scholarly journals Nephrology follow-up and all-cause mortality of severe acute kidney injury survivors

2013 ◽  
Vol 84 (5) ◽  
pp. 1053
Author(s):  
José A. Lopes ◽  
Sofia C. Jorge
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
All Cause Mortality

scholarly journals Unsupervised Clustering Identifies Sub-Phenotypes and Reveals Pre-Dialysis Hyperlactatemia as a Novel Outcome Predictor in Dialysis-Requiring Sepsis-Associated Acute Kidney Injury

2021 ◽  
Author(s):  
Chun-Fu Lai ◽  
Vin-Cent Wu ◽  
Jung-Hua Liu ◽  
Shuei-Liong Lin ◽  
Yung-Ming Chen
Keyword(s):  
Acute Kidney Injury ◽  
Clustering Analysis ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Consensus Clustering ◽  
Risk Modeling ◽  
Outcome Predictor ◽  
All Cause Mortality ◽  
Observational Cohort

Abstract BackgroundHeterogeneity exists in sepsis-associated acute kidney injury (SA-AKI). This prospective observational cohort study aimed to perform consensus cluster analysis and investigate the clinical relevance of identified sub-phenotypes of critically ill patients with dialysis-requiring SA-AKI.MethodsAll septic patients with dialysis-requiring SA-AKI, defined by the Sepsis-3 and Kidney Disease: Improving Global Outcomes AKI criteria, admitted to an intensive care unit in Taiwan between 2002 and 2018 were included. We employed unsupervised consensus clustering based on 22 clinical variables upon initialising renal replacement therapy. They were observed until death or 90 days after hospital discharge. The outcomes were mortality and being free of dialysis.ResultsIn total, 1,397 patients were enrolled (mean age of 63.8 ± 16.38 years and 69.7% were men). After a median follow-up period of 31 (interquartile range 8-123) days, all-cause mortality occurred in 911 patients (65.12%). Moreover, 133 (9.51%) survivors were dialysis dependent, where 355 (25.38%) survivors were free of dialysis. Unsupervised consensus clustering identified three sub-phenotypes associated with significantly different risks of mortality and being free of dialysis. This strategy led us to reveal that the pre-dialysis hyperlactatemia of ≥ 3.1 mmol/L was an independent predictor of mortality and being free of dialysis according to the competing risk modeling. Our results were validated in an independent multi-center AKI cohort.ConclusionsBy the data-driven clustering analysis, we identified sub-phenotypes in septic patients with dialysis-requiring SA-AKI and revealed pre-dialysis hyperlactatemia as a novel outcome predictor. This result represents a step towards precision medicine for septic patients.

scholarly journals Associations of serum sodium levels with mortality in very elderly acute kidney injury patients

