In PICU acute kidney injury stage 3 or mortality is associated with early excretion of urinary renin

2021 ◽  
Author(s):  
Yuxian Kuai ◽  
Hui Huang ◽  
Xiaomei Dai ◽  
Zhongyue Zhang ◽  
Zhenjiang Bai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Acute Kidney Injury Stage

scholarly journals Postoperative hypotension in patients discharged to the intensive care unit after non-cardiac surgery is associated with adverse clinical outcomes

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Nathan J. Smischney ◽  
Andrew D. Shaw ◽  
Wolf H. Stapelfeldt ◽  
Isabel J. Boero ◽  
Qinyu Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Kidney Injury ◽  
Intraoperative Hypotension ◽  
Cerebrovascular Events ◽  
Acute Kidney Injury Stage

Abstract Background The postoperative period is critical for a patient’s recovery, and postoperative hypotension, specifically, is associated with adverse clinical outcomes and significant harm to the patient. However, little is known about the association between postoperative hypotension in patients in the intensive care unit (ICU) after non-cardiac surgery, and morbidity and mortality, specifically among patients who did not experience intraoperative hypotension. The goal of this study was to assess the impact of postoperative hypotension at various absolute hemodynamic thresholds (≤ 75, ≤ 65 and ≤ 55 mmHg), in the absence of intraoperative hypotension (≤ 65 mmHg), on outcomes among patients in the ICU following non-cardiac surgery. Methods This multi-center retrospective cohort study included specific patient procedures from Optum® healthcare database for patients without intraoperative hypotension (MAP ≤ 65 mmHg) discharged to the ICU for ≥ 48 h after non-cardiac surgery with valid mean arterial pressure (MAP) readings. A total of 3185 procedures were included in the final cohort, and the association between postoperative hypotension and the primary outcome, 30-day major adverse cardiac or cerebrovascular events, was assessed. Secondary outcomes examined included all-cause 30- and 90-day mortality, 30-day acute myocardial infarction, 30-day acute ischemic stroke, 7-day acute kidney injury stage II/III and 7-day continuous renal replacement therapy/dialysis. Results Postoperative hypotension in the ICU was associated with an increased risk of 30-day major adverse cardiac or cerebrovascular events at MAP ≤ 65 mmHg (hazard ratio [HR] 1.52; 98.4% confidence interval [CI] 1.17–1.96) and ≤ 55 mmHg (HR 2.02, 98.4% CI 1.50–2.72). Mean arterial pressures of ≤ 65 mmHg and ≤ 55 mmHg were also associated with higher 30-day mortality (MAP ≤ 65 mmHg, [HR 1.56, 98.4% CI 1.22–2.00]; MAP ≤ 55 mmHg, [HR 1.97, 98.4% CI 1.48–2.60]) and 90-day mortality (MAP ≤ 65 mmHg, [HR 1.49, 98.4% CI 1.20–1.87]; MAP ≤ 55 mmHg, [HR 1.78, 98.4% CI 1.38–2.31]). Furthermore, we found an association between postoperative hypotension with MAP ≤ 55 mmHg and acute kidney injury stage II/III (HR 1.68, 98.4% CI 1.02–2.77). No associations were seen between postoperative hypotension and 30-day readmissions, 30-day acute myocardial infarction, 30-day acute ischemic stroke and 7-day continuous renal replacement therapy/dialysis for any MAP threshold. Conclusions Postoperative hypotension in critical care patients with MAP ≤ 65 mmHg is associated with adverse events even without experiencing intraoperative hypotension.

Incidence, Predictors, and Prognosis of Acute Kidney Injury Among Cardiac Arrest Survivors

2020 ◽  
pp. 088506662091135
Author(s):  
Abhishek Dutta ◽  
Krupal J. Hari ◽  
John Azizian ◽  
Youssef Masmoudi ◽  
Fatima Khalid ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Kidney Injury ◽  
Disease Stage ◽  
Neurological Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Acute Kidney Injury Stage

