Predictors of Acute Kidney Injury Following Surgical Valve Replacement

2020 ◽  
Author(s):  
Khalid S. Ibrahim ◽  
Khalid A. Kheirallah ◽  
Fadia A. Mayyas ◽  
Nizar A. Alwaqfi
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Blood Transfusion ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Inotropic Support ◽  
History Of ◽  
Surgical Valve Replacement ◽  
Perioperative Blood Transfusion

Abstract Background Acute kidney injury is a serious complication after surgical valve replacement and holds increased mortality rates. Objectives To study predictors of acute kidney injury after surgical valve replacement. Materials and Methods Patients who underwent valve surgery procedures at our center were included. Procedures included aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG. Results A total of 346 patients were included. The mean age was 51.56 (16.1). Males (n = 178) comprised 51%.At the univariate level analysis, predictors of acute kidney injury were found including age, ejection fraction, hypertension, history of CAD, emergency surgery, recent myocardial infarction, diabetes, atrial fibrillation, history of heart failure, mitral regurgitation (MR), pump time >120 minutes, aortic cross clamp >90 minutes, perioperative blood transfusion, re-exploration for bleeding, use of mechanical and biologic valve in aortic position, use of biologic valve in mitral position, prolonged inotropic support, postoperative stroke, and use of angiotensin converting enzyme inhibitors (ACEi) < a month, (all p < 0.05).By Logistic regression analysis, Age (p < 0.0001, odds ratio[AOR] = 1.076), hypertension (p = 0.039, AOR = 1.829), heart failure (p = 0.019, AOR = 2.448), MR (p = 0.0001, AOR = 3.110), use of ACEi <month (p = 0.043, AOR= 2.181), pump time >120 minutes (p = 0.022, AOR = 1.797), perioperative blood transfusion (p = 0.008, AOR = 2.532), and prolonged inotropic support (p = 0.012, AOR = 2.591) were significant and independent predictors of AKI. Conclusion Independent predictors of acute kidney injury following valve surgeries include age, hypertension, heart failure, MR, use of ACEi <month, perioperative blood transfusion, and prolonged pump time or inotropic support.

Abstract 18018: Clinical Predictors of Acute Kidney Injury After Lower Extremity Surgical Bypass in the Society for Vascular Surgery Vascular Quality Initiative

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Erica Flores ◽  
Ke Chen ◽  
Juan Pablo Lewinger ◽  
Leonardo Clavijo ◽  
David Shavelle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Blood Transfusion ◽  
Lower Extremity ◽  
Emergency Surgery ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Clinical Predictors ◽  
Factors Associated ◽  
History Of

Introduction: The incidence and factors associated with acute kidney injury (AKI) development after lower extremity bypass (LEB) are not well defined. The objective of this study is to determine the incidence and characteristics associated with the development of AKI in patients undergoing infrainguinal LEB. Methods: A retrospective review of all LEB surgeries in the Vascular Quality Initiative (VQI) registry from January 2003 to April 2015 was performed. AKI was defined as post-operative rise in creatinine (Cr) > 0.5 mg/dl or new renal impairment requiring dialysis. Demographic, procedural and clinical variables were collected. Patients on dialysis and those missing pre and post-operative Cr values were excluded. Multivariate logistic regression analysis was performed to identify variables associated with the development of AKI following LEB. Results: 12,564 patients were included in the analysis; 509 (4%) developed AKI. Comparison of baseline characteristics between patients that developed AKI and those that did not are shown in the Table. In multivariate analysis, diabetes (OR 1.57, p<0.01), history of heart failure (OR 1.60, p<0.01), emergency surgery (OR 1.34, p<0.01), need for blood transfusion (OR 2.41, p<0.01) and chronic kidney disease (CKD) stages 2 (OR 1.39, p<0.01), 3(OR 2.85, p<0.01), and 4(OR 5.46, p<0.01) were all significantly associated with AKI. Factors associated with a lower incidence of AKI included smoking (OR 0.72, p<0.05), female gender (OR 0.69, p<0.01) and higher hemoglobin levels (OR 0.92, p<0.01). Conclusions: Overall, the development of AKI in a large contemporary database was 4%. Multiple clinical characteristics are associated with development of AKI, including history of heart failure, diabetes, CKD, emergency surgery and need for blood transfusion, and may help to identify at-risk patients. Further studies are needed to prospectively validate these findings and determine if postoperative AKI increases the mortality risk.

