AKI were identified. The primary outcome was a composite of progression to stage 3 AKI, requirement of renal replacement therapy, or 14-day in-hospital mortality. The association between NLR and the primary outcome was examined using a logistic regression model and multivariable analysis. The nonlinearity and cutoff points of this relationship were determined using a restricted cubic spline model. Results A total of 10,441 patients were enrolled. NLR level at the time of stage 1–2 AKI diagnosis was a marker of adverse outcomes. After adjustment for confounders, NLR was independently associated with the composite outcome of AKI progression, renal replacement therapy, or mortality. The restricted cubic spline model revealed a J-shaped curve, with the lowest odds ratio for an NLR between 7 and 38. Subgroup analysis revealed linear and J-shaped relationships between NLR and the primary outcome in patients admitted to the intensive care unit for medical reasons and for cardiovascular surgery, respectively. Conclusions NLR is an independent marker of AKI progression and in-hospital mortality. Because it is readily available in daily practice, it might be used for risk stratification in the AKI population. Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01162-3.
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Acute kidney injury in the critically ill: an updated review on pathophysiology and management. Intensive Care Med 2021; 47:835-850. [PMID: 34213593 PMCID: PMC8249842 DOI: 10.1007/s00134-021-06454-7] [Citation(s) in RCA: 163] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/04/2021] [Indexed: 01/10/2023]
Abstract
Acute kidney injury (AKI) is now recognized as a heterogeneous syndrome that not only affects acute morbidity and mortality, but also a patient’s long-term prognosis. In this narrative review, an update on various aspects of AKI in critically ill patients will be provided. Focus will be on prediction and early detection of AKI (e.g., the role of biomarkers to identify high-risk patients and the use of machine learning to predict AKI), aspects of pathophysiology and progress in the recognition of different phenotypes of AKI, as well as an update on nephrotoxicity and organ cross-talk. In addition, prevention of AKI (focusing on fluid management, kidney perfusion pressure, and the choice of vasopressor) and supportive treatment of AKI is discussed. Finally, post-AKI risk of long-term sequelae including incident or progression of chronic kidney disease, cardiovascular events and mortality, will be addressed.
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Langston C, Gordon D. Effects of IV Fluids in Dogs and Cats With Kidney Failure. Front Vet Sci 2021; 8:659960. [PMID: 33959654 PMCID: PMC8093391 DOI: 10.3389/fvets.2021.659960] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/18/2021] [Indexed: 12/25/2022] Open
Abstract
Intravenous fluid therapy has long been the mainstay of treatment of kidney disease, including acute kidney injury and uremic crisis associated with chronic kidney disease. Careful management of fluid dose is critical, as animals with kidney disease may have marked derangements in their ability to regulate fluid homeostasis and acid-base status. Understanding of the physiology of renal fluid handling is necessary, along with repeated attention to parameters of fluid status, electrolytes, and acid-base balance, to achieve optimal hydration status and avoid further damage or decrease in function from dehydration or overhydration.
