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Nishino T, Kubota Y, Kashiwagi T, Hirama A, Asai K, Yasutake M, Kumita S. Hepatic function markers as prognostic factors in patients with acute kidney injury undergoing continuous renal replacement therapy. Ren Fail 2024; 46:2352127. [PMID: 38771116 PMCID: PMC11110873 DOI: 10.1080/0886022x.2024.2352127] [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: 11/28/2023] [Accepted: 05/01/2024] [Indexed: 05/22/2024] Open
Abstract
Acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT), secondary to cardiovascular disease and sepsis, is associated with high in-hospital mortality. Although studies have examined cardiovascular disease and sepsis in AKI, the association between AKI and hepatic functional impairment remains unclear. We hypothesized that hepatic function markers would predict mortality in patients undergoing CRRT. We included 1,899 CRRT patients from a multi-centre database. In Phase 1, participants were classified according to the total bilirubin (T-Bil) levels on the day of, and 3 days after, CRRT initiation: T-Bil < 1.2, 1.2 ≤ T-Bil < 2, and T-Bil ≥ 2 mg/dL. In Phase 2, propensity score matching (PSM) was performed to examine the effect of a T-Bil cutoff of 1.2 mg/dL (supported by the Sequential Organ Failure Assessment score); creating two groups based on a T-Bil cutoff of 1.2 mg/dL 3 days after CRRT initiation. The primary endpoint was total mortality 90 days after CRRT initiation, which was 34.7% (n = 571). In Phase 1, the T-Bil, aspartate transaminase (AST), alanine transaminase (ALT), and AST/ALT (De Ritis ratio) levels at CRRT initiation were not associated with the prognosis, while T-Bil, AST, and the De Ritis ratio 3 days after CRRT initiation were independent factors. In Phase 2, T-Bil ≥1.2 mg/dL on day 3 was a significant independent prognostic factor, even after PSM [hazard ratio: 2.41 (95% CI; 1.84-3.17), p < 0.001]. T-Bil ≥1.2 mg/dL 3 days after CRRT initiation predicted 90-day mortality. Changes in hepatic function markers in acute renal failure may enable stratification of high-risk patients.
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Affiliation(s)
- Takuya Nishino
- Department of Health Care Administration, Nippon Medical School, Tokyo, Japan
| | - Yoshiaki Kubota
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Tetsuya Kashiwagi
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio Hirama
- Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
- Department of Cardiovascular Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masahiro Yasutake
- Department of Health Care Administration, Nippon Medical School, Tokyo, Japan
- Department of General Medicine and Health Science, Nippon Medical School, Tokyo, Japan
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Biscop A, Castelain D, Stock E, Demeyere K, Meyer E, Devriendt N, Dorn E, De Laet N, Paepe D. Assessment of cell cycle arrest biomarkers and neutrophil gelatinase-associated lipocalin to distinguish acute kidney injury from other diseases in dogs. J Vet Intern Med 2024. [PMID: 39011847 DOI: 10.1111/jvim.17143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Cell cycle arrest biomarkers (tissue inhibitor of metalloproteinase-2 [uTIMP-2] and insulin-like growth factor binding protein 7 [uIGFBP7]), and neutrophil gelatinase-associated lipocalin (NGAL) variables are valuable biomarkers for early diagnosis of acute kidney injury (AKI) in people. OBJECTIVES To evaluate uTIMP-2, uIGFBP7, fractional excretion of NGAL (FeNGAL), and urinary to serum NGAL ratio (u/sNGAL) in healthy dogs, dogs with AKI, dogs with chronic kidney disease (CKD), and critically ill (CI) dogs. ANIMALS Forty-two client-owned dogs (healthy, n = 10; AKI, n = 11; CKD, n = 11; CI, n = 10). METHODS Prospective, observational study. After assessment of routine renal biomarkers, stress (uTIMP-2, uIGFBP7) and damage (NGAL) biomarkers were measured, using ELISA kits, and normalized to urinary creatinine (uCr). RESULTS Normalized uTIMP-2 and [uTIMP-2] × [uIGFBP7]/uCr were significantly higher in the AKI group (median 151.9 [range, 2.2-534.2] and 62.9 [1.1-266.8] pg/mL respectively), compared to healthy dogs (0.3 [0.2-74.7]; P < .001 and 0.16 [0.1-58.1] pg/mL; P < .001), dogs with CKD (0.7 [0.3-742.5]; P = .04 and 0.37 [0.2-180.1] pg/mL; P = .03) and CI dogs (1.9 [0.2-37.0]; P = .03 and 0.8 [0.1-16.1] pg/mL; P = .02). Fractional excretion of NGAL was significantly higher in dogs with AKI (54.17 [7.93-155.32] %), than in healthy (0.03 [0.01-0.21] %; P < .001) and CI dogs (3.05 [0.05-28.86] %; P = .02). CONCLUSIONS AND CLINICAL IMPORTANCE Normalized uTIMP-2, [uTIMP-2] × [uIGFBP7]/uCr, and FeNGAL can be valuable renal biomarkers for early diagnosis of AKI in dogs.
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Affiliation(s)
- Ann Biscop
- Small Animal Department, Ghent University, Merelbeke, Belgium
| | - Donatienne Castelain
- Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Ghent University, Merelbeke, Belgium
| | - Kristel Demeyere
- Department of Veterinary and Biosciences, Ghent University, Merelbeke, Belgium
| | - Evelyne Meyer
- Department of Veterinary and Biosciences, Ghent University, Merelbeke, Belgium
| | | | - Elisabeth Dorn
- Small Animal Department, Ghent University, Merelbeke, Belgium
| | - Nikita De Laet
- Small Animal Department, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Ghent University, Merelbeke, Belgium
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Oliveira CL, Duarte-Ramos F, Alves da Costa F, Fernandez-Llimos F. Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: a historical cohort study. Int J Clin Pharm 2024; 46:623-630. [PMID: 38315304 PMCID: PMC11133048 DOI: 10.1007/s11096-023-01697-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 12/20/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is a multifactorial condition often induced by drugs commonly used in hospitals. Identifying and staging AKI necessitates frequent monitoring of renal function. AIM To assess the impact of real-world hospital practices regarding serum creatinine (SCr) testing on the identification and staging of AKI, and its implications for adjusting drug doses. METHOD A historical cohort study utilizing hospital records from all adult patients admitted between 01/06/2018 and 31/12/2020 was conducted. Patients with no SCr assessment during their stay or those with an SCr at admission ≥ 2 mg/dL were excluded. AKI was determined using two criteria, namely AKIN and KDIGO, considering the time intervals between two SCr tests as outlined in the criteria. Additionally, patients with SCr increases exceeding AKI limits, regardless the time interval, were also identified. The estimated glomerular filtration rate (eGFR) and kinetic eGFR (KeGFR) were calculated. RESULTS During the study period, 17,269 hospitalizations and 62,255 SCr tests were recorded. Among the 17,032 hospitalizations with a length of stay > 48 h, 46.8% experienced periods with no SCr tests performed for more than 48 h. Any stage of AKI was identified in 7.0% of patients and in 9.1% using AKI and KDIGO criteria, respectively. Ignoring time limits in both criteria revealed potential AKI in 1942 patients (11.2%), indicating a potential underdiagnosis of AKI by 37.5% or 19.1%, depending on the criteria used. A total of 76 drugs requiring dose adjustment in patients with eGFR ≤ 50 ml/min were prescribed in 78.5% admissions. These drugs were prescribed in 87.9% of patients potentially underdiagnosed with AKIN and in 88.9% with KDIGO. CONCLUSION There is a need for changes in the established hospital procedures to ensure more frequent testing of SCr levels. Implementing an advanced scope of practice for clinical pharmacists could support these changes.
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Affiliation(s)
- Catarina Luz Oliveira
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Filipa Duarte-Ramos
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Filipa Alves da Costa
- iMED, Research Institute for Medicines, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
| | - Fernando Fernandez-Llimos
- Laboratory of Pharmacology, -Applied Molecular Biosciences Unit, i4HB-Institute for Health and Bioeconomy, Faculty of Pharmacy, Universidade of Porto, Porto, Portugal
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Scurt FG, Bose K, Mertens PR, Chatzikyrkou C, Herzog C. Cardiac Surgery-Associated Acute Kidney Injury. KIDNEY360 2024; 5:909-926. [PMID: 38689404 PMCID: PMC11219121 DOI: 10.34067/kid.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
AKI is a common and serious complication of cardiac surgery that has a significant impact on patient morbidity and mortality. The Kidney Disease Improving Global Outcomes definition of AKI is widely used to classify and identify AKI associated with cardiac surgery (cardiac surgery-associated AKI [CSA-AKI]) on the basis of changes in serum creatinine and/or urine output. There are various preoperative, intraoperative, and postoperative risk factors for the development of CSA-AKI which should be recognized and addressed as early as possible to expedite its diagnosis, reduce its occurrence, and prevent or ameliorate its devastating complications. Crucial issues are the inaccuracy of serum creatinine as a surrogate parameter of kidney function in the perioperative setting of cardiothoracic surgery and the necessity to discover more representative markers of the pathophysiology of AKI. However, except for the tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 ratio, other diagnostic biomarkers with an acceptable sensitivity and specificity are still lacking. This article provides a comprehensive review of various aspects of CSA-AKI, including pathogenesis, risk factors, diagnosis, biomarkers, classification, prevention, and treatment management.
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Affiliation(s)
- Florian G. Scurt
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Katrin Bose
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Peter R. Mertens
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christos Chatzikyrkou
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Carolin Herzog
- Clinic of Nephrology, Hypertension, Diabetes and Endocrinology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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Vahidinia Z, Azami Tameh A, Barati S, Izadpanah M, Seyed Hosseini E. Nrf2 activation: a key mechanism in stem cell exosomes-mediated therapies. Cell Mol Biol Lett 2024; 29:30. [PMID: 38431569 PMCID: PMC10909300 DOI: 10.1186/s11658-024-00551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 03/05/2024] Open
Abstract
Exosomes are nano-sized membrane extracellular vesicles which can be released from various types of cells. Exosomes originating from inflammatory or injured cells can have detrimental effects on recipient cells, while exosomes derived from stem cells not only facilitate the repair and regeneration of damaged tissues but also inhibit inflammation and provide protective effects against various diseases, suggesting they may serve as an alternative strategy of stem cells transplantation. Exosomes have a fundamental role in communication between cells, through the transfer of proteins, bioactive lipids and nucleic acids (like miRNAs and mRNAs) between cells. This transfer significantly impacts both the physiological and pathological functions of recipient cells. Nuclear factor erythroid 2-related factor 2 (Nrf2), a transcription factor, is able to mitigate damage caused by oxidative stress and inflammation through various signaling pathways. The positive effects resulting from the activation of the Nrf2 signaling pathway in different disorders have been documented in various types of literature. Studies have confirmed that exosomes derived from stem cells could act as Nrf2 effective agonists. However, limited studies have explored the Nrf2 role in the therapeutic effects of stem cell-derived exosomes. This review provides a comprehensive overview of the existing knowledge concerning the role of Nrf2 signaling pathways in the impact exerted by stem cell exosomes in some common diseases.
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Affiliation(s)
- Zeinab Vahidinia
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
| | - Abolfazl Azami Tameh
- Anatomical Sciences Research Center, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - Shirin Barati
- Department of Anatomy, Saveh University of Medical Sciences, Saveh, Iran
| | - Melika Izadpanah
- Department of Anatomical Sciences, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elahe Seyed Hosseini
- Gametogenesis Research Center, Institute for Basic Sciences, Kashan University of Medical Science, Kashan, Iran
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Maayah ZH, Ferdaoussi M, Alam A, Takahara S, Silver H, Soni S, Martens MD, Eurich DT, Dyck JRB. Cannabidiol Suppresses Cytokine Storm and Protects Against Cardiac and Renal Injury Associated with Sepsis. Cannabis Cannabinoid Res 2024; 9:160-173. [PMID: 36594988 DOI: 10.1089/can.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: Cytokine release syndrome, also termed "cytokine storm," is the leading cause of morbidity and mortality among patients with various conditions such as sepsis. While cytokine storm is associated with multiple organ damage, acute cardiac and renal injury represents a hallmark of cytokine storm. Since recent reports have suggested that cannabidiol (CBD) may assist in the treatment of inflammatory diseases, our objective was to examine the effect of CBD on cytokine storm-induced cardiac and renal injury using the lipopolysaccharide (LPS)-induced sepsis mouse model. Materials and Methods: At 8 weeks of age, mice were randomly assigned to receive CBD (15 mg/kg) or vehicle one hour before a single injection of either phosphate-buffered saline or LPS (10 mg/kg) for an additional 24 h. Results: Our results show that CBD improves cardiac function and reduces renal injury in a mouse model of cytokine storm. Moreover, our data indicate that CBD significantly reduces systemic and renal inflammation to contribute to the improvements observed in a cytokine storm-model of cardiac and renal injury. Conclusions: Overall, the findings of this study suggest that CBD could be repurposed to reduce morbidity in patients with cytokine storm particularly in severe infections such as sepsis.
