MO372IN-HOSPITAL MORTALITY IN ACUTE CARDIAC DISEASES IS ASSOСIATED WITH CERTAIN PHENOTYPES OF ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Zhanna Kobalava
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
De Novo ◽  
Acute Decompensated Heart Failure ◽  
Kidney Injury ◽  
Common Finding ◽  
Cardiac Diseases ◽  
Coronary Syndrome ◽  
Hospital Acquired ◽  
Transient Aki

Abstract Background and Aims Impaired renal function is a common finding in patients with cardiac diseases and confers an adverse prognosis in this population. To evaluate the incidence, phenotypes and prognostic value of cardiorenal interrelations in patients with acute decompensated heart failure (ADHF) and non-ST-elevation acute coronary syndrome (NSTE-ACS). Method we examined 278 patients with ADHF (85.3% had anamnesis of symptomatic HF with frequent hospitalizations, 20.1% had ejection fraction <35%) and 288 with NSTE-ACS (64.9% developed myocardial infarction (MI)). In ADHF group in comparison with NSTE-ACS the patients were younger (69.7±10.2 vs 72±12.1 years, p<0.01), there were more males (55.4 vs 36.5%, p<0.001), smokers and alcohol abusers (47.8 and 30.6% vs 8 and 5.6%, p<0.001). The comorbidities were more typical for ADHF group: atrial fibrillation 46 vs 24% (p<0.001), obesity 55.8 vs 30.9% (p<0.001), anemia 40.6 vs 25.3% (p<0.001), diabetes mellitus 33.1 vs 23.3% (p<0.01). Chronic kidney disease (CKD) and acute kidney injury (AKI) were diagnosed according to KDIGO 2012 Guidelines. AKI phenotypes were identified depending on time of development (community- or hospital-acquired), persistency (transient or persistent), history of CKD (AKI de novo or AKI on CKD). Results Incidence of CKD in patients with ADHF and NSTE-ACS was 45 and 46.5%, CKD was first diagnosed on admission in 57.6 and 64.2% of patients respectively. In 7.6% cases of ADHF and 14.2% of NSTE-ACS groups the duration of impaired kidney function was unknown. No associations of existing CKD and in-hospital mortality were detected. Incidence of AKI in ADHF and NSTE-ACS groups was 43.5 and 37.2%. The hospital-acquired AKI, AKI on CKD and persistent AKI were found in 52.9, 47.9 and 46.3% of ADHF patients, and in 57.9, 58.9 and 50.5% in NSTE-ACS group respectively. In-hospital mortality was higher in patients with AKI in ADHF and NSTE-ACS groups (12.4 vs 5%, p<0.01 and 17.8 vs 3.3%, p<0.001). Mortality in patients with ADHF and hospital-acquired persistent AKI de novo and community-acquired persistent AKI on CKD was 41 and 29%, and in community-acquired transient AKI on CKD in the NSTE-ACS group – 29%. Conclusion Different cardiorenal interrelations were revealed in 75.2% of patients with ADHF and in 61.8% with NSTE-ACS. In patients with acute cardiac diseases high in-hospital mortality is tightly associated with phenotypes of hospital-acquired persistent AKI de novo and community-acquired persistent AKI on CKD in ADHF, and in community-acquired transient AKI on CKD in the NSTE-ACS.

scholarly journals Acute kidney injury in hospitalized patients with COVID-19

2020 ◽  
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
João Oliveira ◽  
Filipe Marques ◽  
João Bernardo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospitalized Patients ◽  
Single Center ◽  
Transient Aki ◽  
Worse Prognosis

Abstract Introduction: The incidence of AKI in coronavirus disease 2019 (COVID-19) patients ranges from 0.5 to 35% and has been associated with worse prognosis. The purpose of this study was to evaluate the incidence, severity, duration, risk factors and prognosis of AKI in hospitalized patients with COVID-19.Methods: We conducted a retrospective single-center analysis of 192 hospitalized COVID-19 patients from March to May of 2020. AKI was diagnosed using the Kidney Disease Improving Global Outcome (KDIGO) classification based on serum creatinine (SCr) criteria. Persistent and Transient AKI were defined according to the Acute Disease Quality Initiative (ADQI) workgroup definitions.Results: In this cohort of COVID-19 patients, 55.2% developed AKI (n=106). The majority of AKI patients had persistent AKI (n=64, 60.4%). Overall, in-hospital mortality was 18.2% (n=35) and was higher in AKI patients (28.3% vs 5.9%, p<0.001, unadjusted OR 6.03 (2.22-16.37), p<0.001). On a multivariate analysis, older age (adjusted OR 1.08 (95% CI 1.02-1.13), p=0.004), lower Hb level (adjusted OR 0.69 (95% CI 0.53-0.91), p=0.007) and acidemia at presentation (adjusted OR 5.53 (95% CI 1.70-18.63), p=0.005), duration of AKI (adjusted OR 7.91 for persistent AKI (95% CI 2.39-26.21), p=0.001) and severity of AKI (adjusted OR 2.30 per increase in KDIGO stage (95% CI 1.10-4.82), p=0.027) were independent predictors of mortality.Conclusion: AKI was frequent in hospitalized patients with COVID-19. Persistent AKI and higher severity of AKI were independent predictors of in-hospital mortality.

