Prognosis of hospitalized patients with cirrhosis and acute kidney disease

Background and objectivesPatients are informed of the risk of kidney biopsy–related complications using data from nonhospitalized patients, which may underestimate the risk for hospitalized patients. We evaluated the rate and risk factors of kidney biopsy–related complications in hospitalized patients with acute kidney disease (AKD) to better estimate the risk in this population.Design, setting, participants, & measurementsWe used data from the Yale biopsy cohort to evaluate rates of kidney biopsy–related complications including adjudicated procedure-related bleeding requiring blood transfusions or angiographic interventions, medium- or large-sized hematomas, reimaging after biopsy including abdominal ultrasonography or computed tomography, and death in hospitalized patients with AKD (including AKI). We evaluated univariable and multivariable association of risk factors with transfusions. We compared rates of complications between hospitalized and nonhospitalized patients.ResultsBetween 2015 and 2017, 159 hospitalized patients underwent a kidney biopsy for AKD evaluation, of which 80 (51%) had stage 1 AKI, 42 (27%) had stage 2 (or higher) AKI, and 27 (17%) had AKD (without AKI). Of these, 12 (8%; 95% confidence interval [95% CI], 5% to 15%) required a transfusion, three (2%; 95% CI, 1% to 5%) required an intervention, 11 (7%; 95% CI, 4% to 12%) had hematoma, and 31 (20%; 95% CI, 14% to 26%) required reimaging after biopsy. Of the four (3%; 95% CI, 1% to 6%) deaths during hospitalization, none were related to the biopsy. Female sex, lower platelet count, and higher BUN were associated with postbiopsy transfusions on univariable and multivariable analyses. Trainee as proceduralist and larger needle gauge were associated with transfusions in univariable, but not multivariable, analysis. Nonhospitalized patients had lower rates of transfusion than hospitalized patients, although the latter also had lower prebiopsy hemoglobin and greater surveillance after biopsy.ConclusionsHospitalized patients experience higher risk of postbiopsy complications than previously reported and several factors, such as lower platelet count, female sex, and higher BUN, are associated with this risk.

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Kidney Biopsy in Hospitalized Patients with Acute Kidney Disease

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.11400918 ◽

2018 ◽

Vol 13 (11) ◽

pp. 1617-1618 ◽

Cited By ~ 2

Author(s):

Steven Darrow Weisbord

Keyword(s):

Kidney Disease ◽

Kidney Biopsy ◽

Hospitalized Patients ◽

Acute Kidney Disease

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Acute Kidney Injury in Hospitalized Patients with COVID-19

10.1101/2020.05.04.20090944 ◽

2020 ◽

Cited By ~ 8

Author(s):

Lili Chan ◽

Kumardeep Chaudhary ◽

Aparna Saha ◽

Kinsuk Chauhan ◽

Akhil Vaid ◽

...

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Kidney Disease ◽

Replacement Therapy ◽

Predictive Model ◽

Kidney Function ◽

Kidney Injury ◽

Hospitalized Patients ◽

Acute Kidney Disease

ABSTRACTImportancePreliminary reports indicate that acute kidney injury (AKI) is common in coronavirus disease (COVID)-19 patients and is associated with worse outcomes. AKI in hospitalized COVID-19 patients in the United States is not well-described.ObjectiveTo provide information about frequency, outcomes and recovery associated with AKI and dialysis in hospitalized COVID-19 patients.DesignObservational, retrospective study.SettingAdmitted to hospital between February 27 and April 15, 2020.ParticipantsPatients aged ≥18 years with laboratory confirmed COVID-19ExposuresAKI (peak serum creatinine increase of 0.3 mg/dL or 50% above baseline).Main Outcomes and MeasuresFrequency of AKI and dialysis requirement, AKI recovery, and adjusted odds ratios (aOR) with mortality. We also trained and tested a machine learning model for predicting dialysis requirement with independent validation.ResultsA total of 3,235 hospitalized patients were diagnosed with COVID-19. AKI occurred in 1406 (46%) patients overall and 280 (20%) with AKI required renal replacement therapy. The incidence of AKI (admission plus new cases) in patients admitted to the intensive care unit was 68% (553 of 815). In the entire cohort, the proportion with stages 1, 2, and 3 AKI were 35%, 20%, 45%, respectively. In those needing intensive care, the respective proportions were 20%, 17%, 63%, and 34% received acute renal replacement therapy. Independent predictors of severe AKI were chronic kidney disease, systolic blood pressure, and potassium at baseline. In-hospital mortality in patients with AKI was 41% overall and 52% in intensive care. The aOR for mortality associated with AKI was 9.6 (95% CI 7.4-12.3) overall and 20.9 (95% CI 11.7-37.3) in patients receiving intensive care. 56% of patients with AKI who were discharged alive recovered kidney function back to baseline. The area under the curve (AUC) for the machine learned predictive model using baseline features for dialysis requirement was 0.79 in a validation test.Conclusions and RelevanceAKI is common in patients hospitalized with COVID-19, associated with worse mortality, and the majority of patients that survive do not recover kidney function. A machine-learned model using admission features had good performance for dialysis prediction and could be used for resource allocation.Key PointsQuestionWhat is incidence and outcomes of acute kidney injury (AKI) in patients hospitalized with COVID-19?FindingsIn this observational study of 3,235 hospitalized patients with COVID-19 in New York City, AKI occurred in 46% of patients and 20% of those patients required dialysis. AKI was associated with increased mortality. 44% of patients discharged alive had residual acute kidney disease. A machine learned predictive model using baseline features for dialysis requirement had an AUC Of 0.79.MeaningAKI was common in patients with COVID-19, associated with increased mortality, and nearly half of patients had acute kidney disease on discharge.

