scholarly journals MO383COVID - 19 AND AKUTE KIDNEY INJURY- A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ana Bulatovic ◽  
Jelena Bjedov ◽  
Vesna Maslarevic Radovic ◽  
Nada Dimkovic ◽  
Radomir Naumovic
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Wide Spectrum ◽  
Multiorgan Failure ◽  
Fatal Outcome ◽  
Kidney Tissue ◽  
Significant Risk ◽  
Kidney Injury ◽  
Wide Range ◽  
D Dimer

Abstract Background and Aims The new coronavirus disease (COVID 19) has become a worldwide health emergency with a wide spectrum of clinical presentation, from common cold symptoms to multiorgan failure. A great number of medical centers have reported that patients with COVID-19 have developed acute kidney injury. The kidney is a target organ for SARS - COV2 because of ACE2 receptor, the binding site for this virus, is expressed in kidney tissue. The potential mechanisms for kidney injury are direct kidney injury, inflammation, activation of coagulation and complement cascades. Data from centers worldwide reported a wide range of AKI incidence, from 0,5% in China to 46% in USA. The aim of this study was to analyze incidence, risk factors and outcomes of AKI in hospitalized patients with COVID 19 who were treated from 01.04. to 01.06.2020. at Nephrology Department of University Clinical Center Zvezdara, which was at the time transformed into COVID hospital. Method This retrospective observational study included 51 patients who had normal kidney function before the infection with SARS COV2, and 7 of them developed dialysis non-dependent AKI. Analysis included data collection from the patients’ history including demographic, clinical and administrative data. Statistical analysis has been performed using SPSS software version 20 (IBM Corporation, New York, USA). Results Out of 51 patients 7 (13.7%) developed AKI, mean age was 59 + 16 years and 53% were male. Diabetes mellitus was present in 27 of patients with AKI, hypertension in 6/7, obesity in 3/7, coronary artery disease in 1/7 and 1 of 7 patients was smoker. These risk factors except obesity (p= 0.05) didn’t vary significantly between two groups (AKI and non AKI patients with COVID-19). Our results showed significant correlation between AKI development and obesity (p= 0.05, OR 4.75), Charlston index score (p=0.01), D dimer score (p=0.01), and CT COVID score (p=0.03). Regarding the outcome, COVID 19 patients with AKI showed 7-fold higher risk for fatal outcome (p= 0.046). Conclusion Obesity, higher D dimer values, worse CT findings and higher Charlston comorbidity score index were associated with acute kidney injury in patients with COVID 19. AKI proved to be significant risk factor for fatal outcome in patients with SARS COV2 infection.

scholarly journals Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

2019 ◽  
Vol 9 (3) ◽  
pp. 193-196
Author(s):  
Shahana Zaman ◽  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
Ishrat Jahan ◽  
Tufayel Ahmed Chowdhury ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Angiotensin Receptor Blockers ◽  
Significant Risk ◽  
Kidney Injury ◽  
Febrile Illness ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Adult Patients ◽  
Converting Enzyme Inhibitors

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection. Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (>18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls. Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p <0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p <0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant. Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI. Birdem Med J 2019; 9(3): 193-196

scholarly journals Serum chloride and sodium concentration as a predictor of acute kidney injury in premature newborns

2017 ◽  
Vol 145 (7-8) ◽  
pp. 340-345
Author(s):  
Drazenka Todorovic ◽  
Vesna Stojanovic ◽  
Aleksandra Doronjski
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Sodium Concentration ◽  
Premature Newborns ◽  
Serum Chloride

