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

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.

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

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.

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

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.

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

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

<b><i>Introduction:</i></b> 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. <b><i>Methods:</i></b> 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, <i>t</i> test, χ<sup>2</sup> test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. <b><i>Results:</i></b> 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, <i>p</i> = 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). <b><i>Conclusion:</i></b> Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

scholarly journals Renin–angiotensin system blocker use and the risk of acute kidney injury after colorectal cancer surgery: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032964
Author(s):  
Charlotte Slagelse ◽  
H Gammelager ◽  
Lene Hjerrild Iversen ◽  
Kathleen D Liu ◽  
Henrik T Toft Sørensen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Population Based ◽  
Adjusted Risk ◽  
Increased Risk ◽  
The Impact ◽  
Postoperative Aki

ObjectivesIt is unknown whether preoperative use of ACE inhibitors (ACE-I) or angiotensin receptor blockers (ARBs) affects the risk of acute kidney injury (AKI) after colorectal cancer (CRC) surgery. We assessed the impact of preoperative ACE-I/ARB use on risk of AKI after CRC surgery.DesignObservational cohort study. Patients were divided into three exposure groups—current, former and non-users—through reimbursed prescriptions within 365 days before the surgery. AKI within 7 days after surgery was defined according to the current Kidney Disease Improving Global Outcome consensus criteria.SettingPopulation-based Danish medical databases.ParticipantsA total of 9932 patients undergoing incident CRC surgery during 2005–2014 in northern Denmark were included through the Danish Colorectal Cancer Group Database.Outcome measureWe computed cumulative incidence proportions (risk) of AKI with 95% CIs for current, former and non-users of ACE-I/ARB, including death as a competing risk. We compared current and former users with non-users by computing adjusted risk ratios (aRRs) using log-binomial regression adjusted for demographics, comorbidities and CRC-related characteristics. We stratified the analyses of ACE-I/ARB users to address any difference in impact within relevant subgroups.ResultsTwenty-one per cent were ACE-I/ARB current users, 6.4% former users and 72.3% non-users. The 7-day postoperative AKI risk for current, former and non-users was 26.4% (95% CI 24.6% to 28.3%), 25.2% (21.9% to 28.6%) and 17.8% (17.0% to 18.7%), respectively. The aRRs of AKI were 1.20 (1.09 to 1.32) and 1.16 (1.01 to 1.34) for current and former users, compared with non-users. The relative risk of AKI in current compared with non-users was consistent in all subgroups, except for higher aRR in patients with a history of hypertension.ConclusionsBeing a current or former user of ACE-I/ARBs is associated with an increased risk of postoperative AKI compared with non-users. Although it may not be a drug effect, users of ACE-I/ARBs should be considered a risk group for postoperative AKI.

scholarly journals Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽  
2019 ◽  
Vol 23 (1) ◽  
Author(s):  
François Dépret ◽  
Clément Hoffmann ◽  
Laura Daoud ◽  
Camille Thieffry ◽  
Laure Monplaisir ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Smoke Inhalation ◽  
Logistic Regression Models ◽  
Increased Risk ◽  
The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

scholarly journals The impact of biomarkers of acute kidney injury on individual patient care

2019 ◽  
Vol 35 (8) ◽  
pp. 1295-1305 ◽  
Author(s):  
Jay L Koyner ◽  
Alexander Zarbock ◽  
Rajit K Basu ◽  
Claudio Ronco
Keyword(s):  
Acute Kidney Injury ◽  
Patient Care ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Functional Markers ◽  
Close Monitoring ◽  
Clinical Implementation ◽  
Care Bundles ◽  
Increased Risk ◽  
The Impact

