Hospitalised heat-related acute kidney injury in indoor and outdoor workers in the USA

2021 ◽  
pp. oemed-2021-107933
Author(s):  
Dallas S Shi ◽  
Virginia M Weaver ◽  
Michael J Hodgson ◽  
Aaron W Tustin
Keyword(s):  
Acute Kidney Injury ◽  
Heat Stress ◽  
Occupational Safety ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Data Sources ◽  
Work Related ◽  
The Usa ◽  
Prevention Programmes ◽  
Indoor And Outdoor

ObjectivesTo characterise heat-related acute kidney injury (HR-AKI) among US workers in a range of industries.MethodsTwo data sources were analysed: archived case files of the Occupational Safety and Health Administration’s (OSHA) Office of Occupational Medicine and Nursing from 2010 through 2020; and a Severe Injury Reports (SIR) database of work-related hospitalisations that employers reported to federal OSHA from 2015 to 2020. Confirmed, probable and possible cases of HR-AKI were ascertained by serum creatinine measurements and narrative incident descriptions. Industry-specific incidence rates of HR-AKI were computed. A capture–recapture analysis assessed under-reporting in SIR.ResultsThere were 608 HR-AKI cases, including 22 confirmed cases and 586 probable or possible cases. HR-AKI occurred in indoor and outdoor industries including manufacturing, construction, mail and package delivery, and solid waste collection. Among confirmed cases, 95.2% were male, 50.0% had hypertension and 40.9% were newly hired workers. Incidence rates of AKI hospitalisations from 1.0 to 2.5 hours per 100 000 workers per year were observed in high-risk industries. Analysis of overlap between the data sources found that employers reported only 70.6% of eligible HR-AKI hospitalisations to OSHA, and only 41.2% of reports contained a consistent diagnosis.ConclusionsWorkers were hospitalised with HR-AKI in diverse industries, including indoor facilities. Because of under-reporting and underascertainment, national surveillance databases underestimate the true burden of occupational HR-AKI. Clinicians should consider kidney risk from recurrent heat stress. Employers should provide interventions, such as comprehensive heat stress prevention programmes, that include acclimatisation protocols for new workers, to prevent HR-AKI.

scholarly journals Incidence and Impact of Acute Kidney Injury after Liver Transplantation: A Meta-Analysis

2019 ◽  
Vol 8 (3) ◽  
pp. 372 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Kaewput ◽  
Natanong Thamcharoen ◽  
Tarun Bathini ◽  
Kanramon Watthanasuntorn ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Graft Failure ◽  
Meta Analysis ◽  
Random Effect ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Liver Graft ◽  
Inverse Variance ◽  
Increased Risk ◽  
The Individual

Background: The study’s aim was to summarize the incidence and impacts of post-liver transplant (LTx) acute kidney injury (AKI) on outcomes after LTx. Methods: A literature search was performed using the MEDLINE, EMBASE and Cochrane Databases from inception until December 2018 to identify studies assessing the incidence of AKI (using a standard AKI definition) in adult patients undergoing LTx. Effect estimates from the individual studies were derived and consolidated utilizing random-effect, the generic inverse variance approach of DerSimonian and Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018100664). Results: Thirty-eight cohort studies, with a total of 13,422 LTx patients, were enrolled. Overall, the pooled estimated incidence rates of post-LTx AKI and severe AKI requiring renal replacement therapy (RRT) were 40.7% (95% CI: 35.4%–46.2%) and 7.7% (95% CI: 5.1%–11.4%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of post-LTx AKI (p = 0.81). The pooled estimated in-hospital or 30-day mortality, and 1-year mortality rates of patients with post-LTx AKI were 16.5% (95% CI: 10.8%–24.3%) and 31.1% (95% CI: 22.4%–41.5%), respectively. Post-LTx AKI and severe AKI requiring RRT were associated with significantly higher mortality with pooled ORs of 2.96 (95% CI: 2.32–3.77) and 8.15 (95%CI: 4.52–14.69), respectively. Compared to those without post-LTx AKI, recipients with post-LTx AKI had significantly increased risk of liver graft failure and chronic kidney disease with pooled ORs of 3.76 (95% CI: 1.56–9.03) and 2.35 (95% CI: 1.53–3.61), respectively. Conclusion: The overall estimated incidence rates of post-LTx AKI and severe AKI requiring RRT are 40.8% and 7.0%, respectively. There are significant associations of post-LTx AKI with increased mortality and graft failure after transplantation. Furthermore, the incidence of post-LTx AKI has remained stable over the ten years of the study.