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Affiliation(s)
- Zaid H Maayah
- Department of Pharmaceutical Sciences, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Mourad Ferdaoussi
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Abrar Alam
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shingo Takahara
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Heidi Silver
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shubham Soni
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew D Martens
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jason R B Dyck
- Cardiovascular Research Centre, Departments of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Habib R, Fahim S, Wahid M, Ainuddin J. Optimisation of a Method for the Differentiation of Human Umbilical Cord-derived Mesenchymal Stem Cells Toward Renal Epithelial-like Cells. Altern Lab Anim 2023; 51:363-375. [PMID: 37831588 DOI: 10.1177/02611929231207774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
Human umbilical cord-derived mesenchymal stem cells (hucMSCs) can differentiate into multiple cell lineages, but few methods have been developed to generate kidney lineage cells. Due to their human origin, pluripotent nature and immunomodulatory properties, these stem cells are attractive candidates for clinical applications such as the repair or regeneration of damaged organs. This study evaluated the renal differentiation potential of hucMSCs, when exposed for 10 days to optimised concentrations of retinoic acid, activin-A and bone morphogenetic protein-7 (BMP-7) in various combinations, with and without the priming of the cells with a Wnt signalling pathway activator (CHIR99021). The hucMSCs were isolated and characterised according to surface marker expression (CD73, CD90, CD44, CD146 and CD8) and tri-lineage differentiation potential. The expression of key marker genes (OSR1, TBXT, HOXA13, SIX2, PAX2, KRT18 and ZO1) was examined by qRT-PCR. Specific marker protein expression (E-cadherin, cytokeratin-8 and cytokeratin-19) was analysed by immunocytochemistry. CHIR99021-primed cells treated with the retinoic acid, activin-A and BMP-7 cocktail showed epithelial cell-like differentiation - i.e. distinct phenotypic changes, as well as upregulated gene and protein expression, were observed that were consistent with an epithelial cell phenotype. Thus, our results showed that hucMSCs can efficiently differentiate into renal epithelial-like cells. This work may help in the development of focused therapeutic strategies, in which lineage-defined human stem cells can be used for renal regeneration.
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Affiliation(s)
- Rakhshinda Habib
- Dow Research Institute of Biotechnology and Biomedical Sciences, Dow University of Health Sciences (Ojha campus), Karachi, Pakistan
| | - Shumaila Fahim
- Dow Research Institute of Biotechnology and Biomedical Sciences, Dow University of Health Sciences (Ojha campus), Karachi, Pakistan
| | - Mohsin Wahid
- Department of Pathology, Dow International Medical College, Dow University of Health Sciences (Ojha campus), Karachi, Pakistan
| | - Jahanara Ainuddin
- Department of Gynaecology and Obstetrics, Dow University Hospital, Karachi, Pakistan
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Wang W, Shen Q, Zhou X. The predictive value of [TIMP-2]*[IGFBP7] in adverse outcomes for acute kidney injury: a systematic review and meta-analysis. Ren Fail 2023; 45:2253933. [PMID: 37724518 PMCID: PMC10512823 DOI: 10.1080/0886022x.2023.2253933] [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: 06/12/2023] [Accepted: 08/27/2023] [Indexed: 09/21/2023] Open
Abstract
MATERIALS AND METHODS Relevant articles published up to 17 June 2023 were retrieved from five databases (Cochrane Library/Embase/PubMed/SinoMed/Web of Science). The pre-established inclusion and exclusion criteria determined the selection of publications. Pooled sensitivity (SEN), specificity (SPE), diagnostic odds ratio, likelihood ratio, and summary receiver operating characteristic curve were employed to assess the predictive value. The presence or potential sources of heterogeneity were investigated via subgroup and SEN analyses. RESULTS Ten published and eligible studies (1559 cases) were included in the evaluation for the capability of [TIMP-2]*[IGFBP7] to predict the poor prognosis of AKI through the random effect model. Pooled SEN, SPE, diagnostic odds ratio, and positive and negative likelihood ratios were 0.82 (95% CI: 0.77-0.86, I2 = 53.4%), 0.64 (95% CI: 0.61-0.67, I2 = 88.3%), 14.06 (95% CI: 7.31-27.05, I2 = 55.0%), 2.859 (95% CI: 2.15-3.77, I2 = 80.7%), and 0.28 (95% CI: 0.20-0.40, I2 = 35.0%), respectively. The estimated area under the curve was 0.8864 (standard error: 0.0306), and the Q* was 0.7970 (standard error: 0.0299). The endpoints and cutoff values were the main causes of heterogeneity. CONCLUSIONS [TIMP-2]*[IGFBP7] is possible in predicting poor prognosis of AKI, but it is better to be applied along with other indicators or clinical risk factors.
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Affiliation(s)
- Wenlei Wang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Shen
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinrui Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Stottlemyer BA, Abebe KZ, Palevsky PM, Fried L, Schulman IH, Parikh CR, Poggio E, Siew ED, Gutierrez OM, Horwitz E, Weir MR, Wilson FP, Kane-Gill SL. Expert Consensus on the Nephrotoxic Potential of 195 Medications in the Non-intensive Care Setting: A Modified Delphi Method. Drug Saf 2023; 46:677-687. [PMID: 37223847 PMCID: PMC10208182 DOI: 10.1007/s40264-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Nephrotoxin exposure is significantly associated with acute kidney injury (AKI) development. A standardized list of nephrotoxic medications to surveil and their perceived nephrotoxic potential (NxP) does not exist for non-critically ill patients. OBJECTIVE This study generated consensus on the nephrotoxic effect of 195 medications used in the non-intensive care setting. METHODS Potentially nephrotoxic medications were identified through a comprehensive literature search, and 29 participants with nephrology or pharmacist expertise were identified. The primary outcome was NxP by consensus. Participants rated each drug on a scale of 0-3 (not nephrotoxic to definite nephrotoxicity). Group consensus was met if ≥ 75% of responses were one single rating or a combination of two consecutive ratings. If ≥ 50% of responses indicated "unknown" or not used in the non-intensive care setting, the medication was removed for consideration. Medications not meeting consensus for a given round were included in the subsequent round(s). RESULTS A total of 191 medications were identified in the literature, with 4 medications added after the first round from participants' recommendations. NxP index rating consensus after three rounds was: 14 (7.2%) no NxP in almost all situations (rating 0); 62 (31.8%) unlikely/possibly nephrotoxic (rating 0.5); 21 (10.8%) possibly nephrotoxic (rating 1); 49 (25.1%) possibly/probably nephrotoxic (rating 1.5); 2 (1.0%) probably nephrotoxic (rating 2); 8 (4.1%) probably/definite nephrotoxic (rating 2.5); 0 (0.0%) definitely nephrotoxic (rating 3); and 39 (20.0%) medications were removed from consideration. CONCLUSIONS NxP index rating provides clinical consensus on perceived nephrotoxic medications in the non-intensive care setting and homogeneity for future clinical evaluations and research.
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Affiliation(s)
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Paul M Palevsky
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Linda Fried
- Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Kidney Medicine Section, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ivonne H Schulman
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Chirag R Parikh
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emilio Poggio
- Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Tennessee Valley Health Systems (TVHS) Nashville Veterans Affairs Hospital, Nashville, TN, USA
| | - Orlando M Gutierrez
- Department of Medicine, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Matthew R Weir
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - F Perry Wilson
- Clinical and Translational Research Accelerator, Department of Medicine, Yale School of Medicine, New Haven, CT, USA
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Wu W, Ding R, Chen J, Yuan Y, Song Y, Yan M, Hu Y. Effect of body mass index on clinical outcomes after robotic cardiac surgery: is there an obesity paradox? BMC Cardiovasc Disord 2023; 23:271. [PMID: 37221463 DOI: 10.1186/s12872-023-03277-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND To investigate the effect of body mass index (BMI) on clinical outcomes after robotic cardiac surgery, and to explore the postoperative obesity paradox. METHODS The data of 146 patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (42.88 ± 13.01) years, 55 (37.67%) were male and 91 (62.33%) were female. Patients were divided into 3 groups according to preoperative BMI: lean group (BMI < 18.5 kg/m2; n = 17; 11.64%), normal group (BMI 18.5 kg/m2 to 23.9 kg/m2; n = 81; 55.48%), and overweight and obese group (BMI ≥ 24 kg/m2; n = 48; 32.88%). Multivariate analysis was performed to compare clinical outcomes across BMI groups. RESULTS Preoperative data in different BMI groups showed that there were statistically significant differences in age, height, weight, body surface area (BSA), diabetes, left atrial anteroposterior diameter (LAD), triglyceride (TG), and high-density lipoprotein (HDL) (all P < 0.05). Postoperative clinical outcomes showed that there was no statistical difference between the lean group and the normal group; the intensive care unit stay and postoperative hospital stay in the overweight and obese group were significantly higher than those in the normal group (P < 0.05), and the risk of postoperative cardiac surgery-related acute kidney injury (CSA-AKI) was significantly increased (P = 0.021); further Multiple Binary Logistic Regression Analysis suggested that preoperative TG (OR = 1.772, 95% CI 1.068-2.942, P = 0.027) and operation time ≥ 300 min (OR = 3.823, 95% CI 1.098-13.308, P = 0.035) were independent risk factors for postoperative CSA-AKI. CONCLUSIONS Overweight and obese patients had significantly prolonged intensive care unit stay and postoperative hospital stay after robotic cardiac surgery, and significantly increased incidence of postoperative CSA-AKI, which did not support the obesity paradox; preoperative TG and operation time ≥ 300 min were independent risk factors for postoperative CSA-AKI.
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Affiliation(s)
- Wenjun Wu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Renzhong Ding
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Jianming Chen
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Ye Yuan
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Yi Song
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Manrong Yan
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China
| | - Yijie Hu
- Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China.
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11
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Lee W, Wu X, Heo S, Kim JM, Fong KC, Son JY, Sabath MB, Trisovic A, Braun D, Park JY, Kim YC, Lee JP, Schwartz J, Kim H, Dominici F, Al-Aly Z, Bell ML. Air Pollution and Acute Kidney Injury in the U.S. Medicare Population: A Longitudinal Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:47008. [PMID: 37036790 PMCID: PMC10084931 DOI: 10.1289/ehp10729] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Recent studies have reported the association between air pollution exposure and reduced kidney function. However, it is unclear whether air pollution is associated with an increased risk of acute kidney injury (AKI). OBJECTIVES To address this gap in knowledge, we investigated the effect estimates of long-term exposures to fine particulate matter [PM ≤ 2.5 μ m in aerodynamic diameter (PM 2.5 )], nitrogen dioxide (NO 2 ), and ozone (O 3 ) on the risk of first hospital admission for AKI using nationwide Medicare data. METHODS This nationwide population-based longitudinal cohort study included 61,300,754 beneficiaries enrolled in Medicare Part A fee-for-service (FFS) who were ≥ 65 years of age and resided in the continental United States from the years 2000 through 2016. We applied Cox-equivalent Poisson models to estimate the association between air pollution and first hospital admission for AKI. RESULTS Exposure to PM 2.5 , NO 2 , and O 3 was associated with increased risk for first hospital admission for AKI, with hazard ratios (HRs) of 1.17 (95% CI: 1.16, 1.19) for a 5 - μ g / m 3 increase in PM 2.5 , 1.12 (95% CI: 1.11, 1.13) for a 10 -ppb increase in NO 2 , and 1.03 (95% CI: 1.02, 1.04) for a 10 -ppb increase in summer-period O 3 (June to September). The associations persisted at annual exposures lower than the current National Ambient Air Quality Standard. DISCUSSION This study found an association between exposures to air pollution and the risk of the first hospital admission with AKI, and this association persisted even at low concentrations of air pollution. Our findings provide beneficial implications for public health policies and air pollution guidelines to alleviate health care expenditures and the disease burden attributable to AKI. https://doi.org/10.1289/EHP10729.
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Affiliation(s)
- Whanhee Lee
- School of Biomedical Convergence Engineering, Pusan National University, Yangsan, Republic of Korea
| | - Xiao Wu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Seulkee Heo
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Joyce Mary Kim
- Department of Environmental Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Kelvin C. Fong
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Ji-Young Son
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
| | - Matthew Benjamin Sabath
- Faculty of Arts and Sciences Research Computing Department, Harvard University, Boston, Massachusetts, USA
| | - Ana Trisovic
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Danielle Braun
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jae Yoon Park
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Republic of Korea
- Department of Internal Medicine, Dongguk University College of Medicine, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Republic of Korea
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ho Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute for Sustainable Development, Graduate School of Public Health, Seoul National University, Republic of Korea
| | - Francesca Dominici
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Ziyad Al-Aly
- Nephrology Section, Medicine Service, Veterans Affairs Saint Louis Health Care System, Saint Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
- Institute for Public Health, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Michelle L. Bell
- Yale School of the Environment, Yale University, New Haven, Connecticut, USA
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12
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Tobin JD, Robinson CN, Luttrell-Williams ES, Landry GM, McMartin KE. Lack of efflux of diglycolic acid from proximal tubule cells leads to its accumulation and to toxicity of diethylene glycol. Toxicol Lett 2023; 379:48-55. [PMID: 36958672 DOI: 10.1016/j.toxlet.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/07/2023] [Accepted: 03/16/2023] [Indexed: 03/25/2023]
Abstract
Diethylene glycol (DEG) mass poisonings have resulted from ingestion of adulterated pharmaceuticals, leading to proximal tubular necrosis and acute kidney injury. Diglycolic acid (DGA), one of the primary metabolites, accumulates greatly in kidney tissue and its direct administration results in toxicity identical to that in DEG-treated rats. DGA is a dicarboxylic acid, similar in structure to Krebs cycle intermediates such as succinate. Previous studies have shown that DGA is taken into kidney cells via the succinate-related dicarboxylate transporters. These studies have assessed whether the DGA that is taken up by primary cultures of human proximal tubule (HPT) cells is effluxed. In addition, a possible mechanism for efflux, via organic anion transporters (OATs) that exchange external organic anions for dicarboxylates inside the cell, was assessed using transformed cell lines that actively express OAT activities. When HPT cells were cultured on membrane inserts, then loaded with DGA and treated with the OAT4/5 substrate estrone sulfate or the OAT1/3 substrate para-aminohippurate, no DGA efflux was seen. A repeat of this experiment utilizing RPTEC/TERT1 cells with overexpressed OAT1 and OAT3 had similar results. In these cells, but not in HPT cells, co-incubation with succinate increased the uptake of PAH, confirming the presence of OAT activity in the RPTEC/TERT1 cells. Thus, despite OATs stimulation in cells with OAT activity, there was little to no efflux of DGA from the cells. This study concluded that DGA is poorly transported out of cells and that stimulation of OAT transporters is not a viable target for reducing DGA accumulation in cells.
