Analysis of the short-term prognosis and risk factors of elderly acute kidney injury patients in different KDIGO diagnostic windows

Abstract Background and aims Follow-up observation was performed on elderly acute kidney injury (AKI) patients to analyze the short-term prognosis and risk factors of AKI patients in the 48-h diagnostic window and 7-day diagnostic window of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. Methods Inpatients aged ≥ 75 years in the geriatric ward of the People’s Liberation Army General Hospital, China, between January 2007 and December 2015 were selected as the research subjects. According to two diagnostic criteria in the KDIGO guidelines, patients were divided into a 48-h diagnostic window group and a 7-day diagnostic window group. The medical data of the patients were divided into the death group and the survival group for analysis based on the survival condition of the patients after 90 days of AKI. Factors that affected the 90-day survival of patients in the 48-h diagnostic window and 7-day diagnostic window groups were analyzed using multivariate Cox regression. Results During the follow-up period, a total of 652 patients were enrolled in this study. Among them, 623 cases were men, accounting for 95.6% of the patients. The median age was 87 (84–91) years. According to the KDIGO staging criteria, there were 308 (47.2%) cases in AKI stage 1, 164 (25.2%) cases in stage 2, and 180 (27.6%) cases in stage 3. Among the 652 patients, 334 (51.2%) were diagnosed with AKI based on the 48-h diagnostic criteria window, and 318 (48.8%) were diagnosed with AKI based on the baseline 7-day diagnostic criteria. The 90-day mortality of AKI patients was 42.5% in the 48-h diagnostic window and 24.2% in the 7-day diagnostic window. The multivariate Cox analysis results showed that low mean arterial pressure (HR = 0.966; P < 0.001), low serum prealbumin level (HR = 0.932; P < 0.001), infection (HR = 1.448; P = 0.047), mechanical ventilation (HR = 1.485; P = 0.038), high blood urea nitrogen (BUN) level (HR = 1.026; P < 0.001), blood magnesium level (HR = 2.560; P = 0.024), and more severe AKI stage (stage 2: HR = 3.482; P < 0.001 and stage 3: HR = 6.267; P < 0.001) were independent risk factors affecting the 90-day mortality of elderly patients in the 48-h diagnostic window, whereas low body mass index (HR = 0.851; P < 0.001), low mean arterial pressure (HR = 0.980; P = 0.036), low serum prealbumin level (HR = 0.950; P = 0.048), low serum albumin level (HR = 0.936; P = 0.015), high BUN level (HR = 1.046; P < 0.001), and more severe AKI stage (stage 2: HR = 4.249; P = 0.001 and stage 3: HR = 9.230; P < 0.001) were independent risk factors affecting the 90-day mortality of elderly patients in the 7-day diagnostic window. Conclusions The clinical differences of AKI and risk factors for 90-day mortality in elderly AKI individuals vary depending on the definition used. An increment of Scr ≥ 26.5 μmol/L in 48 h (48-h KDIGO window) alone predicts adverse clinical outcomes.

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Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9443 ◽

2018 ◽

Vol 11 (12) ◽

pp. 912-917 ◽

Cited By ~ 1

Author(s):

Ali Ciftci ◽

Seval Izdes ◽

Neriman Defne Altintas

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Demographic Data ◽

Kidney Injury ◽

Apache Ii ◽

Factors Affecting ◽

Acute Kidney Injury Group ◽

Injury Group ◽

Independent Risk Factors ◽

Critical Patients

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

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Acute kidney injury as a risk factor for mortality in oncological patients receiving check-point inhibitors

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab034 ◽

2021 ◽

Author(s):

Clara García-Carro ◽

Mónica Bolufer ◽

Roxana Bury ◽

Zaira Catañeda ◽

Eva Muñoz ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Checkpoint Inhibitors ◽

Metastatic Cancer ◽

Kidney Injury ◽

Actuarial Survival ◽

Oncological Patients ◽

Check Point Inhibitors ◽

Independent Risk Factors

Abstract Background Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Methods All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving anti-PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusions 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