Abstract Acute kidney injury (AKI) remains a common clinical syndrome associated with increased morbidity and mortality. In the last several years there have been several advances in the identification of patients at increased risk for AKI through the use of traditional and newer functional and damage biomarkers of AKI. This article will specifically focus on the impact of biomarkers of AKI on individual patient care, focusing predominantly on the markers with the most expansive breadth of study in patients and reported literature evidence. Several studies have demonstrated that close monitoring of widely available biomarkers such as serum creatinine and urine output is strongly associated with improved patient outcomes. An integrated approach to these biomarkers used in context with patient risk factors (identifiable using electronic health record monitoring) and with tests of renal reserve may guide implementation and targeting of care bundles to optimize patient care. Besides traditional functional markers, biochemical injury biomarkers have been increasingly utilized in clinical trials both as a measure of kidney injury as well as a trigger to initiate other treatment options (e.g. care bundles and novel therapies). As the novel measures are becoming globally available, the clinical implementation of hospital-based real-time biomarker measurements involves a multidisciplinary approach. This literature review discusses the data evidence supporting both the strengths and limitations in the clinical implementation of biomarkers based on the authors’ collective clinical experiences and opinions.

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

2021 ◽  
Author(s):  
Pinghong He ◽  
Ruixuan Chen ◽  
Liping Zhou ◽  
Yanqin Li ◽  
Licong Su ◽  
...  
Keyword(s):  
Air Pollution ◽  
Acute Kidney Injury ◽  
Nitrogen Dioxide ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Onset Date ◽  
Ambient Level ◽  
Increased Risk ◽  
Pm2.5 And Pm10 ◽  
Hospital Acquired

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 &lt; 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.

scholarly journals The Impact of Anti-Microbial Drug-Drug Interactions on Acute Kidney Injury after Allogeneic Hematopoietic Cell Transplantation

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 29-30
Author(s):  
Fumiya Wada ◽  
Yasuyuki Arai ◽  
Junya Kanda ◽  
Toshio Kitawaki ◽  
Masakatsu Hishizawa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Drug Interactions ◽  
Antimicrobial Agents ◽  
Hematopoietic Cell Transplantation ◽  
Kidney Injury ◽  
Time Dependent ◽  
Post Transplant ◽  
Increased Risk ◽  
The Impact

Introduction: Acute kidney injury (AKI) is one of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT), and several studies have demonstrated a relationship between poor outcome and the concomitant AKI in the early phase after allo-HCT. Among various post-transplant factors, usage of antimicrobial agents, especially in cases where multiple agents are combined, may be one of the major causes of post-transplant AKI, due the potential nephrotoxicity of each agent and drug-drug interactions. An association between the combination of vancomycin (VCM) with piperacillin/tazobactam (PIPC/TAZ) and increased risk of developing AKI after allo-HCT has been reported; however, no reports have demonstrated the impact of other combinations on post-transplant AKI. Herein, we performed a retrospective analysis to compare the incidence of AKI according to selected antimicrobial agents, using a database with information covering the time-dependent administrative status of all the agents involved. Methods: We included patients with hematological malignancies who received allo-HCT between 2006 and 2018 in Kyoto University, Kyoto, Japan to evaluate the incidence and risk factors of AKI early after transplantation (before Day100). The incidence of AKI was defined according to Acute Kidney Injury Network (AKIN) classification and evaluated, considering early death as a competing risk. Administrative status of each antimicrobial agent was treated as a time-dependent covariate, and the synergetic effects on AKI by multiple agents in combination were evaluated as p for interaction. Results: In total, 465 transplant cases (416 patients) were included. The median age at HCT was 49 years old (range, 17-70). Among these, 104 cases received a related-donor transplant (64 patients received bone marrow and 40 peripheral-blood stem cell grafts), 207 received a transplant from unrelated donors, and 154 received a single-unit cord-blood transplant. The median value for pre-transplant serum creatinine (sCr) was 0.6 (range, 0.20-1.68). The cumulative incidence of AKI at Day100 was 40.0%, and overall survival (OS) at 3 years after HCT was 43.5% in patients with AKI while 70.9% in those without AKI (hazard ratio [HR] = 2.63, 95% confidence interval = 1.95-3.55, p &lt; 0.01). Being male and having a higher pre-transplant sCr were significant risk factors for AKI (HR = 1.53, p &lt; 0.01 and HR = 4.21, p &lt; 0.01, respectively). After HCT, 34 types of oral or intravenous antimicrobial agents (17 antibiotics, 6 antivirals, and 11 antifungals) were utilized across the entire cohort. A higher incidence of AKI was significantly associated with the use of intravenous ciprofloxacin, foscarnet (FCN), ganciclovir (GCV), liposomal amphotericin B (L-AMB), meropenem (MEPM), PIPC/TAZ, and VCM (p &lt; 0.05). Next, we investigated the synergistic impacts of using anti-pseudomonal antibiotics and anti-methicillin resistant staphylococcus aureus (MRSA) agents, because empiric treatment of febrile neutropenia after HCT often relies on this combination, i.e. CFPM, PIPC/TAZ, or MEPM in combination with VCM or teicoplanin (TEIC). As a result, sole administration of VCM was associated with a higher incidence of AKI; this effect was enhanced when VCM was used in combination with PIPC/TAZ (HR = 3.03, p &lt; 0.01 for VCM without PIPC/TAZ; HR = 4.38, p &lt; 0.01 for VCM with PIPC/TAZ), indicating the existence of interaction between VCM and PIPC/TAZ. However, for the concomitant use of VCM plus CFPM or MEPM, no synergistic interaction was observed with regard to the increased incidence of AKI. In addition, administration of TEIC alone and any combination used with TEIC were not associated with an increased risk of AKI. An increased risk of AKI was also confirmed for the combination of MEPM plus GCV or FCN, and GCV plus L-AMB. Conclusions: AKI was significantly associated with poorer OS, and specific antimicrobial combinations were suggested to increase the risk of AKI. Avoidance of such combinations should be considered to preserve renal function and to reduce AKI-related morbidity and mortality. Disclosures No relevant conflicts of interest to declare.

