scholarly journals Risk of acute kidney injury and Clostridioides difficile infection with piperacillin/tazobactam, cefepime and meropenem with or without vancomycin

2020 ◽  
Author(s):  
Jazmin D Lee ◽  
Brett H Heintz ◽  
Hilary J Mosher ◽  
Daniel J Livorsi ◽  
Jason A Egge ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Base Rate ◽  
Patient Specific ◽  
Veterans Health ◽  
Health Administration ◽  
Beta Lactam ◽  
Minimal Impact

Abstract Background Empiric antimicrobial therapy for healthcare-acquired infections often includes vancomycin plus an antipseudomonal beta-lactam (AP-BL). These agents vary in risk for adverse events, including acute kidney injury (AKI) and Clostridium difficile infection (CDI). Studies have only examined these risks separately; thus, our objective was to simultaneously evaluate AKI and CDI risks with AP-BL in the same patient cohort. Methods This retrospective cohort study included 789,200 Veterans Health Administration medical admissions from July 1, 2010 through June 30, 2016. The antimicrobials examined were vancomycin, cefepime, piperacillin/tazobactam, and meropenem. Cox proportional hazards regression was used to contrast risks for AKI and CDI across individual target antimicrobials and vancomycin combination therapies, including adjustment for known confounders. Results With respect to the base rate of AKI among patients who did not receive a target antibiotic (4.6%), the adjusted hazards ratios for piperacillin/tazobactam, cefepime, and meropenem were 1.50 (95% CI: 1.43-1.54), 1.00 (0.95-1.05), 0.92 (0.83-1.01), respectively. Co-administration of vancomycin increased AKI rates (data not shown). Similarly, against the base rate of CDI (0.7%), these ratios were 1.21 (1.07-1.36), 1.89 (1.62-2.20), and 1.99 (1.55-2.56), respectively. Addition of vancomycin had minimal impact on CDI rates (data not shown). Conclusions Piperacillin/tazobactam increased AKI risk, which was exacerbated by concurrent vancomycin. Cefepime and meropenem increased CDI risk relative to piperacillin/tazobactam. Clinicians should consider the risks and benefits of AP-BL when selecting empiric regimens. Further well-designed studies evaluating the global risks of AP-BL and patient specific characteristics that can guide empiric selection are needed.

scholarly journals Acute Kidney Injury After Major Surgery: A Retrospective Analysis of Veterans Health Administration Data

2016 ◽  
Vol 67 (6) ◽  
pp. 872-880 ◽  
Author(s):  
Morgan E. Grams ◽  
Yingying Sang ◽  
Josef Coresh ◽  
Shoshana Ballew ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Analysis ◽  
Kidney Injury ◽  
Veterans Health Administration ◽  
Major Surgery ◽  
Veterans Health ◽  
Health Administration

scholarly journals Association Between Base Excess and Mortality Among Patients in ICU with Acute Kidney Injury

2021 ◽  
Author(s):  
Yi Cheng ◽  
Yuanjun Tang ◽  
Boxiang Tu ◽  
Xin Cheng ◽  
Ran Qi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Medical Information ◽  
Proportional Hazards ◽  
Base Excess ◽  
Proportional Hazards Model ◽  
Kidney Injury ◽  
Prognostic Indicator ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Icu Patients

Abstract Objective This study aimed to explore the association between base excess (BE) and risk of 30-day mortality among patients with acute kidney injury (AKI) in ICU.Methods This retrospective study including ICU patients with AKI from Medical Information Mart for Intensive Care (MIMIC)-IV database. We used multivariate Cox proportional-hazards model to calculate the hazard ratio (HR) for risk of 30-day mortality among patients with AKI. Furthermore, we utilized Cox proportional-hazard model with restrict cubic splines (RCS) to explore the potential no-linear association. Results Of all the 14238 ICU patients with AKI, BE showed U-shaped relationship with risk of 30-day mortality for patients with AKI, and higher or lower BE value could increase the risk. Compared with normal base excess (-3~3 mmol/L), patients with difference groups (BE ≤ -9mmol/L, -9 mmol/L <BE≤-3 mmol/L, 3 mmol/L <BE≤9 mmol/L and BE＞9 mmol/L) had different HR for mortality: 1.57(1.40,1.76), 1.26(1.14,1.39), 0.97(0.83,1.12), 1.53(1.17,2.02) respectively. And the RCS analyses also showed U-shaped curve between BE and 30-day mortality risk.Conclusion Our results suggest both higher and lower BE in patients with AKI would increase the risk of 30-day mortality. BE measured at administration could be a critical prognostic indicator for ICU patients with AIK and provide guidance for clinicians.