ACUTE KIDNEY INJURY IN PATIENTS WITH PULMONARY ARTERY THROMBOEMBOLIA

2021 ◽  
pp. 36-45
Author(s):  
V.V. Filimonova ◽  
M.V. Menzorov ◽  
A.Yu. Bol'shakova
Keyword(s):  
Acute Kidney Injury ◽  
Pulmonary Artery ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
De Novo ◽  
Central City ◽  
Kidney Injury ◽  
Cardiology Department ◽  
Estimated Risk ◽  
Stage 1

The aim of the study is to diagnose acute kidney injury, its severity, and types in patients with pulmonary artery thromboembolia (PATE), to establish the correlation between AKI and the estimated mortality risk, hospital mortality. Materials and Methods. The study enrolled 111 patients (61 males (55 %), and 50 females (45 %), average age 66.8±11.7 years) with PATE, hospitalized to the cardiology department of Ulyanovsk Central City Clinical Hospital. Results. Acute kidney injury was diagnosed in 36 patients with PATE (34 %): among them 24 patients with stage 1 PATE (67 %); 7 patients with stage 2 (19 %); 5 patients with stage 3 (14 %). Prehospital complications were diagnosed in 20 patients (56 %), hospital AKI was detected in 16 patients (44 %). CKD-associated AKI was observed in 24 patients (67 %), de novo AKI was diagnosed in 12 trial subjects (33 %). Twenty-six patients (23 %) died during hospitalization. The relative hospital mortality risk in AKI patients was 5.2 (95 % CI: 2.02–13.39; p<0.001). The estimated risk of 30-day mortality according to the PESI score was higher in AKI patients (120.0 (87.5–158,0) and 90 (87.5-158.0), respectively, p=0.004). Conclusion. Patients with PATE had a high incidence of AKI, which was diagnosed in every 3rd patient. In 67 % of patients, AKI was associated with chronic kidney disease. Patients with prehospital AKI prevailed (56 %). AKI in patients with PATE was associated with increased in-hospital mortality and an estimated 30-day mortality risk. Keywords: acute kidney injury, pulmonary embolism, hospital mortality, estimated mortality risk. Цель исследования. Оценить наличие, степень выраженности и варианты острого повреждения почек (ОПП) у пациентов с тромбоэмболией легочной артерии (ТЭЛА); уточнить связь между ОПП и расчетным риском смерти, госпитальной летальностью. Материалы и методы. Обследовано 111 пациентов (мужчин – 61 (55 %), женщин – 50 (45 %), средний возраст – 66,8±11,7 года) с ТЭЛА, госпитализированных в отделение кардиологии ГУЗ «Центральная городская клиническая больница г. Ульяновска». Результаты. Острое повреждение почек диагностировано у 36 (34 %) пациентов с ТЭЛА, причем у 24 (67 %) из них выявлена 1 стадия, у 7 (19 %) – 2 стадия и у 5 (14 %) – 3 стадия. У 20 (56 %) пациентов диагностирован догоспитальный вариант осложнения, госпитальное ОПП выявлялось в 16 (44 %) случаях. ОПП при ХБП имело место у 24 (67 %) обследованных, ОПП de novo – у 12 (33 %). В период госпитализации умерло 26 (23 %) пациентов. Относительный риск смерти в стационаре у пациентов с ОПП составил 5,2 (95 % ДИ: 2,02–13,39; р<0,001). Расчетный риск 30-дневной смерти по шкале PESI при наличии ОПП был выше, чем при его отсутствии (120,0 (87,5–158,0) и 90 (87,5–158,0) соответственно, p=0,004). Выводы. У пациентов с ТЭЛА наблюдается высокая частота ОПП, оно диагностируется у каждого 3-го пациента. У 67 % пациентов острое повреждение почек развивается на фоне предшествующей хронической болезни почек. Преобладают пациенты с догоспитальным ОПП (56 %). Острое повреждение почек у пациентов с ТЭЛА ассоциировано с увеличением госпитальной летальности и расчетного риска 30-дневной смертности. Ключевые слова: острое повреждение почек, тромбоэмболия легочной артерии, госпитальная летальность, расчетный риск смерти.

