Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study

Abstract Background The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG). Methods Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr >0.3 mg/dL or >50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality. Results Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47). Conclusions Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG. FUNDunding Acknowledgement Type of funding sources: None. Association of AKI and mortality Subgroups analysis

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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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Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation

American Journal of Perinatology ◽

10.1055/s-0039-3400311 ◽

2019 ◽

Vol 37 (03) ◽

pp. 341-348 ◽

Cited By ~ 6

Author(s):

Michelle C. Starr ◽

Louis Boohaker ◽

Laurie C. Eldredge ◽

Shina Menon ◽

Russell Griffin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Bronchopulmonary Dysplasia ◽

Premature Infants ◽

Gestational Age ◽

Odds Ratio ◽

Retrospective Cohort ◽

Primary Outcome ◽

Secondary Analysis ◽

Kidney Injury ◽

Multiple Factors

Abstract Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA). Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality. Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001). Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.

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

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 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

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Vancomycin Area Under the Curve and Acute Kidney Injury: A Meta-analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciz051 ◽

2019 ◽

Vol 69 (11) ◽

pp. 1881-1887 ◽

Cited By ~ 25

Author(s):

Doaa M Aljefri ◽

Sean N Avedissian ◽

Nathaniel J Rhodes ◽

Michael J Postelnick ◽

Kevin Nguyen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Primary Outcome ◽

Meta Analysis ◽

Area Under The Curve ◽

Kidney Injury ◽

Monitoring Strategy ◽

Case Control Studies ◽

Time Curve ◽

The Impact ◽

The Relationship

Abstract Background This study analyzed the relationship between vancomycin area under the concentration-time curve (AUC) and acute kidney injury (AKI) reported across recent studies. Methods A systematic review of PubMed, Medline, Scopus, and compiled references was conducted. We included randomized cohort and case-control studies that reported vancomycin AUCs and risk of AKI (from 1990 to 2018). The primary outcome was AKI, defined as an increase in serum creatinine of ≥0.5 mg/L or a 50% increase from baseline on ≥2 consecutive measurements. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Primary analyses compared the impact of AUC cutpoint (greater than ~650 mg × hour/L) and AKI. Additional analysis compared AUC vs trough-guided monitoring on AKI incidence. Results Eight observational studies met inclusion/exclusion criteria with data for 2491 patients. Five studies reported first-24-hour AUCs (AUC0-24) and AKI, 2 studies reported 24- to 48-hour AUCs (AUC24-48) and AKI, and 2 studies reported AKI associated with AUC- vs trough-guided monitoring. AUC less than approximately 650 mg × hour/L was associated with decreased AKI for AUC0-24 (OR, 0.36 [95% CI, .23–.56]) as well as AUC24-48 (OR, 0.45 [95% CI, .27–.75]). AKI associated with the AUC monitoring strategy was significantly lower than trough-guided monitoring (OR, 0.68 [95% CI, .46–.99]). Conclusions AUCs measured in the first or second 24 hours and lower than approximately 650 mg × hour/L may result in a decreased risk of AKI. Vancomycin AUC monitoring strategy may result in less vancomycin-associated AKI. Additional investigations are warranted.

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Acute Kidney Injury before Dialysis Initiation Predicts Adverse Outcomes in Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000489949 ◽

2018 ◽

Vol 47 (6) ◽

pp. 427-434 ◽

Cited By ~ 1

Author(s):

