P0646PREDICTABLE CAPACITY OF ACUTE KIDNEY INJURY OF NEPHROCHECK TEST IN EMERGENCY ROOM PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Elena Gomá ◽  
Guillermo Gonzalez-Martin ◽  
Juan Alfredo López-López ◽  
Maria Vanessa Perez Gomez ◽  
Alberto Ortiz ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Emergency Room ◽  
Past History ◽  
Kidney Injury ◽  
Urine Osmolality ◽  
Mortality Prediction ◽  
Emergency Room Patients ◽  
History Of ◽  
Heat Failure

Abstract Background and Aims Acute kidney injury (AKI) is increasingly prevalent and it is associated to increased hospital stay and costs, higher risk of developing a chronic kidney disease, and also major morbidity and mortality. Prediction tools may identify patients at high risk of AKI, allowing early intervention. Nephrocheck quantifies biomarkers of AKI (TIMP-2 and IGFBP-7), providing results within 20 minutes. This may allow stratification of the risk of developing an AKI in the next 12 hours in critically cardiovascular or respiratory ill patients and therefore implement preventive measures. We aimed to assess Nephrocheck performance to predict AKI development within 12 hours to 5 days in incident Emergency Room (ER) patients. Method Prospective observational study of 52 incident ER patients. Data were collected from April 2017 to November 2018. Inclusion criteria: sepsis of any origin, or cardiopulmonary insufficiency without AKI at baseline. Nephrochek was performed at baseline, patients were stratified into low (Nephrocheck test < 0.3), moderate (Nephrocheck between 0.3-2) and high risk (Nephrocheck >2) of AKI and occurrence of AKI was assessed (diagnosed as an increase of 0.3 mg/dl of serum creatinine) at 12, 24, 48 h and 5 days. Results Mean age as 70±13 years, 22/52 (43%) were women, risk factors included hypertension (54%), DM (29%), Cirrhosis: 2/52 (4%), heat failure (27%), prior CKD (12%), nephrotoxic use (38%). 18/52 (35%) of patients were Nephrocheck low risk, 21/52 (40%) were intermediate risk and 13/52 (25%) were high risk. AKI developed in 7/18 (39%), 3/21 (14%) and 3/13 (23%) of low, intermediate and high risk, respectively. When comparing patients who developed AKI with those who did not, those who developed AKI had been exposed more frequently to nephrotoxins and had lower urinary osmolarity and higher MAP (Table 1). However, a high risk Nephrocheck score identified patients with significantly higher urine osmolality (672±139 vs 387±172 mOsm/L, P=0.005) and lower MAP (76.7 ± 18.4 vs 101.62±22.7 mmHg; P=0.002). Conclusion LIMITATIONS: knowledge of Nephrocheck results may have changed patient care. CONCLUSIONS: A high risk Nephrocheck score was not associated with a higher risk of AKI in a ER setting. More nephrotoxins were used in the AKI group. Presumabily, these were discontinued in the ER, thus lowering AKI risk. By contrast, a past history of nephrotoxin use and lower urine osmolarity were associated with a higher incidence of AKI.

scholarly journals Acute Kidney Injury Following Ingestion of Averrhoa bilimbi Juice

2015 ◽  
Vol 3 (2) ◽  
pp. 71-73 ◽  
Author(s):  
Md Mostarshid Billah ◽  
Md Anisur Rahman ◽  
Muhammad Abdur Rahim ◽  
Ayesha Tabassum Swarna ◽  
Palash Mitra ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
High Risk ◽  
Kidney Injury ◽  
Renal Tubules ◽  
Fasting State ◽  
Calcium Oxalate Crystals ◽  
The Family ◽  
History Of ◽  
Very High

Bilimbi/belembu fruit belongs to the family of Oxalidacae, species Averrhoa bilimbi. Freshly prepared concentrated juice of bilimbi has very high oxalic acid content and consumption carries a high risk of developing acute kidney injury (AKI) by deposition of calcium oxalate crystals in renal tubules. AKI due to Averrhoa bilimbi juice injestion is very rare. We report the case history of a 60-year-old hypertensive, dyslipidemic patient, with normal renal function, who ingested around 600ml of juice in fasting state for treating dyslipidemia. The patient developed AKI and required three sessions of hemodialysis. Her renal function returned to normal after five weeks.Bangladesh Crit Care J September 2015; 3 (2): 71-73

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

scholarly journals Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wen En Joseph Wong ◽  
Siew Pang Chan ◽  
Juin Keith Yong ◽  
Yen Yu Sherlyn Tham ◽  
Jie Rui Gerald Lim ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Hospital Mortality ◽  
Structural Equation Model ◽  
Structural Equation ◽  
Injury Risk ◽  
Kidney Injury ◽  
Equation Model ◽  
Surgical Icu ◽  
One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

Predictors of acute kidney injury in patients after extracorporeal cardiopulmonary resuscitation

Perfusion ◽  
2021 ◽  
pp. 026765912110497
Author(s):  
Christopher Gaisendrees ◽  
Borko Ivanov ◽  
Stephen Gerfer ◽  
Anton Sabashnikov ◽  
Kaveh Eghbalzadeh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
High Risk ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Kidney Injury ◽  
Dialysis Patients ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Outcome Parameters

Objectives: Extracorporeal cardiopulmonary resuscitation (eCPR) is increasingly used due to its beneficial outcomes and results compared with conventional CPR. Data after eCPR for acute kidney injury (AKI) are lacking. We sought to investigate factors predicting AKI in patients who underwent eCPR. Methods: From January 2016 until December 2020, patients who underwent eCPR at our institution were retrospectively analyzed and divided into two groups: patients who developed AKI ( n = 60) and patients who did not develop AKI ( n = 35) and analyzed for outcome parameters. Results: Overall, 63% of patients suffered AKI after eCPR and 45% of patients who developed AKI needed subsequent dialysis. Patients who developed AKI showed higher values of creatinine (1.1 mg/dL vs 1.5 mg/dL, p ⩽ 0.01), urea (34 mg/dL vs 42 mg/dL, p = 0.04), CK (creatine kinase) (923 U/L vs 1707 U/L, p = 0.07) on admission, and CK after 24 hours of ECMO support (1705 U/L vs 4430 U/L, p = 0.01). ECMO explantation was significantly more often performed in patients who suffered AKI (24% vs 48%, p = 0.01). In-hospital mortality (86% vs 70%; p = 0.07) did not differ significantly. Conclusion: Patients after eCPR are at high risk for AKI, comparable to those after conventional CPR. Baseline urea levels predict the development of AKI during the hospital stay.

782-P: Machine Learning to Identify Diabetes Patients Initiating SGLT2i at High-Risk of Acute Kidney Injury

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 782-P
Author(s):  
LANTING YANG ◽  
NICO GABRIEL ◽  
INMACULADA HERNANDEZ ◽  
ALMUT G. WINTERSTEIN ◽  
STEPHEN KIMMEL ◽  
...  
Keyword(s):  
Machine Learning ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Diabetes Patients

scholarly journals Preventing contrast-induced acute kidney injury in the emergency room

2015 ◽  
Vol 3 (1) ◽  
pp. 59-60 ◽  
Author(s):  
Koichiro Homma ◽  
Tadashi Yoshida ◽  
Joe Yoshizawa ◽  
Masaru Suzuki ◽  
Junichi Sasaki ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Emergency Room ◽  
Kidney Injury

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

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