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Affiliation(s)
- Julie D Tobin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Corie N Robinson
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Elliot S Luttrell-Williams
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Greg M Landry
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130
| | - Kenneth E McMartin
- Department of Pharmacology, Toxicology and Neuroscience, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana 71130.
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13
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Hod T, Oberman B, Scott N, Levy L, Shlomai G, Beckerman P, Cohen-Hagai K, Mor E, Grossman E, Zimlichman E, Shashar M. Predictors and Adverse Outcomes of Acute Kidney Injury in Hospitalized Renal Transplant Recipients. Transpl Int 2023; 36:11141. [PMID: 36968791 PMCID: PMC10033630 DOI: 10.3389/ti.2023.11141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/27/2023] [Indexed: 03/11/2023]
Abstract
Data about in-hospital AKI in RTRs is lacking. We conducted a retrospective study of 292 RTRs, with 807 hospital admissions, to reveal predictors and outcomes of AKI during admission. In-hospital AKI developed in 149 patients (51%). AKI in a previous admission was associated with a more than twofold increased risk of AKI in subsequent admissions (OR 2.13, p < 0.001). Other major significant predictors for in-hospital AKI included an infection as the major admission diagnosis (OR 2.93, p = 0.015), a medical history of hypertension (OR 1.91, p = 0.027), minimum systolic blood pressure (OR 0.98, p = 0.002), maximum tacrolimus trough level (OR 1.08, p = 0.005), hemoglobin level (OR 0.9, p = 0.016) and albumin level (OR 0.51, p = 0.025) during admission. Compared to admissions with no AKI, admissions with AKI were associated with longer length of stay (median time of 3.83 vs. 7.01 days, p < 0.001). In-hospital AKI was associated with higher rates of mortality during admission, almost doubled odds for rehospitalization within 90 days from discharge and increased the risk of overall mortality in multivariable mixed effect models. In-hospital AKI is common and is associated with poor short- and long-term outcomes. Strategies to prevent AKI during admission in RTRs should be implemented to reduce re-admission rates and improve patient survival.
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Affiliation(s)
- Tammy Hod
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- *Correspondence: Tammy Hod,
| | - Bernice Oberman
- Bio-Statistical and Bio-Mathematical Unit, The Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, Israel
| | - Noa Scott
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Liran Levy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Gadi Shlomai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D and Hypertension Unit, The Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Ramat Gan, Israel
| | - Pazit Beckerman
- Nephrology Department, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Keren Cohen-Hagai
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Eytan Mor
- Renal Transplant Center, Sheba Medical Center, Ramat Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Ehud Grossman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Central Management, Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
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14
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Identification of Pre-Renal and Intrinsic Acute Kidney Injury by Anamnestic and Biochemical Criteria: Distinct Association with Urinary Injury Biomarkers. Int J Mol Sci 2023; 24:ijms24031826. [PMID: 36768149 PMCID: PMC9916069 DOI: 10.3390/ijms24031826] [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: 12/03/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/19/2023] Open
Abstract
Acute kidney injury (AKI) is a syndrome of sudden renal excretory dysfunction with severe health consequences. AKI etiology influences prognosis, with pre-renal showing a more favorable evolution than intrinsic AKI. Because the international diagnostic criteria (i.e., based on plasma creatinine) provide no etiological distinction, anamnestic and additional biochemical criteria complement AKI diagnosis. Traditional, etiology-defining biochemical parameters, including the fractional excretion of sodium, the urinary-to-plasma creatinine ratio and the renal failure index are individually limited by confounding factors such as diuretics. To minimize distortion, we generated a composite biochemical criterion based on the congruency of at least two of the three biochemical ratios. Patients showing at least two ratios indicative of intrinsic AKI were classified within this category, and those with at least two pre-renal ratios were considered as pre-renal AKI patients. In this study, we demonstrate that the identification of intrinsic AKI by a collection of urinary injury biomarkers reflective of tubular damage, including NGAL and KIM-1, more closely and robustly coincide with the biochemical than with the anamnestic classification. Because there is no gold standard method for the etiological classification of AKI, the mutual reinforcement provided by the biochemical criterion and urinary biomarkers supports an etiological diagnosis based on objective diagnostic parameters.
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15
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Liu S, Qiu C, Li X, Yu Z, Liu F, Hu G. A nomogram for predicting the mortality of patients with type 2 diabetes mellitus complicated with acute kidney injury in the intensive care unit. BMC Anesthesiol 2023; 23:4. [PMID: 36600212 PMCID: PMC9811712 DOI: 10.1186/s12871-022-01961-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There is no predictive tool for type 2 diabetes mellitus (T2DM) patients with acute kidney injury (AKI). Our study aimed to establish an effective nomogram model for predicting mortality in T2DM patients with AKI. METHOD Data on T2DM patients with AKI were obtained from the Medical Information Mart for Intensive Care III. 70% and 30% of the patients were randomly selected as the training and validation cohorts, respectively. Univariate and multivariate logistic regression analyses were used to identify factors associated with death in T2DM patients with AKI. Factors significantly associated with survival outcomes were used to construct a nomogram predicting 90-day mortality. The nomogram effect was evaluated by receiver operating characteristic curve analysis, Hosmer‒Lemeshow test, calibration curve, and decision curve analysis (DCA). RESULTS There were 4375 patients in the training cohort and 1879 in the validation cohort. Multivariate logistic regression analysis showed that age, BMI, chronic heart failure, coronary artery disease, malignancy, stages of AKI, white blood cell count, blood urea nitrogen, arterial partial pressure of oxygen and partial thromboplastin time were independent predictors of patient survival. The results showed that the nomogram had a higher area under the curve value than the sequential organ failure assessment score and simplified acute physiology score II. The Hosmer‒Lemeshow test and calibration curve suggested that the nomogram had a good calibration effect. The DCA curve showed that the nomogram model had good clinical application value. CONCLUSION The nomogram model accurately predicted 90-day mortality in T2DM patients with AKI. It may provide assistance for clinical decision-making and treatment, thereby reducing the medical burden.
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Affiliation(s)
- Shizhen Liu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Chuangye Qiu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Xingai Li
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
| | - Zongchao Yu
- grid.412601.00000 0004 1760 3828Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630 China
| | - Fanna Liu
- grid.412601.00000 0004 1760 3828Department of Nephrology, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630 China
| | - Guoqiang Hu
- grid.459671.80000 0004 1804 5346Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong China
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16
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Jo SY, Cho HJ, Kim TM. Fenoldopam Mesylate Enhances the Survival of Mesenchymal Stem Cells Under Oxidative Stress and Increases the Therapeutic Function in Acute Kidney Injury. Cell Transplant 2023; 32:9636897221147920. [PMID: 36594258 PMCID: PMC9830573 DOI: 10.1177/09636897221147920] [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] [Indexed: 01/04/2023] Open
Abstract
Mesenchymal stem cells (MSCs) have gained interest as an alternative therapeutic option for renal diseases, including acute kidney injury (AKI). However, their use is often limited owing to low survival rates in vivo. Fenoldopam mesylate (FD) is a selective dopamine D1 receptor agonist with antioxidative and anti-apoptotic roles. Herein, we investigated whether FD can enhance the survival of MSCs undergoing oxidative stress in vitro. In addition, the therapeutic effect of MSCs and FD-treated MSCs (FD-MSCs) was compared in a mouse model of AKI induced by cisplatin. The survival of MSCs under oxidative stress was augmented by FD treatment. FD induced the phosphorylation of cAMP response element-binding protein and AKT, contributing to enhanced growth compared with untreated MSCs. The expression of nuclear factor erythroid-2-related factor 2 (NRF2) and heme oxygenase-1 was increased by FD treatment, and nuclear translocation of NRF2 was found exclusively in FD-MSCs. FD downregulated BAX expression, increased the mitochondrial membrane potential, reduced reactive oxygen species generation, and decreased the apoptotic death of MSCs induced by oxidative stress. Moreover, renal function and tubular injury were improved in FD-MSCs compared with non-treated MSCs. Furthermore, tubular injury, apoptosis, and macrophage infiltration, as well as the serum level of tumor necrosis factor-α were reduced, while tubular cell proliferation was markedly increased in FD-MSCs compared with MSCs. Our study demonstrated that FD increases the survivability of MSCs in an oxidative environment, and its use may be effective in preparing robust therapeutic MSCs.
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Affiliation(s)
- Seo Yeon Jo
- Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, South Korea
| | - Hye Jin Cho
- Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, South Korea
| | - Tae Min Kim
- Graduate School of International Agricultural Technology, Seoul National University, Pyeongchang, South Korea,Institutes of Green Bio Science & Technology, Seoul National University, Pyeongchang, South Korea,Tae Min Kim, Graduate School of International Agricultural Technology and Institutes of Green Bio Science & Technology, Seoul National University, Pyeongchang Daero 1447, Pyeongchang 25354, Gangwon-do, South Korea.
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17
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Sůva M, Kala P, Poloczek M, Kaňovský J, Štípal R, Radvan M, Hlasensky J, Hudec M, Brázdil V, Řehořová J. Contrast-induced acute kidney injury and its contemporary prevention. Front Cardiovasc Med 2022; 9:1073072. [PMID: 36561776 PMCID: PMC9763312 DOI: 10.3389/fcvm.2022.1073072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.
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Affiliation(s)
- Marek Sůva
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia,*Correspondence: Petr Kala,
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jan Kaňovský
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Roman Štípal
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Radvan
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiří Hlasensky
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Martin Hudec
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Vojtěch Brázdil
- Department of Internal Medicine and Cardiology, University Hospital, Brno, Czechia,Department of Internal Medicine and Cardiology, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jitka Řehořová
- Department of Internal Medicine and Gastroenterology, University Hospital, Brno, Czechia
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18
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Lertussavavivat T, Kulvichit W, Peerapornratana S, Lumlertgul N, Bhumitrakul J, Tungsanga K, Eiam-Ong S, Avihingsanon Y, Kellum JA, Srisawat N. The epidemiology and long-term outcomes of acute kidney disease in a resource-limited setting. J Nephrol 2022; 35:2283-2292. [PMID: 35445946 DOI: 10.1007/s40620-022-01328-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/03/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The concept of acute kidney disease (AKD) implies kidney damage that results in a significant decrease in glomerular filtration rate, including acute kidney injury (AKI), but that is not persistent enough to meet the criteria of chronic kidney disease (CKD). While a few studies have shown associations between AKD and the risk of adverse outcomes, there is still a lack of evidence from resource-limited settings. METHODS All hospitalized patients at the study hospital during 2017 were retrospectively reviewed. Diagnosis of AKI, AKD, and CKD was based on the diagnostic algorithm proposed by KDIGO. Patients were followed up for 2 years to determine their risks of mortality, development of CKD, and progression of pre-existing CKD. RESULTS A total of 9800 patients were included in the analysis, 26.1% of whom had pre-existing CKD, while AKD without AKI was found in 8% and 7% of individuals with and without pre-existing CKD, respectively. Patients with AKD without AKI were associated with higher in-hospital mortality than those without pre-existing CKD [adjusted hazard ratio (aHR) of 2.50; 95% CI 1.43, 4.37] and with pre-existing CKD (aHR 1.79; 95% CI 1.16, 2.76). The incidence of new CKD was higher in the group of AKD without AKI than in the AKI group (34.8 vs. 14.7%). CONCLUSION In a resource-limited setting, AKD is associated with short- and long-term mortality and CKD progression, especially in individuals with pre-existing CKD.