Timmy Lee ◽

Silvi Shah ◽

Anthony C. Leonard ◽

Pratik Parikh ◽

Charuhas V. Thakar

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

The United States ◽

Hemodialysis Patients ◽

Adverse Outcomes ◽

Study Cohort ◽

All Cause Mortality ◽

Arteriovenous Access ◽

The Impact ◽

Esrd Patients

Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality. Mortality in end-stage renal disease (ESRD) patients is highest during the first year of dialysis. The impact of pre-ESRD AKI events on long-term outcomes in incident ESRD patients remains unknown. Methods: We evaluated a retrospective cohort of 47,341 incident hemodialysis patients from the United States Renal Data System with linked Medicare data for at least 2 years prior to hemodialysis initiation. We examined the impact of pre-ESRD AKI events in the 2-year pre-ESRD period on the type of vascular access used at hemodialysis initiation (central venous catheter (CVC) versus arteriovenous access), and 1-year all-cause mortality after initiating hemodialysis. Results: The mean age was 72 ± 11 years. Of the study cohort, 18% initiated hemodialysis with arteriovenous access, and 54% of patients had at least one pre-ESRD AKI event. One-year, all-cause mortality was 32%. Compared to 75% for patients without a pre-ESRD AKI event, 89% of patients with a pre-ESRD AKI event initiated hemodialysis with CVC than arteriovenous access (p < 0.001). A pre-ESRD AKI event was associated with lower adjusted odds of starting hemodialysis with an arteriovenous access (OR 0.47; 95% CI 0.44–0.50, p < 0.001), and higher adjusted odds of 1-year mortality (OR 1.36; 95% CI 1.30–1.42, p < 0.001). Conclusion: An AKI event prior to initiating hemodialysis independently increases the risk of CVC use and predicts 1-year mortality. Improving processes of care after AKI events may improve dialysis outcomes in patients who progress to ESRD.

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Impact of bioprosthetic valve type on peri-procedural myocardial injury and mortality after transcatheter aortic valve replacement

Heart and Vessels ◽

10.1007/s00380-021-01861-8 ◽

2021 ◽

Author(s):

Vincenzo De Marzo ◽

Gabriele Crimi ◽

Matteo Vercellino ◽

Stefano Benenati ◽

Fabio Pescetelli ◽

...

Keyword(s):

Valve Replacement ◽

Myocardial Injury ◽

Multivariable Analysis ◽

Academic Research ◽

Kidney Injury ◽

Bleeding Complications ◽

Reference Limit ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

The Impact

AbstractPeri-procedural myocardial injury (PPMI) is a common complication after transcatheter valve replacement (TAVR), often remaining clinically silent. The role of valve type on PPMI and the association between PPMI and mortality are still unclear. We sought to evaluate predictors and outcome of PPMI after TAVR, and the impact of self-expandable valve (SEV) vs. balloon-expandable valve (BEV) deployment on PPMI. Consecutive patients who underwent successful TAVR in a single-center from January 2014 to December 2019 were included. PPMI was defined according to a modified Valve Academic Research Consortium (VARC)-2 definition as a post-procedure elevation of troponin (with a peak value ≥ 15-times the upper-reference limit) < 72 h after TAVR. We included 596 patients, of whom 258 (43.3%) were men. Mean age was 83.4 ± 5.5 years. We deployed 368 (61.7%) BEV and 228 (38.3%) SEV. PPMI was observed in 471 (79.0%) patients. At multivariable analysis, SEV (OR 2.70, 95% CI 1.64–4.55, p < 0.001), creatinine clearance (OR 0.98, 95% CI 0.97–1.00, p = 0.011), and baseline ejection fraction (OR 1.05, 95% CI 1.02–1.07, p < 0.001) were independent predictors of PPMI; these findings were also confirmed using a propensity-weighted analysis. Thirty-day and 1-year all-cause mortality rates were 2.5% and 8.1%, respectively. No associations between PPMI and 30-day (p = 0.488) or 1-year (p = 0.139) all-cause mortality were found. Independent predictors of 30-day mortality were increasing EUROSCORE II (HR 1.16 per score point, 95% CI 1.08–1.19, p < 0.001) and life-threatening/major bleeding complications (HR 5.87, 95% CI 1.28–26.58, p = 0.019), whereas EUROSCORE II (HR 1.08, 95% CI 1.04–1.13, p = 0.031) and acute kidney injury (HR 2.59, 95% CI 1.20–5.35, p = 0.020) were related to 1-year mortality. PPMI is frequent after TAVR, but it does not affect 30-day or 1-year all-cause mortality. SEV implantation is associated with an increased frequency of PPMI.

