Natriuretic peptide as a predictor of adverse renal outcomes in patients with acute kidney injury

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Chaikijurajai ◽  
S Demirjian ◽  
Y Wu ◽  
W Tang
Keyword(s):  
Acute Kidney Injury ◽  
Natriuretic Peptide ◽  
Cleveland Clinic ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Funding Source ◽  
Renal Outcomes ◽  
Cardiovascular Stress ◽  
Significant Difference ◽  
Acute Increase

Abstract Background Since cardiorenal syndrome has been increasingly recognised as the intense interaction between the heart and the kidneys, we hypothesised that in patients with acute kidney injury (AKI), a biomarker of cardiovascular stress and heart failure (HF), N-terminal pro-brain natriuretic peptide (NT-proBNP), can predict adverse renal outcomes. Purpose The purpose of this study was to investigate the ability of NT-proBNP to predict need for dialysis and dialysis dependence in patients with AKI. Methods We analysed the association between baseline NT-proBNP measured before renal consultation, and need for dialysis and dialysis dependence, using a cohort of 1,052 AKI patients admitted to the Cleveland Clinic between 2011 and 2016. AKI was defined as acute increase in serum creatinine (Cr) of at least 0.3 mg/dL or 50% from baseline. Dialysis dependence was defined as patients still need dialysis within 72 hours of discharge. Results Mean age was 65.8±13.6 years, 57% were male, 45.4% had chronic HF and 28.2% had chronic kidney disease (CKD). There was no significant difference in chronic HF, CKD, or baseline Cr between AKI patients with and without dialysis. Median NT-proBNP was 6,484.50 pg/mL (interquartile range 2,200.75–15,717.50 pg/mL). We observed that 43.1% had dialysis (among them 67.8% became dialysis dependence). After adjustment for age, gender, hypertension, and baseline Cr, higher NT-proBNP levels were associated with greater likelihood of needing dialysis [quartile (Q) 4 vs. 1, Odd ratio (OR) 1.98, 95% confidence interval (CI) 1.38–2.85, P<0.001] and dialysis dependence (Q 4 vs. 1, OR 2.63, 95% CI 1.41–4.9, P=0.002) (Figure 1). Conclusion Elevated NT-proBNP was independently associated with need for dialysis and dialysis dependence in patients with AKI. Figure 1 Funding Acknowledgement Type of funding source: None

Procalcitonin and N-Terminal Pro-B-Type Natriuretic Peptide for Prognosis in Septic Acute Kidney Injury Patients Receiving Renal Replacement Therapy

2019 ◽  
Vol 48 (3) ◽  
pp. 262-271 ◽  
Author(s):  
Xiaohua Sheng ◽  
Jingye Yang ◽  
Gang Yu ◽  
Yang Fei ◽  
Hongda Bao ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Natriuretic Peptide ◽  
Kidney Injury ◽  
University Hospital ◽  
Kaplan Meier ◽  
Septic Acute Kidney Injury ◽  
Significant Difference

Background: Sepsis is a complex clinical syndrome leading to severe sepsis and septic shock. It is very common in the intensive care unit with high mortality. Thus, judging its prognosis is extremely important. Procalcitonin (PCT) and ­N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels are commonly elevated in sepsis patients, but only a few are discussed in the septic acute kidney injury patients (AKI) who received renal replacement therapy (RRT). Our study is aimed at investigating the prognostic value of PCT and NT-proBNP in septic AKI patients who received RRT. Methods: This was a retrospective study of septic AKI patients who underwent RRT in a Chinese university hospital. All enrolled patients tested PCT and NT-proBNP at RRT initiation. PCT and NT-proBNP levels were compared between the survivors and non-survivors. Receiver operating characteristic (ROC) curves of the 2 biomarkers were performed for predicting in-hospital mortality. According to the median value of PCT (16.2 ng/mL) and NT-proBNP (10,271 pg/mL), patients were divided into 4 groups (low PCT and low NT-proBNP; high PCT and low NT-proBNP; low PCT and high NT-proBNP; high PCT and high NT-proBNP). The Kaplan-Meier survival curves were used to analyze the 28-day survival rate in the 4 groups. Results: A total of 81 patients were enrolled in the study. Of which, 48 (59.3%) patients died during hospitalization. The median of NT-proBNP in non-survivors was significantly higher than in survivors (p = 0.001), while PCT had no significant difference (p = 0.412). The area under the ROC curve of PCT and NT-proBNP for predicting in-hospital mortality was 0.561 (95% CI 0.426–0.695) and 0.729 (95% CI 0.604–0.854). Kaplan-Meier survival curve analysis showed that increased NT-proBNP level was associated with 28-day mortality while combined with PCT there was no statistical difference in 4 different level groups. Conclusion: NT-proBNP has a certain predictive value for the prognosis in septic AKI patients who received RRT. It seems that the initial PCT value for prognosis is limited. The combination of PCT and ­NT-proBNP to evaluate the prognosis in these critically ill patients is currently unclear.