scholarly journals Development and external validation of an acute kidney injury risk score for use in the general population

2020 ◽  
Vol 13 (3) ◽  
pp. 402-412
Author(s):  
Samira Bell ◽  
Matthew T James ◽  
Chris K T Farmer ◽  
Zhi Tan ◽  
Nicosha de Souza ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Risk Score ◽  
Validation Cohort ◽  
External Validation ◽  
Kidney Injury ◽  
Routinely Collected Data ◽  
C Statistic ◽  
Increased Risk ◽  
The Impact

Abstract Background Improving recognition of patients at increased risk of acute kidney injury (AKI) in the community may facilitate earlier detection and implementation of proactive prevention measures that mitigate the impact of AKI. The aim of this study was to develop and externally validate a practical risk score to predict the risk of AKI in either hospital or community settings using routinely collected data. Methods Routinely collected linked datasets from Tayside, Scotland, were used to develop the risk score and datasets from Kent in the UK and Alberta in Canada were used to externally validate it. AKI was defined using the Kidney Disease: Improving Global Outcomes serum creatinine–based criteria. Multivariable logistic regression analysis was performed with occurrence of AKI within 1 year as the dependent variable. Model performance was determined by assessing discrimination (C-statistic) and calibration. Results The risk score was developed in 273 450 patients from the Tayside region of Scotland and externally validated into two populations: 218 091 individuals from Kent, UK and 1 173 607 individuals from Alberta, Canada. Four variables were independent predictors for AKI by logistic regression: older age, lower baseline estimated glomerular filtration rate, diabetes and heart failure. A risk score including these four variables had good predictive performance, with a C-statistic of 0.80 [95% confidence interval (CI) 0.80–0.81] in the development cohort and 0.71 (95% CI 0.70–0.72) in the Kent, UK external validation cohort and 0.76 (95% CI 0.75–0.76) in the Canadian validation cohort. Conclusion We have devised and externally validated a simple risk score from routinely collected data that can aid both primary and secondary care physicians in identifying patients at high risk of AKI.

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