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Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0000000000000765 ◽

2015 ◽

Vol 123 (3) ◽

pp. 515-523 ◽

Cited By ~ 246

Author(s):

Louise Y. Sun ◽

Duminda N. Wijeysundera ◽

Gordon A. Tait ◽

W. Scott Beattie

Keyword(s):

Acute Kidney Injury ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Primary Outcome ◽

Kidney Injury ◽

Noncardiac Surgery ◽

Intraoperative Hypotension ◽

Outcome Relationship ◽

Surgical Duration ◽

Postoperative Aki

Abstract Background: Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear. The authors investigated the association between varying periods of IOH with mean arterial pressure (MAP) less than 55, less than 60, and less than 65 mmHg with AKI. Methods: The authors conducted a retrospective cohort study of 5,127 patients undergoing noncardiac surgery (2009 to 2012) with invasive MAP monitoring and length of stay of 1 or more days. Exclusion criteria were preoperative MAP less than 65 mmHg, dialysis dependence, urologic surgery, and surgical duration less than 30 min. The primary exposure was IOH. The primary outcome was AKI (50% or 0.3 mg/dl increase in creatinine) during the first 2 postoperative days. Multivariable logistic regression was used to model the exposure–outcome relationship. Results: AKI occurred in 324 (6.3%) patients and was associated with MAP less than 60 mmHg for 11 to 20 min and MAP less than 55 mmHg for more than 10 min in a graded fashion. The adjusted odds ratio of AKI for MAP less than 55 mmHg was 2.34 (1.35 to 4.05) for 11- to 20-min exposure and 3.53 (1.51 to 8.25) for more than 20 min. For MAP less than 60 mmHg, the adjusted odds ratio for AKI was 1.84 (1.11 to 3.06) for 11- to 20-min exposure. Conclusions: In this analysis, postoperative AKI is associated with sustained intraoperative periods of MAP less than 55 and less than 60 mmHg. This study provides an impetus for clinical trials to determine whether interventions that promptly treat IOH and are tailored to individual patient physiology could help reduce the risk of AKI.

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Early vs late development of acute kidney injury and its prognostic relevance in ACS patients

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.160 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

B Sara ◽

JJ Monteiro ◽

P Carvalho ◽

C Ribeiro Carvalho ◽

J Chemba ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Composite Endpoint ◽

Prognostic Impact ◽

Mortality And Morbidity ◽

Coronary Syndrome ◽

Funding Sources ◽

Primary Endpoints ◽

All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute kidney injury (AKI) in acute coronary syndrome (ACS) patients is a well-known marker of worse prognosis. However, it remains unclear how timing of AKI development correlates with mortality and morbidity; Objective Assess the timing of AKI development and evaluate its short and long term prognostic impact. Methods Retrospective study of patients with ACS periodically included in our center registry between March/2013 and December/2018. AKIwas defined as increase in creatinine ≥0.3 mg/dl or ≥50% within 48 h after admission. Patients were classified into 3 groups according to the occurrence and timing of AKI development : no-AKI(NA), early-AKI(EA)(<48h) and late-AKI(LA) (>48 h). The primary endpoints were all cause mortality and a composite of all cause mortality, nonfatal myocardial infarction/stroke and readmission in the follow-up. Results We included 518 patients (67 ± 13 years; 73% males, 46% STEMI) of whom 17% developed AKI(8% EA and 9% LA). Patients with AKI, particularly EA, were older (NA: 67± 17; EA 80± 12; LA 74 ± 16, p< 0.001), had more hypertension, previous heart failure (9% vs 1.5%, p < 0.001) and dementia (7 vs 0.5%, p < 0.001). Coronariograhy was performed more often in NA patients (98%), followed by LA (100%) and lastly EA (87.5%), p < 0.001. During hospitalization, those who developed AKI had a higher Killip Kimball class (p = 0.043) and lower ejection fraction (EF) (p = 0.05). In-hospital mortality was significantly higher in patients with EA (12,5%) than LA (2.2%) or LA (2.3%)( p= 0.029) ; During a median follow-up of 35 months, the composite endpoint was particularly higher in the EA group, but no differences were found between LA and NA group. In multivariate analysis, only EA was an independent predictor of all-cause mortality (HR: 3.8 IC 95% 1.8-8.1, p = 0.001) and composite endpoint (HR:2.02 IC95%1.1-3.8; p = 0.032), even after adjusting for age, EF and Killip Kimball class; Conclusion In this population of ACS patients, AKI is a frequent complication and the timing of its development has major prognostic implications, since early AKI(<48h) is associated with worse outcomes. Curiously, mortality and CV events in patients with LA are not different from those who do not develop AKI.