Background: Acute kidney injury (AKI) is common among cardiac arrest survivors. However, the outcomes and predictors are not well studied. Methods: This is a cohort study of cardiac arrest patients enrolled from January 2012 to December 2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation. Patients with anuria, chronic kidney disease (stage 5), and end-stage renal disease were excluded. Acute kidney injury (stage 1) or higher was defined using Kidney Disease: Improving Global Outcomes classification. Multivariable adjusted regression models were used to compute hazard ratio (HR) for association of AKI with risk of mortality and odds ratio (OR) with risk of poor neurological outcomes after adjusting for demographics, comorbidities, and medical therapy. Multivariable logistic regression model was used to compute OR for association of various predictors with AKI. Results: Of 842 cardiac arrest survivors, 588 (69.8%) developed AKI. Among AKI patients, 69.4% died compared with 52.0% among non-AKI patients. In multivariable adjusted Cox proportional hazard model, development of AKI post-cardiac arrest was significantly associated with mortality (HR: 1.35; 95% confidence interval [CI]: 1.07-1.71, P = .01) and poor neurological outcomes defined as cerebral performance category >2 (OR: 2.27; 95% CI: 1.45-3.57, P < .001) and modified Rankin scale >3 (OR: 2.22; 95% CI: 1.43-3.45, P < .001). Postdischarge dialysis was also associated with increased risk of mortality (HR: 2.57; 95% CI: 1.57-4.23, P < .001). Use of vasopressors was strongly associated with development of AKI and continued need for postdischarge dialysis. Conclusions: Acute kidney injury was associated with increased risk of mortality and poor neurological outcomes. There is need for further studies to prevent AKI in cardiac arrest survivors.

scholarly journals Long-term ACE Inhibitor/ARB Use Is Associated With Severe Renal Dysfunction and Acute Kidney Injury in Patients With Severe COVID-19: Results From a Referral Center Cohort in the Northeast of France

2020 ◽  
Author(s):  
Abderrahim Oussalah ◽  
Stanislas Gleye ◽  
Isabelle Clerc Urmes ◽  
Elodie Laugel ◽  
Jonas Callet ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Multilevel Modeling ◽  
Repeated Measures ◽  
Kidney Injury ◽  
Characteristic Analysis ◽  
Disease Outcomes ◽  
Increased Risk ◽  
Acute Kidney Injury Stage

Abstract Background In patients with severe coronavirus disease 2019 (COVID-19), data are scarce and conflicting regarding whether chronic use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) influences disease outcomes. In patients with severe COVID-19, we assessed the association between chronic ACEI/ARB use and the occurrence of kidney, lung, heart, and liver dysfunctions and the severity of the inflammatory reaction as evaluated by biomarkers kinetics, and their association with disease outcomes. Methods We performed a retrospective longitudinal cohort study on consecutive patients with newly diagnosed severe COVID-19. Independent predictors were assessed through receiver operating characteristic analysis, time-series analysis, logistic regression analysis, and multilevel modeling for repeated measures. Results On the 149 patients included in the study 30% (44/149) were treated with ACEI/ARB. ACEI/ARB use was independently associated with the following biochemical variations: phosphorus &gt;40 mg/L (odds ratio [OR], 3.35, 95% confidence interval [CI], 1.83–6.14), creatinine &gt;10.1 mg/L (OR, 3.22, 2.28–4.54), and urea nitrogen (UN) &gt;0.52 g/L (OR, 2.65, 95% CI, 1.89–3.73). ACEI/ARB use was independently associated with acute kidney injury stage ≥1 (OR, 3.28, 95% CI, 2.17–4.94). The daily dose of ACEI/ARB was independently associated with altered kidney markers with an increased risk of +25 to +31% per each 10 mg increment of lisinopril-dose equivalent. In multivariable multilevel modeling, UN &gt;0.52 g/L was independently associated with the risk of acute respiratory failure (OR, 3.54, 95% CI, 1.05–11.96). Conclusions Patients chronically treated with ACEI/ARB who have severe COVID-19 are at increased risk of acute kidney injury. In these patients, the increase in UN associated with ACEI/ARB use could predict the development of acute respiratory failure.

scholarly journals Acute Kidney Injury and Associated Factors in Intensive Care Units at a Tertiary Hospital in Northern Tanzania