2020 ◽  
Author(s):  
Qinglin Li ◽  
Liang Pan ◽  
Zhi Mao ◽  
Hongjun Kang ◽  
Feihu Zhou
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Serum Sodium ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Very Elderly ◽  
Adjusted Analysis ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background: Patients suffering from acute kidney injury (AKI) have been associated with impaired sodium. However, studies on the association of dysnatremia with all-cause mortality risk in AKI patients are particularly lacking. We examined the relationship between different levels of serum sodium and mortality among very elderly patients with AKI. Methods: We retrospectively enrolled very elderly patients (≥ 75 years) from Chinese PLA General Hospital from 2007, to 2018. All-cause mortality was examined according to eight predefined sodium levels: <130.0 mmol/L, 130.0–134.9 mmol/L, 135.0–137.9 mmol/L, 138.0–141.9 mmol/L, 142.0–144.9 mmol/L, 145.0–147.9 mmol/L, 148.0–151.9 mmol/L, and ≥152.0 mmol/L. We estimated the risk of all-cause mortality using a multivariable adjusted Cox proportional hazard model, with a normal serum potassium level of 135.0–137.9 mmol/L as a reference. Results: In total, 744 geriatric patients were suitable for the final evaluation. Among them, 260 (34.9%) died within 90 days; during the 1-year follow-up, 5 patients were lost to follow-up, and 383 (51.8%) died. After 90 days, the mortality rates in the eight strata were 36.1, 27.8, 19.6, 24.4, 30.7, 48.6, 52.8, and 57.7%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L [hazard ratio (HR): 2.247; 95% confidence interval (CI): 1.117–4.521], from 142.0 to 144.9 mmol/L (HR: 1.964; 95% CI: 1.100–3.508), from 145.0 to 147.9 mmol/L (HR: 2.942; 95% CI: 1.693–5.114), from 148.0 to 151.9 mmol/L (HR: 3.455; 95% CI: 2.009–5.944), and ≥152.0 mmol/L (HR: 3.587; 95% CI: 2.151–5.983) had an increased risk of all-cause mortality. After 1 year, the mortality rates in the eight strata were 58.3, 47.8, 33.7, 38.9, 45.5, 64.3, 69.4, and 78.4%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L (HR: 1.944; 95% CI: 1.125–3.360), from 142.0 to 144.9 mmol/L (HR: 1.681; 95% CI: 1.062–2.660), from 145.0 to 147.9 mmol/L (HR: 2.631; 95% CI: 1.683–4.112), from 148.0 to 151.9 mmol/L (HR: 2.411; 95% CI: 1.552–3.744), and ≥152.0 mmol/L (HR: 3.037; 95% CI: 2.021–4.563) had an increased risk of all-cause mortality. Conclusion: Sodium levels outside the interval of 130.0–141.9 mmol/L were associated with increased risks of 90-day mortality and 1-year mortality in very elderly AKI patients.

scholarly journals Early vs late development of acute kidney injury and its prognostic relevance in ACS patients

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
B Sara ◽  
JJ Monteiro ◽  
P Carvalho ◽  
C Ribeiro Carvalho ◽  
J Chemba ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Composite Endpoint ◽  
Prognostic Impact ◽  
Mortality And Morbidity ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
Primary Endpoints ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute kidney injury (AKI) in acute coronary syndrome (ACS) patients is a well-known marker of worse prognosis. However, it remains unclear how timing of AKI development correlates with mortality and morbidity; Objective Assess the timing of AKI development and evaluate its short and long term prognostic impact. Methods Retrospective study of patients with ACS periodically included in our center registry between March/2013 and December/2018. AKIwas defined as increase in creatinine ≥0.3 mg/dl or ≥50% within 48 h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI development : no-AKI(NA), early-AKI(EA)(&lt;48h) and late-AKI(LA) (&gt;48 h). The primary endpoints were all cause mortality and a composite of all cause mortality, nonfatal myocardial infarction/stroke and readmission in the follow-up. Results We included 518 patients (67 ± 13 years; 73% males, 46% STEMI) of whom 17% developed AKI(8% EA and 9% LA). Patients with AKI, particularly EA, were older (NA: 67± 17; EA 80± 12; LA 74 ± 16, p&lt; 0.001), had more hypertension, previous heart failure (9% vs 1.5%, p &lt; 0.001) and dementia (7 vs 0.5%, p &lt; 0.001). Coronariograhy was performed more often in NA patients (98%), followed by LA (100%) and lastly EA (87.5%), p &lt; 0.001. During hospitalization, those who developed AKI had a higher Killip Kimball class (p = 0.043) and lower ejection fraction (EF) (p = 0.05). In-hospital mortality was significantly higher in patients with EA (12,5%) than LA (2.2%) or LA (2.3%)( p= 0.029) ; During a median follow-up of 35 months, the composite endpoint was particularly higher in the EA group, but no differences were found between LA and NA group. In multivariate analysis, only EA was an independent predictor of all-cause mortality (HR: 3.8 IC 95% 1.8-8.1, p = 0.001) and composite endpoint (HR:2.02 IC95%1.1-3.8; p = 0.032), even after adjusting for age, EF and Killip Kimball class; Conclusion In this population of ACS patients, AKI is a frequent complication and the timing of its development has major prognostic implications, since early AKI(&lt;48h) is associated with worse outcomes. Curiously, mortality and CV events in patients with LA are not different from those who do not develop AKI.