Effect of acute kidney injury on hospital-based outcomes in patients with multiple myeloma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20006-e20006
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Bradley Walter Lash
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Teaching Hospitals ◽  
Inpatient Mortality ◽  
History Of

e20006 Background: Multiple Myeloma, a cancer of plasma cells, is treatable, but incurable. 5-year survival rate is about 54% depending upon the stage. Studies have suggested that up to 50% of the patients experience acute kidney injury or chronic kidney disease at some point in their disease course. Approximately 3% of the patients will end up on hemodialysis. In this study we utilize the National Inpatient Sample (NIS) to understand the effect of acute kidney injury (AKI) on inpatient mortality in multiple myeloma patients. Methods: This is a retrospective study utilizing the data obtained from the NIS for the year 2018. We queried this NIS database for ICD-10 codes for multiple myeloma or plasmacytoma that had not achieved remission or was in relapse. We also looked at codes for acute kidney injury as secondary diagnosis. Primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay and cost utilization. We then ran multivariate logistic regression analysis in STATA MP 16.1. Various comorbidities were accounted for by adding them into the analysis. These included previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, stem cell transplant, neutropenia and chemotherapy. Results: The population of multiple myeloma patients under investigation were all adults more than 18 years of age and numbered in 3944 patients. The mean age was 65.71 years. Among these 45% were females. While examining inpatient mortality we see that for patients that had AKI the odds of inpatient mortality are higher (Odds Ratio (OR) 1.75, p = 0.003, 95% Confidence Interval (CI) 1.21 – 2.56). History of Heart Failure (OR 2.28, 95% CI 1.59 – 3.28), and increasing age (OR 1.02, 95% CI 1.01 – 1.04) also appear to contribute towards higher odds of mortality. The effect of other comorbidities was not statistically significant. Among demographical characteristics being of Native American heritage or not belonging to any descriptive race predicted higher odds of mortality. Mean LOS was 11 days. Patients with AKI stayed in the hospital longer by ̃1.4 days (Coef. 1.39, 95% CI 0.41 – 2.37). LOS was higher in patients with a history of heart failure (2.61, 95% CI 0.89 – 4.34 and in those with a history of neutropenia (5.52, 95% CI 4.42 – 6.62). LOS was lower in patients with a history of smoking by 1 day. Age lowered the LOS by a clinically insignificant amount. Teaching hospitals had higher LOS by ̃4 days. The total charge for hospitalizations from AKI is higher by $31019 (95% CI 14444.23 – 47594.37). Other factors incurring higher cost include history of neutropenia, and teaching hospitals. Hospitals in the Midwest had lower cost compared to hospitals in the Northeast. Conclusions: Among patients that present with a principal diagnosis of multiple myeloma, having acute kidney injury, adversely affects inpatient outcomes that include, mortality, hospital length of stay and total hospitalization cost.

Abstract 16705: Prevalence and Outcomes Among Hospitalized Patients With Covid-19 and Atrial Fibrillation or Flutter

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zaniar Ghazizadeh ◽  
Chad Gier ◽  
Avinainder Singh ◽  
Lina Vadlamani ◽  
Maxwell Eder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Adverse Events ◽  
Cardiac Injury ◽  
Kidney Injury ◽  
Prior History ◽  
New Haven ◽  
History Of ◽  
Record Review

Introduction: The prevalence and outcomes of patients hospitalized with COVID-19 with atrial fibrillation and atrial flutter (AF/FL) remains unclear. Methods: The Yale Cardiovascular COVID Registry is a cohort study of adult patients >=18 years hospitalized with COVID-19 in the Yale New Haven Health System. Retrospective medical record review was performed on consecutive patients from the registry admitted between March and June 2020. We calculated the rates of prior and in-hospital AF/FL and evaluated the unadjusted rates of in-hospital adverse events for both groups; we then calculated the adjusted odds of adverse events using logistic regression. Results: Among 396 patients, the mean age was 68.2, 52.3% were men, 56.4% were Caucasian, 28.4% Black and 16.9% Hispanic. 15.7% of patients had prior history of AF/FL. 19.9% of patients had in-hospital AF/FL, 7.83% of which did not have a prior history of AF/FL. Patients with in-hospital AF/FL had significantly more CV complications compared to those without including cardiac injury (78.5% vs 42.7%, p=0.000), type 2 myocardial infarction (53.3 vs 30.3%, p=0.002), and heart failure (32.9% vs 9.2%, p=0.000). In-hospital AF/FL was associated with significantly worse outcomes related to COVID-19 including ICU survival (OR 0.22 [0.08-0.59], p=0.002), heart failure (5.19 [2.56-10.5], p=0.000), myocardial injury (OR 2.87 [1.49-5.49], p=0.001), acute kidney injury (OR 2.02 [1.09-3.74], p=0.027), dialysis (OR 4.07 [1.38-12.03], p=0.011) and hospice/death (OR 2.47 [1.35-4.53], p=0.004). Conclusion: AF/FL are common in patients hospitalized with COVID-19 and these patients had significantly worse outcomes, including lower odds of ICU survival and higher odds of heart failure, acute kidney injury, dialysis and hospice/death.