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MO141ACUTE KIDNEY INJURY AS A RISK FACTOR FOR MORTALITY IN ONCOLOGICAL PATIENTS RECEIVING CHECK-POINT INHIBITORS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab092.0019 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Clara García Carro ◽

Mónica Bolufer ◽

Roxana Bury ◽

Zaira CAstañeda ◽

Eva Muñoz ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Checkpoint Inhibitors ◽

Metastatic Cancer ◽

Kidney Injury ◽

Actuarial Survival ◽

Oncological Patients ◽

Check Point Inhibitors ◽

Independent Risk Factors

Abstract Background and Aims Checkpoint inhibitors (CPI) have drastically improved metastatic cancer outcomes. However, immunotherapy is associated to multiple toxicities, including acute renal injury (AKI). Data about CPI related AKI are limited. Our aim was to determine risk factors for CPI related AKI, as well as its clinical characteristics and its impact on mortality in patients undergoing immunotherapy. Method All patients under CPI at our center between March 2018 and May 2019, and with a follow up until April 2020, were included. Demographical, clinical data and laboratory results were collected. AKI was defined according to KDIGO guidelines. We performed a logistic regression model to identify independent risk factors for AKI and actuarial survival analysis to establish risk factors for mortality in this population. Results 759 patients were included, with a median age of 64 years. 59% were men and baseline median creatinine was 0.80 mg/dL. Most frequent malignance was lung cancer and 56% were receiving PD1. 15.5% developed AKI during the follow-up. Age and baseline kidney function were identified as independent risk factors for AKI related ICI. At the end of follow-up, 52.3% patients had died. Type of cancer (not melanoma, lung or urogenital malignance), type of CPI (not CTLA4, PD-1, PD-L1 or their combination) and the presence of an episode of AKI were identified as risk factors for mortality. Conclusion 15.5% of patients under immunotherapy presented AKI. A single AKI episode was identified as an independent risk factor for mortality in these patients and age and baseline renal function were risks factors for the development of AKI.

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Acute kidney injury in head and neck cancer patients treated with chemoradiation with cisplatin: A single-center cohort study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e17559 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e17559-e17559

Author(s):

Esther Van Meerten ◽

Catherine Owusuaa ◽

Ewout Hoorn ◽

Esther Oomen De Hoop

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Univariate Analysis ◽

Kidney Injury ◽

Tertiary Center ◽

Kdigo Guidelines ◽

Independent Risk Factors

e17559 Background: Patients with advanced head and neck cancer (HNC) are commonly treated with chemoradiation with concomitant cisplatin. Acute kidney injury (AKI) is considered a dose-limiting toxicity of cisplatin. We aim to describe the incidence and risk factors of AKI. Methods: In our tertiary center, we retrospectively identified 261 patients with advanced HNC and adequate renal function who were treated curatively from 2008 to 2015 using radiotherapy and concurrent three-weekly cisplatin. Outcome was the first AKI episode, defined according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines as a ≥50% rise in serum creatinine compared to baseline. Several potential predictors were investigated by means of logistic regression analyses. Results: In our cohort (mean age 58 ± 8 years, 74.3% male), a total of 102 (39.1%) patients developed AKI. Factors significantly associated with AKI in the univariate analysis were: age, alcohol consumption, excessive smoking, diabetes, hypertension, diuretic use, renin-angiotensin-aldosterone-system blockers, and administration of furosemide when indicated during first cisplatin cycle. In the multivariable model smoking 6-25 and > 25 cigarettes per day (OR 1.85; 95% CI 1.01-3.39 and OR 3.22; 95% CI 1.34-7.70, respectively), diabetes (OR 2.58; 95% CI, 1.01-6.61), furosemide (OR 2.39; 95% CI, 1.36-4.18) , and hypertension (OR 2.79; 95% CI, 1.52-5.12) remained independent risk factors for AKI. Conclusions: The identified risk factors smoking, diabetes, and hypertension may have caused pre-existing kidney damage and therefore have predisposed to AKI. Co-administration of furosemide with cisplatin is a potentially reversible risk factor for AKI.