scholarly journals Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors

2013 ◽  
Vol 83 (5) ◽  
pp. 901-908 ◽  
Author(s):  
Ziv Harel ◽  
Ron Wald ◽  
Joanne M Bargman ◽  
Muhammad Mamdani ◽  
Edward Etchells ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
All Cause Mortality

scholarly journals Urine Alpha-1-Microglobulin Levels and Acute Kidney Injury, Mortality, and Cardiovascular Events following Cardiac Surgery

2021 ◽  
pp. 1-11
Author(s):  
Jonathan G. Amatruda ◽  
Michelle M. Estrella ◽  
Amit X. Garg ◽  
Heather Thiessen-Philbrook ◽  
Eric McArthur ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Ckd Progression ◽  
Urine Albumin ◽  
All Cause Mortality

<b><i>Introduction:</i></b> Urine alpha-1-microglobulin (Uα1m) elevations signal proximal tubule dysfunction. In ambulatory settings, higher Uα1m is associated with acute kidney injury (AKI), progressive chronic kidney disease (CKD), cardiovascular (CV) events, and mortality. We investigated the associations of pre- and postoperative Uα1m concentrations with adverse outcomes after cardiac surgery. <b><i>Methods:</i></b> In 1,464 adults undergoing cardiac surgery in the prospective multicenter Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) cohort, we measured the pre-and postoperative Uα1m concentrations and calculated the changes from pre- to postoperative concentrations. Outcomes were postoperative AKI during index hospitalization and longitudinal risks for CKD incidence and progression, CV events, and all-cause mortality after discharge. We analyzed Uα1m continuously and categorically by tertiles using multivariable logistic regression and Cox proportional hazards regression adjusted for demographics, surgery characteristics, comorbidities, baseline estimated glomerular filtration rate, urine albumin, and urine creatinine. <b><i>Results:</i></b> There were 230 AKI events during cardiac surgery hospitalization; during median 6.7 years of follow-up, there were 212 cases of incident CKD, 54 cases of CKD progression, 269 CV events, and 459 deaths. Each 2-fold higher concentration of preoperative Uα1m was independently associated with AKI (adjusted odds ratio [aOR] = 1.36, 95% confidence interval 1.14–1.62), CKD progression (adjusted hazard ratio [aHR] = 1.46, 1.04–2.05), and all-cause mortality (aHR = 1.19, 1.06–1.33) but not with incident CKD (aHR = 1.21, 0.96–1.51) or CV events (aHR = 1.01, 0.86–1.19). Postoperative Uα1m was not associated with AKI (aOR per 2-fold higher = 1.07, 0.93–1.22), CKD incidence (aHR = 0.90, 0.79–1.03) or progression (aHR = 0.79, 0.56–1.11), CV events (aHR = 1.06, 0.94–1.19), and mortality (aHR = 1.01, 0.92–1.11). <b><i>Conclusion:</i></b> Preoperative Uα1m concentrations may identify patients at high risk of AKI and other adverse events after cardiac surgery, but postoperative Uα1m concentrations do not appear to be informative.

scholarly journals TO019PROGNOSTIC VALUE OF ACUTE KIDNEY INJURY AND HEMOCONCENTRATION DURING ACUTE HEART FAILURE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yannis Lombardi ◽  
Franck Boccara ◽  
Kadiatou Baldet ◽  
Stéphane Ederhy ◽  
Pascal Nhan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Clinical Practice ◽  
Prognostic Value ◽  
Serum Proteins ◽  
Kidney Injury ◽  
Hospital Entry ◽  
Furosemide Administration ◽  
Transient Aki