Acute Kidney Injury Requiring Dialysis and Incident Dialysis Patient Outcomes in US Outpatient Dialysis Facilities

2021 ◽  
pp. CJN.18311120
Author(s):  
Claudia Dahlerus ◽  
Jonathan Segal ◽  
Kevin He ◽  
Wenbo Wu ◽  
Shu Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Race And Ethnicity ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Patient Characteristics ◽  
Outpatient Setting ◽  
Cox Proportional Hazards ◽  
Medicare Beneficiaries ◽  
Dialysis Patients ◽  
Dialysis Facilities

Background and Objectives: About 30% of patients with acute kidney injury (AKI) may require ongoing dialysis in the outpatient setting after hospital discharge. A 2017 CMS policy change allows Medicare beneficiaries with AKI requiring dialysis to receive outpatient treatment in dialysis facilities. Outcomes for these patients have not been reported. We compare patient characteristics and mortality among AKI dialysis patients and non-AKI incident dialysis patients. Design, setting, participants, and measurements: Retrospective cohort design, using 2017 Medicare Claims to follow outpatient AKI dialysis patients and non-AKI incident dialysis patients up to 365 days. Outcomes are unadjusted and adjusted mortality using Kaplan-Meier estimation for unadjusted survival probability, Poisson regression for monthly mortality, and Cox proportional hazards modeling for adjusted mortality. Results: 10,821 of 401,973 (3%) Medicare dialysis patients had at least one AKI claim, and 52,626 patients were Medicare non-AKI incident dialysis patients. AKI dialysis patients were more likely to be White (76% vs 70%), non-Hispanic (92% vs 87%), and age 60 or greater (82% vs 72%) compared to non-AKI incident dialysis patients. Unadjusted mortality was markedly higher for AKI dialysis patients compared to non-AKI incident dialysis patients. Adjusted mortality differences between both cohorts persisted through month 4 of the follow-up period (all P<0.01) then declined and were no longer statistically significant. Adjusted monthly mortality stratified by Black and other race between AKI dialysis patients vs non-AKI incident dialysis patients was lower throughout month 4 (1.5 v .60, 1.20 v 0.84, 1.00 v 0.80, 0.95 v 0.74, all P<0.001 which persisted through month 7. Overall adjusted mortality risk was 22% higher for AKI dialysis patients (1.22, CI 1.17, 1.27). Conclusions: In fully adjusted analyses AKI dialysis patients had higher early mortality compared to non-AKI incident dialysis patients, but these differences declined after several months. Differences were also observed by age, race and ethnicity within both patient cohorts.

scholarly journals High-dose influenza vaccination and mortality among predominantly male, white, senior veterans, United States, 2012/13 to 2014/15

2020 ◽  
Vol 25 (19) ◽  
Author(s):  
Yinong Young-Xu ◽  
Julia Thornton Snider ◽  
Salaheddin M Mahmud ◽  
Ellyn M Russo ◽  
Robertus Van Aalst ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Standard Dose ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
High Dose ◽  
Veterans Health ◽  
Health Administration ◽  
Influenza Pneumonia ◽  
Residual Confounding

Introduction It is unclear whether high-dose influenza vaccine (HD) is more effective at reducing mortality among seniors. Aim This study aimed to evaluate the relative vaccine effectiveness (rVE) of HD. Methods We linked electronic medical record databases in the Veterans Health Administration (VHA) and Medicare administrative files to examine the rVE of HD vs standard-dose influenza vaccines (SD) in preventing influenza/pneumonia-associated and cardiorespiratory mortality among VHA-enrolled veterans 65 years or older during the 2012/13, 2013/14 and 2014/15 influenza seasons. A multivariable Cox proportional hazards model was performed on matched recipients of HD vs SD, based on vaccination time, location, age, sex, ethnicity and VHA priority level. Results Among 569,552 person-seasons of observation, 207,574 (36%) were HD recipients and 361,978 (64%) were SD recipients, predominantly male (99%) and white (82%). Pooling findings from all three seasons, the adjusted rVE estimate of HD vs SD during the high influenza periods was 42% (95% confidence interval (CI): 24–59) against influenza/pneumonia-associated mortality and 27% (95% CI: 23–32) against cardiorespiratory mortality. Residual confounding was evident in both early and late influenza periods despite matching and multivariable adjustment. Excluding individuals with high 1-year predicted mortality at baseline reduced the residual confounding and yielded rVE of 36% (95% CI: 10–62) and 25% (95% CI: 12–38) against influenza/pneumonia-associated and cardiorespiratory mortality, respectively. These were confirmed by results from two-stage residual inclusion estimations. Discussion The HD was associated with a lower risk of influenza/pneumonia-associated and cardiorespiratory death in men during the high influenza period.

