scholarly journals Acute kidney injury after thoracic surgery: a proposal for a multicentre evaluation (MERITS)

2019 ◽  
Vol 29 (6) ◽  
pp. 861-866
Author(s):  
Vinci Naruka ◽  
Mikel A Mckie ◽  
Rasoel Khushiwal ◽  
James Clayton ◽  
Giuseppe Aresu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Thoracic Surgery ◽  
Thoracoscopic Surgery ◽  
Age Groups ◽  
Kidney Injury ◽  
Staging System ◽  
Pilot Project ◽  
Old Patients ◽  
Significant Difference

Abstract OBJECTIVES Because the mortality rate is very low in thoracic surgery, its use as a quality discriminator is limited. Acute kidney injury (AKI) is a candidate measure because it is associated with increased rates of morbidity and mortality and is partly preventable. The incidence of AKI after thoracic surgery is not well documented. We conducted an audit to determine the incidence and outcomes of AKI. This audit became a pilot project, and the results indicate the feasibility of a larger study. METHODS Retrospective data on renal function post-thoracic surgery were collected at a tertiary cardiothoracic unit over 12 months. Renal impairment was classified according to the Kidney Disease Improving Global Outcomes criteria. RESULTS Of 568 patients (mean = 59  ±  SD 18; 38% women), AKI was diagnosed in 86 (15.1%) within 72 h post-thoracic surgery based on the Kidney Disease Improving Global Outcomes staging system (stage 1, n = 55; stage 2, n = 25; stage 3, n = 6). Significant differences were found in postoperative length of stay (3 vs 5 days; P < 0.001) of patients with and without AKI. There was a significant difference between the age groups of patients with and without AKI (P < 0.05) in the open surgical group but not in the group having video-assisted thoracoscopic surgery (VATS). There was no significant difference in the mortality rates between patients with and without AKI. CONCLUSIONS The incidence of AKI after thoracic surgery was 15.1%. AKI was associated with longer hospital stays and was more likely in ≥60-year-old patients after open surgery than after VATS. Reducing AKI could improve patient outcomes. We propose that AKI may be a useful quality measure in thoracic surgery. We are developing a multicentre audit based on this approach.

Management of acute kidney injury and chronic kidney disease

2017 ◽  
pp. 1087-1096
Author(s):  
Natalie Ebert ◽  
Elke Schaeffner
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Staging System ◽  
Kidney Damage ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Both acute and chronic states of kidney disease have considerable healthcare impact as they can produce enormous disease burden and costs. To classify chronic kidney disease into the CKD staging system, glomerular filtration rate as an index of kidney function, as well as albuminuria as a marker of kidney damage have to be assessed as correctly as possible. Misclassification is a serious concern due to the difficulties in precise GFR assessment and correct interpretation of results. Differentiating between pure senescence and true disease among older adults can be a delicate issue. To find the right renal replacement option for individuals that progress to end-stage renal disease can be challenging, and some older patients may even benefit from conservative care without dialysis. To prevent acute kidney injury as a frequent and potentially life-threatening complication, clinicians need to develop an understanding of the common vulnerability to kidney damage among older adults.

scholarly journals Acute kidney injury in children with chronic kidney disease is associated with faster decline in kidney function

2020 ◽  
Author(s):  
Nabil Melhem ◽  
Pernille Rasmussen ◽  
Triona Joyce ◽  
Joanna Clothier ◽  
Christopher J. D. Reid ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Kidney Injury ◽  
End Point ◽  
Significant Difference

Abstract Background This study aimed to investigate the association of acute kidney injury (AKI) with change in estimated glomerular filtration rate (eGFR) in children with advanced chronic kidney disease (CKD). Methods Single centre, retrospective longitudinal study including all prevalent children aged 1–18 years with nondialysis CKD stages 3–5. Variables associated with CKD were analysed for their potential effect on annualised eGFR change (ΔGFR/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated. Results Of 147 children, 116 had at least 1-year follow-up in a dedicated CKD clinic with mean age 7.3 ± 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 ± 11.9 ml/min/1.73 m2 with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean ΔGFR/year for all patients was − 1.08 ± 5.64 ml/min/1.73 m2 but reduced significantly from 2.03 ± 5.82 to − 3.99 ± 5.78 ml/min/1.73 m2 from youngest to oldest age tertiles (P < 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, P = 0.048) but no difference in AKI incidence (37% versus 31%, P = 0.85) between age tertiles. Multiple regression analysis identified age (β = − 0.53, P < 0.001) and AKI (β = − 3.2, P = 0.001) as independent predictors of ΔGFR/year. 48.7% versus 22.1% with and without AKI reached composite end-point (P = 0.01). Conclusions We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction. Graphical abstract

scholarly journals Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yujie Dai ◽  
Zhifen Liu ◽  
Xingguo Du ◽  
Honglan Wei ◽  
Yang Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Outcome Data ◽  
Study Results ◽  
Significant Difference ◽  
Novel Coronavirus