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Affiliation(s)
- Tanat Lertussavavivat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Win Kulvichit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Sadudee Peerapornratana
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Nuttha Lumlertgul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand.,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Jom Bhumitrakul
- King's College London GKT School of Medical Education, King's College London, London, England, UK
| | - Kriang Tungsanga
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Somchai Eiam-Ong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Yingyos Avihingsanon
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - John A Kellum
- Department of Critical Care Medicine, The Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nattachai Srisawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand. .,Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. .,Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand. .,Department of Critical Care Medicine, The Center for Critical Care Nephrology, CRISMA, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Academy of Science, Royal Society of Thailand, Bangkok, Thailand. .,Tropical Medicine Cluster, Chulalongkorn University, Bangkok, Thailand. .,Excellence Center for Critical Care Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
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19
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Cao L, Ru W, Hu C, Shen Y. Interaction of hemoglobin, transfusion, and acute kidney injury in patients undergoing cardiopulmonary bypass: a group-based trajectory analysis. Ren Fail 2022; 44:1368-1375. [PMID: 35946481 PMCID: PMC9373743 DOI: 10.1080/0886022x.2022.2108840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anemia is a risk factor for acute kidney injury (AKI) following cardiopulmonary bypass (CPB). Whether red blood cell (RBC) transfusion-enhanced hemoglobin levels contribute to low AKI rates remains unclear. We investigated the interaction between hemoglobin, RBC transfusion, and AKI after CPB. Hemoglobin trajectories within 72 h were analyzed using group-based trajectory analysis. Multivariable logistic analysis and inverse probability-weighted regression were adopted to evaluate the associations between hemoglobin and AKI in RBC and non-RBC transfusion subgroups. We analyzed 6226 patients’ data. In the transfusion subgroup, three hemoglobin trajectories were identified. The AKI incidence was lowest in the trajectory with the lowest hemoglobin level (trajectory 1, less transfusion), and it was comparable in trajectories 2 and 3 (20.7% vs. 32.7% vs. 29.4%, p < 0.001, respectively). In four logistic models, the odds ratio for AKI with trajectory 1 as the reference ranged from 1.44 to 1.85 for trajectory 2 (p < 0.001) and 1.45 to 1.66 for trajectory 3 (p < 0.050). The average treatment effect on AKI was 5.6% (p = 0.009) for trajectory 2 and 7.5% (p = 0.041) for trajectory 3, with trajectory 1 as the reference. In the non-RBC transfusion subgroup, three approximately linear hemoglobin trajectories (9, 10, and 12 g/dL) were observed; however, both the crude and adjusted AKI incidence were similar within the three trajectories. In patients undergoing CPB, hemoglobin level >9 g/dL was not associated with decreased AKI incidence in the subgroup without RBC transfusion. However, in patients with RBC transfusion, maintaining hemoglobin level >9 g/dL by RBC transfusion was associated with increased AKI incidence.
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Affiliation(s)
- Lingyong Cao
- Department of Internal Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weizhe Ru
- Department of Oncology, Cixi People's Hospital, Cixi, China
| | - Caibao Hu
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
| | - Yanfei Shen
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, China
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20
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Shen X, Lv K, Hou B, Ao Q, Zhao J, Yang G, Cheng Q. Impact of Diabetes on the Recurrence and Prognosis of Acute Kidney Injury in Older Male Patients: A 10-Year Retrospective Cohort Study. Diabetes Ther 2022; 13:1907-1920. [PMID: 36044176 PMCID: PMC9663794 DOI: 10.1007/s13300-022-01309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION While patients with diabetes are at higher risk of developing acute kidney injury (AKI), there are few studies on the recurrence of AKI in older adult patients. This study therefore aimed to examine the impact of diabetes on AKI recurrence and long-term outcomes in older male patients. METHODS This retrospective cohort study included older male patients who experienced AKI during hospitalization from July 2007 to August 2011. Medical records of all patients were followed up for 10 years. Patients with AKI were classified into groups with and without diabetes. We analyzed differences in common geriatric comorbidities, AKI recurrence frequency, and severity between the two groups, identified risk factors affecting recurrence frequency, and assessed outcomes. RESULTS Of all 266 patients, 128 had diabetes and 138 did not. The AKI recurrence rate was significantly higher in the group with diabetes (80.5 vs. 66.7%; P = 0.011). There was a significantly higher proportion of AKI caused by infections in patients with diabetes (43.3 vs. 33.2%, P = 0.006). The proportion of patients with an AKI recurrence frequency ≥ 3 was significantly higher in the group with diabetes (44.7 vs. 29.4%, P = 0.027). Diabetes and coronary heart disease were independent risk factors for AKI recurrence (P < 0.05), diabetes control was associated with multiple AKI recurrences (P = 0.016), and no significant difference was found between the groups regarding the 10-year prognosis (P = 0.522). However, a subgroup analysis showed that patients with multiple AKI recurrences within 2 years had the worst survival outcome (P = 0.004). CONCLUSIONS Older male patients with diabetes are prone to AKI recurrence after initial onset of AKI. Diabetes is an independent risk factor for AKI recurrence, and active diabetes control (HbA1c < 7%) may thus reduce the recurrence of AKI and improve the very poor outcomes of patients with multiple recurrences of AKI within 2 years.
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Affiliation(s)
- Xin Shen
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Kunming Lv
- Department of Geriatric Gastroenterology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Baicun Hou
- Department of Geriatric Gastroenterology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Qiangguo Ao
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Jiahui Zhao
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China
| | - Guang Yang
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China.
| | - Qingli Cheng
- Department of Geriatric Nephrology, The Second Medical Centre, National Clinical Research Centre for Geriatric Diseases, Chinese PLA General Hospital, No. 28 Fuxing Road, Beijing, China.
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21
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Chen Z, Qi F, Qiu W, Wu C, Zong M, Ge M, Xu D, You Y, Zhu Y, Zhang Z, Lin H, Shi J. Hydrogenated Germanene Nanosheets as an Antioxidative Defense Agent for Acute Kidney Injury Treatment. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2202933. [PMID: 36202760 PMCID: PMC9685437 DOI: 10.1002/advs.202202933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/12/2022] [Indexed: 06/16/2023]
Abstract
Acute kidney injury (AKI) is a sudden kidney dysfunction caused by aberrant reactive oxygen species (ROS) metabolism that results in high clinical mortality. The rapid development of ROS scavengers provides new opportunities for AKI treatment. Herein, the use of hydrogen-terminated germanene (H-germanene) nanosheets is reported as an antioxidative defense nanoplatform against AKI in mice. The simulation results show that 2D H-germanene can effectively scavenge ROS through free radical adsorption and subsequent redox reactions. In particular, the H-germanene exhibits high accumulation in injured kidneys, thereby offering a favorable opportunity for treating renal diseases. In the glycerol-induced murine AKI model, H-germanene delivers robust antioxidative protection against ROS attack to maintain normal kidney function indicators without negative influence in vivo. This positive in vivo antioxidative defense in living animals demonstrates that the present H-germanene nanoplatform is a powerful antioxidant against AKI and various anti-inflammatory diseases.
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Affiliation(s)
- Zhixin Chen
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Fenggang Qi
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Wujie Qiu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
| | - Chenyao Wu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Ming Zong
- Department of Clinical LaboratoryShanghai East HospitalTongji University School of MedicineShanghai200120P. R. China
| | - Min Ge
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Deliang Xu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Yanling You
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Ya‐Xuan Zhu
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineSchool of Medicine Tongji UniversityShanghai200331P. R. China
| | - Zhimin Zhang
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
| | - Han Lin
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineSchool of Medicine Tongji UniversityShanghai200331P. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine MicrostructuresShanghai Institute of CeramicsChinese Academy of SciencesResearch Unit of Nanocatalytic Medicine in Specific Therapy for Serious DiseaseChinese Academy of Medical Sciences (2021RU012)Shanghai200050P. R. China
- Center of Materials Science and Optoelectronics EngineeringUniversity of Chinese Academy of SciencesBeijing100049P. R. China
- Shanghai Tenth People's HospitalShanghai Frontiers Science Center of Nanocatalytic MedicineSchool of Medicine Tongji UniversityShanghai200331P. R. China
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22
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Chen Z, Qi F, Qiu W, Wu C, Zong M, Ge M, Xu D, You Y, Zhu Y, Zhang Z, Lin H, Shi J. Hydrogenated Germanene Nanosheets as an Antioxidative Defense Agent for Acute Kidney Injury Treatment. ADVANCED SCIENCE 2022; 9. [DOI: doi.org/10.1002/advs.202202933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 09/08/2023]
Abstract
AbstractAcute kidney injury (AKI) is a sudden kidney dysfunction caused by aberrant reactive oxygen species (ROS) metabolism that results in high clinical mortality. The rapid development of ROS scavengers provides new opportunities for AKI treatment. Herein, the use of hydrogen‐terminated germanene (H‐germanene) nanosheets is reported as an antioxidative defense nanoplatform against AKI in mice. The simulation results show that 2D H‐germanene can effectively scavenge ROS through free radical adsorption and subsequent redox reactions. In particular, the H‐germanene exhibits high accumulation in injured kidneys, thereby offering a favorable opportunity for treating renal diseases. In the glycerol‐induced murine AKI model, H‐germanene delivers robust antioxidative protection against ROS attack to maintain normal kidney function indicators without negative influence in vivo. This positive in vivo antioxidative defense in living animals demonstrates that the present H‐germanene nanoplatform is a powerful antioxidant against AKI and various anti‐inflammatory diseases.
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Affiliation(s)
- Zhixin Chen
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Fenggang Qi
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Wujie Qiu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
| | - Chenyao Wu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Ming Zong
- Department of Clinical Laboratory Shanghai East Hospital Tongji University School of Medicine Shanghai 200120 P. R. China
| | - Min Ge
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Deliang Xu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Yanling You
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Ya‐Xuan Zhu
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Shanghai Tenth People's Hospital Shanghai Frontiers Science Center of Nanocatalytic Medicine School of Medicine Tongji University Shanghai 200331 P. R. China
| | - Zhimin Zhang
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
| | - Han Lin
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Shanghai Tenth People's Hospital Shanghai Frontiers Science Center of Nanocatalytic Medicine School of Medicine Tongji University Shanghai 200331 P. R. China
| | - Jianlin Shi
- State Key Laboratory of High Performance Ceramics and Superfine Microstructures Shanghai Institute of Ceramics Chinese Academy of Sciences Research Unit of Nanocatalytic Medicine in Specific Therapy for Serious Disease Chinese Academy of Medical Sciences (2021RU012) Shanghai 200050 P. R. China
- Center of Materials Science and Optoelectronics Engineering University of Chinese Academy of Sciences Beijing 100049 P. R. China
- Shanghai Tenth People's Hospital Shanghai Frontiers Science Center of Nanocatalytic Medicine School of Medicine Tongji University Shanghai 200331 P. R. China
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23
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Medina KRP, Jeong JC, Ryu JW, Kang E, Chin HJ, Na KY, Chae DW, Kim S. Comparison of Outcomes of Mild and Severe Community- and Hospital-Acquired Acute Kidney Injury. Yonsei Med J 2022; 63:902-907. [PMID: 36168242 PMCID: PMC9520041 DOI: 10.3349/ymj.2021.0238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Acute kidney injury (AKI) has shown an increasingly common occurrence among hospitalized patients worldwide. We determined the incidence and compared the short- and long-term outcomes of all stages of community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI), and identified predictors for such outcomes. MATERIALS AND METHODS This observational, single-center, retrospective study identified patients admitted between January 2013 and December 2013 who developed CA-AKI or HA-AKI. Short- and long-term patient and renal outcomes were analyzed. RESULTS AKI incidence was 14.3% (1882, CA-AKI 4.8% and HA-AKI 9.5%). The highest 30-day and 1-year mortality were recorded in the CA-AKI group. Thirty-day mortality rate was 11.4% in CA-AKI group and 5.7% in HA-AKI group (p<0.001). One-year mortality rates were 20.1% and 13.3%, respectively (p<0.001). More CA-AKI patients developed kidney failure with replacement therapy within 1 year (27, 4.3% vs. 18, 1.4% respectively, p<0.001). CONCLUSION In conclusion, patients with CA-AKI had worse short- and long-term outcomes compared to HA-AKI patients. AKI severity and discharge serum creatinine were significant independent predictors of 30-day and 1-year mortality.
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Affiliation(s)
| | - Jong Cheol Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Won Ryu
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Young Na
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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24
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Bondi CD, Rush BM, Hartman HL, Wang J, Al-Bataineh MM, Hughey RP, Tan RJ. Suppression of NRF2 Activity by HIF-1α Promotes Fibrosis after Ischemic Acute Kidney Injury. Antioxidants (Basel) 2022; 11:1810. [PMID: 36139884 PMCID: PMC9495756 DOI: 10.3390/antiox11091810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/26/2023] Open
Abstract
Acute kidney injury (AKI) is a rapid decline in renal function and can occur after ischemia/reperfusion injury (IRI) to the tubular epithelia. The nuclear factor erythroid-2-related factor 2 (NRF2) pathway protects against AKI and AKI-to-chronic kidney disease (CKD) progression, but we previously demonstrated that severe IRI maladaptively reduced NRF2 activity in mice. To understand the mechanism of this response, we subjected C57BL/6J mice to unilateral kidney IRI with ischemia times that were titrated to induce mild to severe injury. Mild IRI increased NRF2 activity and was associated with renal recovery, whereas severe IRI decreased NRF2 activity and led to progressive CKD. Due to these effects of ischemia, we tested the hypothesis that hypoxia-inducible factor-1α (HIF-1α) mediates NRF2 activity. To mimic mild and severe ischemia, we activated HIF-1α in HK-2 cells in nutrient-replete or nutrient-deficient conditions. HIF-1α activation in nutrient-replete conditions enhanced NRF2 nuclear localization and activity. However, in nutrient-deficient conditions, HIF-1α activation suppressed NRF2 nuclear localization and activity. Nuclear localization was rescued with HIF-1α siRNA knockdown. Our results suggest that severe ischemic AKI leads to HIF-1α-mediated suppression of NRF2, leading to AKI-to-CKD progression.