scholarly journals Serum Myoglobin Potentiates Acute Kidney Injury Following Exertional Heatstroke and Its Mechanisms Involved Endoplasmic Reticulum Stress-Associated Ferroptosis

2021 ◽  
Author(s):  
Ying-yi Luan ◽  
En-ping Huang ◽  
Rong-ping Zhou ◽  
Jia-jia Huang ◽  
Zhen-jia Yang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Heat Stress ◽  
Molecular Mechanisms ◽  
Primary Outcome ◽  
Experimental Studies ◽  
Kidney Injury ◽  
High Serum ◽  
Secondary Outcome ◽  
Therapeutic Drug ◽  
Serum Myoglobin

Abstract Background: Myoglobin released by rhabdomyolysis (RM) is considered to be involved in the pathogenesis of kidney disease caused by crush injury, but whether a high level of serum myoglobin predisposes patients to acute kidney injury (AKI) and increases mortality following exertional heatstroke (EHS) and its molecular mechanisms are still unclear. Methods: Serum myoglobin concentrations in patients with EHS were measured at admission, 24 h and 48 h after admission and discharge. The risk of AKI at 48 hours was the primary outcome, AKI at discharge and death at 90 days were the secondary outcome. In experimental studies, we further investigated the mechanisms of human kidney proximal tubular (HK-2) cells that were exposed to human myoglobin under heat stress conditions and the effect of baicalein.Results: The myoglobin levels were assessed in 187 patients who were undergoing EHS, 82 who were undergoing AKI. The highest myoglobin quartile (vs. the lowest) had an adjusted odds ratio (OR) of 18.95 (95% confidence interval [CI], 6.00 to 59.83) for the primary outcome and the OR (vs. quartile 2) was 7.92 (95% CI, 1.62 to 38.89) for the secondary outcome. The survival rate of HK-2 cells treated with myoglobin under heat stress was significantly decreased, and the production of Fe2+ and ROS was markedly increased, accompanied by changes in ferroptosis proteins, including increased p53, decreased SLC7A11 and GPX4, and alterations in ERS marker proteins. Treatment with baicalein attenuated HK-2 cell ferroptosis induced by myoglobin under heat stress through inhibition of ERS. Conclusions: High serum myoglobin levels were associated with AKI and mortality following EHS, which mechanisms involved ferroptosis and ERS. Baicalein-targeted ERS- ferroptosis may be a potential therapeutic drug for the treatment of AKI in patients with RM after EHS.

scholarly journals Non‐Vitamin K Antagonist Oral Anticoagulants Provide Less Adverse Renal Outcomes Than Warfarin In Non‐Valvular Atrial Fibrillation: A Systematic Review and MetaAnalysis

2021 ◽  
Author(s):  
Patita Sitticharoenchai ◽  
Kullaya Takkavatakarn ◽  
Smonporn Boonyaratavej ◽  
Kearkiat Praditpornsilpa ◽  
Somchai Eiam‐Ong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Kidney Injury ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Oral Anticoagulants ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Renal Outcomes ◽  
Stage Renal Disease ◽  
End Stage

Background Non‐vitamin K antagonist oral anticoagulants (NOACs) have better pharmacologic properties than warfarin and are recommended in preference to warfarin in most patients with non‐valvular atrial fibrillation. Besides lower bleeding complications, other advantages of NOACs over warfarin particularly renal outcomes remain inconclusive. Methods and Results Electronic searches were conducted through Medline, Scopus, Cochrane Library databases, and ClinicalTrial.gov. Randomized controlled trials and observational cohort studies reporting incidence rates and hazard ratio (HR) of renal outcomes (including acute kidney injury, worsening renal function, doubling serum creatinine, and end‐stage renal disease) were selected. The random‐effects model was used to calculate pooled incidence and HR with 95% CI. Eighteen studies were included. A total of 285 201 patients were enrolled, 118 863 patients with warfarin and 166 338 patients with NOACs. The NOACs group yielded lower incidence rates of all renal outcomes when compared with the warfarin group. Patients treated with NOACs showed significantly lower HR of risk of acute kidney injury (HR, 0.70, 95% CI, 0.64–0.76; P <0.001), worsening renal function (HR, 0.83; 95% CI, 0.73–0.95; P =0.006), doubling serum creatinine (HR, 0.58; 95% CI, 0.41–0.82; P =0.002), and end‐stage renal disease (HR, 0.82; 95% CI, 0.78–0.86; P <0.001). Conclusions In non‐valvular atrial fibrillation, patients treated with NOACs have a lower risk of both acute kidney injury and end‐stage renal disease when compared with warfarin.

