Impact of the development of acute kidney injury on patients admitted to the pediatric intensive care unit

OBJECTIVE

To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit.

MATERIALS AND METHODS

Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members.

RESULTS

A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit.

CONCLUSION

Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.

Challenges in COVID-19 medical response: a nephrology perspective

The new coronavirus disease, named by World Health Organization (WHO) as COVID-19 brought great challenges to patients with end-stage renal disease (ESRD). In general, ESRD patients have higher number of comorbidities and are at age-risk for severe pulmonary presentation of this disease. Another important issue is that hemodialysis (HD) clinics are usually not located in small towns, and these frail patients often travel to their dialysis center in groups and also cannot keep the 6-feet safe distance during their HD session.1.

Nurses' knowledge to identify early acute kidney injury

Abstract OBJECTIVE To evaluate the knowledgeof nurses on early identification of acute kidney injury (AKI) in intensive care, emergency and hospitalization units. METHOD A prospective multi-center study was conducted with 216 nurses, using a questionnaire with 10 questions related to AKI prevention, diagnosis, and treatment. RESULTS 57.2% of nurses were unable to identify AKI clinical manifestations, 54.6% did not have knowledge of AKI incidence in patients admitted to the ICU, 87.0% of the nurses did not know how to answer as regards the AKI mortality rate in patients admitted to the ICU, 67.1% answered incorrectly that slight increases in serum creatinine do not have an impact on mortality, 66.8% answered incorrectly to the question on AKI prevention measures, 60.4% answered correctly that loop diuretics for preventing AKI is not recommended, 77.6% answered correctly that AKI does not characterize the need for hemodialysis, and 92.5% said they had no knowledge of the Acute Kidney Injury Networkclassification. CONCLUSION Nurses do not have enough knowledge to identify early AKI, demonstrating the importance of qualification programs in this field of knowledge.

Mortality risk factors and validation of severity scoring systems in critically ill patients with acute renal failure

BACKGROUND

Risk stratification and prediction of outcome in acute renal failure patients in the intensive care unit are important determinants for improvement of patient care and design of clinical trials.

METHODS

In order to identify mortality risks factors and validate general and specific predictive models for acute renal failure (ARF) patients in the intensive care unit (ICU), 324 patients were prospectively evaluated. Multivariate analysis by logistic regression was utilized for identification of mortality risk factors. Discrimination and calibration were used to evaluate the performance of the following models at referral to nephrologist and at initiation of renal replacement therapy: APACHE II, SAPS II, LODS, and ATN-ISI. Organ failure was assessed by SOFA and OSF.

RESULTS

The hospital mortality rate was 85%. The identified mortality risk factors were: age > or = 65 yr, BUN > or = 70 mg/dL, ARF of septic origin, and previous hypertension. Serum creatinine > or = 3.5 mg/dL, systolic blood pressure > or = 100 mm Hg, and normal consciousness were associated with mortality risk reduction. Performance of all prognostic models was disappointing with unsatisfactory calibration and underestimation of mortality on the day of referral to the nephrologist and at initiation of renal replacement therapy.

CONCLUSIONS

Cross-validation of prognostic models for ARF resulted in poor performance of all studied scores. Therefore, a specific model is still warranted for the design of clinical trials, comparison of studies, and for prediction of outcome in ARF patients, especially in the ICU.

Mechanisms underlying the genesis of post-extrasystolic potentiation in rat cardiac muscle

Changes of contractility resulting from changes in stimulation pattern (post-extrasystolic potentiation - PESP) were investigated in right ventricular papillary muscles from female albino rats (EPM strain, 160-200 g). The preparations were superfused with bicarbonate buffered solution at 24 +/- 0.5 degrees C, and stimulated at 0.5 Hz. Maintained paired stimulation was performed at several coupling intervals (360, 500, 660, 770 and 920 ms) with normal Krebs for 30 s. After treatment with ryanodine (1 microM), used as an inhibitor of the release of sarcoplasmic reticulum Ca2+ activity, the same protocol was repeated in the presence of normal Krebs, low Na+ (80 mM, LiCl used as substitute) and low K+ concentrations to change the level of activity of the Na+/Ca2+ exchange mechanism. With normal Krebs, paired pulse stimulation produced a maintained potentiation of the post-extrasystolic beat and an extrasystole with a reduced force generation when compared to the control steady-state contraction. As the interval between the extrasystole and the normal beat was increased the potentiation of the post-extrasystolic beat was reduced and the force of the extrasystole was increased. Ryanodine treatment reduced the force of contraction and increased its duration, and the pattern of the PESP phenomenon was altered. Both the post-extrasystolic and the extrasystolic beats were potentiated compared to the steady-state contraction obtained under ryanodine treatment. The extrasystole displayed a greater potentiation than the post-extrasystolic beat. As the interval between them increased the amplitude of the extrasystolic beat was enhanced.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of isoproterenol on the mechanical activity of isolated papillary muscles and perfused rat hearts in various calcium concentrations

The aim of the study was to examine, in papillary muscles and in a whole heart preparation, the effects of isoproterenol on the myocardial mechanical activity at different extracellular Ca2+ concentrations. Papillary muscles from left ventricles, contracting isometrically, and rat hearts perfused by the Langendorff technique developing isovolumetric pressure at a fixed rate (200 bpm) and diastolic pressure of 5 mmHg were studied at different Ca2+ concentrations for analysis of the effects of increasing doses of isoproterenol. Papillary muscles were treated with isoproterenol (0.5 to 8 ng ml-1) at four extracellular Ca2+ concentrations (0.25, 0.5, 1.25 and 2.5 mM) and Langendorff perfused hearts were stimulated by isoproterenol (0.05 ng ml-1 to 0.8 ng ml-1), also at four extracellular Ca2+ concentrations (0.5, 1.25, 2.5 and 3.75 mM). Both papillary muscles and perfused hearts showed that force and isovolumetric systolic pressure increase in response to isoproterenol at low Ca2+ concentrations. As Ca2+ concentration is increased, isoproterenol's positive inotropic effect subsides. However, papillary muscle isometric contractions showed a similar time to peak tension decrease in response to isoproterenol at all external Ca2+ concentrations used. The results suggest that the positive inotropic response to isoproterenol, in isolated preparations, changes as a function of extracellular Ca2+ concentration decreasing as external Ca2+ increases. Time to peak tension reduction reinforces the idea that this small positive inotropic response to isoproterenol of the rat myocardium, at the physiological Ca2+ concentration, is due to the Ca2+ saturation of the mechanical activity.