Albumin Levels Predict Mortality In Sepsis Patients With Acute Kidney Injury Undergoing Continuous Renal Replacement Therapy: A Secondary Analysis Based On A Retrospective Cohort Study

2021 ◽  
Author(s):  
Song Sheng ◽  
Ye Huang
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Proportional Hazards ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Negatively Associated ◽  
Risk Of Death

Abstract Background Albumin (ALB) levels are negatively associated with mortality in patients with sepsis. However, among sepsis patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), there has been no similar study on the correlation between ALB levels and mortality alone. This study tested the hypothesis that ALB levels are negatively associated with mortality among such patients. Methods We conducted a secondary analysis of 794 patients with sepsis who were diagnosed with AKI and underwent CRRT in South Korea. For the Kaplan–Meier survival analysis, Cox proportional hazards models were used to study the hypotheses, with adjustments for the pertinent covariables. Results The ALB level was an independent prognostic factor for death at 28 and 90 days after CRRT initiation (HR=0.75, 95% CI: 0.62–0.90, P=0.0024 for death at 28 days and HR=0.73, 95% CI: 0.63–0.86, P<0.0001 for death at 90 days). A nonlinear association was not identified between ALB levels and the endpoints. Subgroup analyses and tests for interactions indicated that patients with low HCO3 levels (<22 mmol/L) had a higher rate of death at 28 days (P for interaction=0.0235), and there was a significantly increased mortality at 90 days among patients with high CRP levels (P for interaction=0.0195). Conclusion A 1 g/dL increase in ALB levels was independently associated with a 25% and 27% decrease in the risk of death at 28 and 90 days, respectively. It is feasible to predict mortality using ALB levels in sepsis patients with AKI undergoing CRRT.

Long-term Kidney Outcomes Following Childhood Acute Kidney Injury Receiving Dialysis: A Population-based Cohort Study

2021 ◽  
pp. ASN.2020111665
Author(s):  
Cal Robinson ◽  
Nivethika Jeyakumar ◽  
Bin Luo ◽  
Ron Wald ◽  
Amit Garg ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Kidney Failure ◽  
Proportional Hazards ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Administrative Databases ◽  
Pediatric Dialysis ◽  
Increased Risk

Background Acute kidney injury (AKI) is common during pediatric hospitalizations and associated with adverse short-term outcomes. However, long-term outcomes among survivors of pediatric AKI who received dialysis remain uncertain. Methods To determine the long-term risk of kidney failure (defined as receipt of chronic dialysis or kidney transplant) or death over a 22-year period for pediatric survivors of dialysistreated AKI, we used province-wide health administrative databases to perform a retrospective cohort study of all neonates and children (aged 0-18 years) hospitalized in Ontario, Canada, from April 1, 1996, to March 31, 2017, who survived a dialysis-treated AKI episode. Each AKI survivor was matched to four hospitalized pediatric comparators without dialysis-treated AKI, based on age, sex, and admission year. We reported the incidence of each outcome and performed Cox proportional hazards regression analyses, adjusting for relevant covariates. Results We identified 1688 pediatric dialysis-treated AKI survivors (median age 5 years) and 6752 matched comparators. Among AKI survivors, 53.7% underwent mechanical ventilation and 33.6% had cardiac surgery. During a median 9.6-year follow-up, AKI survivors were at significantly increased risk of a \ composite outcome of kidney failure or death versus comparators. Death occurred in 113 (6.7%) AKI survivors, 44 (2.6%) developed kidney failure, 174 (12.1%) developed hypertension, 213 (13.1%) developed chronic kidney disease (CKD), and 237 (14.0%) had subsequent AKI. AKI survivors had significantly higher risks of developing CKD and hypertension versus comparators. Risks were greatest in the first year after discharge and gradually decreased over time. Conclusions Survivors of pediatric dialysis-treated AKI are at higher long-term risks of kidney failure, death, CKD, and hypertension, compared with a matched hospitalized cohort.

