Higher Ambient Nitrogen Dioxide Is Associated With An Elevated Risk Of Hospital-Acquired Acute Kidney Injury

Abstract Background Previous studies have suggested that long-term exposure to air pollution increased the risk of chronic kidney disease and its progression. However, the effect of air pollution on the risk of acute kidney injury (AKI) has not been studied. We aim to evaluate the transient effect of air pollution on the risk of hospital-acquired AKI (HA-AKI). Methods We selected from the Epidemiology of AKI in Chinese Hospitalized patients (EACH2 study) AKI cases of which the onset date could be unambiguously determined. We obtained city-specific daily averages of the ambient level of particulate matter (PM2.5 and PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2) and ozone (O3), from the Ministry of Environmental Protection of China. We used the time-stratified case crossover approach to examine the association between the ambient level of air pollutants and the risk of HA-AKI in the selected cases. Results A total of 11,293 AKI cases that met the inclusion and exclusion criteria were selected. In univariable analysis, the ambient levels of NO2 and SO2, were significantly associated with the risk of HA-AKI. In the multivariable analysis that incorporated all six pollutants in the same model, NO2 was the sole pollutant whose level remained to be associated with the risk of AKI (p < 0.001). The relationship between level of NO2 and the risk of HA-AKI appeared to be linear, with an estimated odds ratio of 1.063 (95% CI: 1.026, 1.101) for each increment of one median absolute deviance in the exposure. The association was consistent across the subgroups stratified by age, gender, baseline estimated glomerular filtration rate, AKI severity, need for intensive care, and season. Conclusions Higher ambient level of NO2 was associated with an increased risk of HA-AKI in hospitalized adults in China.

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Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

Journal of Clinical Medicine ◽

10.3390/jcm10102151 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2151

Author(s):

Rita Pavasini ◽

Matteo Tebaldi ◽

Giulia Bugani ◽

Elisabetta Tonet ◽

Roberta Campana ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Multivariable Analysis ◽

Kidney Injury ◽

Coronary Intervention ◽

Pooled Analysis ◽

Coronary Syndrome ◽

Risk Of Mortality ◽

Increased Risk ◽

Short Term Mortality

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

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Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab044 ◽

2021 ◽

Author(s):

Andrew M Vekstein ◽

Babtunde A Yerokun ◽

Oliver K Jawitz ◽

Julie W Doberne ◽

Jatin Anand ◽

...

Keyword(s):

Acute Kidney Injury ◽

Circulatory Arrest ◽

Aortic Surgery ◽

Multivariable Analysis ◽

Kidney Injury ◽

Deep Hypothermia ◽

Moderate Hypothermia ◽

Bladder Temperature ◽

Increased Risk ◽

The Impact

Abstract OBJECTIVES The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS A total of 85% (n = 645) of patients underwent deep hypothermia (14.1–20.0°C), 11% (n = 83) low-moderate hypothermia (20.1–24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1–28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1–34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.

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CIRP Secretion during Cardiopulmonary Bypass Is Associated with Increased Risk of Postoperative Acute Kidney Injury

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0041-1730450 ◽

2021 ◽

Author(s):

Wenyan Liu ◽

Yang Yan ◽

Dan Han ◽

Yongxin Li ◽

Qian Wang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Rna Binding ◽

Multivariable Analysis ◽

Kidney Injury ◽

Proinflammatory Response ◽

Increased Risk ◽

Before And After ◽

The Difference

Abstract Background Systemic inflammation contributes to cardiac surgery–associated acute kidney injury (AKI). Cardiomyocytes and other organs experience hypothermia and hypoxia during cardiopulmonary bypass (CPB), which induces the secretion of cold-inducible RNA-binding protein (CIRP). Extracellular CIRP may induce a proinflammatory response. Materials and Methods The serum CIRP levels in 76 patients before and after cardiac surgery were determined to analyze the correlation between CIRP levels and CPB time. The risk factors for AKI after cardiac surgery and the in-hospital outcomes were also analyzed. Results The difference in the levels of CIRP (ΔCIRP) after and before surgery in patients who experienced cardioplegic arrest (CA) was 26-fold higher than those who did not, and 2.7-fold of those who experienced CPB without CA. The ΔCIRP levels were positively correlated with CPB time (r = 0.574, p < 0.001) and cross-clamp time (r = 0.54, p < 0.001). Multivariable analysis indicated that ΔCIRP (odds ratio: 1.003; 95% confidence interval: 1.000–1.006; p = 0.027) was an independent risk factor for postoperative AKI. Patients who underwent aortic dissection surgery had higher levels of CIRP and higher incidence of AKI than other patients. The incidence of AKI and duration of mechanical ventilation in patients whose serum CIRP levels more than 405 pg/mL were significantly higher than those less than 405 pg/mL (65.8 vs. 42.1%, p = 0.038; 23.1 ± 18.2 vs. 13.8 ± 9.2 hours, p = 0.007). Conclusion A large amount of CIRP was released during cardiac surgery. The secreted CIRP was associated with the increased risk of AKI after cardiac surgery.

