scholarly journals Acute Kidney Injury Associated with Combination Antimicrobial Therapy in the Medical Information Mart for Intensive Care (MIMIC) III Database

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S344-S344
Author(s):  
W Cliff Rutter ◽  
David S Burgess
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Hepatorenal Syndrome ◽  
Medical Information ◽  
Kidney Injury ◽  
Rifle Criteria ◽  
Multivariable Logistic Regression

Abstract Background Increased acute kidney injury (AKI) incidence is linked with coadministration of vancomycin (VAN) and piperacillin-tazobactam (TZP) in the general hospital population when compared with VAN and cefepime (FEP); however, this phenomenon was not found in critically ill patients. Methods Patients receiving VAN in combination with FEP or TZP for at least 48 hours during an intensive care unit stay were included in this retrospective review. AKI was defined with the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Exposure to common nephrotoxins was captured within 24 hours of combination therapy initiation through the entire treatment window. Basic descriptive statistics were performed, along with bivariable and multivariable logistic regression models of AKI odds. Results In total, 2230 patients were included, with 773 receiving FEP+VAN and 1457 receiving TZP+VAN. The groups were well balanced at baseline in most covariates, with the exception of hepatorenal syndrome diagnosis (TZP+VAN 1.4% vs. FEP+VAN 0.3%, P = 0.02) and vasopressor exposure (TZP+VAN 26.2% vs 21.5%, P = 0.01) being more common in the TZP+VAN group. Patients in the FEP+VAN group had a higher underlying severity of disease (Charlson comorbidity index [CCI] 2.7 vs. 2.3, P =0.0002). AKI incidence was higher in the TZP+VAN cohort (35.1% vs. 26.5%, P = 0.00004), with each stratification of the RIFLE criteria being higher. The time until onset of AKI was similar between groups (TZP+VAN median 1 [0–3] days vs. FEP+VAN 1 [0–4] days, P =0.2). After multivariable logistic regression, TZP+VAN therapy was associated with an adjust odds ratio (aOR) of AKI of 1.54 (95% confidence interval [CI] 1.25–1.89) compared with FEP+VAN. Other variables associated with increased odds of AKI included: age >= 65, duration of antibiotic therapy, higher baseline renal function, sepsis, endocarditis, hepatorenal syndrome, thiazide diuretic exposure, and increased CCI. Conclusion Treatment with TZP+VAN is associated with significant increases in AKI incidence among critically ill patients, independent of other risks for AKI. Disclosures All authors: No reported disclosures.

scholarly journals The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study

2021 ◽  
Vol 104 (2) ◽  
pp. 003685042110180
Author(s):  
Yu Chen ◽  
Fang Feng ◽  
Xue-ni Chang ◽  
Dong Liu ◽  
Yuan Yuan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
White Blood Cells ◽  
Kidney Injury ◽  
Gansu Province ◽  
Incidence And Mortality

To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province. This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. (2) Logistic regression analysis showed that sex, age, AKI stage, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time, and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury ( p < 0.05). Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals Association Between Serum Osmolality and Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Yang ◽  
Yisong Cheng ◽  
Ruoran Wang ◽  
Bo Wang
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
High Serum ◽  
Serum Osmolality ◽  
Multivariate Logistic Regression ◽  
Low Serum

Purposes: Acute kidney injury (AKI) is a common complication in critically ill patients and is usually associated with poor outcomes. Serum osmolality has been validated in predicting critically ill patient mortality. However, data about the association between serum osmolality and AKI is still lacking in ICU. Therefore, the purpose of the present study was to investigate the association between early serum osmolality and the development of AKI in critically ill patients.Methods: The present study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. 20,160 patients were involved in this study and divided into six subgroups according to causes for ICU admission. The primary outcome was the incidence of AKI after ICU admission. The association between early serum osmolality and AKI was explored using univariate and multivariate logistic regression analyses.Results: The normal range of serum osmolality was 285–300 mmol/L. High serum osmolality was defined as serum osmolality &gt;300 mmol/L and low serum osmolality was defined as serum osmolality &lt;285 mmol/L. Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P &lt; 0.001) and low serum osmolality was also independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P &lt; 0.001), compared with normal serum osmolality, respectively.Conclusions: In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI.

scholarly journals SAT-150 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS IN A SOUTH AFRICAN TERTIARY INTENSIVE CARE UNIT

2019 ◽  
Vol 4 (7) ◽  
pp. S68
Author(s):  
R. AYLWARD ◽  
M. van Niekerk ◽  
D. Baker ◽  
J. Ensor ◽  
S. Pazi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
South African ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury

scholarly journals Nephrotoxic drug burden among 1001 critically ill patients: impact on acute kidney injury

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Stephan Ehrmann ◽  
◽  
Julie Helms ◽  
Aurélie Joret ◽  
Laurent Martin-Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Drug Prescription ◽  
Kidney Injury ◽  
Simplified Acute Physiology Score ◽  
Severity Of Disease ◽  
Lower Severity

Abstract Background Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case–control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI. Results Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04–1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48). Conclusions The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.

Continuous renal replacement therapy for critically ill patients in the intensive care units of two tertiary hospitals. v1

2021 ◽  
Author(s):  
Jorge not provided not provided Machado Alba
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intensive Care Units ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Severity Scores

Introduction: Acute kidney injury is characterized by a sudden decrease in renal function. The objective was to determine the variables that are associated with the need for continuous renal replacement therapy and its outcome in critically ill patients treated in two intensive care units. Methods. A cohort follow-up study with reviewed clinical histories of 140 patients admitted between January-2012 and July-2015, who were receiving continuous therapy, and the main outcome was survival after discharge. Clinical variables, severity scores, disease prognosis, continuous renal replacement techniques and outcomes were collected. Results. Mean age was 61.9±17.6 years, and 60.7% were men. Septic shock was the main cause of acute kidney injury. In total, 79.4% of cases died in the intensive care units. The median dose of continuous renal replacement therapy was 28 ml/kg/hour (interquartile range: 35-37). The late initiation of the therapy between 25-72 hours after the diagnosis increased the probability that the patient would experience a fatal outcome (OR:6.9, 95%CI:1.5-33.0). Conclusions: Acute kidney injury secondary to sepsis is a frequent condition in critically ill patients and is associated with high mortality rates. In these cases, continuous renal replacement therapy was the main recourse for its treatment.

scholarly journals Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

2019 ◽  
Vol 17 ◽  
pp. 205873921984682
Author(s):  
Ying Zhou ◽  
Ming-Hua Zheng ◽  
Chao-Sheng Chen ◽  
Dan-Qin Sun ◽  
Xin-Xin Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Inverse Association ◽  
Risk Of Mortality ◽  
Increased Risk

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

Sign in / Sign up

Export Citation Format

Share Document