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P0595CHANGING EPIDEMIOLOGY AND OUTCOME OF AKI PATIENTS IN TEACHING HOSPITAL FROM A DEVELOPING COUNTRY: A POPULATION-BASED COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0595 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Daniela Ponce ◽

Welder Zamoner ◽

Marci Batistoco ◽

Andre Balbi

Keyword(s):

Risk Factors ◽

Patient Survival ◽

Kidney Injury ◽

Population Based ◽

Epidemiologic Studies ◽

Dialysis Treatment ◽

Risk Approach ◽

Independent Risk Factors ◽

Disease Stages

Abstract Background and Aims While considerable information is available on acute kidney injury (AKI) in North America and Europe, large comprehensive epidemiologic studies of AKI from Latin America and Asia are still lacking. The present study aimed to evaluate the epidemiology and outcome of AKI in patients evaluated by nephrologists in a teaching Brazilian hospital. Method We performed a large retrospective observational study that looked into epidemiology for AKI and its effect on patient outcome across time periods. For comparison purposes, patients were divided into two groups according to the year of follow up: 2011-2014 and 2015-2018. Results We enrolled 7,976 AKI patients and after excluding patients with Chronic Kidney Disease stages 3 to 5, kidney transplanted and those with incomplete data, 5,428 AKI patients were included (68%). The maximum AKI stage was 3 (50.6%) and mortality rate occurred in 1865 patients (34.3%). Dialysis treatment was indicated in 928 patients (17.1%). Patient survival improved along study periods: patients treated at 2015-2018 had a relative risk death reduction of 0.89 (95% CI 0.81–0.98, p=0.02). The independent risk factors for mortality were sepsis, older >65 anos, admission to ICU, AKI-KDIGO 3, recurrent AKI, no metabolic and fluid demand to capacity imbalance as dialysis indication and the period of treatment. Conclusion We observed an improvement in AKI patient survival along the years even after correction for several confounders and using a competing risk approach. Identification of risk factors for mortality can help in decision making for timely intervention, leading to better clinical outcomes.

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Factors Affecting the Outcome of Multiple Intracranial Aneurysm Surgery

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1668493 ◽

2018 ◽

Vol 07 (02) ◽

pp. 116-121 ◽

Cited By ~ 4

Author(s):

Anas Abdallah ◽

Murad Asiltürk ◽

Erhan Emel ◽

Betül Güler Abdallah

Keyword(s):

Risk Factors ◽

Surgical Outcomes ◽

Medical Records ◽

Core Sample ◽

Morbidity Rate ◽

Factors Affecting ◽

Unruptured Aneurysms ◽

History Of ◽

Independent Risk Factors

Abstract Objectives Multiple intracranial aneurysms (MIAs) are fairly common entities. Unless MIAs are incidentally diagnosed, they remain asymptomatic until they rupture. In this study, the authors investigated factors affecting the surgical outcomes in patients with MIA by evaluating the surgical outcomes of 90 consecutive cases. Material and Methods Medical records were retrospectively reviewed for 409 consecutive cerebral aneurysm cases that underwent surgery in the hospital from 2011 to 2013. The patients’ data were prospectively collected. All MIA patients (n = 90) constituted the core sample for this study. Results The authors detected 221 aneurysms in 90 patients (49 females and 41 males; mean age: 50.8 ± 11.9 years; range: 25–82 years). Of the patients, 67 presented with subarachnoid hemorrhage, whereas 23 were incidentally diagnosed with unruptured aneurysms. The mortality rate was 13.3% (n = 12). The morbidity rate was 18.8% (n = 17). Of the patients, 67.8% (n = 61) had returned to their jobs and normal daily activities by their last follow-up (average: 52.3 months). History of coronary artery diseases (CADs) and low neurologic grade at presentation (Hunt-Hess grade 4/5) are independent risk factors for increasing morbidity and mortality in patients with MIA (odds ratio [OR]: 18.46; p = 0.007); (OR: 30.0; p = 0.002) and (OR: 0.06; p = 0.0001); (OR: 0.07; p = 0.002), respectively. Conclusion History of CADs and high Hunt-Hess grade are independent risk factors for poor surgical outcomes of patients with MIA.