scholarly journals Utility of Self-Reported Heat Stress Symptoms and NGAL Biomarker to Screen for Chronic Kidney Disease of Unknown Origin (CKDu) in Sri Lanka

2021 ◽  
Vol 18 (19) ◽  
pp. 10498
Author(s):  
Pavithra N. Kulasooriya ◽  
Kithsiri B. Jayasekara ◽  
Thilini Nisansala ◽  
Sajani Kannangara ◽  
Ranawaka Karunarathna ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Heat Stress ◽  
Sri Lanka ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Agricultural Workers ◽  
Endemic Region ◽  
Stress Symptoms ◽  
Urine Markers

Objective. We examined heat stress symptoms and urine markers of chronic kidney disease (CKDu) in Sri Lanka to assess differences between endemic vs. non-endemic regions and by occupation. Sample and Methods. We assessed a total of 475 villagers. In the endemic region, 293 were agricultural workers and 67 were not working primarily in agriculture. In the non-endemic region, 76 were agricultural workers. Of the residents, 218 were assessed for neutrophil gelatinase-associated lipocalin (NGAL), an early predictor of acute kidney injury, along with urine markers of chronic kidney disease. Results. The mean (sd) age of the sample was 45.2 (12.6), with males comprising 52.7%; 7.2% reported kidney disease (n = 34), and 5.7% reported diabetes (n = 27). The heat stress index (mean (sd)) was highest among agricultural workers in the endemic region (8.05 (5.9)), intermediate in non-agricultural workers in the endemic region (4.61 (4.5)), and lowest among agricultural workers in the non-endemic region (3.85 (3.3)); p < 0.0001. Correlations were higher between NGAL and serum microalbumin in the endemic agricultural worker sample than in the other two samples (Spearman’s r = 0.34 vs. 0.15 and 0.20). Conclusions. Both heat stress symptoms and NGAL values were higher among agricultural workers in endemic CKDu regions. Correlations between NGAL and microalbumin suggested a link between acute kidney injury and chronic kidney disease in the more-exposed sample.

scholarly journals Acute Kidney Injury in Patients Undergoing Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (1) ◽  
pp. 66 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Kaewput ◽  
Natanong Thamcharoen ◽  
Tarun Bathini ◽  
Kanramon Watthanasuntorn ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Significant Negative Correlation ◽  
Incidence Rates ◽  
Random Effects Model ◽  
Total Hip ◽  
Cochrane Database ◽  
Potential Improvement ◽  
Hip Arthroplasties

Background: The number of total hip arthroplasties (THA) performed across the world is growing rapidly. We performed this meta-analysis to evaluate the incidence of acute kidney injury (AKI) in patients undergoing THA. Methods: A literature search was performed using MEDLINE, EMBASE and Cochrane Database from inception until July 2018 to identify studies assessing the incidence of AKI (using standard AKI definitions of RIFLE, AKIN, and KDIGO classifications) in patients undergoing THA. We applied a random-effects model to estimate the incidence of AKI. The protocol for this meta-analysis is registered with PROSPERO (no. CRD42018101928). Results: Seventeen cohort studies with a total of 24,158 patients undergoing THA were enrolled. Overall, the pooled estimated incidence rates of AKI and severe AKI requiring dialysis following THA were 6.3% (95% CI: 3.8%–10.2%) and 0.5% (95% CI: 0.1%–2.3%). Subgroup analysis based on the countries by continent was performed and demonstrated the pooled estimated incidence of AKI following THA of 9.2% (95% CI: 5.6%–14.8%) in Asia, 8.1% (95% CI: 4.9%–13.2%) in Australia, 7.4% (95% CI: 3.2%–16.3%) in Europe, and 2.8% (95% CI: 1.2%–17.0%) in North America. Meta-regression of all included studies showed significant negative correlation between incidence of AKI following THA and study year (slope = −0.37, p <0.001). There was no publication bias as assessed by the funnel plot and Egger’s regression asymmetry test with p = 0.13 for the incidence of AKI in patients undergoing THA. Conclusion: The overall estimated incidence rates of AKI and severe AKI requiring dialysis in patients undergoing THA are 6.3% and 0.5%, respectively. There has been potential improvement in AKI incidence for patients undergoing THA over time.

scholarly journals Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

2019 ◽  
Vol 8 (7) ◽  
pp. 981 ◽  
Author(s):  
Charat Thongprayoon ◽  
Wisit Cheungpasitporn ◽  
Ploypin Lertjitbanjong ◽  
Narothama Reddy Aeddula ◽  
Tarun Bathini ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Adult Patients ◽  
Membrane Oxygenation ◽  
The Impact