scholarly journals Long Term Renal Outcomes in Children with Acute Kidney Injury Post-Cardiac Surgery

2021 ◽  
Author(s):  
Sidharth Kumar Sethi ◽  
Rajesh Sharma ◽  
Aditi Gupta ◽  
Abhishek Tibrewal ◽  
Romel Akole ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Injury ◽  
Renal Outcomes ◽  
Post Cardiac Surgery

scholarly journals P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
Keyword(s):  
Acute Kidney Injury ◽  
Quality Improvement ◽  
Colorectal Surgery ◽  
Prognostic Score ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Elective Colorectal Surgery ◽  
National Quality ◽  
Significant Difference ◽  
The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p<0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

scholarly journals 113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
C McCann ◽  
A Hall ◽  
J Min Leow ◽  
A Harris ◽  
N Hafiz ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Ward Round ◽  
Fluid Administration ◽  
Ward Staff ◽  
Intravenous Fluid Therapy ◽  
Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

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.

MO398DETERIORATION OF RENAL OUTCOMES AND INCREASED MORTALITY RISK DUE TO ACUTE KIDNEY INJURY AFTER ORTHOTOPIC LIVER TRANSPLANTATION: SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Boby Pratama Putra ◽  
Felix Nugraha Putra
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Cohort Studies ◽  
Orthotopic Liver Transplantation ◽  
Mortality Risk ◽  
Random Effect ◽  
Kidney Injury ◽  
Cochrane Library ◽  
Ckd Progression ◽  
Renal Outcomes

Abstract Background and Aims Orthotopic liver transplantation (OLT) procedure is increased as incremental end-stage liver disease patients’ prevalence. Acute kidney injury (AKI) is one of most common post-OLT complications that is associated with poor renal outcomes and increased mortality risk although the results are still inconclusive. This study aims to measure the risk of deterioration of renal outcomes and mortality risk due to AKI incidence in post-OLT patients. Method We did comprehensive searching using predefined terms in online databases of Pubmed, EMBASE, ScienceDirect, and The Cochrane Library, to include all relevant studies from 2000-2020. We included all cohort studies that reported AKI incidence in post-OLT patients and accessed the risk of 3-month renal replacement therapy (RRT) need, 1-year chronic kidney disease (CKD) progression, and 1-year mortality rate. We used The Newcastle-Ottawa Scale for cohort study for accessing bias risk. We conducted analysis to pooled risk ratio (RR) with 95% confidence interval (CI) using random-effect heterogeneity test. Results We included 10 cohort studies met our inclusion criteria. The AKI incidence significantly both increases the need of RRT in post-OLT patients (pooled RR = 8.41. 95% CI = 2.82 to 25.09, p = 0.0001, I2 = 0%) then leads the CKD progression in one year (pooled RR = 6.76. 95% CI = 2.03 to 22.51, p = 0.002, I2 = 84%). The post-OLT patients who suffered from AKI has significant incremental 1-year mortality risk (pooled RR = 7.27. 95% CI = 4.34 to 12.18, p&lt;0.00001, I2 = 5%). Conclusion The incidence of AKI in post-OLT patients significantly increase the deterioration of renal outcomes and mortality risks. However, further trials are needed to establish the causalities.

The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sameh Mohamed Ghaly ◽  
Moataz Serry Seyam ◽  
Mohamed Osama Aly ◽  
Ahmed Mohamed Hesham Abdelfattah ◽  
Ahmed R. Mashaal
Keyword(s):  
Acute Kidney Injury ◽  
Differential Diagnosis ◽  
Kidney Injury ◽  
Fractional Excretion ◽  
Final Diagnosis ◽  
Good Alternative ◽  
Decompensated Cirrhosis ◽  
Eligibility Criteria ◽  
Significant Difference ◽  
Cirrhotic Patients

Abstract Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P &lt; 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (&gt;33%) compared to lower cut-off values for PRA (&lt;33% and &gt;21%) and HRS (&lt;21%). Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding &gt;90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

scholarly journals Acute kidney injury in cardiorenal syndrome type 1: a meta-analysis

Critical Care ◽  
2014 ◽  
Vol 18 (Suppl 1) ◽  
pp. P364
Author(s):  
W Vandenberghe ◽  
S Gevaert ◽  
H Peperstraete ◽  
I Herck ◽  
J Decruyenaere ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Syndrome Type
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