Introduction/Objective. Hyperchloremia is often registered in adults? studies after administration with 0.9% sodium chloride, which contributes to the development of acute kidney injury (AKI) as it leads to vasoconstriction of renal blood vessels. The aim of this study was to determine the correlation of sodium and chloride imbalance with the development of AKI, with consideration of other risk factors for this disorder. Methods. This retrospective study included 146 randomly selected preterm infants hospitalized at the Neonatal Intensive Care Unit from 2008 to 2015. Results. Among the patients registered for the study, 23.97% developed AKI, and they were of a significantly lower gestational age (26.3 ? 2.8 weeks vs. 31.7 ? 2.90 weeks, p < 0.05); birth weight (971.31 ? 412.1 g vs. 1,753.3 ? 750.3 g, p < 0.05); Apgar score in the first (3.2 ? 1.7 vs. 5.7 ? 2.4, p < 0.05) and fifth minute (5.3 ? 1.7 vs. 7.1 ? 1.8, p < 0.05) of life compared to those without AKI. The neonates with AKI had significantly higher maximum chloremia (Clmax: 114.1 ? 8.4 vs. 111.7 ? 4.6, p = 0.029) and maximum natremia (Namax: 147.9 ? 8.8 vs. 142.9 ? 4, p < 0.05). Each of these parameters is (independently) a statistically significant risk factor for the development of AKI, and gestational age is the strongest (OR = 1 / 0.643 = 1.55; 95% CI 1.24?1.94). Mortality in neonates with AKI was higher than in neonates without AKI (19.4% vs. 92.7%, p < 0.05). Conclusion. Hyperchloremia and hypernatremia are more common in the premature newborns with AKI compared to the premature newborns without AKI. Higher maximum sodium and chloride values are independent risk factors for AKI.

scholarly journals Acute kidney injury in patients with severe COVID-19 in Mexico

2020 ◽  
Author(s):  
GUSTAVO CASAS ◽  
MARIA-ISABEL LEON ◽  
MAURICIO GONZALEZ-NAVARRO ◽  
CLAUDIA ALVARADO DE LA BARRERA ◽  
Santiago Avila-Rios ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Systemic Disease ◽  
Invasive Mechanical Ventilation ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Vasoactive Drugs ◽  
D Dimer

Introduction: Some patients with COVID-19 pneumonia present systemic disease involving multiple systems. There is limited information about the clinical characteristics and events leading to acute kidney injury (AKI). We described the factors associated with the development of AKI and explored the relation of AKI and mortality in Mexican population with severe COVID-19. Methods: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 hospitalized at the largest third-level reference institution for COVID-19 care in Mexico between March and April 2020. Demographic information, comorbidities, clinical and laboratory data, dates of mechanical ventilation and hospitalization, mechanical-ventilator settings and use of vasoactive drugs were recorded. Results: Of 99 patients studied, 58 developed AKI (58.6%). The group with AKI had higher body mass index (p=0.0003) and frequency of obesity (p=0.001); a higher requirement of invasive mechanical ventilation (p=0.008) and vasoactive drugs (p=0.004); greater levels of serum creatinine (p<0.001) and D-dimer on admission (p<0.001); and lower lymphocyte counts (p=0.001) than the non-AKI group. The multivariate analysis indicated that risk factors for AKI were obesity (adjusted hazard ratio (HR)=2.71, 95% confidence interval (CI)=1.33-5.51, p=0.005); higher serum creatinine (HR=1.44, CI=1.02-2.02, p=0.035) and D-dimer levels on admission (HR=1.14, CI=1.06-1.23, p<0.001). In-hospital mortality was higher in the AKI group than in the non-AKI group (65.5% vs. 14.6%; p=0.001). Conclusions: AKI was common in our cohort of patients with severe COVID-19 and it was associated with mortality. The risk factors for AKI were obesity, elevated creatinine levels and higher D-dimer levels on admission. Key words: Acute kidney injury; AKI; acute renal failure; COVID-19; SARS-CoV-2.