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Renal C3 Production Drives Acute Kidney Injury and Acute Kidney Disease in Diabetics with Sepsis

Diabetes ◽

10.2337/db18-1737-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1737-P

Author(s):

LYNN M. FRYDRYCH ◽

GUOWU BIAN ◽

PETER A. WARD ◽

MARKUS BITZER ◽

MATTHEW DELANO

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Acute Kidney Disease

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Acute kidney disease and the community

The Lancet ◽

10.1016/s0140-6736(16)30239-2 ◽

2016 ◽

Vol 387 (10032) ◽

pp. 1974-1976 ◽

Cited By ~ 9

Author(s):

John A Kellum ◽

Claudio Ronco ◽

Rinaldo Bellomo

Keyword(s):

Kidney Disease ◽

Acute Kidney Disease

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Antibiotic dosing adjustments in hospitalized patients with chronic kidney disease: a retrospective chart review

International Urology and Nephrology ◽

10.1007/s11255-021-02834-6 ◽

2021 ◽

Author(s):

Bahia Chahine

Keyword(s):

Chronic Kidney Disease ◽

Kidney Disease ◽

Chart Review ◽

Retrospective Chart Review ◽

Hospitalized Patients ◽

Antibiotic Dosing

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Healthcare-related impact of gout in hospitalized patients in Spain

Scientific Reports ◽

10.1038/s41598-021-92673-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Diego Benavent ◽

Diana Peiteado ◽

María Ángeles Martinez-Huedo ◽

María Hernandez-Hurtado ◽

Alejandro Balsa ◽

...

Keyword(s):

Heart Failure ◽

Kidney Disease ◽

Mortality Rates ◽

Progressive Increase ◽

Cerebrovascular Diseases ◽

Hospitalized Patients ◽

Data Set ◽

Private Hospitals ◽

Risk Of Mortality ◽

General Mortality

AbstractTo analyze the epidemiology, clinical features and costs of hospitalized patients with gout during the last decade in Spain. Retrospective observational study based on data from the Minimum Basic Data Set (MBDS) from the Spanish National Health Service database. Patients ≥ 18 years with any gout diagnosis at discharge who had been admitted to public or private hospitals between 2005 and 2015 were included. Patients were divided in two periods: p1 (2005–2010) and p2 (2011–2015) to compare the number of hospitalizations, mean costs and mortality rates. Data from 192,037 patients with gout was analyzed. There was an increase in the number of hospitalized patients with gout (p < 0.001). The more frequent comorbidities were diabetes (27.6% of patients), kidney disease (26.6%) and heart failure (19.3%). Liver disease (OR 2.61), dementia (OR 2.13), cerebrovascular diseases (OR 1.57), heart failure (OR 1.41), and kidney disease (OR 1.34) were associated with a higher mortality risk. Women had a lower risk of mortality than men (OR 0.85). General mortality rates in these hospitalized patients progressively increased over the years (p < 0.001). In addition, costs gradually rose, presenting a significant increase in p2 even after adjusting for inflation (p = 0.001). A progressive increase in hospitalizations, mortality rates and cost in hospitalized patients with gout was observed. This harmful trend in a preventable illness highlights the need for change and the search for new healthcare strategies.

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