MO369ACUTE KIDNEY INJURY IS ASSOCIATED WITH ELEVATED AMINOTRANSFERASES AT ADMISSION IN HOSPITALIZED PATIENTS WITH COVID-19

Abstract Background and Aims Initial reports indicate a high incidence of abnormal liver tests and acute kidney injury (AKI) in the novel coronavirus infection (COVID-19). However, outcomes in hospitalized patients with COVID-19 and elevated aspartate transaminase (AST) and alanine transaminase (ALT) levels at admission and their associations with AKI are not well understood. The aim of the study was to investigate the incidence of cytolysis at admission and its contribution to the development of AKI, severity of COVID-19 and outcomes. Method A retrospective analysis of the register of patients hospitalized with COVID-19 was performed (n=481). COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture. We excluded patients with previously known liver disease, re-hospitalization, acute surgical pathology, single serum creatinine measurement during hospitalization. Abnormality in aminotransferases was deﬁned as ALT and/or AST >40 U/L. Definition of AKI was based on KDIGO criteria. P value <0.05 was considered statistically significant. Results 462 patients were included (50.4% males, mean age 63±16 years, mean Charlson index 3±2.4, 67% with hypertension, 48% with obesity, 25% with diabetes mellitus). 26,4% (122) of patients were hospitalized in the intensive care unit (ICU), 71,3% (87) of them were treated with mechanical ventilation. The median length of stay was 11 [9;15] days, in the ICU – 4 [2;9] days. 20% (92) of patients died. At admission 43% (200) of the patients had abnormal level of aminotransferases. Elevated AST was more common than ALT, (39% (178) vs 29% (132)). The median levels of AST and ALT at admission were 54.5[44;72] and 45.9[34;66] U/L in the group with cytolysis and 26[19;33] and 19[11;27] U/L in the group without it, respectively. The AKI incidence in the register was 24.8%. The 1st stage of AKI was observed in the majority of the patients (46% - 1st stage, 36% - 2nd stage, 18% - 3rd stage. Patients in ICU compared to non-ICU patients more often had AKI (50% vs 13%, p<0.001). In-hospital mortality was significantly higher in the group with AKI (54% vs 10% for patients with and without AKI development, respectively, p<0.001). Groups with and without aminotransferases elevation were similar in age, gender, presence of comorbidities, coagulation status, statins and frequency of antibiotic intake before admission. Increase in AST and/or ALT levels at admission showed no association with AKI severity. The higher incidence of elevated ALT or/and AST was observed in ICU compared with non-ICU patients (59% vs 37%, p<0.001). Patients with elevation of aminotransferases at admission compared to patients without it had more severe lung injury by CT scan (22.4% vs 18.6%, with 50-75% lung injury; 5.5% vs 0.4% with 75-90% lung injury, p=0.008 for the trend), higher ferritin (598[404;715] vs 391[189;587] µkg/l, p=0.03) and serum creatinine levels (91[78;118] vs 86[74;109] µmol/l, p=0.008), higher rate of AKI development (29% vs 18%, p=0.005) and in-hospital mortality (26% vs 15,4%, p=0.005). Elevated ALT and/or AST at admission were the independent predictors for the development of AKI (OR 1.87 95%CI 1.17-2.92, p=0.005) and in-hospital mortality (OR 1.89 95%CI 1.17-3.08, p=0.006). Conclusion Syndrome of cytolysis is common among hospitalized patients with COVID-19. Development of AKI and disease severity were associated with elevated levels of aminotransferases at admission, and are predictors for AKI development and in-hospital mortality in this population.