Acute Kidney Injury in Critically Ill Children: A Retrospective Analysis of Risk Factors

2019 ◽  
Vol 49 (1-2) ◽  
pp. 1-7 ◽  
Author(s):  
Francesca De Zan ◽  
Angela Amigoni ◽  
Roberta Pozzato ◽  
Andrea Pettenazzo ◽  
Luisa Murer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Critically Ill ◽  
Significant Risk ◽  
Kidney Injury ◽  
Multiple Organ ◽  
Critically Ill Children ◽  
Multiple Organ Dysfunction ◽  
Risk Of Mortality ◽  
Nephrotoxic Drugs

Introduction: Children admitted to paediatric intensive care unit (PICU) are at risk of acute kidney injury (AKI). However, few paediatric studies have focused on the identification of factors potentially associated with the development of this condition. The aim of our study was to assess the incidence rate of AKI, identify risk factors, and evaluate clinical outcome in a large sample of critically ill children. Methods: This retrospective observational study was conducted including patients admitted to our PICU from January 2014 to December 2016. AKI was defined according to Kidney Disease: Improving Global Outcome criteria. Results: A total of 222 PICU patients out of 811 (27%) had AKI (stage I 39%, stage II 24%, stage III 37%). The most common PICU admission diagnoses in AKI cases were heart disease (38.6%), respiratory failure (16.8%) and postsurgical non-cardiac patients (11%). Hypoxic-ischaemic was the most frequent cause of AKI. Significant risk factors for AKI following multivariate analysis were age >2 months (OR 2.43; 95% CI 1.03–7.87; p = 0.05), serum creatinine at admission >44 µmol/L (OR 2.23; 95% CI 1.26–3.94; p = 0.006), presence of comorbidities (OR 1.84; 95% CI 1.03–3.30; p = 0.04), use of inotropes (OR 2.56; 95% CI 1.23–5.35; p= 0.012) and diuretics (OR 2.78; 95% CI 1.49–5.19; p = 0.001), exposure to nephrotoxic drugs (OR 1.66; 95% CI 1.01–2.91; p= 0.04), multiple organ dysfunction syndrome (OR 2.68; 95% CI 1.43–5.01; p = 0.002), and coagulopathy (OR 1.89; 95% CI 1.05–3.38, p = 0.03). AKI was associated with a significant longer PICU stay (median LOS of 8 days, interquartile range [IQR] 3–16, versus 4 days, IQR 2–8, in non-AKI patients; p < 0.001). The mortality rate resulted tenfold higher in AKI than non-AKI patients (12.6 vs. 1.2%; p < 0.001). Conclusions: The incidence of AKI in critically ill children is high, with an associated increased length of stay and risk of mortality. In the PICU setting, risk factors of AKI are multiple and mainly associated with illness severity.

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

scholarly journals Characteristics of and risk factors for death in elderly patients with acute kidney injury: a multicentre retrospective study in China

2018 ◽  
Vol 94 (1111) ◽  
pp. 249-253 ◽  
Author(s):  
Jie-Qiong Liu ◽  
Guang-Yan Cai ◽  
Shuang Liang ◽  
Wen-Ling Wang ◽  
Si-Yang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Multiple Logistic Regression Analysis ◽  
Significant Risk ◽  
Kidney Injury ◽  
The Elderly ◽  
Younger Patients

Purpose of the studyThe incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics of and risk factors for death from AKI in the elderly and help improve prognosis.Study designThis study was a retrospective cohort study based on data from adult patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of AKI in the elderly were compared with those in younger patients.ResultsIn elderly patients with AKI, rates of hypertension, cardiovascular disease and multiple organ dysfunction syndrome (MODS) were higher than in younger patients (44.2% vs 31.2%, 16.1% vs 4.6% and 20.9% vs 16.9%, respectively), the length of ICU stay was longer (3.8 days vs 2.7 days, P=0.019) and renal biopsy (1.0% vs 7.13%, P<0.001) and dialysis (9.6% vs 19.2%, P<0.001) were performed less. Hospital-acquired (HA) AKI was more common than community-acquired (CA) AKI (60.3% vs 39.7%), while the most common cause of AKI was pre-renal (53.5%). Multiple logistic regression analysis showed that age (OR 1.041, 95% CI 1.023 to 1.059), cardiovascular disease (OR 1.980, 95% CI 1.402 to 2.797), cancer (OR 2.302, 95% CI 1.654 to 3.203), MODS (OR 3.023, 95% CI 1.627 to 5.620) and mechanical ventilation (OR 2.408, 95% CI 1.187 to 4.887) were significant risk factors for death.ConclusionsHA-AKI and pre-renal AKI were more common in the elderly. Age, cardiovascular disease, cancer, MODS and mechanical ventilation were independent risk factors for death in the elderly with AKI.