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Affiliation(s)
| | | | | | | | | | | | - Roderick J. Tan
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 152671, USA
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25
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Li XQ, Liu JF, Liu H, Meng Y. Extracellular vesicles for ischemia/reperfusion injury-induced acute kidney injury: a systematic review and meta-analysis of data from animal models. Syst Rev 2022; 11:197. [PMID: 36076305 PMCID: PMC9461206 DOI: 10.1186/s13643-022-02003-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) induced by ischemia/reperfusion injury significantly contribute to the burden of end-stage renal disease. Extracellular vesicles (EVs), especially for stem/progenitor cell-derived EVs (stem/progenitor cell-EVs), have emerged as a promising therapy for ischemia/reperfusion injury-induced AKI. However, their regulatory effects remain poorly understood, and their therapeutic efficiency in clinical trials is controversial. Here, we performed this systematic review and meta-analysis to assess the stem/progenitor cell-EV efficacy in treating ischemia/reperfusion injury-induced AKI in preclinical rodent models. METHODS A literature search was performed in PubMed, Embase, Scopus, and Web of Science to identify controlled studies about the therapeutic efficiency of stem/progenitor cell-EVs on ischemia/reperfusion injury-induced AKI rodent models. The level of SCr, an indicator of renal function, was regarded as the primary outcome. Meta-regression analysis was used to reveal the influential factors of EV therapy. Sensitivity analysis, cumulative meta-analysis, and assessment of publication bias were also performed in our systematic review and meta-analysis. A standardized mean difference (SMD) was used as the common effect size between stem/progenitor cell-EV-treated and control groups, with values of 0.2, 0.5, 0.8, and 1.0 defined as small, medium, large, and very large effect sizes, respectively. RESULTS A total of 30 studies with 985 ischemia/reperfusion injury-induced AKI rodent models were included. The pooled results showed that EV injection could lead to a remarkable sCr reduction compared with the control group (SMD, - 3.47; 95%CI, - 4.15 to - 2.80; P < 0.001). Meanwhile, the EV treatment group had lower levels of BUN (SMD, - 3.60; 95%CI, - 4.25 to - 2.94; P < 0.001), indexes for tubular and endothelial injury, renal fibrosis (fibrosis score and α-SMA), renal inflammation (TNF-α, IL-1β, iNOS, and CD68 + macrophages), but higher levels of indexes for tubular proliferation, angiogenesis-related VEGF, and reactive oxygen species. However, our meta-regression analysis did not identify significant associations between sCr level and cell origins of EVs, injection doses, delivery routes, and therapy and outcome measurement time (all P values > 0.05). Significant publication bias was observed (Egger's test, P < 0.001). CONCLUSION Stem/progenitor cell-EVs are effective in improving renal function in rodent ischemia/reperfusion injury-induced AKI model. These vesicles may help (i) reduce cell apoptosis and stimulate cell proliferation, (ii) ameliorate inflammatory injury and renal fibrosis, (iii) promote angiogenesis, and (iv) inhibit oxidative stress. However, the current systematic review and meta-analysis did not identify significant influential factors associated with treatment effects. More preclinical studies and thoughtfully designed animal studies are needed in the future.
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Affiliation(s)
- Xia-Qing Li
- Department of Nephrology, The First Hospital Affiliated to Jinan University, No. 613 Huangpu West Road, Guangzhou, 510630, China.,Central Laboratory, The Fifth Hospital Affiliated to Jinan University, Heyuan, China
| | - Jin-Feng Liu
- Department of Nephrology, The First Hospital Affiliated to Jinan University, No. 613 Huangpu West Road, Guangzhou, 510630, China.,Central Laboratory, The Fifth Hospital Affiliated to Jinan University, Heyuan, China
| | - Han Liu
- Department of Nephrology, The First Hospital Affiliated to Jinan University, No. 613 Huangpu West Road, Guangzhou, 510630, China.,Central Laboratory, The Fifth Hospital Affiliated to Jinan University, Heyuan, China
| | - Yu Meng
- Department of Nephrology, The First Hospital Affiliated to Jinan University, No. 613 Huangpu West Road, Guangzhou, 510630, China. .,Central Laboratory, The Fifth Hospital Affiliated to Jinan University, Heyuan, China.
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26
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Fink JC, Maguire RM, Blakeman T, Tomlinson LA, Tomson C, Wagner LA, Zhan M. Medication Holds in CKD During Acute Volume-Depleting Illnesses: A Randomized Controlled Trial of a "Sick-Day" Protocol. Kidney Med 2022; 4:100527. [PMID: 36046613 PMCID: PMC9421397 DOI: 10.1016/j.xkme.2022.100527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Rationale & Objective Some drugs prescribed for chronic kidney disease (CKD) may become hazardous on sick days with volume depletion by increasing the risk of acute kidney injury (AKI) and kidney function loss; however, the risks and benefits of their use during intercurrent illness is unknown. Study Design 6-month pragmatic trial examining a sick-day protocol to determine if withholding prespecified drugs during a volume-depleting illness reduces the incidence AKI or kidney function loss in CKD. Setting & Participants 315 veterans with stage 3-5 CKD, treated with a renin-angiotensin-aldosterone inhibitor blocker, diuretic, nonsteroidal anti-inflammatory drug, or metformin were randomized into the study with n = 159 and n = 156 in sick-day protocol and usual care groups, respectively. Intervention Sick-day protocol administered via interactive voice response system (IVRS) or usual care with 6-month follow-up. Outcomes The outcomes of the study are as follows: (1) Change in kidney function, (2) incidence of AKI based on International Classification of Diseases, Tenth Revision codes and ambulatory laboratory testing, (3) urgent service utilizations, and (4) sick days. Results The mean age was 70.1 ± 7.4 and 69.2 ± 8.1 years, with a mean baseline glomerular filtration rate (GFR) of 43.1 ± 13.1 and 43.8 ± 13.0 mL/min/1.73 m2, and 112 (70%) and 100 (64%) of participants with diabetes in the sick-day protocol and usual care groups, respectively. The mean change in GFR in the sick-day protocol and usual care groups from baseline to 6-month follow-up, adjusting for baseline GFR, was -0.71 (95% CI, -2.11 to 0.69) and -0.72 (95% CI, -2.12 to 0.68), respectively, with no significant difference, P = 0.99. Hospitalizations in the sick-day protocol and usual care groups were 11.5/100 and 8.4/100 events per person-months, respectively, with the adjusted rate ratio not significantly increased (prevalence ratio, 1.30; 95% CI, 0.96-1.76). Participants interacted with the IVRS in 81% of expected weeks and 19 had one or more qualifying events. In 33 true sick days, participants correctly followed the protocol in only 14. Limitations Low incidence of sick days over the 6-month period of the study. Conclusions The sick-day protocol was not associated with a significant reduction in AKI episodes or kidney function loss in a high-risk CKD population. Engagement with the IVRS was high, but successful implementation of the sick-day protocol was not optimal. Trial Registration ClinicalTrials.gov; NCT03141905.
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Affiliation(s)
- Jeffrey C. Fink
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Rebecca M. Maguire
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Thomas Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Division of Population health, University of Manchester, Manchester, United Kingdom
| | - Laurie A. Tomlinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Charles Tomson
- Department of Renal Medicine, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Lee-Ann Wagner
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Min Zhan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD
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27
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Agar A, Gulabi D, Sahin A, Gunes O, Hancerli CO, Kılıc B, Erturk C. Acute kidney injury after hip fracture surgery in patients over 80 years of age. Arch Orthop Trauma Surg 2022; 142:2245-2252. [PMID: 34056678 DOI: 10.1007/s00402-021-03969-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of the study is to determine the rate of acute kidney injury (AKI) after hip fracture surgery over the age of 80 and to investigate the factors associated with AKI. METHODS From January 2015 to January 2020, 589 patients who underwent surgery of hip fractures at our institution were retrospectively reviewed. Serum creatinine (sCr) was analysed daily pre- and postoperatively during the hospital stay. Patients were divided into groups; AKI and non-AKI based on KDIGO (Kidney Disease Global Outcomes) criteria. The incidence, risk factors, and mortality of postoperative AKI were investigated. RESULTS Out of 589 patients, 58 developed an AKI (9.8%). Smoking (p: 0.004), pre and postoperative low albumin level (p < 0.05), pre- and postoperative high potassium level (p < 0.05), pre- and postoperative high urea levels (p < 0.05), high amount of intra-operative bleeding (p: 0.003) and prolonged surgery time (p: 0.003) were found to be risk factors associated with AKI. Although the mortality rate was higher in the AKI group, it was not statistically significant (p > 0.05). CONCLUSION AKI is a temporary but common complication following hip fracture surgery, which can also be predicted if risk factors are adequately observed. It typically increases the length of hospital stays, mortality and morbidity. LEVEL OF EVIDENCE Level III evidence, Retrospective comparative study.
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Affiliation(s)
- Anil Agar
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey.
| | - Deniz Gulabi
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Adem Sahin
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Orhan Gunes
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Cafer Ozgur Hancerli
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Bulent Kılıc
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
| | - Cemil Erturk
- Orthopaedic and Traumatology Department, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Atakent mah, Istanbul cad. No: 1, Kucukcekmece, 34303, Istanbul, Turkey
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Inoue T, Kohira S, Ebine T, Shikata F, Fujii K, Miyaji K. Monitoring of intraoperative femoral oxygenation predicts acute kidney injury after pediatric cardiac surgery. Int J Artif Organs 2022; 45:981-987. [PMID: 36032034 DOI: 10.1177/03913988221119527] [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]
Abstract
Cardiopulmonary bypass-associated acute kidney injury (CPB-AKI) is a pediatric cardiac surgery postoperative complication that is associated with a longer duration of mechanical ventilation and length of hospital stay. Identifying an early predictor of CPB-AKI is critical. Near infrared spectroscopy (NIRS), which can provide real-time monitoring of regional tissue oxygen saturation (rSO2) during CPB, may predict CPB-AKI in an early phase of surgical treatment. This study analyzed clinical data from 87 children who underwent an elective surgical repair of ventricular septal defect (VSD) from January 2013 to March 2019. NIRS sensors were placed on the patients' forehead, abdomen, and thighs. The pediatric modified risk, injury, failure, loss, and end-stage (p-RIFLE) score was determined for each patient postoperatively. The incidence of AKI based on the p-RIFLE classification was 11.5% at the end of surgery, 23.0% at 24 h after surgery, and 5.7% at 48 h after surgery. The AKI incidence rate was highest at 24 h after surgery. Multiple regression analysis revealed that femoral oxygenation (rSO2) during CPB, CPB time, oxygen delivery index (DO2i), and lactate at the end of CPB were independent risk factors for AKI. Receiver-operating characteristic curve analysis indicated that femoral oxygenation of 74% or less predicted AKI development within 24 h after surgery. In conclusion, rSO2 measured at the thigh during CPB is highly predictive of CPB-AKI.
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Affiliation(s)
- Takamichi Inoue
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Satoshi Kohira
- Department of Medical Engineering, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Tomoyo Ebine
- Department of Medical Engineering, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Kiyotaka Fujii
- Department of Medical Engineering, Kitasato University School of Allied Health Sciences, Sagamihara, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
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29
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Diagnosis of Cardiac Surgery-Associated Acute Kidney Injury: State of the Art and Perspectives. J Clin Med 2022; 11:jcm11154576. [PMID: 35956190 PMCID: PMC9370029 DOI: 10.3390/jcm11154576] [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: 06/30/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Diagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.
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30
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The Role of Gut-Derived, Protein-Bound Uremic Toxins in the Cardiovascular Complications of Acute Kidney Injury. Toxins (Basel) 2022; 14:toxins14050336. [PMID: 35622583 PMCID: PMC9143532 DOI: 10.3390/toxins14050336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/04/2022] [Accepted: 05/07/2022] [Indexed: 02/04/2023] Open
Abstract
Acute kidney injury (AKI) is a frequent disease encountered in the hospital, with a higher incidence in intensive care units. Despite progress in renal replacement therapy, AKI is still associated with early and late complications, especially cardiovascular events and mortality. The role of gut-derived protein-bound uremic toxins (PBUTs) in vascular and cardiac dysfunction has been extensively studied during chronic kidney disease (CKD), in particular, that of indoxyl sulfate (IS), para-cresyl sulfate (PCS), and indole-3-acetic acid (IAA), resulting in both experimental and clinical evidence. PBUTs, which accumulate when the excretory function of the kidneys is impaired, have a deleterious effect on and cause damage to cardiovascular tissues. However, the link between PBUTs and the cardiovascular complications of AKI and the pathophysiological mechanisms potentially involved are unclear. This review aims to summarize available data concerning the participation of PBUTs in the early and late cardiovascular complications of AKI.