scholarly journals Duration of Acute Kidney Injury and in-hospital Mortality in Elder Patients With Severe COVID-19: a Retrospective Cohort Study

2021 ◽  
Author(s):  
Yue Cai ◽  
Qinglin Li ◽  
Shanshan Guo ◽  
Yanyan Chen ◽  
Fang Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Cox Regression ◽  
Kidney Injury ◽  
Final Analysis ◽  
Prognostic Impact ◽  
Cox Regression Analysis ◽  
Elder Patients ◽  
Kaplan Meier ◽  
Transient Aki

Abstract Background Patients with severe coronavirus disease 2019 (COVID-19) who develop acute kidney injury (AKI) in the intensive care unit (ICU) have extremely high rates of mortality. This study evaluated the prognostic impact of AKI duration on in-hospital mortality in elder patients.Methods We performed a retrospective study of 126 patients with confirmed COVID-19 with severe or critical disease who treated in the ICU from February 4, 2020, to April 16, 2020. AKI was defined according to the Kidney Disease Improving Global Outcomes serum creatinine (Scr) criteria. AKI patients were divided into transient AKI and persistent AKI groups based on whether Scr level returned to baseline within 48 h post-AKI.Results In total, 107 patients were included in the final analysis. The mean age was 70 (64–78) years, and 69 (64.5%) patients were men. AKI occurred in 48 (44.9%) during their ICU stay. Of these, 11 (22.9%) had transient AKI, 37 (77.9%) had persistent AKI. In-hospital mortality was 18.6% (n =11) for patients without AKI, 72.7% (n=8) for patients with transient AKI, and 86.5% (n=32) for patients with persistent AKI (P<0.001). Kaplan–Meier curve analysis revealed that patients with both transient AKI and persistent AKI had significantly higher death rates than those without AKI (log-rank P<0.001). Multivariate Cox regression analysis revealed that transient and persistent AKI were an important risk factor for in-hospital mortality in older patients with severe COVID-19 even after adjustment for variables (hazard ratio [HR]=2.582; 95% CI: 1.025–6.505; P=0.044; and HR=6.974; 95% CI: 3.334–14.588; P<0.001).Conclusions AKI duration is a useful parameter to predict of worse clinical outcomes in elder patients with COVID-19 in the ICU. Among AKI patients, those persistent AKI have a lower in-hospital survival rate than those transient AKI, emphasizing the importance of identifying an appropriate treatment window for early intervention.

scholarly journals Risk assessment of acute kidney injury in patients with acute cardiovascular disease without invasive intervention

Kardiologiia ◽  
2020 ◽  
Vol 59 (12S) ◽  
pp. 46-56
Author(s):  
S. V. Avdoshina ◽  
M. A. Efremovtseva ◽  
S. V. Villevalde ◽  
Zh. D. Kobalava
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Acute Decompensated Heart Failure ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Decompensated Heart Failure ◽  
Coronary Syndrome ◽  
Patients At Risk ◽  
Stage 1

Objective. To evaluate the prevalence, predictors, prognostic value of cardiorenal interrelations in patients with acute cardiovascular disease (CVD), and to develop an algorithm for stratification these patients at risk of acute kidney injury (AKI). Materials and methods. 566 patients (pts) were examined: 278 with acute decompensated heart failure (ADHF) and 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS). The levels of electrolytes, glucose, urea, creatinine were evaluated, glomerular filtration rate (GFR) was determined according to the formula CKD-EPI. Chest x-ray, electrocardiography at admission and in dynamics, echocardiography at admission with assessment of systolic and diastolic myocardial functions were performed. Chronic kidney disease (CKD), AKI, ADHF, NSTE-ACS were diagnosed according to Russian and international Guidelines. Mann-Whitney test and multivariate logistic regression analysis were considered significant if p<0.05. Results. Different variants of cardiorenal interrelations were revealed in 366 (64.7%) pts. CKD was diagnosed in 259 (45.8%), with more than half of the cases (61%) diagnosed for the first time at this hospitalization, 62 (11%) pts had signs of kidney damage of unknown duration (which did not allow to diagnose CKD). AKI occurred in 228 (40,3%) pts, more frequently in patients with ADHF vs with NSTE-ACS (43.5 and 37.2%). In all groups stage 1 of AKI was prevalent. In-hospital mortality was significantly higher in pts with AKI vs without AKI (14.9 vs 3.6%, p<0.001). The risk of AKI was determined by kidney function and blood pressure levels at admission, and comorbidities. Conclusion. Prevalence of cardiorenal interactions in patients with acute CVD (ADHF and NSTE-ACS) was 64.7%. Development of AKI was associated with poor prognosis in both groups. Renal function and blood pressure levels on admission are the main predictors of AKI.