scholarly journals Risk Factors for Acute Kidney Injury in Adult Patients With COVID-19: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaoyue Cai ◽  
Guiming Wu ◽  
Jie Zhang ◽  
Lichuan Yang
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Meta Analysis ◽  
Significant Risk ◽  
Kidney Injury ◽  
Adult Patients ◽  
Cochrane Library ◽  
Male Sex

Background and Objective: Since December 2019, coronavirus disease 2019 (COVID-19) has spread rapidly around the world. Studies found that the incidence of acute kidney injury (AKI) in COVID-19 patients was more than double the incidence of AKI in non-COVID-19 patients. Some findings confirmed that AKI is a strong independent risk factor for mortality in patients with COVID-19 and is associated with a three-fold increase in the odds of in-hospital mortality. However, little information is available about AKI in COVID-19 patients. This study aimed to analyse the risk factors for AKI in adult patients with COVID-19.Methods: A systematic literature search was conducted in PubMed, EMBASE, Web of Science, the Cochrane Library, CNKI, VIP and WanFang Data from 1 December 2019 to 30 January 2021. We extracted data from eligible studies to compare the effects of age, sex, chronic diseases and potential risk factors for AKI on the prognosis of adult patients with COVID-19.Results: In total, 38 studies with 42,779 patients were included in this analysis. The meta-analysis showed that male sex (OR = 1.37), older age (MD = 5.63), smoking (OR = 1.23), obesity (OR = 1.12), hypertension (OR=1.85), diabetes (OR=1.71), pneumopathy (OR = 1.36), cardiovascular disease (OR = 1.98), cancer (OR = 1.26), chronic kidney disease (CKD) (OR = 4.56), mechanical ventilation (OR = 8.61) and the use of vasopressors (OR = 8.33) were significant risk factors for AKI (P &lt; 0.05).Conclusions: AKI is a common and serious complication of COVID-19. Overall, male sex, age, smoking, obesity, hypertension, diabetes, pneumopathy, cardiovascular disease, cancer, CKD, mechanical ventilation and the use of vasopressors were independent risk factors for AKI in adult patients with COVID-19. Clinicians need to be aware of these risk factors to reduce the incidence of AKI.System Review Registration: PROSPERO, identifier [CRD42021282233].

scholarly journals Community- versus hospital-acquired acute kidney injury in hospitalised COVID-19 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jack S Bell ◽  
Benjamin D James ◽  
Saif Al-Chalabi ◽  
Lynne Sykes ◽  
Philip A Kalra ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Hospital Acquired

Abstract Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p < 0.0001) while atrial fibrillation conferred a protective effect (adjusted odds ratio 0.29, p < 0.0209). Mortality was significantly higher for patients who had an AKI compared to those who didn’t have an AKI (54.3 % vs. 29.4 % respectively, p < 0.0001). On Cox regression, hospital-acquired AKI was significantly associated with mortality (adjusted hazard ratio 4.64, p < 0.0001) while community-acquired AKI was not. Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

scholarly journals Clinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre

2017 ◽  
Vol 4 (2) ◽  
pp. 635
Author(s):  
Divya Durga ◽  
Sudha Rudrappa
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Serum Creatinine ◽  
Neonatal Sepsis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Kidney Injury ◽  
Morbidity And Mortality ◽  
Incidence And Mortality