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31
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McLarnon SC, Johnson C, Giddens P, O'Connor PM. Hidden in Plain Sight: Does Medullary Red Blood Cell Congestion Provide the Explanation for Ischemic Acute Kidney Injury? Semin Nephrol 2022; 42:151280. [PMID: 36460572 DOI: 10.1016/j.semnephrol.2022.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute kidney injury (AKI) represents a sudden reduction in renal function and is a major clinical problem with a high mortality rate. Despite decades of research, there are currently no direct therapies for AKI. The failure of therapeutic approaches identified in rodents to translate to human beings has led to questions regarding the appropriateness of these models. Our recent data indicate that there are two distinct processes driving tubular injury in the commonly used rat model of warm bilateral renal ischemia reperfusion injury, which often is used to mimic ischemic AKI. One results from the period of warm ischemia, manifesting as sublethal injury and coagulative necrosis of the proximal tubules in the renal cortex. This is the predominate type of injury observed 24 hours after reperfusion and the most well studied. The other results from red blood cell congestion of the outer medullary vasculature. This type of injury manifests as cell sloughing, along with the later formation of heme casts that fill distal nephron segments. Cell sloughing from congestion is most prominent in the early hours after reperfusion and often is masked by regeneration of the tubular epithelium by 24 hours postischemia. In this review, we argue that injury from outer medullary red blood cell congestion reflects the pathology observed in human kidneys and likely is representative of injury in most cases of ischemic AKI after shock. Greater focus on this congestive injury is likely to lead to improved translation in AKI.
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Affiliation(s)
- Sarah C McLarnon
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Chloe Johnson
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Priya Giddens
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia
| | - Paul M O'Connor
- Department of Physiology, Medical College of Georgia, Augusta University, Augusta, Georgia.
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32
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Kidney Disease: Improving Global Outcomes Classification of Chronic Kidney Disease and Short-Term Outcomes of Patients Undergoing Liver Resection. J Am Coll Surg 2022; 234:827-839. [DOI: 10.1097/xcs.0000000000000112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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33
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Moon JK, Kim H, Chang JS, Moon SH, Kim JW. Acute kidney injury after hip fracture in organ transplant recipients. Clin Transplant 2022; 36:e14664. [PMID: 35384076 DOI: 10.1111/ctr.14664] [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: 01/18/2022] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to investigate the incidence and risk factors of acute kidney injury (AKI) after hip fracture in organ transplant recipients. METHODS In this single-center retrospective cohort study, 795 elderly patients who underwent hip fracture surgery were enrolled. AKI was defined according to Acute Kidney Injury Network criteria. Among the 795 patients, 23 underwent kidney transplantation (KT) and 20 underwent liver transplantation (LT). The incidence of AKI, dialysis requirement, and renal recovery rate were investigated. RESULTS AKI occurred in 83 patients (10.5%), of whom 9 (39.1%), 3 (15%), and 71 (9.5%) were in the KT, LT, and non-transplantation groups, respectively. The incidence rates of AKI and severe AKI (17.4% vs. 1.4%) were significantly higher in the KT group than in the non-transplantation group (p = 0.001 for both). The renal recovery rate was significantly lower in the KT group than in the non-transplantation group (p = 0.033). The multivariate analysis revealed that male; body mass index; CKD; alkaline phosphatase; intraoperative hypotension; and history of KT were independent predictors of AKI development. CONCLUSIONS AKI and severe AKI after hip fracture occurred more frequently in the KT recipients with lower renal recovery rates. Transplanted kidneys are more vulnerable to AKI after hip fracture. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jun-Ki Moon
- Department of Orthopedic Surgery, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Hyosang Kim
- Division of Nephrology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Suk Chang
- Department of Orthopedic Surgery, Good Gangan Hospital, Busan, Republic of Korea
| | - Sung Ho Moon
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
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34
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Jiang G, Luk AO, Tam CH, Ozaki R, Lim CK, Chow EY, Lau ES, Kong AP, Fan B, Lee KF, Siu SC, Hui G, Tsang CC, Lau KP, Leung JY, Tsang MW, Kam G, Lau IT, Li JK, Yeung VT, Lau E, Lo S, Fung S, Cheng YL, Chow CC, Tang NL, Huang Y, Lan HY, Oram RA, Szeto CC, So WY, Chan JC, Ma RC. Clinical Predictors and Long-term Impact of Acute Kidney Injury on Progression of Diabetic Kidney Disease in Chinese Patients With Type 2 Diabetes. Diabetes 2022; 71:520-529. [PMID: 35043149 PMCID: PMC8893937 DOI: 10.2337/db21-0694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/14/2021] [Indexed: 11/13/2022]
Abstract
We aim to assess the long-term impact of acute kidney injury (AKI) on progression of diabetic kidney disease (DKD) and all-cause mortality and investigate determinants of AKI in Chinese patients with type 2 diabetes (T2D). A consecutive cohort of 9,096 Chinese patients with T2D from the Hong Kong Diabetes Register was followed for 12 years (mean ± SD age 57 ± 13.2 years; 46.9% men; median duration of diabetes 5 years). AKI was defined based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria using serum creatinine. Estimated glomerular filtration rate measurements were used to identify the first episode with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Polygenic risk score (PRS) composed of 27 single nucleotide polymorphisms (SNPs) known to be associated with serum uric acid (SUA) in European populations was used to examine the role of SUA in pathogenesis of AKI, CKD, and ESRD. Validation was sought in an independent cohort including 6,007 patients (age 61.2 ± 10.9 years; 59.5% men; median duration of diabetes 10 years). Patients with AKI had a higher risk for developing incident CKD (hazard ratio 14.3 [95% CI 12.69-16.11]), for developing ESRD (12.1 [10.74-13.62]), and for all-cause death (7.99 [7.31-8.74]) compared with those without AKI. Incidence rate for ESRD among patients with no episodes of AKI and one, two, and three or more episodes of AKI was 7.1, 24.4, 32.4, and 37.3 per 1,000 person-years, respectively. Baseline SUA was a strong independent predictor for AKI. A PRS composed of 27 SUA-related SNPs was associated with AKI and CKD in both discovery and replication cohorts but not ESRD. Elevated SUA may increase the risk of DKD through increasing AKI. The identification of SUA as a modifiable risk factor and PRS as a nonmodifiable risk factor may facilitate the identification of individuals at high risk to prevent AKI and its long-term impact in T2D.
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Affiliation(s)
- Guozhi Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, Guangdong, China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
| | - Andrea O. Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Claudia H.T. Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
| | - Risa Ozaki
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
| | - Cadmon K.P. Lim
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
| | - Elaine Y.K. Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
| | - Eric S. Lau
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
| | - Alice P.S. Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Baoqi Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
| | | | - Ka Fai Lee
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | | | - Grace Hui
- Diabetes Centre, Tung Wah Eastern Hospital, Hong Kong
| | - Chiu Chi Tsang
- Diabetes and Education Centre, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | | | - Jenny Y. Leung
- Department of Medicine and Geriatrics, Ruttonjee Hospital, Hong Kong
| | - Man-wo Tsang
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | - Grace Kam
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | | | - June K. Li
- Department of Medicine, Yan Chai Hospital, Hong Kong
| | - Vincent T. Yeung
- Centre for Diabetes Education and Management, Our Lady of Maryknoll Hospital, Hong Kong
| | - Emmy Lau
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Stanley Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Samuel Fung
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong
| | - Chun Chung Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | | | - Nelson L.S. Tang
- Department of Chemical Pathology, The Chinese University of Hong Kong, Hong Kong
| | - Yu Huang
- School of Biomedical Sciences, The Chinese University of Hong Kong
| | - Hui-yao Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, U.K
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Wing Yee So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
| | - Juliana C.N. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
| | - Ronald C.W. Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
- Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong
- CUHK-SJTU Joint Research Centre in Diabetes Genomics and Precision Medicine, Hong Kong
- Corresponding author: Ronald C.W. Ma,
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35
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Yi HM, Lowerison MR, Song PF, Zhang W. A Review of Clinical Applications for Super-resolution Ultrasound Localization Microscopy. Curr Med Sci 2022; 42:1-16. [PMID: 35167000 DOI: 10.1007/s11596-021-2459-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/11/2021] [Indexed: 12/21/2022]
Abstract
Microvascular structure and hemodynamics are important indicators for the diagnosis and assessment of many diseases and pathologies. The structural and functional imaging of tissue microvasculature in vivo is a clinically significant objective for the development of many imaging modalities. Contrast-enhanced ultrasound (CEUS) is a popular clinical tool for characterizing tissue microvasculature, due to the moderate cost, wide accessibility, and absence of ionizing radiation of ultrasound. However, in practice, it remains challenging to demonstrate microvasculature using CEUS, due to the resolution limit of conventional ultrasound imaging. In addition, the quantification of tissue perfusion by CEUS remains hindered by high operator-dependency and poor reproducibility. Inspired by super-resolution optical microscopy, super-resolution ultrasound localization microscopy (ULM) was recently developed. ULM uses the same ultrasound contrast agent (i.e. microbubbles) in CEUS. However, different from CEUS, ULM uses the location of the microbubbles to construct images, instead of using the backscattering intensity of microbubbles. Hence, ULM overcomes the classic compromise between imaging resolution and penetration, allowing for the visualization of capillary-scale microvasculature deep within tissues. To date, many in vivo ULM results have been reported, including both animal (kidney, brain, spinal cord, xenografted tumor, and ear) and human studies (prostate, tibialis anterior muscle, and breast cancer tumors). Furthermore, a variety of useful biomarkers have been derived from using ULM for different preclinical and clinical applications. Due to the high spatial resolution and accurate blood flow speed estimation (approximately 1 mm/s to several cm/s), ULM presents as an enticing alternative to CEUS for characterizing tissue microvasculature in vivo. This review summarizes the principles and present applications of CEUS and ULM, and discusses areas where ULM can potentially provide a better alternative to CEUS in clinical practice and areas where ULM may not be a better alternative. The objective of the study is to provide clinicians with an up-to-date review of ULM technology, and a practical guide for implementing ULM in clinical research and practice.
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Affiliation(s)
- Hui-Ming Yi
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, 61801, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, 61801, USA
| | - Matthew R Lowerison
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, 61801, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, 61801, USA
| | - Peng-Fei Song
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, 61801, USA.,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, 61801, USA
| | - Wei Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, 61801, USA. .,Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, 61801, USA.
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36
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Zhang P, Fu H, Liu J, Liu X, Yang S, Guo Z, Fu N. Preoperative Fasting Blood Glucose Levels and the Risk of Contrast-Induced Nephropathy in Patients With Diabetes and Pre-diabetes Undergoing Coronary Arteriography or Percutaneous Coronary Intervention: A Cross-Sectional Study. Angiology 2022; 73:660-667. [PMID: 35084237 DOI: 10.1177/00033197211061916] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Diabetes mellitus is an independent risk factor for contrast-induced nephropathy (CIN) in patients undergoing coronary arteriography/percutaneous coronary intervention (CAG/PCI). We evaluated whether preoperative fasting blood glucose (FBG) levels in diabetic and pre-diabetic patients who underwent CAG/PCI influenced the occurrence of CIN. From June 1, 2020, to February 28, 2021, 687 patients were divided into five groups based on their preoperative FBG levels. Blood samples were collected at admission and at 48 hours and 72 hours after the procedure to determine serum creatinine levels. The P value for trend was used to analyze the trend between preoperative FBG levels and the increased risk of CIN. Univariable and multivariable logistic regression analysis were used to exclude the influence of confounding factors, and some high-risk confounders were selected for subgroup analysis. The results of our cross-sectional study show that elevated preoperative FBG levels are independently associated with the risk of CIN in diabetic and pre-diabetic patients undergoing CAG/PCI. Furthermore, the incidence of CIN gradually increases with the rise in preoperative FBG levels. Patients with elevated preoperative FBG at admission should be carefully monitored and more active measures should be taken to prevent CIN.
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Affiliation(s)
- Peng Zhang
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Clinical College of Chest, 12610Tianjin Medical University, Tianjin, China.,12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Han Fu
- 12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Jie Liu
- 12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Xiaogang Liu
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Clinical College of Chest, 12610Tianjin Medical University, Tianjin, China.,12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Shicheng Yang
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Clinical College of Chest, 12610Tianjin Medical University, Tianjin, China.,12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Zhigang Guo
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Clinical College of Chest, 12610Tianjin Medical University, Tianjin, China.,12610Graduate School of Tianjin Medical University, Tianjin, China
| | - Naikuan Fu
- Department of Cardiology, 499773Tianjin Chest Hospital, Tianjin, China.,Clinical College of Chest, 12610Tianjin Medical University, Tianjin, China.,12610Graduate School of Tianjin Medical University, Tianjin, China
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Uremic Toxins and Protein-Bound Therapeutics in AKI and CKD: Up-to-Date Evidence. Toxins (Basel) 2021; 14:toxins14010008. [PMID: 35050985 PMCID: PMC8780792 DOI: 10.3390/toxins14010008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 12/28/2022] Open
Abstract
Uremic toxins are defined as harmful metabolites that accumulate in the human body of patients whose renal function declines, especially chronic kidney disease (CKD) patients. Growing evidence demonstrates the deteriorating effect of uremic toxins on CKD progression and CKD-related complications, and removing uremic toxins in CKD has become the conventional treatment in the clinic. However, studies rarely pay attention to uremic toxin clearance in the early stage of acute kidney injury (AKI) to prevent progression to CKD despite increasing reports demonstrating that uremic toxins are correlated with the severity of injury or mortality. This review highlights the current evidence of uremic toxin accumulation in AKI and the therapeutic value to prevent CKD progression specific to protein-bound uremic toxins (PBUTs).