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Affiliation(s)
- Cathy Langston
- The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
| | - Daniel Gordon
- The Ohio State University College of Veterinary Medicine, Columbus, OH, United States
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Ostermann M, Lumlertgul N. Predicting AKI: do we have the necessary tools? Minerva Anestesiol 2021; 87:397-399. [PMID: 33688704 DOI: 10.23736/s0375-9393.21.15635-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marlies Ostermann
- Department of Critical Care, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK -
| | - Nuttha Lumlertgul
- Department of Critical Care, King's College London, Guy's and St. Thomas' NHS Foundation Trust, London, UK.,Division of Nephrology and Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Unit of Critical Care Nephrology Research, Chulalongkorn University, Bangkok, Thailand
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Chen JJ, Kuo G, Hung CC, Lin YF, Chen YC, Wu MJ, Fang JT, Ku SC, Hwang SJ, Huang YT, Wu VC, Chang CH. Risk factors and prognosis assessment for acute kidney injury: The 2020 consensus of the Taiwan AKI Task Force. J Formos Med Assoc 2021; 120:1424-1433. [PMID: 33707141 DOI: 10.1016/j.jfma.2021.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/03/2021] [Accepted: 02/19/2021] [Indexed: 12/23/2022] Open
Abstract
Risk and prognostic factors for acute kidney injury (AKI) have been published in various studies across various populations. We aimed to explore recent advancements in and provide updated recommendations on AKI risk stratification and information about local AKI risk factors. The Taiwan Acute Kidney Injury Task Force reviewed relevant recently published literature and reached a consensus after group meetings. Systemic review and group discussion were performed. We conducted a meta-analysis according to the PRISMA statement for evaluating the diagnostic performance of the furosemide stress test. Several risk and susceptibility factors were identified through literature review. Contrast-associated AKI prediction models after coronary angiography were one of the most discussed prediction models we found. The basic approach and evaluation of patients with AKI was also discussed. Our meta-analysis found that the furosemide stress test can be used as a prognostic tool for AKI progression and to identify patients with AKI who are at low risk of renal replacement therapy. Factors associated with de novo chronic kidney injury or renal non-recovery after AKI were identified and summarized. Our review provided practical information about early identification of patients at high risk of AKI or disease progression for Taiwan local clinics.
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Affiliation(s)
- Jia-Jin Chen
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
| | - George Kuo
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chi-Chih Hung
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Feng Lin
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ji-Tseng Fang
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan
| | - Shih-Chi Ku
- Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yen-Ta Huang
- Division of Experimental Surgery, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Surgical Intensive Care Unit, Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan; Department of Pharmacology, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Vin-Cent Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; National Taiwan University Study Group on ARF, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taiwan.
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Law LS, Lo EA, Yeoh SF. Direct Measurement of Creatinine Clearance over a Short Interval in Intensive Care Settings. Indian J Crit Care Med 2021; 25:800-802. [PMID: 34316176 PMCID: PMC8286371 DOI: 10.5005/jp-journals-10071-23825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The definition of acute kidney injury (AKI), based on serum creatinine and urine output, bears significant limitations in intensive care units (ICUs). Serum creatinine has significant lag-time as it needs to be accumulated and stabilized at a new level whereas urine output is affected by diuresis, antidiuresis, and antinatriuresis. Direct measurement of creatinine clearance (CrCldirect = urine creatinine × urine flow rate/serum creatinine) over a short interval (3-6 hours) was explored to identify patients with AKI. Materials and methods We reanalyzed a previous published dataset. We included 11 patients who had serial daily urine collections over 0 to 3 days of stay in ICU and baseline (day -1) serum creatinine levels. Result The ratio of CrCldirect on day 0 to baseline creatinine clearance predicted the progression of AKI over the subsequent 1 to 3 days of ICU stay [area under receiver operating characteristic curve = 0.933 and 95% confidence interval (CI) = 0.780-1.000]. Discussion CrCldirect over a short interval may be an alternative marker of kidney function. Future studies may explore its use to identify patients with AKI who may benefit from early renal replacement therapy. How to cite this article Law LSC, Lo EAG, Yeoh SF. Direct Measurement of Creatinine Clearance over a Short Interval in Intensive Care Settings. Indian J Crit Care Med 2021;25(7):800-802.
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Affiliation(s)
- Lawrence Sc Law
- Alexandra Hospital, National University Health System, Singapore
| | - Elaine Ag Lo
- Department of Pharmacy, National University Hospital, National University Health System, Singapore; Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
| | - Siang F Yeoh
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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Sohaney R, Yessayan LT, Heung M. Towards Consensus in Timing of Kidney Replacement Therapy for Acute Kidney Injury? Am J Kidney Dis 2020; 77:542-545. [PMID: 32920155 DOI: 10.1053/j.ajkd.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Ryann Sohaney
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | | | - Michael Heung
- Division of Nephrology, University of Michigan, Ann Arbor, MI.
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