MO389PREDICTORS OF COMMUNITY-ACQUIRED ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE CARDIAC DISEASES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Maria Markova ◽  
Zhanna Kobalava
Keyword(s):  
Blood Pressure ◽  
Risk Assessment ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Kidney Function ◽  
Kidney Injury ◽  
Assessment Scale ◽  
Cardiac Diseases ◽  
L 14

Abstract Background and Aims Acute kidney injury (AKI) is a common and serious problem associated with poor prognosis. The aim of the study was to reveal the prevalence and predictors of community-acquired AKI in patients with acute cardiac diseases. Method 566 patients (278 with acute decompensated heart failure (ADHF), 288 with non-ST-elevation acute coronary syndrome (NSTE-ACS), 46% male, 71±11 years (M±SD), smokers 26%, arterial hypertension 91%, previous myocardial infarction (MI) 45%, diabetes mellitus (DM) 28%, atrial fibrillation 35%, chronic kidney disease (CKD) 46%, previous hospitalization with ADHF 36%, ejection fraction (EF) &lt;35% 15%, blood pressure (BP) 142±30/83±16 mmHg) were examined. AKI was diagnosed according 2012 KDIGO Guidelines. Community-acquired AKI was identified in patients with elevated serum creatinine levels on admission, which decreased during hospitalization. Results: Incidence of AKI in all patients, patients with ADHF and NSTE-ACS was 40, 43.5 and 37.2%. In-hospital mortality in patients with AKI was higher than in those with stable kidney function (14.9 vs 3.6%, p&lt;0.001). Community-acquired AKI was present in 18% of patients (20.5 and 15.6% in ADHF and NSTE-ACS respectively), in-hospital mortality was 16.7% (10.5 and 24.4% respectively). The risk assessment scale for community-acquired AKI was developed based on independent predictors of AKI, using binary logistic regression and ROC analysis (AUC 0.860, 95% CI 0.821-0.898). Independent variables included in the model, and the corresponding points (pts) are listed below: clinical and demographic characteristics (male gender - 6 pts, alcohol abuse - 7 pts, DM - 1 pt), present on admission (MI - 5 pts, AHF/ADHF - 9 pts, systolic BP &lt;120 - 10 pts, &lt;110 - 15 pts, &lt;90 mmHg - 27 pts; state of kidney function on admission: serum creatinine &gt;98 and &gt;128 mkmol/L - 14 and 22 pts, GFRCKD-EPI &lt;45 and &lt;15 ml/min/1.73 m2 - 7 and 14 pts; glucose level &gt;7 mmol/L - 4 pts), outpatient intake of ACE inhibitors - 4 pts, absence of spironolactone in outpatient therapy - 1 pt. Diagnostically significant risk score for predicting AKI was &gt;30 pts, the risk prediction model showed sensitivity 89%, specificity 66%. Conclusion Community-acquired AKI is common in patients in acute cardiovascular events, is associated with high mortality, and often is underdiagnosed. Usage of risk assessment scale in clinical practice may help to detect patients with high-risk of AKI on admission. Baseline kidney function and blood pressure level are main predictors of AKI in patients admitted with acute cardiac diseases.

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

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 &gt;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 &lt;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&lt;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&lt;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.