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Adjuvant β-Lactam Therapy Combined with Vancomycin for Methicillin-ResistantStaphylococcus aureusBacteremia: Does β-Lactam Class Matter?

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02211-18 ◽

2019 ◽

Vol 63 (3) ◽

Cited By ~ 4

Author(s):

Thomas J. Dilworth ◽

Anthony M. Casapao ◽

Omar M. Ibrahim ◽

David M. Jacobs ◽

Dana R. Bowers ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Acute Kidney Injury ◽

Odds Ratio ◽

Observational Studies ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Content Type ◽

Pooled Data ◽

Persistent Bacteremia ◽

The Impact

ABSTRACTWe analyzed the impact of vancomycin (VAN) combined with adjuvant β-lactam therapy (Combo) on persistent (≥5 days) methicillin-resistantStaphylococcus aureusbacteremia versus VAN alone by using pooled data from two previously published observational studies (n = 156). Combo was inversely associated with persistent bacteremia (adjusted odds ratio, 0.460; 95% confidence interval, 0.229 to 0.923). Acute kidney injury was more common with Combo than with VAN (18.9% and 7.6%, respectively;P= 0.062).

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Incremental effect of complications on mortality and hospital costs in adult ECMO patients

Perfusion ◽

10.1177/02676591211005697 ◽

2021 ◽

pp. 026765912110056

Author(s):

Ankit Dhamija ◽

Dylan Thibault ◽

James Fugett ◽

Heather K Hayanga ◽

Paul McCarthy ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Bloodstream Infection ◽

Primary Outcome ◽

Linear Regression Analysis ◽

Hospital Costs ◽

Kidney Injury ◽

Central Line ◽

Incremental Effect ◽

The Impact

Introduction: Extracorporeal membrane oxygenation (ECMO) is a resource-intense modality whose usage is expanding rapidly. It is a costly endeavor and best conducted in a multidisciplinary setting. There is a growing impetus to mitigate the mortality and costs associated with ECMO. We sought to examine the impact of complications on mortality and hospital costs in patients on ECMO. Methods: Using the NIS database, we performed multivariable logistic regression to assess the influence of complications on the primary outcome, in-hospital mortality. Similarly, we performed multivariable survey linear regression analysis to evaluate the effect of the complications on hospital costs. Results: Of the 12,637 patients supported using ECMO between 2004 and 2013, 9836 (78%) developed at least one complication. The three most common complications were acute kidney injury (32.8%), bloodstream infection (31.8%), and bleeding (27.8%). An ECMO hospitalization with no complications was associated with median costs of $53,470, a single complication with costs of $97,560, two complications with costs of $139,035, and three complication with costs of $162,284. A single complication was associated with a 165% increase in odds of mortality. Two or three complications resulted in 375% or 627% higher odds of mortality, respectively. Having one, two, or three complications was associated with 24%, 38%, or 38% increase in median costs respectively (Figure 1). Complications associated with the highest median costs were central line-associated bloodstream infection $217,751; liver failure $176,201; bloodstream infection $169,529. Conclusion: In-hospital mortality and costs increase with each incremental complication in patients on ECMO. Accurate prediction and mitigation of complications is likely to improve outcomes and cost.

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