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

Acute Kidney Injury in Extracorporeal Membrane Oxygenation Patients: National Analysis of Impact of Age

2021 ◽  
pp. 1-10
Author(s):  
Ankit Sakhuja ◽  
Paul McCarthy ◽  
Jeremiah A. Hayanga ◽  
Steven Turley ◽  
Gordon Smith ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Extracorporeal Membrane Oxygenation ◽  
Independent Predictor ◽  
Kidney Injury ◽  
International Classification Of Diseases ◽  
Ecmo Support ◽  
Membrane Oxygenation ◽  
Nationwide Inpatient Sample Database ◽  
The Usa ◽  
National Analysis

<b><i>Background:</i></b> The aim of this study was to determine epidemiology and outcomes of acute kidney injury (AKI) in patients on extracorporeal membrane oxygenation (ECMO) and to assess if age modifies the effect of AKI on mortality. <b><i>Methods:</i></b> Using National (Nationwide) Inpatient Sample Database for hospitalizations in the USA from 2003 to 2014, we identified adult patients on ECMO support. Using International Classification of Diseases 9th Revision, we assessed the rates of AKI and AKI requiring dialysis (AKI-D) among them and associated survival. We used a multivariable logistic regression to identify risk factors of and differential effect of age on mortality from AKI. <b><i>Results:</i></b> AKI was seen in 63.9% of 17,942 ECMO hospitalizations: 21.9% of those with AKI required dialysis. The percentage of those with AKI increased steadily. Mortality was higher in those with AKI, with highest in those with AKI-D (70.8% vs. 61.7%; <i>p</i> &#x3c; 0.001). While both age and AKI were independent predictors of mortality, age was neither a risk factor for AKI nor did it modify the effect of AKI on mortality. <b><i>Conclusions:</i></b> AKI is common and is increasing among patients on ECMO support. Patients on ECMO have high mortality and AKI is an independent predictor of mortality. Though age is also an independent predictor of mortality in patients on ECMO, it is neither a predictor of AKI nor does not modify the relationship between AKI and mortality.

scholarly journals Climatological Nephropathy: An Overview

2021 ◽  
Vol 11 (9) ◽  
pp. 83-96
Author(s):  
Priya Jaswal ◽  
Priyanka . ◽  
Jhilli Basu
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Heat Stress ◽  
Kidney Disease ◽  
Heat Waves ◽  
Kidney Injury ◽  
The Body ◽  
Mitigating Factors ◽  
The Government ◽  
Thermoregulatory Function

Globally hike in temperature provokes the heat waves, results in heat stress and becomes a silent health peril to the existing population. Today, heat stress or climatological stress is one of the dominant pathological conditions which comes in focus when the body means of handling its thermoregulatory function starts to fail, show its associated symptoms followed by eventual loss of consciousness and finally death. The condition of heat stress along with intermittent dehydration worsens the renal damage and enhances the risk of Acute Kidney Injury (AKI), results in chronic kidney disease (CKD). Therefore, CKD comes up as a leading cause of death, specifically in those patients having long-lasting medical conditions like heart problem, hypertension, diabetes and obesity etc. High temperature, work rate, humidity and working time wearing accessories, all become mitigating factors for causing heat stress. Distinguish molecular ups and downs specifically decrease production of uric acid (polyol-fructokinase pathway), increase ROS (oxidative stress), intracellular Ca2+ overload (mitochondrial dysfunctioning) and decrease NO (vascular endothelial dysfunctioning) has been responsible for the severe outcomes of Climatological Nephropathy (CN) or Heat Stress Nephropathy (HSN). However, prevention is the best approach to dealing with heat-related illness, therefore, the Government established some valuable policies as a preventive measures. This review epitomizes the alarming outcomes of the heat stress followed by recurrent dehydration and also enlightened the global talk of HSN, pathogenicity, molecular level peculiarities and recommended measures for HSN. Key words: Acute Kidney Injury, Chronic Kidney Disease, Nephropathy, Mitochondrial Dysfunctioning.

scholarly journals Decentralized Water Purification Using Novel Membrane Filtration Technology Approach to Improve Community Health

2019 ◽  
Author(s):  
Jochen G. Raimann ◽  
Joseph Marfo Boaheng ◽  
Phillip Narh ◽  
Seth Johnson ◽  
Linda Donald ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Rural Communities ◽  
Health Outcomes ◽  
Membrane Filtration ◽  
Gastrointestinal Disease ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Control Group ◽  
Systematic Effect ◽  
Rural Ghana