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MO384ERYTHROCYTURIAAT ADMISSION IS A PREDICTOR OF ACUTE KIDNEY INJURY AND IN-HOSPITAL MORTALITY IN HOSPITALIZED PATIENTS WITH COVID-19

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0038 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Yulia Khruleva ◽

Elena Troitskaya ◽

Marina Efremovtseva ◽

Tapiwa Mubayazvamba ◽

Zhanna Kobalava

Keyword(s):

Acute Kidney Injury ◽

Lung Injury ◽

Hospital Mortality ◽

Oral Anticoagulants ◽

Clinical Signs ◽

Kidney Injury ◽

Hospitalized Patients ◽

Adverse Outcomes ◽

Common Finding ◽

P Value

Abstract Background and Aims Acute kidney injury (AKI) is common among patients with coronavirus disease (COVID-19) and a major risk factor associated with mortality in hospitalized patients. Previously abnormal urine tests were reported to have a high incidence in COVID-19. We aimed to investigate the prevalence of urine tests changes and their impact on the outcomes in patients hospitalized with COVID-19. Method A retrospective analysis of the register of patients with COVID-19 was performed. COVID-19 was defined as the laboratory-confirmed infection and/or presence of the typical computer tomography (CT) picture with typical clinical signs. We excluded patients with re-hospitalizations, urinary tract infection, and single serum creatinine (SCr) measurement during hospitalization. Urine tests were performed within the first 24 h after hospitalization. Erythrocyturia was defined as the presence of >3 red blood cells (RBC) per high-power field. Definition of acute kidney injury (AKI) was based on KDIGO criteria. Patients were identified as having in-hospital AKI, if AKI developed during hospitalization. P value <0.05 was considered statistically significant. Results In final analysis we included 495 patients. Mean age was 64 [53;74], 51% (244) were males, mean Charlson index 3 [1;3], 66% with hypertension, 48% with obesity, 24% with diabetes mellitus (DM) and 6% with chronic kidney disease (CKD). 25% of patients were hospitalized in the intensive care unit (ICU), 17.8% (88) were treated with mechanical ventilation at some point during hospitalization. Patients were hospitalized on the 6±4 day of illness at mean. The mean length of stay was 11 [9;14] days, in the ICU - 4 [2;7] days. 19.4% patients died in hospital. The incidence of AKI was 22%, 47% patients had the 1st stage of AKI, 41% - the 2nd and 20% - the 3rd. In-hospital AKI was observed in 8.3% (41) of patients. Among discharged patients AKI was registered in 13%, of those who died in 60% (p<0.0001). 52% (256) of patients had erythrocyturia and/or proteinuria and/or leukocyturia in urine test and admission: 35% of patients had proteinuria, 17% - hematuria and 19% - leukocyturia. The most prognostically significant associations of urinalysis changes were identified for erythrocyturia, which was present in 82 patients at admission, their mean RBC count in urine was 18.5 [7;52]. The presence of еrythrocyturia at admission was independent of age, gender, presence of hypertension, DM, obesity, blood test changes, pre-admission drug intake, included oral anticoagulants. Patients with erythrocyturia at admission had higher level of SCr at admission (101[83;140] vs 88[74;109] µmol/l, p=0.003), were more likely to develop AKI compared to patients without AKI (31.2% vs 12.4%, p<0.001, respectively), had higher prevalence of in-hospital AKI (17% vs 6.5%, p=0.002) and more severe course of AKI (the 1st stage – 31% vs 54%, the 2nd - 43% vs 32%, the 3rd – 26% vs 14%, p=0.02). They also more often had CKD (13,4% vs 4.4%, p=0.001), more severe lung injury by CT scan during hospitalization (15.6% vs 5.5% with 75-90% lung injury, p=0.005, for the trend), were more frequently hospitalized in ICU (39% vs 22%, p=0.001), and had higher level of in-hospital mortality (32% vs 17%, p=0.002). Erythrocyturia at admission was predictor for development of in-hospital AKI (odds ratio (OR) 2.94 with a 95% confidence interval (CI) of 1.35 to 6.15, p=0.002) and in-hospital mortality (OR 2.28, 95% CI of 1.28 to 3.97, p=0.002). Conclusion Erythrocyturia at admission is a common finding in hospitalized patients with COVID-19, and is associated with severity of disease and adverse outcomes in this population.