2021 ◽  
Vol 8 ◽  
pp. 205435812110279
Author(s):  
Neema W. Minja ◽  
Huda Akrabi ◽  
Karen Yeates ◽  
Kajiru Gad Kilonzo
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Associated Factors ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Tertiary Hospital ◽  
Baseline Serum ◽  
Northern Tanzania ◽  
Acute Kidney Injury Stage

Background: Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown. Objective: We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania. Design: Prospective observational study from November 2017 to May 2018. Methods: In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status. Results: More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19). Limitations: Being based at a referral center, the findings do not represent the true burden of AKI in the community. Conclusion: The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.

scholarly journals Serum sodium trajectory during AKI and mortality risk

2021 ◽  
Author(s):  
Jonathan Samuel Chavez-Iñiguez ◽  
Pablo Maggiani-Aguilera ◽  
Helbert Rondon-Berrios ◽  
Kianoush Kashani ◽  
Christian Pérez-Flores ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Serum Sodium ◽  
Prospective Cohort ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Kidney Injury ◽  
Primary Role ◽  
Acute Kidney Injury Stage ◽  
Kidney Replacement Therapy

Abstract Introduction: Kidneys play a primary role in electrolyte homeostasis. The association between serum sodium level and mortality or the need for kidney replacement therapy during acute kidney injury has not been adequately explored. Methods: In this prospective cohort study, we enrolled patients admitted to the Civil Hospital of Guadalajara from August 2017 to March 2020. We divided patients into five groups based on the serum sodium level trajectories up to ten days following hospitalization, 1) stable normonatremia (serum sodium 135 and 145 mEq/L), 2) fluctuating serum sodium levels (increased/decreased in and out of normonatremia), 3) uncorrected hyponatremia, 4) corrected hyponatremia, and 5) uncorrected hypernatremia. We assessed the association of serum sodium trajectories with mortality and the need for kidney replacement therapy (secondary objective). Results: A total of 288 patients were included. The mean age was 55±18 years, and 175 (60.7%) were male. Acute kidney injury stage 3 was present in 145 (51%). Kidney replacement therapy started in 72 (25%) patients, and 45 (15.6%) died. After adjusting for confounders, 10-day hospital mortality was significantly higher in group 5 (HR, 3.12; 95% CI, 1.05 to 9.24, p = 0.03), and kidney replacement therapy initiation was higher in group 3 (HR, 2.44; 95% CI, 1.04 to 5.70, p = 0.03) compared with group 1. Conclusion: In our prospective cohort, most patients with acute kidney injury had alterations in serum sodium. Uncorrected hypernatremia was associated with death, and uncorrected hyponatremia was correlated with the need for kidney replacement therapy.

scholarly journals Machine Learning to Predict Post-Operative Acute Kidney Injury Stage 3 After Heart Transplantation

2021 ◽  
Author(s):  
Tingyu Li ◽  
Yuelong Yang ◽  
Jinsong Huang ◽  
Rui Chen ◽  
Yijin Wu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
Heart Transplantation ◽  
Model Building ◽  
Kidney Injury ◽  
Predictive Performance ◽  
Right Atrial ◽  
Serum Cystatin C ◽  
Post Transplant ◽  
Acute Kidney Injury Stage

Abstract Background Acute kidney injury (AKI) stage 3, one of the most severe complications in patients with heart transplantation (HT), is associated with substantial morbidity and mortality. We aimed to develop a machine learning (ML) model to predict post-transplant AKI stage 3 based on preoperative and perioperative features. Methods Data from 107 consecutive HT recipients in the provincial center between 2018 and 2020 were included for analysis. Logistic regression with L2 regularization was used for the ML model building. The predictive performance of the ML model was assessed using the area under the curve (AUC) in 10-fold stratified cross-validation and was compared with that of the existing clinical metrics. Results Post-transplant AKI occurred in 71 (66.3%) patients including 13 (12.1%) stage 1, 13 (12.1%) stage 2, and 45 (42.1%) stage 3 cases. The top four features selected for the ML model to predicate AKI stage 3 were serum cystatin C, estimated glomerular filtration rate (eGFR), right atrial long-axis dimension, and serum creatinine (SCr). The predictive performance of the ML model (AUC: 0.828; 95% confidence interval [CI]: 0.745–0.913) was significantly higher compared with that of the existing clinical metrics including eGFR (AUC: 0.694; 95%[CI]: 0.594–0.795, p < 0.05) and SCr (AUC: 0.525; 95%[CI]: 0.411–0.636), p < 0.001). Conclusions The ML model, which achieved an effective predictive performance for post-transplant AKI stage 3, may be helpful for timely intervention to improve the patient’s prognosis.

scholarly journals Outcomes in patients with acute kidney injury reviewed by Critical Care Outreach: What is the role of the National Early Warning Score?