Abstract Background and Aims Acute kidney injury (AKI) occurring after diuretic treatment initiation for acute heart failure (AHF) is a common phenomenon, with an incidence estimated between 20 and 50% of AHF hospitalizations. Previous studies found that persistent AKI is associated with poor prognosis. Treatment-induced hemoconcentration is associated with improved prognosis, but several definitions previously used are not suited for clinical practice. Transient AKI, with or without hemoconcentration, is of unsettled prognosis. We aim to determine the independent prognostic value of transient AKI, persistent AKI and hemoconcentration in the context of AHF hospitalization, using practical definitions. Method Data were obtained from the Greater Paris University Hospitals (GPUH) Clinical Data Warehouse. Patients hospitalized for AHF in various GPUH units were included. AHF hospitalization was defined as hospitalization with at least one AHF ICD-10 code and at least one recorded furosemide administration. Bumetanide is rarely used in GPUH hospitals hence it was not considered. AKI in a period of 14 days following first furosemide administration was defined based on KDIGO guidelines. Hemoconcentration was defined as an increase in serum proteins ≥ 5 g/l during the same period. Multivariate logistic regression was performed to determine which characteristics were predictive of AKI. Cox regression of 100 days all-cause mortality using multiple confounders was performed to determine the prognostic value of transient AKI (&lt; 14 days), persistent AKI (≥ 14 days) and hemoconcentration. Patients with AKI upon hospital entry were excluded from regression analyses. AKI and hemoconcentration were treated as time-dependent covariates to adjust for immortality bias. Results Five hundred seventy nine patients were included. Among them, 529 had no AKI upon hospital entry and 513 had at least one recorded serum proteins and creatinine value following furosemide initiation. Median follow-up was 114 days. AKI in a period of 14 days following furosemide initiation occurred in 234 patients (40.4%). At baseline, patients in the AKI group more frequently suffered from chronic kidney disease or presented with clinical and echocardiographic signs of right heart failure. Independent predictors of AKI were arterial hypertension upon furosemide initiation (adjusted OR 1.86 [1.08 – 3.22]), elevated serum creatinine upon furosemide initiation (adjusted OR 1.07 [1.01 – 1.14] per 10 µmol/l increase) and initial intravenous administration of furosemide (adjusted OR 2.42 [1.39 – 4.29]). Death during follow-up occurred in 35% of patients in the AKI group compared to 21% in the non-AKI group (p &lt; 0.001). In multivariate analysis, persistent AKI was independently associated with increased mortality in a period of 100 days following furosemide initiation (adjusted HR 2.31 [1.07 – 4.99]). Transient AKI was not significantly associated with mortality (adjusted HR 0.64 [0.34 – 1.19]). Hemoconcentration was independently associated with decreased mortality (adjusted HR 0.46 [0.27 – 0.79]). Conclusion After furosemide initiation during hospitalization for AHF, persistent AKI (≥ 14 days) was independently associated with increased 100 days mortality. Hemoconcentration, using a definition suited for clinical practice (≥ 5 g/l increase in serum proteins), was independently associated with decreased 100 days mortality. No significant association was found between mortality and transient AKI (&lt; 14 days). Those findings show that laboratory tests at a limited cost – serum proteins and creatinine – are helpful to evaluate treatment response and mortality risk during AHF. Prospective randomized controlled trials are needed to establish diuretic strategies based on both AKI and hemoconcentration.

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

2021 ◽  
pp. postgradmedj-2020-139021
Author(s):  
Manoj Kumar ◽  
Maasila Arcot Thanjan ◽  
Natarajan Gopalakrishnan ◽  
Dhanapriya Jeyachandran ◽  
Dineshkumar Thanigachalam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Urine Protein ◽  
Renal Outcomes ◽  
Snake Envenomation ◽  
The Mean ◽  
New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

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