The Risk of Acute Kidney Injury with Oral Anticoagulants in Elderly Adults with Atrial Fibrillation

2021 ◽  
pp. CJN.05920421
Author(s):  
Ziv Harel ◽  
Eric McArthur ◽  
Nivethika Jeyakumar ◽  
Manish Sood ◽  
Amit Garg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Lower Risk ◽  
Propensity Scores ◽  
Proportional Hazards ◽  
Oral Anticoagulants ◽  
Kidney Injury ◽  
International Normalized Ratio ◽  
Population Based ◽  
Cox Proportional Hazards

Background: Anticoagulation with either with a vitamin K antagonist or a direct oral anticoagulant (DOAC) may be associated with acute kidney injury (AKI). Our objective was to assess the risk of AKI among elderly individuals with atrial fibrillation (AF) newly prescribed a DOAC (dabigatran, rivaroxaban, or apixaban) versus warfarin. Methods: A population-based cohort study of 20,683 outpatients in Ontario, Canada, ≥66 years, with atrial fibrillation who were prescribed warfarin, dabigatran, rivaroxaban or apixaban between 2009- 2017. Inverse probability of treatment weighting based on derived propensity scores for the treatment with each DOAC was used to balance baseline characteristics among patients receiving each of the three DOACs, compared to warfarin. Cox proportional hazards regression was performed in the weighted population to compare the association between the prescribed anticoagulant and the outcomes of interest. The exposure was an outpatient prescription of warfarin, or one of the DOACs. The primary outcome was a hospital encounter with AKI, defined using KDIGO thresholds. Prespecified subgroup analyses were conducted by estimated glomerular filtration rate (eGFR) category, and by the percentage of international normalized ratio measurements in range, a validated marker of anticoagulation control. Results: : Each DOAC was associated with a significantly lower risk of AKI compared to warfarin (weighted HR 0.65; 95% CI 0.53 to 0.80 for dabigatran, weighted HR 0.85; 95% CI 0.73 to 0.98 for rivaroxaban; and weighted HR 0.81; 95% CI 0.72 to 0.93 for apixaban). In subgroup analysis, the lower risk of AKI associated with each DOAC was consistent across each eGFR strata. The risk of AKI was significantly lower among users of each of the DOACs compared to warfarin users who had a percentage of international normalized ratio measurements ≤56.1%. Conclusions: DOACs were associated with a lower risk of AKI compared to warfarin.

Risk of acute kidney injury in patients with HIV receiving proton pump inhibitors

2019 ◽  
Vol 8 (10) ◽  
pp. 781-790
Author(s):  
S Scott Sutton ◽  
Joseph Magagnoli ◽  
Tammy H Cummings ◽  
James W Hardin
Keyword(s):  
Acute Kidney Injury ◽  
Cohort Study ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Proportional Hazards ◽  
Proportional Hazards Model ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Increased Risk

Aims/patients & methods: To evaluate the risk of acute kidney injury (AKI) in patients with HIV receiving proton pump inhibitors (PPI) a cohort study was conducted utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Patients were followed from the index date until the earliest date of AKI, 120 days or end of study period, or death. Statistical analyses utilized a Cox proportional hazards model. Results: A total of 21,643 patients (6000 PPI and 15,643 non-PPI) met all study criteria. The PPI cohort had twice the risk of AKI compared with controls (2.12, hazard ratio: 1.46–3.1). Conclusion: A nationwide cohort study supported the relationship of an increased risk of AKI in patients receiving PPIs.

scholarly journals Evaluation of the Risk Factors for Acute Kidney Injury in Neonates Exposed to Antenatal Indomethacin

2020 ◽  
Vol 25 (7) ◽  
pp. 606-616
Author(s):  
Jennifer T. Pham ◽  
Jessica L. Jacobson ◽  
Kirsten H. Ohler ◽  
Donna M. Kraus ◽  
Gregory S. Calip
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Bloodstream Infection ◽  
Proportional Hazards ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Increased Risk ◽  
Patent Ductus