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Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

Kidney & Blood Pressure Research ◽

10.1159/000511946 ◽

2020 ◽

Vol 45 (6) ◽

pp. 1018-1032

Author(s):

Imran Chaudhri ◽

Richard Moffitt ◽

Erin Taub ◽

Raji R. Annadi ◽

Minh Hoai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Invasive Mechanical Ventilation ◽

Multivariable Analysis ◽

Kidney Injury ◽

Hospitalized Patients ◽

Hospital Death ◽

Study Cohort ◽

Icu Admission ◽

Risk Of Death ◽

Increased Risk

Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ2 test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

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Abstract WMP100: Excessive Blood Pressure Reduction Increases the Risk of Acute Kidney Injury After Intracerebral Hemorrhage

Stroke ◽

10.1161/str.51.suppl_1.wmp100 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Kenichi Irie ◽

Kaori Miwa ◽

Kanta Tanaka ◽

Hajime Ikenouchi ◽

Masafumi Ihara ◽

...

Keyword(s):

Blood Pressure ◽

Acute Kidney Injury ◽

Intracerebral Hemorrhage ◽

Characteristic Curve ◽

Blood Pressure Reduction ◽

Multivariable Analysis ◽

Kidney Injury ◽

Hospital Death ◽

Stroke Registry ◽

Increased Risk

Background: Elevated blood pressure (BP) in the first 24 hours of admission of acute intracerebral hemorrhage (ICH) has been the focus of intensive therapeutic investigation, although early intensive BP lowering addresses a concern about development of acute kidney injury (AKI). However, it is unclear as to the effect of BP measure including the absolute BP reduction and increased BP variability on AKI in patients with acute ICH. Methods: We retrieved data of consecutive patients with acute ICH from our prospective stroke registry between July 2015 and August 2017. We excluded patients with preexisting end-stage renal disease or in-hospital death within 24 hours. The primary outcome was AKI within 7days after admission defined using the AKI Network criteria. We recorded BP on emergency department arrival and for every 1 hour from 1 to 24 hours after admission (25 measurements). We measured mean systolic BP (SBP) and maximum minus minimum SBP within both 12 hours and 24 hours, and also quantified SBP variabilities (SBPV) including standard deviation, coefficient of variation, successive variation, and average real variability. Results: Among 361 patients with ICH (age 72.7±12.8, male 55%, non-lobar 76%), 31 (9%) developed AKI. For all SBP measure, the 12-hour SBP reduction was associated with the increased risk of AKI in multivariable analysis (odds ratio [per10 mmHg increase] 1.30; 95% CI 1.10-1.35). There was no significant association between the SBP variability and risk of AKI. The area under the receiver operating characteristic curve of the 12-hour SBP reduction for predicting AKI was 0.75. The association between the 12-hour SBP reduction and AKI was not modified by preexisting chronic kidney disease (interaction P=0.40). Conclusion: Early BP reduction in the first 12 hours of admission contributed to the risk of AKI in acute ICH. This may have clinical implication to avoid excess absolute BP reduction in patients with acute ICH.

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Serum Uric Acid and Risk for Acute Kidney Injury Following Contrast

Angiology ◽

10.1177/0003319716644395 ◽

2016 ◽

Vol 68 (2) ◽

pp. 132-144 ◽

Cited By ~ 17

Author(s):

Mehmet Kanbay ◽

Yalcin Solak ◽

Baris Afsar ◽

Ionut Nistor ◽

Gamze Aslan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Clinical Trials ◽

Uric Acid ◽

Cohort Studies ◽

Meta Analysis ◽

Kidney Injury ◽

Significant Heterogeneity ◽

Increased Risk ◽

Hospital Acquired ◽

Significant Protective Effect

Contrast-induced acute kidney injury (CI-AKI) is a common cause of hospital-acquired acute kidney injury (AKI). We evaluated the evidence that uric acid (UA) plays a pathogenic role in CI-AKI. Ten studies were eligible for inclusion for meta-analysis. Hyperuricemia predicted risk for cases with AKI in prospective cohort studies. Higher levels of serum UA (SUA), as defined by the authors, were associated with a 2-fold increased risk to develop AKI (pooled odds ratio 2.03; 95% confidence interval [CI] 1.48-2.78). Significant heterogeneity was found in cohort studies ( P = .001, I2 = 85.7%). In 2 clinical trials, lowering of SUA with saline hydration was significantly associated with reduced risk for AKI compared with saline hydration alone or saline hydration with N-acetyl cysteine. An analysis of 2 randomized controlled trials found that allopurinol with saline hydration had a significant protective effect on renal function (assessed by serum creatinine values) compared with hydration alone (mean difference: −0.52 mg/dL; 95% CI: −0.81 to −0.22). Hyperuricemia independently predicts CI-AKI. Two clinical trials suggest lowering SUA may prevent CI-AKI. The mechanism by which UA induces CI-AKI is likely related to acute uricosuria.