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The Revelations of Acute Kidney Injury in Cases of Acute Febrile Illness – A Hospital Based Observational Study from North Eastern India

Advancements in Journal of Urology and Nephrology ◽

10.33140/ajun.02.01.04 ◽

2020 ◽

Vol 2 (1) ◽

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Urine Volume ◽

Kidney Injury ◽

Febrile Illness ◽

Hospitalized Patients ◽

Acute Febrile Illness ◽

Medical College ◽

Definition Of ◽

Unexpected Outcome

Background: Clinicians across the globe refer to the published KDIGO definition of Acute Kidney Injury (AKI) as one of the following: • An increase in serum creatinine by ≥0.3 mg/dl (≥26.5 µmol/l) within 48 hrs • An increase in serum creatinine to ≥1.5 times baseline within the previous 7 days • Urine volume <0.5 ml/kg/h for 6 hrs Acute febrile illnesses are a common cause of AKI in hospitalized patients. The present study was undertaken to evaluate the incidence of AKI in patients presenting with acute febrile illness and also study the different etiological factors responsible for acute febrile illness. Materials and Methods: The study included 200 patients of acute febrile illness admitted in Silchar Medical College And Hospital in the Department of Medicine over a period of 24 months. The data regarding the various causes such as the etiology of fever, kidney function tests and other parameters of the cases were obtained and analyzed using simple statistical methods. Results and Observations: A total of 52 patients (26%) with acute febrile illness due to etiologies like Leptospirosis, Falciparum Malaria, Enteric fever, Dengue, Scrub Typhus, and mixed Malaria, etc developed AKI out of the 200 admitted cases presenting with acute febrile illness. Conclusion: The incidence of AKI is common in hospitalized patients of acute febrile illness and a thorough evaluation and detailed clinicobiochemical monitoring of the patients are necessary as it has varied etiology and often lead to an unfavorable or even unexpected outcome.

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Acute kidney injury in hospitalized patients with COVID-19 (retrospective study)

Egyptian Journal of Bronchology ◽

10.1186/s43168-021-00056-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Haitham A. Azeem ◽

Hytham Abdallah ◽

Mohamad M. Abdelnaser

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Serum Creatinine ◽

Kidney Injury ◽

Multiple Organ ◽

Hospitalized Patients ◽

World Health ◽

Incidence And Mortality ◽

Novel Coronavirus ◽

Health Organization

Abstract Background The World Health Organization (WHO) has named the virus as 2019 novel coronavirus on January 12, 2020, and has declared a public health emergency globally on January 30, 2020. The epidemic started in Wuhan, China, in December of 2019 and quickly spread to over 200 countries. COVID-19 can cause multiple organ injuries (e.g., kidney, heart, blood, and nervous system). Among them, acute kidney injury (AKI) is a critical complication due to its high incidence and mortality rate. So, it is essential to evaluate AKI in COVID-19 patients during this pandemic state. The aim of this work is to detect the occurrence of AKI in hospitalized COVID-19 patients. So, a retrospective study was conducted on hospitalized adult patients > 18 years old with confirmed SARS-CoV-2 infection admitted to the Abo Teeg Hospital at Assiut City, Egypt, from May 1, 2020, to July 1, 2020. All data were collected from medical records, patients’ follow-up, and charts. Data were verified, coded by the researcher, and analyzed using IBM-SPSS 21.0. Results Eighty-six COVID-19 patients were admitted to Abo Teeg Hospital in Assiut City, Egypt, between May and July 2020. Thirty-eight patients (33%) were of the male gender. Mean age was 58.07 ± 17.9, and 61 patients developed AKI. 32.8% of the AKI group were a stage I severity (increase in serum creatinine by 0.3 mg/dl within 48 h), 21.3% of them presented by stage II (2–2.9 times increase in serum creatinine), and 45.9% were in stage III (3 times or more increase in serum creatinine). The overall hospital mortality for the patients admitted to ICU with AKI was 6.7% (11/61), compared to 1% (4/25) in those without AKI. Conclusion Hospitalized patients with COVID-19 had a higher risk of AKI, and we recommended that those patients should be evaluated after discharge for the development of CKD.