Introduction: In rural communities in regions with limited resources the provision of clean water remains challenging. Fecal contamination of water is very common and results in a high incidence of diarrhea, subsequent acute kidney injury and mortality particularly in the very young and old. Membrane filtration is a practical solution to this problem and recent innovation allows membrane filtration using recycled hemodialyzers. We, Easy Water for Everyone, have quantified the systematic effect on health outcomes. Material and Methods: Between 02/2018 and 12/2018, 4 communities in rural Ghana (in the Greater-Accra region) were each provided with a high-volume membrane filtration devices (NUF 500; NuFiltration using recycled hemodialyzers). Health data from montly household surveys and chart review in local healthcare facilities were collected with approval from Ghana Health Services. Specifically, data was collected on gastrointestinal disease, acute kidney injury and therapeutic interventions. Incidence rates for a five-months period before and after implementation of the device were calculated and compared to rates during the same months from 4 neighboring communities that were not yet provided with the device. Results: Acceptance of the devices and the purified water in the studied villages was good and self-reported data of 1130 villagers over 10 months from 9 studied communities in rural Ghana (11% younger than 5 years and 14 % older than 65 years) were included in this analysis. The overall monthly incidence rate of diarrhea showed a decline following the implementation of the device in the 4 study villages from a mean of 0.18 to 0.05 cases per person-month for a reduction in rates by 72% (rate ratio = 0.27). By contrast, the control group of 4 villages in the same region showed no decline in mean rates during the same months as the study period with mean rates changing not significantly from 0.11 to 0.08 cases per person-month. Discussion: Provision of a hemodialyzer membrane filtration device markedly improves health outcomes as measured by diarrhea incidence within rural communities. While our data awaits confirmation in a larger population and further statistical analyses accounting for village characteristics, seasonality and subject demographics, the obvious decline in incidence rates supports widespread use of hemodialyzer membrane filtration devices, particularly in rural regions. Rollout of the device in further sites will likely increase our understanding in terms of risk and other preventive factors modifying the incidence of diarrhea and subsequent acute kidney injury.

Can sodium fluorescein cause contrast-induced nephropathy?

2019 ◽  
Author(s):  
Donghwan Yun ◽  
Dong Ki Kim ◽  
Jung Pyo Lee ◽  
Yon Su Kim ◽  
Sohee Oh ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cox Regression ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Incidence Rates ◽  
Sodium Fluorescein ◽  
Contrast Imaging ◽  
Contrast Induced Nephropathy ◽  
Iodinated Contrast

Abstract Background Contrast-induced nephropathy (CIN) is a common cause of acute kidney injury (AKI), and can be diagnosed when the etiology of AKI is unclear other than via a contrast agent. Fluorescent angiography (FAG) with fluorescein sodium dye is generally considered to be safe for patients with kidney diseases. However, it remains unresolved whether or not FAG can induce CIN. Methods Patients from two tertiary hospitals who underwent FAG and had serum creatinine results within 4 weeks before FAG and 3 days after FAG between 2001 and 2017 were retrieved. Cases with concurrent iodinated contrast imaging or undergoing dialysis were excluded from the analysis. CIN was defined by two criteria: CIN criteria as >0.5 mg/dL or >25% increase in serum creatinine (sCr) level within 3 days after FAG, and contrast-induced acute kidney injury (CIAKI) criteria as ≥0.3 mg/dL increase within 2 days or ≥50% increase within 7 days after FAG. Results A total of 979 patients were screened, and we found 124 patients with AKI after FAG. After excluding 32 patients with clear causes of AKI other than FAG, the incidence rates of CIN were 7.3% by CIN criteria and 6.4% by CIAKI criteria. CIN incidence had a U-shaped distribution according to chronic kidney disease (CKD) stages in CIN criteria, while linear association between CIN incidence and CKD stages were found in CIAKI criteria. Kaplan–Meier curves showed the CIN group was significantly associated with end-stage renal disease (ESRD) progression (log-rank P < 0.001, in both CIN criteria and CIAKI criteria), and adjusted hazard ratios by multivariable Cox regression were 2.23 [95% confidence interval (CI) 1.468–3.378] in CIN criteria and 2.17 (95% CI 1.462–3.232) in CIAKI criteria. Conclusions According to CIN and CIAKI criteria, FAG may cause CIN and appeared to be a possible risk factor for ESRD progression. However, CIN or CIAKI criteria themselves may overestimate AKI and require meticulous attention to the interpretation of results.

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