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Acute kidney injury associated with immune checkpoint inhibitor therapy: incidence, risk factors and outcomes

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2019-000467 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000467 ◽

Cited By ~ 1

Author(s):

Alejandro Meraz-Muñoz ◽

Eitan Amir ◽

Pamela Ng ◽

Carmen Avila-Casado ◽

Claire Ragobar ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Angiotensin Receptor Blockers ◽

Multivariable Analysis ◽

Kidney Injury ◽

Baseline Serum ◽

Increased Risk ◽

Incidence Risk

BackgroundImmune checkpoint inhibitors (ICPi) are a novel and promising anti-cancer therapy. There are limited data on the incidence, risk factors and outcomes of acute kidney injury (AKI) in patients receiving ICPi.MethodsWe conducted a cohort study of patients receiving ICPi at our center between 2010 and 2017 via electronic health record. The primary outcome was AKI (increase of >50% from baseline serum creatinine (sCr)). Risk factors for AKI were assessed using logistic regression. Survival among those with and without AKI was compared using the Kaplan-Meier method.ResultsAmong 309 patients on ICPi, 51 (16.5%) developed AKI (Kidney Disease Improving Global Outcomes (KDIGO) stages 1: 53%, 2: 22%, 3: 25%). AKI was associated with other immune-related adverse events (IRAE) (OR 3.2, 95% CI 1.6 to 6; p<0.001), hypertension (OR 4.3, 95% CI 1.8 to 6.1; p<0.001) and cerebrovascular disease (OR 9.2; 95% CI 2.1 to 40; p<0.001). Baseline sCr, cancer, and ICPi type was not associated with AKI. Use of angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (OR 2.9; 95% CI 1.5 to 5.7; p=0.002), diuretics (OR 4.3; 95% CI 1.9 to 9.8; p<0.001), and corticosteroid treatment (OR 1.9; 95% CI 1.1 to 3.6; p=0.03) were associated with AKI. In the multivariable analysis, AKI was associated only with other IRAE (OR 2.82; 95% CI 1.45 to 5.48; p=0.002) and hypertension (OR 2.96; 95% CI 1.33 to 6.59; p=0.008). AKI was not associated with increased risk of mortality (HR 1.1; 95% CI: 0.8 to 1.6; p=0.67). ICPi nephrotoxicity was attributed via biopsy or nephrologist assessment in 12 patients (six interstitial nephritis, two membranous nephropathy, two minimal change disease, and two thrombotic microangiopathy). Subsequent doses of ICPi were administered to 12 patients with prior AKI, with one (8.3%) having recurrent AKI.ConclusionAKI is a common complication in patients receiving ICPi treatment. The development of other IRAE and previous diagnosis of hypertension were associated with increased AKI risk. AKI was not associated with worse survival. Distinguishing kidney IRAE from other causes of AKI will present a frequent challenge to oncology and nephrology practitioners. Kidney biopsy should be considered to characterize kidney lesions and guide potential therapy.

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Gender differences in the susceptibility of hospital-acquired acute kidney injury: more questions than answers

International Urology and Nephrology ◽

10.1007/s11255-020-02526-7 ◽

2020 ◽

Vol 52 (10) ◽

pp. 1911-1914 ◽

Cited By ~ 1

Author(s):

Helmut Schiffl

Keyword(s):

Acute Kidney Injury ◽

Ischemia Reperfusion ◽

Critical Role ◽

Menopausal Status ◽

Kidney Injury ◽

Basic Research ◽

Epidemiological Studies ◽

Experimental Models ◽

Increased Risk ◽

Hospital Acquired

Abstract Hospital-acquired acute kidney injury (HA-AKI) is a heterogeneous renal syndrome which occurs in different clinical settings. It is characterized by multiple aetiologies, various pathogeneses and unpredictable outcomes. HA-AKI, once predominantly viewed as a self-limited and reversible short-term condition, is now recognized as a harbinger for chronic kidney disease and a cause of long-term morbidity with an increased risk of cardiovascular, renal and cancer mortality. Recent clinical studies contradict the generally held belief that female sex is a risk factor for HA-AKI. They show, consistent with basic research performed with experimental models of AKI, that only male sex is associated with HA-AKI. The presence of testosterone, more likely than the absence of estrogen, plays a critical role in sex differences in the susceptibility of ischemia/reperfusion kidney injury. The conflicting data in epidemiological studies related to sex as susceptibility variable for human AKI, underscore the need for more rigorous, well designed observational studies taking into account the menopausal status and hormone therapy.

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