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Risk factors affecting seizure recurrence in childhood epilepsy during short-term follow-up

Child s Nervous System ◽

10.1007/s00381-021-05227-3 ◽

2021 ◽

Author(s):

Yasemin Baranoglu Kilinc ◽

Fatma Hancı ◽

Handan Ankaralı ◽

Seyit Ankaralı ◽

Nimet Kabakus

Keyword(s):

Risk Factors ◽

Childhood Epilepsy ◽

Seizure Recurrence ◽

Short Term ◽

Factors Affecting

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Development and Validation of a Prediction Model for Survival in Diabetic Patients With Acute Kidney Injury

Frontiers in Endocrinology ◽

10.3389/fendo.2021.737996 ◽

2021 ◽

Vol 12 ◽

Author(s):

Manqiu Mo ◽

Ling Pan ◽

Zichun Huang ◽

Yuzhen Liang ◽

Yunhua Liao ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Survival Rate ◽

Prediction Model ◽

Validation Cohort ◽

Kidney Injury ◽

Calibration Plot ◽

Diabetic Patients ◽

Factors Affecting

ObjectiveWe aimed to analyze the risk factors affecting all-cause mortality in diabetic patients with acute kidney injury (AKI) and to develop and validate a nomogram for predicting the 90-day survival rate of patients.MethodsClinical data of diabetic patients with AKI who were diagnosed at The First Affiliated Hospital of Guangxi Medical University from April 30, 2011, to April 30, 2021, were collected. A total of 1,042 patients were randomly divided into a development cohort and a validation cohort at a ratio of 7:3. The primary study endpoint was all-cause death within 90 days of AKI diagnosis. Clinical parameters and demographic characteristics were analyzed using Cox regression to develop a prediction model for survival in diabetic patients with AKI, and a nomogram was then constructed. The concordance index (C-index), receiver operating characteristic curve, and calibration plot were used to evaluate the prediction model.ResultsThe development cohort enrolled 730 patients with a median follow-up time of 87 (40–98) days, and 86 patients (11.8%) died during follow-up. The 90-day survival rate was 88.2% (644/730), and the recovery rate for renal function in survivors was 32.9% (212/644). Multivariate analysis showed that advanced age (HR = 1.064, 95% CI = 1.043–1.085), lower pulse pressure (HR = 0.964, 95% CI = 0.951–0.977), stage 3 AKI (HR = 4.803, 95% CI = 1.678–13.750), lower 25-hydroxyvitamin D3 (HR = 0.944, 95% CI = 0.930–0.960), and multiple organ dysfunction syndrome (HR = 2.056, 95% CI = 1.287–3.286) were independent risk factors affecting the all-cause death of diabetic patients with AKI (all p < 0.01). The C-indices of the prediction cohort and the validation cohort were 0.880 (95% CI = 0.839–0.921) and 0.798 (95% CI = 0.720–0.876), respectively. The calibration plot of the model showed excellent consistency between the prediction probability and the actual probability.ConclusionWe developed a new prediction model that has been internally verified to have good discrimination, calibration, and clinical value for predicting the 90-day survival rate of diabetic patients with AKI.