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Franco ML, Beyerstedt S, Rangel ÉB. Klotho and Mesenchymal Stem Cells: A Review on Cell and Gene Therapy for Chronic Kidney Disease and Acute Kidney Disease. Pharmaceutics 2021; 14:pharmaceutics14010011. [PMID: 35056905 PMCID: PMC8778857 DOI: 10.3390/pharmaceutics14010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic kidney disease (CKD) and acute kidney injury (AKI) are public health problems, and their prevalence rates have increased with the aging of the population. They are associated with the presence of comorbidities, in particular diabetes mellitus and hypertension, resulting in a high financial burden for the health system. Studies have indicated Klotho as a promising therapeutic approach for these conditions. Klotho reduces inflammation, oxidative stress and fibrosis and counter-regulates the renin-angiotensin-aldosterone system. In CKD and AKI, Klotho expression is downregulated from early stages and correlates with disease progression. Therefore, the restoration of its levels, through exogenous or endogenous pathways, has renoprotective effects. An important strategy for administering Klotho is through mesenchymal stem cells (MSCs). In summary, this review comprises in vitro and in vivo studies on the therapeutic potential of Klotho for the treatment of CKD and AKI through the administration of MSCs.
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Affiliation(s)
- Marcella Liciani Franco
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (M.L.F.); (S.B.)
| | - Stephany Beyerstedt
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (M.L.F.); (S.B.)
| | - Érika Bevilaqua Rangel
- Albert Einstein Research and Education Institute, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil; (M.L.F.); (S.B.)
- Nephrology Division, Federal University of São Paulo, Sao Paulo 04038-901, Brazil
- Correspondence: ; Tel.: +55-11-2151-2148
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Tang Y, Luo H, Xiao Q, Li L, Zhong X, Zhang J, Wang F, Li G, Wang L, Li Y. Isoliquiritigenin attenuates septic acute kidney injury by regulating ferritinophagy-mediated ferroptosis. Ren Fail 2021; 43:1551-1560. [PMID: 34791966 PMCID: PMC8604484 DOI: 10.1080/0886022x.2021.2003208] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Defined differently from apoptosis, necrosis, and autophagy, ferroptosis has been implicated in acute kidney injury (AKI) such as ischemia-reperfusion injury induced AKI, folic acid caused AKI and cisplatin induced AKI. However, whether ferroptosis is involved in LPS induced AKI could be remaining unclear and there is still a lack of therapies associated with ferroptosis in LPS induced AKI without side effects. This study aimed to elucidate the role of isoliquiritigenin (ISL) in ferroptosis of LPS-induced AKI. We used LPS to induce renal tubular injury, followed by treatment with ISL both in vitro and in vivo. Human renal tubular HK2 cells were pretreated with 50 μM or 100 μM ISL for 5 h before stimulation with 2 μg/mL LPS. Mice were administered a single dose of either 50 mg/kg ISL orally or 5 mg/kg ferroptosis inhibitor ferrostatin-1 intraperitoneally before 10 mg/kg LPS injection. We found that LPS could induce mitochondria injury of renal tubular presented as the shape of mitochondria appeared smaller than normal with increased membrane density and are faction or destruction of mitochondrial crista through scanning electron microscope. Ferrostatin-1 significantly protected mice against renal dysfunction and renal tubular damage in LPS-induced AKI. ISL inhibited Fe2+ and lipid peroxidation accumulation in LPS-stimulated HK2 cells. It also increased the expression of GPX4 and xCT, reduced the expression of HMGB1 and NCOA4 then attenuated mitochondria injury in renal tubular following LPS stimulation. These results indicated the potential role of ISL against ferritinophagy-mediated ferroptosis in renal tubular following LPS stimulation.
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Affiliation(s)
- Yun Tang
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Haojun Luo
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Qiong Xiao
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Li
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Zhong
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Jiong Zhang
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Fang Wang
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Guisen Li
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Wang
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Li
- Department of Nephrology, School of Medicine, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Clinical Research Center for Kidney Diseases, Clinical Immunology Translational Medicine Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, China
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40
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Shen Y, Ru W, Cao L, Jiang R, Xu X. Impact of partial pressure of oxygen trajectories on the incidence of acute kidney injury in patients undergoing cardiopulmonary bypass. J Cardiol 2021; 79:545-550. [PMID: 34799218 DOI: 10.1016/j.jjcc.2021.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND To investigate the impact of the dynamic oxygenation status on the incidence of acute kidney injury (AKI) in patients undergoing cardiopulmonary bypass. METHODS This retrospective study was performed using data extracted from the Medical Information Mart for Intensive Care III database. A group-based trajectory approach was used to identify partial pressure of oxygen (PaO2) trajectories using dynamic change in PaO2 within 48 hours after intensive care unit admission. RESULTS In total, 5,824 patients were included. Four PaO2 trajectories were identified: Trajectory 1 (Traj-1), hyperoxia and rapid decrease; Trajectory 2 (Traj-2), hyperoxia and rapid decrease similar to that of Traj-1; Trajectory 3 (Traj-3), normoxemia and rapid increase in PaO2; and Trajectory 4 (Traj-4), hyperoxia and gradual decrease. Compared with the Traj-1 group, the Traj-3 group had a significantly lower initial Sequential Organ Failure Assessment score, similar vasopressor use rate, and a higher fraction of inspired oxygen. However, the risk of developing AKI was significantly higher in the Traj-3 [adjusted odds ratio (OR): 1.7, 95% confidence interval (CI): 1.1-2.7] and Traj-4 groups (OR: 1.9, 95% CI: 1.4-2.5) than in the Traj-1 group. CONCLUSIONS Patients with persistent hyperoxia had a higher incidence of AKI than those with transient hyperoxia. Further studies are required to determine potential underlying mechanisms.
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Affiliation(s)
- Yanfei Shen
- Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Weizhe Ru
- Cixi People's Hospital, Cixi, Zhejiang, China
| | - Lingyong Cao
- Zhejiang University of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Ronglin Jiang
- Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
| | - Xiaoming Xu
- Zhejiang Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China.
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Leu JG, Su WH, Chen YC, Liang YJ. Hydralazine attenuates renal inflammation in diabetic rats with ischemia/reperfusion acute kidney injury. Eur J Pharmacol 2021; 910:174468. [PMID: 34478692 DOI: 10.1016/j.ejphar.2021.174468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/24/2021] [Accepted: 08/30/2021] [Indexed: 01/23/2023]
Abstract
Acute kidney injury (AKI) is one of the major complications with increased oxidative stress and inflammation in diabetic patients. Hyperglycemia stimulates the formation of advanced glycation end products (AGEs). However, hyperglycemia directly triggers the interaction between AGEs and transmembrane AGEs receptors (RAGE), which enhances oxidative stress and increases the production of inflammatory substances. Therefore, diabetes plays a pivotal role in kidney injury. Hydralazine, a vasodilator and antihypertensive drug, was found to have the ability to reduce ROS, oxidative stress, and inflammation. We applied Hydralazine co-culture with AGEs in rat mesangial cells (RMC) and to renal ischemia/reperfusion(I/R) injury models in streptozotocin-induced diabetic rats. Hydralazine significantly decreased AGEs-induced RAGE, iNOS, and COX-2 expressions in RMC. Compared to the diabetic with AKI group, hydralazine decreased inflammation-related protein, and JAK2, STAT3 signaling in rat kidney tissue. Our studies indicate that Hydralazine has the potential to become a beneficial drug in the treatment of diabetic acute kidney injury.
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Affiliation(s)
- Jyh-Gang Leu
- Fu-Jen Catholic University School of Medicine, New Taipei City, Taiwan, ROC; Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Hsiang Su
- Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Yu-Cheng Chen
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yao-Jen Liang
- Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City, Taiwan, ROC.
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42
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Lim JH, Jeon Y, Ahn JS, Kim S, Kim DK, Lee JP, Ryu DR, Seong EY, Ahn SY, Baek SH, Jung HY, Choi JY, Park SH, Kim CD, Kim YL, Cho JH. GDF-15 Predicts In-Hospital Mortality of Critically Ill Patients with Acute Kidney Injury Requiring Continuous Renal Replacement Therapy: A Multicenter Prospective Study. J Clin Med 2021; 10:jcm10163660. [PMID: 34441955 PMCID: PMC8397174 DOI: 10.3390/jcm10163660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 02/01/2023] Open
Abstract
Growth differentiation factor-15 (GDF-15) is a stress-responsive cytokine. This study evaluated the association between GDF-15 and in-hospital mortality among patients with severe acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). Among the multicenter prospective CRRT cohort between 2017 and 2019, 66 patients whose blood sample was available were analyzed. Patients were divided into three groups according to the GDF-15 concentrations. The median GDF-15 level was 7865.5 pg/mL (496.9 pg/mL in the healthy control patients). Baseline characteristics were not different among tertile groups except the severity scores and serum lactate level, which were higher in the third tertile. After adjusting for confounding factors, the patients with higher GDF-15 had significantly increased risk of mortality (second tertile: adjusted hazards ratio [aHR], 3.67; 95% confidence interval [CI], 1.05-12.76; p = 0.041; third tertile: aHR, 6.81; 95% CI, 1.98-23.44; p = 0.002). Furthermore, GDF-15 predicted in-hospital mortality (area under the curve, 0.710; 95% CI, 0.585-0.815) better than APACHE II and SOFA scores. Serum GDF-15 concentration was elevated in AKI patients requiring CRRT, higher in more severe patients. GDF-15 is a better independent predictor for in-hospital mortality of critically ill AKI patients than the traditional risk scoring system such as APACHE II and SOFA scores.
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Affiliation(s)
- Jeong-Hoon Lim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
- Correspondence: (J.-H.L.); (J.-H.C.); Tel.: +82-53-200-3209 (J.-H.L.); +82-53-200-5550 (J.-H.C.); Fax: +82-53-426-9464 (J.-H.L.); +82-53-426-2046 (J.-H.C.)
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu 41566, Korea;
| | - Ji-Sun Ahn
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Sejoong Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si 13620, Korea;
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 08826, Korea; (D.K.K.); (J.P.L.)
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul 08826, Korea; (D.K.K.); (J.P.L.)
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul 07061, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul 07804, Korea;
| | - Eun Young Seong
- Division of Nephrology, Pusan National University School of Medicine, Busan 50612, Korea;
| | - Shin Young Ahn
- Department of Internal Medicine, Korea University College of Medicine, Seoul 02841, Korea;
| | - Seon Ha Baek
- Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Korea;
| | - Hee-Yeon Jung
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Ji-Young Choi
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Sun-Hee Park
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Chan-Duck Kim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Yong-Lim Kim
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
| | - Jang-Hee Cho
- Department of Internal Medicine, Division of Nephrology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Korea; (J.-S.A.); (H.-Y.J.); (J.-Y.C.); (S.-H.P.); (C.-D.K.); (Y.-L.K.)
- Correspondence: (J.-H.L.); (J.-H.C.); Tel.: +82-53-200-3209 (J.-H.L.); +82-53-200-5550 (J.-H.C.); Fax: +82-53-426-9464 (J.-H.L.); +82-53-426-2046 (J.-H.C.)
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Tummalapalli SL, Zech JR, Cho HJ, Goetz C. Risk stratification for hydronephrosis in the evaluation of acute kidney injury: a cross-sectional analysis. BMJ Open 2021; 11:e046761. [PMID: 34389565 PMCID: PMC8365791 DOI: 10.1136/bmjopen-2020-046761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To validate an existing clinical decision support tool to risk-stratify patients with acute kidney injury (AKI) for hydronephrosis and compare the risk stratification framework with nephrology consultant recommendations. SETTING Cross-sectional study of hospitalised adults with AKI who had a renal ultrasound (RUS) ordered at a large, tertiary, academic medical centre. PARTICIPANTS Two hundred and eighty-one patients were included in the study cohort. Based on the risk stratification framework, 111 (40%), 76 (27%) and 94 (33%) patients were in the high-risk, medium-risk and low-risk groups for hydronephrosis, respectively. OUTCOMES Outcomes were the presence of unilateral or bilateral hydronephrosis on RUS. RESULTS Thirty-five patients (12%) were found to have hydronephrosis. The high-risk group had 86% sensitivity and 67% specificity for identifying hydronephrosis. A nephrology consult was involved in 168 (60%) patients and RUS was recommended by the nephrology service in 95 (57%) cases. Among patients with a nephrology consultation, 9 (56%) of the 16 total patients with hydronephrosis were recommended to obtain an RUS. CONCLUSIONS We further externally validated a risk stratification framework for hydronephrosis. Clinical decision support systems may be useful to supplement clinical judgement in the evaluation of AKI.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science and Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - John R Zech
- Department of Radiology, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Hyung J Cho
- Chief Value Officer, New York City Health and Hospitals, New York, NY, USA
- Senior Fellow, Lown Institute, Brookline, MA, USA
| | - Celine Goetz
- Director of Education, Division of Hospital Medicine, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
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44
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Jiang S, Huang L, Zhang W, Zhang H. Vitamin D/VDR in Acute Kidney Injury: A Potential Therapeutic Target. Curr Med Chem 2021; 28:3865-3876. [PMID: 33213307 DOI: 10.2174/0929867327666201118155625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/29/2020] [Accepted: 10/07/2020] [Indexed: 11/22/2022]
Abstract
Despite many strategies and parameters used in clinical practice, the incidence and mortality of acute kidney injury (AKI) are still high with poor prognosis. With the development of molecular biology, the role of vitamin D and vitamin D receptor (VDR) in AKI is drawing increasing attention. Accumulated researches have suggested that Vitamin D deficiency is a risk factor of both clinical and experimental AKI, and vitamin D/VDR could be a promising therapeutic target against AKI. However, more qualitative clinical researches are needed to provide stronger evidence for the clinical application of vitamin D and VDR agonists in the future. Issues like the route and dosage of administration also await more attention. The present review aims to summarize the current works on the role of vitamin D/VDR in AKI and provides some new insight on its therapeutic potential.