Background. Since the first diagnosed case of infection with the novel coronavirus (SARS-CoV-2), there has been a rapid spread of the disease with an increasing number of cases confirmed every day, as well as a rising death toll. An association has been reported between acute kidney injury (AKI) and mortality in patients infected with SARS-CoV-2. Therefore, our study was conducted to explore possible risk factors of AKI as well as whether AKI was a risk factor for worse outcome, especially mortality among patients with coronavirus disease (COVID-19). Methods. We included all hospital admissions with confirmed or clinically diagnosed COVID-19 from January 29 to February 25, 2020. We collected demographic and epidemiological information, past medical history, symptoms, laboratory tests, treatments, and outcome data from electronic medical records. A total of 492 patients with diagnosed or clinically diagnosed COVID-19 were included in this study. Results. The prevalence rate of AKI was 7.32%. Among the factors associated with AKI, males versus females (aOR 2.73), chronic kidney disease (aOR 42.2), hypertension (aOR 2.82), increased leucocytes (aOR 6.08), and diuretic use (aOR 7.89) were identified as independent risk factors for AKI among patients infected by SARS-CoV-2. There was a significant difference in hospital fees and death in patients with and without AKI ( p < 0.05 ). The mortality rate in patients with AKI was 63.9%. Conclusions. AKI was widespread among patients with COVID-19. The risk factors of AKI in COVID-19 patients included sex, chronic kidney disease, hypertension, infection, and diuretic use. AKI may be associated with a worse outcome, especially mortality in COVID-19 patients.

scholarly journals 212. Acute Kidney Injury with Piperacillin-tazobactam versus Cefepime in Combination with Vancomycin

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S109-S109
Author(s):  
Phuong Khanh Nguyen ◽  
Thuong Tran ◽  
Kristy Jetsupphasuk ◽  
Nina Wang ◽  
Patricia Chun ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Length Of Stay ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Kidney Injury ◽  
Hospital Length Of Stay ◽  
Increased Risk ◽  
Significant Difference ◽  
Time To Onset

Abstract Background Drug-induced nephrotoxicity in the form of acute kidney injury (AKI) is a potential adverse effect of vancomycin, which is commonly prescribed empirically with an antipseudomonal agent. It is unclear if combinations with certain antipseudomonal agents (e.g., piperacillin-tazobactam) are associated with more AKI relative to others. Methods This retrospective cohort study conducted at two Veterans Affairs (VA) Medical Centers with differing preferred empiric vancomycin-antipseudomonal regimens aimed to assess the incidence of AKI in patients receiving vancomycin and piperacillin-tazobactam (VPT) at VA Greater Los Angeles Healthcare System (HCS) versus vancomycin and cefepime (VC) at VA Long Beach HCS. Patients who received VPT or VC for at least 48 hours in 2016–2018 were included. AKI definitions were derived from 2012 Kidney Disease Improving Global Outcomes guidelines. Secondary assessments included hospital length of stay, 90-day mortality, and incidence of Clostridioides difficile infection (CDI) within 90 days. Patients who developed AKI were further assessed for time-to-onset of AKI, development of chronic kidney disease (CKD) within 90 days, and hemodialysis (HD) dependence within 1 year. Statistical analysis was performed using Fisher’s exact and Mann-Whitney U tests where appropriate. Propensity score matching using logistic regression with nearest-neighbor matching was performed to control for potential confounding baseline characteristics. Results 21/120 patients receiving VPT developed AKI vs. 4/120 receiving VC (17.5% vs. 3.3%, p=0.0005). After propensity score matching, AKI incidence remained significantly higher for VPT patients (15.2% vs. 4.0%, p=0.01). Median length of stay was significantly longer for VPT patients (10 days vs. 8 days, p=0.03). There was no significant difference in time-to-onset of AKI, 90-day mortality, or CDI. No significant difference was found in the development of CKD within 90 days nor the requirement of HD within 1 year. Conclusion VPT combination therapy was associated with increased incidence of AKI compared to VC, though 90-day mortality and other outcomes were similar. Advising prescribers about potentially increased risk of AKI with VPT is a viable stewardship intervention. Disclosures All Authors: No reported disclosures

Renal C3 Production Drives Acute Kidney Injury and Acute Kidney Disease in Diabetics with Sepsis

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1737-P
Author(s):  
LYNN M. FRYDRYCH ◽  
GUOWU BIAN ◽  
PETER A. WARD ◽  
MARKUS BITZER ◽  
MATTHEW DELANO
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Acute Kidney Disease

ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

2019 ◽  
Vol 72 (8) ◽  
pp. 1466-1472
Author(s):  
Grażyna Kobus ◽  
Jolanta Małyszko ◽  
Hanna Bachórzewska-Gajewska
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Elderly Patients ◽  
Older Patients ◽  
Age Groups ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients ◽  
Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

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