2017 ◽  
Vol 18 (4) ◽  
pp. 300-309 ◽  
Author(s):  
Daniel A Potter ◽  
Nicholas Wroe ◽  
Helen Redhead ◽  
Andrew JP Lewington
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Early Warning ◽  
Kidney Injury ◽  
Early Warning Score ◽  
Acute Kidney Injury Stage ◽  
National Early Warning Score ◽  
One Year ◽  
Critical Care Outreach

Introduction This study investigated outcomes in critically unwell acute kidney injury patients and the role of the National Early Warning Score and other factors in identifying patients who experience negative outcomes. Methods Retrospective cohort study investigating 64 patients seen by Critical Care Outreach between November 2014 and February 2015. Mortality at one year was analysed using multivariate regression; all other statistical tests were non-parametric. Results Forty-four per cent of patients required escalation to higher level care, 56% failed to survive beyond one year and 30% of those who did survive had a deterioration in renal function. Previous acute kidney injury significantly predicted mortality but the National Early Warning Score did not. A subgroup of patients developed Stage 3 acute kidney injury before a rise in National Early Warning Score. Conclusions Acute kidney injury in the Critical Care Outreach patient population is associated with high morbidity and mortality. Previous acute kidney injury and acute kidney injury stage may be superior to the National Early Warning Score at identifying patients in need of Critical Care Outreach review.

Feasibility and safety of combined cytokine adsorption and continuous veno-venous hemodialysis with regional citrate anticoagulation in patients with septic shock

2019 ◽  
Vol 43 (1) ◽  
pp. 10-16
Author(s):  
Thomas Dimski ◽  
Timo Brandenburger ◽  
Torsten Slowinski ◽  
Detlef Kindgen-Milles
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Regional Citrate Anticoagulation ◽  
Adjunct Treatment ◽  
Citrate Anticoagulation ◽  
Acute Kidney Injury Stage ◽  
Norepinephrine Dose

Introduction: Septic shock is characterized by severe metabolic and hemodynamic alterations. It is often accompanied by acute kidney injury. A new adjunct treatment is hemoadsorption using a cytokine adsorber in line with continuous veno-venous renal replacement therapy. We studied the feasibility, efficacy, and safety of cytokine adsorption with citrate-anticoagulated continuous veno-venous hemodialysis (regional citrate anticoagulation–continuous veno-venous hemodialysis). Methods: In 11 patients with septic shock and acute kidney injury stage 3, we studied 12 cycles of cytokine adsorption and regional citrate anticoagulation–continuous veno-venous hemodialysis. We monitored parameters of citrate anticoagulation, circuit lifetime, laboratory parameters, hemodynamics, and vasopressor demand. Results: Ten out of 12 adsorber/continuous veno-venous hemodialysis circuits reached the target lifetime of 24 h for the adsorber. One system clotted and one was stopped for non-device-related reasons. Nine of the remaining continuous renal replacement therapy circuits reached 72 h lifetime. With default settings for regional citrate anticoagulation, serum ionized calcium and pH were in the normal range. Urea and creatinine were reduced significantly, and norepinephrine dose decreased from 0.47 (±0.09) to 0.16 (±0.04) µg/kg/min ( p = 0.016) after 24 h. Discussion: We show that combined cytokine adsorption/continuous veno-venous hemodialysis is effective to control pH, to reduce urea and creatinine, and to improve hemodynamics by reducing norepinephrine doses in patients with septic shock. It can be applied safely with standard settings of regional citrate anticoagulation rendering sufficiently long filter lifetimes for the adsorber and the continuous veno-venous hemodialysis circuit. Further studies are on the way to investigate whether these effects translate into improved outcomes in septic shock patients.

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