scholarly journals MO407POSITIVE COMBINED BIOMARKER TEST IS AN INDEPENDENT PREDICTOR OF ACUTE KIDNEY INJURY IN PATIENTS WITH ACUTE CARDIAC DISEASES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Efremovtseva ◽  
Svetlana Avdoshina ◽  
Zhanna Kobalava
Keyword(s):  
Heart Failure ◽  
Early Diagnosis ◽  
Acute Decompensated Heart Failure ◽  
Simultaneous Detection ◽  
Multivariate Logistic Regression Analysis ◽  
Kidney Injury ◽  
Kidney Damage ◽  
Cardiac Diseases ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background and Aims Biomarkers are currently considered as an additional criterion for the diagnosis of AKI. Early diagnosis of AKI is especially important in acute cardiovascular diseases due to increased risk of severe adverse events associated with development of cardiorenal syndrome. The aim of the study to explore the role of biomarkers in early diagnosis of AKI and their prognostic values in patients with acute cardiac diseases. Method 109 patients (51 with acute decompensated heart failure (ADHF), 58 with non-ST-elevation acute coronary syndrome (NSTE-ACS) were examined. Biomarkers of HF (NT-pro BNP in serum) and kidney damage (cystatin C in serum; neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1) and interleukine-18 (IL-18) in the urine) were estimated. Mann-Whitney test and multivariate logistic regression analysis were performed, p &lt;0.05 was considered statistically significant. Results Patients with vs without AKI had higher levels of NGAL (344±308.8 vs 37.9±65.1 ng/ml, p &lt;0.001) and KIM-1 (0.774±0.36 vs 0.402±0.59 ng/ml, p &lt;0.01) in all groups. Patients with NSTE-ACS with vs without AKI had higher level of NT-proBNP (12857.1±3108.8 vs 10134±2479, p&lt;0.001), no difference was detected in ADHF group. In course of ROC analyses NGAL and KIM-1 showed the best prognostic values (AUC value 0.948 and 0.760). The сut points for NGAL &gt;60.1 ng/ml (sensitivity 87%, specificity 92%) and KIM-1 &gt; 0.519 ng/ml (sensitivity 87%, specificity 67%) were detected, coefficient of association φ was 0,781 and 0,555 respectively. Simultaneous detection of two markers of structural kidney damage (increase of NGAL and/or KIM-1) in high-risk patients permits to diagnose 95% of AKI cases at admission. Patients with AKI and diagnostically significant levels of biomarkers had higher prevalence of CKD (p&lt;0.01), acute heart failure, ADHF (p&lt;0.05) vs those without increase of biomarkers, in-hospital mortality in this group was 29,8%. Conclusion Positive combined biomarker test is an independent and strong predictor of AKI in patients with acute cardiac diseases, and its implementation in clinical practice improve the early diagnostics of AKI when markers of kidney function are still at normal levels.

Hospital-Acquired Acute Kidney Injury in Older Patients: Clinical Characteristics and Drug Analysis

Gerontology ◽  
2021 ◽  
pp. 1-8
Author(s):  
Wei Liu ◽  
Xing-ji Lian ◽  
Yuan-han Chen ◽  
Yi-ping Zou ◽  
Jie-shan Lin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Hospital Outcomes ◽  
Prior Use ◽  
Nephrotoxic Drugs ◽  
Medical Wards ◽  
Hospital Acquired

<b><i>Background:</i></b> Information on older patients with hospital-acquired acute kidney injury (HA-AKI) and use of drugs is limited. <b><i>Aim:</i></b> This study aimed to assess the clinical characteristics, drug uses, and in-hospital outcomes of hospitalized older patients with HA-AKI. <b><i>Methods:</i></b> Patients aged ≥65 years who were hospitalized in medical wards were retrospectively analyzed. The study patients were divided into the HA-AKI and non-AKI groups based on the changes in serum creatinine. Disease incidence, risk factors, drug uses, and in-hospital outcomes were compared between the groups. <b><i>Results:</i></b> Of 26,710 older patients in medical wards, 4,491 (16.8%) developed HA-AKI. Older patients with HA-AKI had higher rates of multiple comorbidities and Charlson Comorbidity Index score than those without AKI (<i>p</i> &#x3c; 0.001). In the HA-AKI group, the proportion of patients with prior use of drugs with possible nephrotoxicity was higher than that of patients with prior use of drugs with identified nephrotoxicity (<i>p</i> &#x3c; 0.05). The proportions of patients with critical illness, use of nephrotoxic drugs, and the requirements of intensive care unit treatment, cardiopulmonary resuscitation, and dialysis as well as in-hospital mortality and hospitalization duration and costs were higher in the HA-AKI than the non-AKI group; these increased with HA-AKI severity (all <i>p</i> for trend &#x3c;0.001). With the increase in the number of patients with continued use of drugs with possible nephrotoxicity after HA-AKI, the clinical outcomes showed a tendency to worsen (<i>p</i> &#x3c; 0.001). Moreover, HA-AKI incidence (adjusted odds ratio [OR], 10.26; 95% confidence interval (CI), 8.27–12.74; <i>p</i> &#x3c; 0.001), and nephrotoxic drugs exposure (adjusted OR, 1.76; 95% CI, 1.63–1.91; <i>p</i> &#x3c; 0.001) had an association with an increased in-hospital mortality risk. <b><i>Conclusion:</i></b> AKI incidence was high among hospitalized older patients. Older patients with HA-AKI had worse in-hospital outcomes and higher resource utilization. Nephrotoxic drug exposure and HA-AKI incidence were associated with an increased in-hospital mortality risk.

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