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Affiliation(s)
- Siqing Jiang
- Department of Nephrology, Third Xiangya Hospital, Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013, China
| | - Lihua Huang
- Center for Medical Experiments, Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China
| | - Wei Zhang
- Department of Nephrology, Third Xiangya Hospital, Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013, China
| | - Hao Zhang
- Department of Nephrology, Third Xiangya Hospital, Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013, China
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45
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Sancho-Martínez SM, Sánchez-Juanes F, Blanco-Gozalo V, Fontecha-Barriuso M, Prieto-García L, Fuentes-Calvo I, González-Buitrago JM, Morales AI, Martínez-Salgado C, Ramos-Barron MA, Gómez-Alamillo C, Arias M, López-Novoa JM, López-Hernández FJ. Urinary TCP1-eta: A Cortical Damage Marker for the Pathophysiological Diagnosis and Prognosis of Acute Kidney Injury. Toxicol Sci 2021; 174:3-15. [PMID: 31825490 DOI: 10.1093/toxsci/kfz242] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Acute kidney injury (AKI) is a serious syndrome with increasing incidence and health consequences, and high mortality rate among critically ill patients. Acute kidney injury lacks a unified definition, has ambiguous semantic boundaries, and relies on defective diagnosis. This, in part, is due to the absence of biomarkers substratifying AKI patients into pathophysiological categories based on which prognosis can be assigned and clinical treatment differentiated. For instance, AKI involving acute tubular necrosis (ATN) is expected to have a worse prognosis than prerenal, purely hemodynamic AKI. However, no biomarker has been unambiguously associated with tubular cell death or is able to provide etiological distinction. We used a cell-based system to identify TCP1-eta in the culture medium as a noninvasive marker of damaged renal tubular cells. In rat models of AKI, TCP1-eta was increased in the urine co-relating with renal cortical tubule damage. When kidneys from ATN rats were perfused in situ with Krebs-dextran solution, a portion of the urinary TCP1-eta protein content excreted into urine disappeared, and another portion remained within the urine. These results indicated that TCP1-eta was secreted by tubule cells and was not fully reabsorbed by the damaged tubules, both effects contributing to the increased urinary excretion. Urinary TCP1-eta is found in many etiologically heterogeneous AKI patients, and is statistically higher in patients partially recovered from severe AKI. In conclusion, urinary TCP1-eta poses a potential, substratifying biomarker of renal cortical damage associated with bad prognosis.
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Affiliation(s)
- Sandra M Sancho-Martínez
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Fernando Sánchez-Juanes
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Víctor Blanco-Gozalo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Miguel Fontecha-Barriuso
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Laura Prieto-García
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Isabel Fuentes-Calvo
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - José M González-Buitrago
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - Ana I Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Martínez-Salgado
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
| | - María A Ramos-Barron
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Carlos Gómez-Alamillo
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Manuel Arias
- Department of Nephrology, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - José M López-Novoa
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain
| | - Francisco J López-Hernández
- Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, Spain.,Department of Physiology and Pharmacology, University of Salamanca, Salamanca, Spain.,Group of Translational Research on Renal and Cardiovascular Diseases (TRECARD), Salamanca, Spain.,Group of Biomedical Research on Critical Care (BioCritic), Valladolid, Spain.,Spanish Renal Research Network (REDinREN), Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Estudios de Ciencias de la Salud de Castilla y León (IECSCYL), Soria, Spain
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Zhang H, Fu H, Fu X, Zhang J, Zhang P, Yang S, Zeng Z, Fu N, Guo Z. Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention. BMC Nephrol 2021; 22:206. [PMID: 34078303 PMCID: PMC8173735 DOI: 10.1186/s12882-021-02405-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/16/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN. Methods We reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN. Results Patients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829). Conclusions Studies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.
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Affiliation(s)
- H Zhang
- Clinical College of Chest,Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - H Fu
- Tianjin Medical University, Tianjin, China
| | - X Fu
- Tianjin Medical University, Tianjin, China
| | - J Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - P Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - S Yang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Z Zeng
- Tianjin Medical University, Tianjin, China
| | - N Fu
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
| | - Z Guo
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
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The role of the neutrophil-lymphocyte ratio for pre-operative risk stratification of acute kidney injury after tetralogy of Fallot repair. Cardiol Young 2021; 31:1009-1014. [PMID: 34016219 DOI: 10.1017/s1047951121001943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Acute kidney injury is a risk factor for chronic kidney disease and mortality after congenital heart surgery under cardiopulmonary bypass. The neutrophil-lymphocyte ratio is an inexpensive and easy to measure biomarker for predicting outcomes in children with congenital heart disease undergoing surgical correction. OBJECTIVE To identify children at high risk of acute kidney injury after tetralogy of Fallot repair using the neutrophil-lymphocyte ratio. METHODS This single-centre retrospective analysis included consecutive patients aged < 18 years who underwent tetralogy of Fallot repair between January 2014 and December 2018. The pre-operative neutrophil-lymphocyte ratio was measured using the last pre-operative complete blood count test. We used the Acute Kidney Injury Network definition. RESULTS A total of 116 patients were included, of whom 39 (33.6%) presented with acute kidney injury: 20 (51.3%) had grade I acute kidney injury, nine had grade II acute kidney injury (23.1%), and 10 (25.6%) had grade III acute kidney injury. A high pre-operative neutrophil-lymphocyte ratio was associated with grade III acute kidney injury in the post-operative period (p = 0.04). Patients with acute kidney injury had longer mechanical ventilation time (p = 0.023), intensive care unit stay (p < 0.001), and hospital length of stay (p = 0.002). CONCLUSION Our results suggest that the pre-operative neutrophil-lymphocyte ratio can be used to identify patients at risk of developing grade III acute kidney injury after tetralogy of Fallot repair.
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Ambruso SL, Gil HW, Fox B, Park B, Altmann C, Bagchi RA, Baker PR, Reisz JA, Faubel S. Lung metabolomics after ischemic acute kidney injury reveals increased oxidative stress, altered energy production, and ATP depletion. Am J Physiol Lung Cell Mol Physiol 2021; 321:L50-L64. [PMID: 33949208 DOI: 10.1152/ajplung.00042.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acute kidney injury (AKI) is a complex disease associated with increased mortality that may be due to deleterious distant organ effects. AKI associated with respiratory complications, in particular, has a poor outcome. In murine models, AKI is characterized by increased circulating cytokines, lung chemokine upregulation, and neutrophilic infiltration, similar to other causes of indirect acute lung injury (ALI; e.g., sepsis). Many causes of lung inflammation are associated with a lung metabolic profile characterized by increased oxidative stress, a shift toward the use of other forms of energy production, and/or a depleted energy state. To our knowledge, there are no studies that have evaluated pulmonary energy production and metabolism after AKI. We hypothesized that based on the parallels between inflammatory acute lung injury and AKI-mediated lung injury, a similar metabolic profile would be observed. Lung metabolomics and ATP levels were assessed 4 h, 24 h, and 7 days after ischemic AKI in mice. Numerous novel findings regarding the effect of AKI on the lung were observed including 1) increased oxidative stress, 2) a shift toward alternate methods of energy production, and 3) depleted levels of ATP. The findings in this report bring to light novel characteristics of AKI-mediated lung injury and provide new leads into the mechanisms by which AKI in patients predisposes to pulmonary complications.
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Affiliation(s)
- Sophia L Ambruso
- Rocky Mountain Regional VA Medical Center, Denver, Colorado.,University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Hyo-Wook Gil
- Soonchunhyang University Cheonan Hospital, Cheonan, ChungcheongNam-do, Republic of Korea
| | - Benjamin Fox
- University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Bryan Park
- University of Colorado Anschutz Medical Campus, Denver, Colorado
| | | | - Rushita A Bagchi
- University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Peter R Baker
- University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Julie A Reisz
- University of Colorado Anschutz Medical Campus, Denver, Colorado
| | - Sarah Faubel
- Rocky Mountain Regional VA Medical Center, Denver, Colorado.,University of Colorado Anschutz Medical Campus, Denver, Colorado
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49
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Abouelkheir M, Shabaan DA, Shahien MA. Delayed blockage of prostaglandin EP 4 receptors can reduce dedifferentiation, epithelial-to-mesenchymal transition and fibrosis following acute kidney injury. Clin Exp Pharmacol Physiol 2021; 48:791-800. [PMID: 33634509 DOI: 10.1111/1440-1681.13478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 09/19/2020] [Accepted: 01/22/2021] [Indexed: 01/05/2023]
Abstract
Dedifferentiation of tubular epithelial cells is involved in both regeneration and fibrosis following acute kidney injury (AKI). Prostaglandin E2 receptor 4 (EP4 ) antagonist can inhibit the dedifferentiation of renal tubular cells. The present study investigated whether the time of blockage of EP4 receptors, using grapiprant, could affect the tubular regeneration or interstitial fibrosis in AKI. Cisplatin was used to induce AKI in 72 C57BL/6 adult female mice. Animals were assigned to four groups; control, cisplatin-treated, cisplatin-treated with early grapiprant intervention and cisplatin-treated with late grapiprant intervention. AKI was assessed by kidney function tests and histopathology. Fibrosis was evaluated by Masson's trichrome and alpha smooth muscle actin (α-SMA) expression. Markers of dedifferentiation, CD133, and epithelial to mesenchymal transition (EMT), vimentin were assessed. Early intervention with grapiprant significantly ameliorated AKI more efficiently than late intervention. However, even late intervention was useful in reducing the overall fibrosis as demonstrated by Masson's trichrome and α-SMA expression. In both grapiprant-treated groups, a parallel reduction of dedifferentiation (CD133) and EMT (vimentin) was evident. It seems that the progressive fibrotic changes that follow AKI could still be reduced possibly by targeting dedifferentiation and/or EMT.
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Affiliation(s)
- Mohamed Abouelkheir
- Department of Pharmacology and Therapeutics, College of Medicine, Jouf University, Sakaka, Saudi Arabia
- Pharmacology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Dalia A Shabaan
- Histology and Cell Biology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Awad Shahien
- Pharmacology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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50
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Liu K, Li M, Li L, Wu B, Xu X, Ge Y, Mao H, Xing C. The Effect of Coronary Angiography Timing on Cardiac Surgery Associated Acute Kidney Injury Incidence and Prognosis. Front Med (Lausanne) 2021; 8:619210. [PMID: 33937278 PMCID: PMC8081843 DOI: 10.3389/fmed.2021.619210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/22/2021] [Indexed: 01/11/2023] Open
Abstract
Introduction: Acute kidney injury has been identified as a common complication of cardiac surgery. To date, the effect of the time interval from coronary angiography to cardiac surgery on postoperative acute kidney injury is still controversial. The aim of this study was to investigate the relationship between the timing of coronary angiography and cardiac surgery associated acute kidney injury. Methods: Eight hundred thirteen patients who underwent coronary angiography and cardiac surgery successively from January 2017 to December 2018 were included in this retrospective cohort study. We applied multivariate logistic regression, propensity score analysis, and subgroup analysis to evaluate the association between the time interval and postoperative acute kidney injury incidence and prognosis. Meta-analysis was conducted to verify the results. Results: The overall incidence of the cardiac surgery associated acute kidney injury was 28.8%. Age (OR = 1.046, 95%CI: 1.017–1.075), cardiopulmonary bypass (OR = 3.439, 95%CI: 1.316–8.986) and diabetes (OR = 2.522, 95%CI: 1.439–4.417) were found to be independent risk factors of postoperative acute kidney injury in multivariate logistic regression and propensity score analysis. Undergoing cardiac surgery within 7 days after coronary angiography was not associated with increased incidence of postoperative acute kidney injury or worse prognosis. Meta-analysis obtained consistent results. Conclusions: The time interval shorter than 7 days had no influence on cardiac surgery associated acute kidney injury incidence and prognosis. The decision of delaying the surgery should be made after comprehensive evaluation of the patient.
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Affiliation(s)
- Kang Liu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Meiyuan Li
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Li Li
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Buyun Wu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Xueqiang Xu
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Yifei Ge
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Huijuan Mao
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
| | - Changying Xing
- Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, China
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