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A Study on the Short-Term Mortality and Related Risk Factors of Fragile Hip Fracture

10.21203/rs.3.rs-129838/v1 ◽

2020 ◽

Author(s):

Pei-Wen Wang ◽

Hua-Feng Zhuang ◽

Yi-Zhong Li ◽

Hao Xu ◽

Jin-Kuang Lin ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Hip Fractures ◽

Total Mortality ◽

Early Mortality ◽

Factors Affecting ◽

Related Risk ◽

Independent Risk Factors ◽

One Year

Abstract BackgroundThis study aimed to observe the mortality of patients with fragile hip fractures and assess the death-associated risk factors.MethodsSix hundred and ninety patients with osteoporotic hip fractures(aged 50-103-years-old) that were treated from January 2010 to December 2015 were enrolled in this study and followed-up and the clinical data were retrospectively examined. Three months, one year, and the total mortality during the follow-up time were measured. Mortality-related risk factors were assessed including age, gender, surgery, the duration from injury to operation, pulmonary infection, and the number and type of complications.ResultsThe 286 patients were followed up between 6 months and 42 months, with an average of 21.42±9.88 months. The three-month mortality was 7.69%, the number of patients who were followed up over one year was 231, the one-year mortality was 16.02%, and the total mortality of the follow-up time was 17.48%. The higher mortality was related to age over 75 years, associated cardio-respiratory diseases, male gender, non-operative treatment, surgery delayed over 5 days. Binary Logistic regression analysis showed that the independent risk factors affecting mortality included age (OR=5.385, P=0.003), surgery (OR=21.217, P=0.000), the number of complications (OR=9.038, P=0.000), and pre-injury cardiovascular disease (OR=3.201, P=0.041).ConclusionThe early mortality of fragile hip fractures was high and was also related to many risk factors. Age, surgery, the number of complications, and pre-injury cardiovascular disease were the independent risk factors affecting the mortality of patients with fragile hip fractures. Effective treatment without complications and early surgery can lower early mortality in patients with fragile hip fractures.

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Evaluation of the nature and etiologies of risk factors for diaphyseal atypical femoral fractures

Medical Principles and Practice ◽

10.1159/000517484 ◽

2021 ◽

Author(s):

Hiroyuki Tsuchie ◽

Naohisa Miyakoshi ◽

Yuji Kasukawa ◽

Koji Nozaka ◽

Kimio Saito ◽

...

Keyword(s):

Risk Factors ◽

Multivariate Analyses ◽

Femoral Fractures ◽

Japanese Patients ◽

High Serum ◽

Control Group ◽

Atypical Femoral Fractures ◽

Factors Affecting ◽

Lateral Curvature ◽

Low Serum

Objectives: Differences in the mechanisms of subtrochanteric and diaphyseal atypical femoral fractures (AFFs) have been speculated in studies that have analyzed differences in the patients’ backgrounds. However, the etiologies of each type of AFF have not been investigated in detail. Therefore, this study aimed to investigate the nature and etiologies of the risk factors for diaphyseal AFFs. Materials and Methods: Eighty consecutive Japanese patients with 91 diaphyseal AFFs (the AFF group) and 110 age-matched female patients with osteoporosis (the non-AFF control group) were included. Their clinical data were compared and the factors affecting AFFs were investigated. Furthermore, the etiologies of the risk factors for diaphyseal AFFs were examined. Results: Multivariate analysis revealed that femoral serrated changes, bisphosphonate or denosumab usage, and lateral and anterior femoral curvatures were the risk factors for diaphyseal AFFs (p<0.0011, p=0.0137, and p<0.0001, respectively). Multivariate analyses also revealed that serrated changes and low serum 25(OH)D levels affected the lateral curvature (p=0.0088 and 0.0205, respectively), while serrated changes affected the anterior curvature (p=0.0006); each significantly affected the femoral curvature. In addition, a high serum calcium (Ca) level, lateral femoral curvature, and anterior femoral curvature were the predictors of serrated changes (p=0.0146, 0.0002, and 0.0098, respectively). Conclusion: The risk factors for diaphyseal AFFs were bone resorption inhibitor usage, a strong femoral curvature, and serrated changes. A low serum 25(OH)D level and serrated changes are the risk factors for lateral curvature, while a high serum Ca level is a risk factor for serrated changes.

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