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Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

Annals of Intensive Care ◽

10.1186/s13613-021-00885-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

William Beaubien-Souligny ◽

Yifan Yang ◽

Karen E. A. Burns ◽

Jan O. Friedrich ◽

Alejandro Meraz-Muñoz ◽

...

Keyword(s):

Renal Replacement Therapy ◽

Hospital Mortality ◽

Replacement Therapy ◽

Kidney Injury ◽

Hemodynamic Instability ◽

Factors Associated ◽

Definition Of ◽

Vasopressor Use ◽

Cumulative Fluid Balance ◽

Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

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Association of Blood Type on Clinical Outcomes in Black/African Americans Hospitalized for COVID-19 Infection

Blood ◽

10.1182/blood-2020-137556 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 14-14

Author(s):

Yan Cheng ◽

Sharif Mohammed ◽

Alexis Okoh ◽

Ki (Steve) Lee ◽

Corinne Raczek ◽

...

Keyword(s):

Acute Kidney Injury ◽

African Americans ◽

Hospital Mortality ◽

Kidney Injury ◽

Type A ◽

Blood Type ◽

P Value ◽

Single Center ◽

Black African ◽

O 31

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19. Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS). Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups. Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival. Disclosures Cohen: GBT: Speakers Bureau.

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Serum potassium disorders predict subsequent kidney injury: a retrospective observational cohort study of hospitalized patients

Kidney & Blood Pressure Research ◽

10.1159/000521833 ◽

2022 ◽

Author(s):

Gianmarco Lombardi ◽

Giovanni Gambaro ◽

Pietro Manuel Ferraro

Keyword(s):

Cohort Study ◽

Serum Potassium ◽

Hospital Admissions ◽

Kidney Injury ◽

Observational Cohort Study ◽

Hospitalized Patients ◽

P Value ◽

Significant Difference ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

Introduction Electrolytes disorders are common findings in kidney diseases and might represent a useful biomarker preceding kidney injury. Serum potassium [K+] imbalance is still poorly investigated for association with acute kidney injury (AKI) and most evidence come from intensive care units (ICU). The aim of our study was to comprehensively investigate this association in a large, unselected cohort of hospitalized patients. Methods: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with at least 2 [K+] and 3 serum creatinine (sCr) measurements who did not develop AKI during an initial 10-day window. The outcome of interest was in-hospital AKI. The exposures of interest were [K+] fluctuations and hypo (HoK) and hyperkalemia (HerK). [K+] variability was evaluated using the coefficient of variation (CV). Cox proportional hazards regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between the exposures of interest and development of AKI. Results: 21,830 hospital admissions from 18,836 patients were included in our study. During a median follow-up of 5 (interquartile range [IQR] 7) days, AKI was observed in 555 hospital admissions (2.9%); median time for AKI development was 5 (IQR 7) days. Higher [K+] variability was independently associated with increased risk of AKI with a statistically significant linear trend across groups (p-value = 0.012). A significantly higher incidence of AKI was documented in patients with HerK compared with normokalemia. No statistically significant difference was observed between HoK and HerK (p-value = 0.92). Conclusion: [K+] abnormalities including fluctuations even within the normal range are associated with development of AKI.

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Endocrine Summary

The Brigham Intensive Review of Internal Medicine ◽

10.1093/med/9780199358274.003.0056 ◽

2014 ◽

pp. 549-566

Author(s):

Graham T. McMahon

Keyword(s):