OBJECTIVE Evidence is limited about important maternal and neonatal risk factors that affect neonatal renal function. The incidence of acute kidney injury (AKI) and identification of associated risk factors in neonates exposed to antenatal indomethacin was studied. METHODS A retrospective cohort of neonates exposed to antenatal indomethacin within 1 week of delivery was analyzed for development of AKI up to 15 days of life. Adjusted hazard ratios (HRs) and 95% CIs for AKI risk were calculated in time-dependent Cox proportional hazards models. RESULTS Among 143 neonates with mean gestational age of 28.3 ± 2.4 weeks, AKI occurred in 62 (43.3%), lasting a median duration of 144 hours (IQR, 72–216 hours). Neonates with AKI had greater exposure to postnatal NSAIDs (48.4% vs 9.9%, p &lt; 0.001) and inotropes (37.1% vs 3.7%, p &lt; 0.001) compared with neonates without AKI. In multivariable-adjusted models, increased AKI risk was observed with antenatal indomethacin doses received within 24 to 48 hours (HR, 1.6; 95% CI, 1.28–1.94; p = 0.036) and &lt;24 hours (HR, 2.33; 95% CI, 1.17–4.64; p = 0.016) prior to delivery. Further, postnatal NSAIDs (HR, 2.8; 95% CI, 1.03–7.61; p = 0.044), patent ductus arteriosus (HR, 4.04; 95% CI, 1.27–12.89; p = 0.018), and bloodstream infection (HR, 3.01; 95% CI, 1.37–6.60; p = 0.006) were associated significantly with increased risk of AKI following antenatal indomethacin. Neonates with AKI experienced more bloodstream infection, severe intraventricular hemorrhage, patent ductus arteriosus, respiratory distress syndrome, and longer hospitalization. CONCLUSIONS Extended risk of AKI with antenatal indomethacin deserves clinical attention among this population at an already increased AKI risk.

scholarly journals P0309IMPACT OF ACUTE KIDNEY INJURY ON CLINICAL COURSE AND TREATMENT RESPONSE IN PATIENTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hiroki Okushima ◽  
Yukimasa Iwata ◽  
Taisuke Takatsuka ◽  
Daisuke Yoshimura ◽  
Tomohiro Kawamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Proportional Hazards ◽  
Clinical Course ◽  
Kidney Injury ◽  
Minimal Change Nephrotic Syndrome ◽  
Cox Proportional Hazards ◽  
Minimal Change ◽  
Factors Associated ◽  
The Mean

Abstract Background and Aims Minimal change nephrotic syndrome (MCNS) has acute onset and is occasionally complicated with acute kidney injury (AKI) in its clinical course. Few studies concerning factors associated with AKI and impact of AKI on clinical course and response to treatments are available to date. Thus, we assessed the prevalence of and factors associated with AKI and its effect on clinical course in MCNS patients. Method Single center retrospective cohort study was conducted on 72 biopsy-proven MCNS patients presented to Osaka General Medical Center, between January 2006 and December 2016. Multivariate logistic regression analysis and Cox proportional hazards analysis were used to assess contributing factors to AKI and its effect on the duration until remission. Results Median age was 58 years and 50% were male. At first presentation, the mean albumin and total cholesterol were 1.7±0.5g/dl and 402±118mg/dl, respectively. The mean urinary protein and eGFR were 12.8±8.2g/gCr and 60.1±29.4ml/min/1.73m2, respectively. A total of 29 patients (40%) had AKI and 10 of them needed renal replacement therapy (RRT). Corticosteroid and cyclosporine A were used in 66 (91%) and 3 (4%) patients, respectively for initial treatment and 3 patients (4%) received neither. 67 patients (93%) achieved complete remission (CR) with a median duration of 18 days after treatment, while 20 of those relapsed during the median follow-up period of 38 months. Logistic regression analysis revealed that older age, lower albumin, and higher urinary protein were significantly associated with AKI. Furthermore, patients with AKI had longer duration to CR induction compared with those without AKI (Log-rank test: p=0.03). Cox proportional hazards analysis showed that older age and RRT induction were associated with the delay of CR. Conclusion AKI occasionally occurs in patients with MCNS and need for RRT is associated with the delay of CR.

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