Cause and risk factors for readmissions after transcatheter aortic valve replacement

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Arora ◽  
P.D Strassle ◽  
M.J Hendrickson ◽  
K Sitammagari ◽  
A Qamar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Kidney Injury ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Discharge Disposition ◽  
Transcatheter Aortic Valve

Abstract Background Hospital readmissions following transcatheter aortic valve replacement (TAVR) are associated with higher costs and worse outcomes. Purpose Identify causes and risk factors for readmissions after TAVR Methods Hospitalizations of adults aged ≥50, with aortic stenosis and undergoing elective TAVR between 2012 and 2016 in the National Readmission Database were analyzed. Multivariable generalized logistic regression, adjusting for age, sex, Charleson Comorbidity Index, primary insurance type, median household income, hospital type and size, were used to assess the effect of inpatient complications, length of stay (LOS), discharge disposition, and TAVR hospital volume on 30-day cardiovascular (CV) and non-cardiovascular (non-CV) readmission. Results Between January 2012 and November 2016, 56,858 weighted TAVR hospitalizations were included. The most common causes of readmissions after TAVR were heart failure (23%), infection (17%), gastrointestinal (11%), respiratory (8%), and “other” non-CV causes (8%). The adjusted odds of both CV and non-CV readmissions were significantly higher in patients with acute kidney injury, inpatient LOS ≥5 days, those discharged to skilled nursing facility (SNF) and those treated at medium volume compared with high volume hospitals, Table 1. Conclusion Heart failure is the most common cause of readmissions after TAVR. Inpatient incidence of acute kidney injury, as well as longer LOS, SNF discharge and lower hospital TAVR volume were associated with higher odds of 30-day readmissions. Funding Acknowledgement Type of funding source: None

scholarly journals Clinical Characteristics and Outcomes of Community- and Hospital-Acquired Acute Kidney Injury with COVID-19 in a US Inner City Hospital System

2020 ◽  
Vol 10 (4) ◽  
pp. 223-231 ◽  
Author(s):  
Jerald Pelayo ◽  
Kevin Bryan Lo ◽  
Ruchika Bhargav ◽  
Fahad Gul ◽  
Eric Peterson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
African American ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Hospital Death ◽  
City Hospital ◽  
History Of ◽  
Hospital Acquired

Introduction: Emerging data have described poor clinical outcomes from infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) among African American patients and those from underserved socioeconomic groups. We sought to describe the clinical characteristics and outcomes of acute kidney injury (AKI) in this special population. Methods: This is a retrospective study conducted in an underserved area with a predominance of African American patients with coronavirus disease 2019 (COVID-19). Descriptive statistics were used to characterize the sample population. The onset of AKI and relation to clinical outcomes were determined. Multivariate logistic regression was used to determine factors associated with AKI. Results: Nearly half (49.3%) of the patients with COVID-19 had AKI. Patients with AKI had a significantly lower baseline estimated glomerular filtration rate (eGFR) and higher FiO2 requirement and D-dimer levels on admission. More subnephrotic proteinuria and microhematuria was seen in these patients, and the majority had a pre-renal urine electrolyte profile. Patients with hospital-acquired AKI (HA-AKI) as opposed to those with community-acquired AKI (CA-AKI) had higher rates of in-hospital death (52 vs. 23%, p = 0.005), need for vasopressors (42 vs. 25%, p = 0.024), and need for intubation (55 vs. 25%, p = 0.006). A history of heart failure was significantly associated with AKI after adjusting for baseline eGFR (OR 3.382, 95% CI 1.121–13.231, p = 0.032). Conclusion: We report a high burden of AKI among underserved COVID-19 patients with multiple comorbidities. Those who had HA-AKI had worse clinical outcomes compared to those who with CA-AKI. A history of heart failure is an independent predictor of AKI in patients with COVID-19.

Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

2016 ◽  
Vol 19 (6) ◽  
pp. 289 ◽  
Author(s):  
Mehmet Yilmaz ◽  
Rezan Aksoy ◽  
Vildan Kilic Yilmaz ◽  
Canan Balci ◽  
Cagri Duzyol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Urine Output ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Urinary Output ◽  
Bypass Grafting

Objective: This study evaluated the relationship between the amount of urinary output during cardiopulmonary bypass and acute kidney injury in the postoperative period of coronary artery bypass grafting.Methods: Two hundred patients with normal preoperative serum creatinine levels, operated on with isolated CABG between 2012-2014 were investigated retrospectively. The RIFLE (Risk, injury, failure, loss of function, and end-stage renal disease) risk scores were calculated for each patient in the third postoperative day. Patients were distributed into two groups in relation to the presence of acute kidney injury or not and these two groups were compared.Results: The urinary output (mL/kg/hour) during cardiopulmonary bypass in the acute kidney injury negative group was significantly higher than in the acute kidney injury positive group (P = .022). In case of a urinary output value 3.70 and lower to predict acute kidney injury positivity, sensitivity was detected as 71.43%. Results of the analysis for urinary output predict positivity of acute kidney injury.Conclusion: We suggest that urine output during cardiopulmonary bypass is a significant criteria that could predict acute kidney injury following coronary artery bypass grafting with cardiopulmonary bypass. Attempts to increase the urine output during cardiopulmonary bypass could help to maintain the renal functions during and after surgery.

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