Acute Kidney Injury ◽

Filtration Rate ◽

Hospital Admissions ◽

Kidney Injury ◽

Acute Interstitial Nephritis ◽

Hospitalized Patients ◽

Acute Glomerulonephritis ◽

Creatinine Concentration ◽

Tubular Necrosis ◽

Definition Of

Acute renal failure, now referred to as acute kidney injury (AKI), complicates 5–10% of general hospital admissions and is associated with increased morbidity and mortality and prolonged hospitalizations. The definition of AKI varies, but it is usually defined as an increase in serum creatinine concentration of 25–50% above the baseline, a decline in estimated glomerular filtration rate (eGFR) of 25–50%, or the need for renal replacement therapy. It is now recognized that changes in GFR are delayed manifestations of renal injury, and the development of urinary biomarkers may help to identify AKI earlier in the course of injury. The major causes of AKI in hospitalized patients include prerenal causes (~40%), postrenal causes (~5–10%), and intrinsic diseases affecting blood vessels, glomeruli, or tubules. Of the intrinsic causes, tubular disorders (acute tubular necrosis and acute interstitial nephritis) are the most common etiologies, accounting for 40–50% of all causes of AKI. Acute glomerulonephritis and vascular disorders are rare etiologies of AKI in hospitalized patients (〈5%).

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TO020POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI BY AUTOMATED DECISION SUPPORT ALGORITHMS: IMPACT ON AKI INCIDENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa141.to020 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Jill Vanmassenhove ◽

Johan Steen ◽

Johan Decruyenaere ◽

Dominique Benoit ◽

Eric Adriaan J Hoste ◽

...

Keyword(s):

Big Data ◽

Decision Support ◽

Serum Creatinine ◽

Sofa Score ◽

Kidney Injury ◽

Baseline Serum ◽

Icu Admission ◽

And Gender ◽

Definition Of ◽

The Impact

Abstract Background and Aims The reported incidence of Acute Kidney Injury (AKI) at the intensive care unit (ICU) is variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of this definition, there is remaining variability in the actual implementation of this AKI definition, with variable interpretation of the urinary output (UO) criterion, and of the baseline serum creatinine (Screa) criterion. This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI or associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means and represents. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the incidence of AKI stage 2. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all available Screa data up to 1 year before ICU admission were retrieved from a dataset external to the ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we sued either a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we also applied two criteria in line with K-DIGO stage 2: a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Def 8 identified patients who did not comply with any of the definitions (1-7), so who had no AKI according to any definition. Definition 9 and 10 identified patients who complied with at least one out of the Screa criteria 1-5 (def 9) or out of the UO criteria (def 10). Definition 11 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset included 16433 ICU admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died at ICU, and another 5.2% during their hospitalisation. The SOFA score at admission was 6.9±4.1. The incidence of AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria from 4.3% when baseline creatinine was defined as the first ICU value, to 35.3% when the UO criterium was interpreted as a UO below 6ml/kg over a 12 hour block (fig). Only half of patients (53.7%) did not comply with any of the definitions (def 8), 10.9% and 19.7% complied with one of the Screa (def 9) OR one of the UO criteria (def 10) respectively, and 15.7% complied with both (def 11). There was substantial reclassification across the different definitions. Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in incidence of AKI, and also with substantial reclassification according to different definitions. This is especially concerning in an era of big data and automated decision support, as clinicians might not know which construct of AKI is actually being represented.

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Acute kidney injury

10.1093/med/9780199659579.003.0127 ◽

2017 ◽

Author(s):

Edward Sharples

Keyword(s):

Acute Kidney Injury ◽

Early Recognition ◽

Kidney Injury ◽

Epidemiological Studies ◽

Hospitalized Patients ◽

Early Management ◽

Common Causes ◽

Definition Of ◽

End Stage

Acute kidney injury (AKI) is a common, major cause of morbidity and mortality in hospitalized patients, and contributes significantly to length of stay and hence costs. Large epidemiological studies consistently demonstrate an incidence of AKI of 5–18% depending on the definition of AKI utilized. Even relatively small changes in renal function are associated with increased mortality, and this has led to strict definition and staging of AKI. Early recognition with good clinical assessment, diagnosis, and management are critical to prevent progression of AKI and reduce the potential complications, including long-term risk of end-stage renal failure. In this chapter, the pathophysiology, causes, and early management of AKI are discussed. Hypovolaemia and sepsis are the most common causes in hospitalized patients, across medical and surgical specialities. Other common causes are discussed, as well as diagnostic criteria.

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