Background: Septicemia remains a leading cause of morbidity and mortality among neonates with AKI complicating as many as 3.4 to 24% of them. The actual incidence of renal failure in all sepsis cases is not documented. There are several studies in the literature on renal failure in neonates which were based on older definitions using blood urea and urine output as parameters. The major limitation of the older studies was that they did not use the current acute kidney injury network (AKIN) definition. In the present study, we have attempted to investigate AKI in neonatal sepsis using the AKIN definition based on serum creatinine (Table1). We also attempted to determine the predictors of AKI in neonatal sepsis.Methods: The present study was an explorative study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute in which a total of 50 neonates with clinical/ culture positive sepsis were enrolled during the period of June 2014 to June 2015.Results: These neonates were investigated for the presence of AKI based on serum creatinine values of three consecutive days and were divided into two groups. Group 1 consisted of septic neonates with AKI and group 2 consisted of septic neonates without AKI. Both the groups were followed up till discharge or death. The risk factors associated with sepsis were compared in both the groups and predictors of morbidity and mortality associated with AKI in sepsis were also determined.Conclusions: Incidence and mortality associated with AKI in sepsis was found to be 24% and 75% respectively. Factors like PROM, foul smelling liquor, > 3 unclean vaginal examinations during labour were significant risk factors for development of AKI in sepsis. Culture positivity, associated meningitis, DIC, shock and need for assisted ventilation were poor prognostic indicators and were significantly associated with mortality. 

scholarly journals Diclofenac--Acetaminophen Combination Induced Acute Kidney Injury In Postoperative Pain Relief

2018 ◽  
Vol 21 (1) ◽  
pp. 19 ◽  
Author(s):  
Yan Zhu ◽  
Ping Xu ◽  
Qing Wang ◽  
Jian-quan Luo ◽  
Yi-wen Xiao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Serum Creatinine ◽  
Single Agent ◽  
Significant Risk ◽  
Kidney Injury ◽  
Postoperative Pain Relief ◽  
Length Of Hospitalization

Purpose: The objective of this study was to determine: 1) the incidence and the risk factors of diclofenac/acetaminophen combination as a single agent induced Acute Kidney Injury (AKI) in postoperative pain relief 2) the average cost and length of hospital stay for patients in AKI group and non-AKI group. Methods: All patients with no prior history of chronic kidney disease (CKD) and normal serum creatinine [44~130 μmol /l] who received diclofenac and acetaminophen combination as a single agent intramuscularly (IM) between January and December 2015 in The Second Xiangya Hospital, Changsha, Hunan, China were included in this retrospective own-control study. Baseline serum creatinine (SCr) and SCr during NSAID use were collected. AKI is defined as an increased of Scr over 1.5 times the baseline. Multivariate analyses were performed with a logistic regression model to assess the significant risk factors of AKI. Results: A total of 821 patients were included in the study with 63 [7.7%] patients had diclofenac/acetaminophen combination single agent induced AKI. Multivariate analysis confirmed that using diclofenac/acetaminophen combination after surgeries within 24 h were significantly associated with AKI [odds ratio, OR, 2.173; 95% CI, 1.113-4.243; P=0.023]. The average cost and length of hospitalization in AKI group was 1.87 times [p=0.000] and 1.2 times [p=0.043] comparison than non-AKI group, respectively. Conclusions: The incidence of diclofenac/acetaminophen combination single agent induced AKI in postoperative pain relief was 7.7%. Patients with hypertension or liver cirrhosis was more likely to develop AKI and using diclofenac/acetaminophen combination after surgeries within 24 h was significant risk factors for AKI. AKI prolonged the cost and length of hospitalization. This article is open to POST-PUBLICATION REVIEW. Registered readers (see “For Readers”) may comment by clicking on ABSTRACT on the issue’s contents page.

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