scholarly journals Colistin-Induced Acute Kidney Injury and the Effect on Survival in Patients with Multidrug-Resistant Gram-Negative Infections: Significance of Drug Doses Adjusted to Ideal Body Weight

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Nittha Arrayasillapatorn ◽  
Palinee Promsen ◽  
Kittrawee Kritmetapak ◽  
Siriluck Anunnatsiri ◽  
Wijittra Chotmongkol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Body Weight ◽  
Total Dose ◽  
Cox Regression ◽  
Kidney Injury ◽  
Ideal Body Weight ◽  
Multidrug Resistant ◽  
Gram Negative ◽  
Cox Regression Analysis ◽  
Ideal Body

Background. Colistin is a lifesaving treatment for multidrug-resistant Gram-negative bacterial (MDR-GNB) infections along with its well-known nephrotoxicity. The controversy of colistin-induced acute kidney injury (AKI) on mortality is noted. This study aimed to determine the risk factors and impact of AKI on the survival and significance of colistin dosage. Methods. A retrospective cohort study was performed in adult patients who received intravenous colistin for MDR-GNB treatment between June 2015 and June 2017. Factors influencing colistin-induced AKI and survival were evaluated by Cox regression analysis. Cut-off levels of the colistin dose per ideal body weight (IBW) that significantly affected clinical outcomes were assessed with linearity trends and receiver operating characteristic analyses. Results. AKI occurred in 68.5% of 412 enrolled patients with an incidence rate of 10.6 per 100 patients-days and a median time was 6 (3–13) days. Stages I–III of AKI were 38.3, 24.5, and 37.2%. Factors associated with colistin-induced AKI were advanced age, high serum bilirubin, AKI presented before colistin administration, increased daily colistin doses per IBW, and concomitant use of nephrotoxic drugs. Colistin-induced AKI was related to mortality (HR 1.74, 95% CI 1.06–2.86, p = 0.028 ). In the non-AKI before colistin usage subgroup, the total dose and total dose/IBW were >1,500–2,000 mg and 30–35 mg/kg to benefit mortality reduction but were <2,500–3,000 mg and 45–50 mg/kg for risk reduction of AKI. A daily colistin dose/IBW >4.5 mg/kg/day also increased the risk of AKI. In the AKI developed before colistin subgroup, the cut-off values of total colistin dose >1250–1350 mg and total dose/IBW >23.5–24 mg/kg demonstrated significant risks of AKI. Conclusion. The incidence of AKI after colistin administration was high and impacted mortality. Prevention and early correction of these related factors are mandatory. Careful use of colistin was also both beneficial in mortality and AKI reductions.

Clearance Confusion: An Exploratory Analysis of Inpatient Dosing Discordances Between Renal Estimating Equations

2020 ◽  
Vol 54 (11) ◽  
pp. 1102-1108 ◽  
Author(s):  
Sean M. McConachie ◽  
Laila Shammout ◽  
Dmitriy M. Martirosov
Keyword(s):  
Body Weight ◽  
Pharmacy Practice ◽  
Kidney Injury ◽  
Estimating Equations ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Cross Sectional ◽  
Drug Dosing ◽  
Disease Epidemiology ◽  
Ideal Body

Background: Numerous equations exist for estimating renal clearance for drug dosing, and discordance rates may be as high as 40% in certain populations. However, the populations and types of equations used in these studies may not be generalizable to broader pharmacy practice. Objectives: To determine the dosing discordance rate between Cockcroft-Gault (C-G), Chronic Kidney Disease Epidemiology (CKD-EPI), and Modification of Diet in Renal Disease (MDRD) equations in a community hospital population. Methods: This was a cross-sectional analysis of inpatients who had documented renal function assessment over a 6-month period. Renal estimation was calculated using 5 equations (MDRD, CKD-EPI, and 3 C-G variants). Differences between equations were assessed using mean bias, dosing discordance, and agreement (κ statistic). Patients with acute kidney injury and those requiring renal replacement therapy were excluded. Results: A total of 466 patients were eligible for inclusion. Dosing discordance was evident between C-G variants and both MDRD and CKD-EPI equations in greater than 20% of patients. Agreement was highest between MDRD and CKD-EPI (κ = 0.93) and lowest between MDRD and C-G calculated using ideal body weight (κ = 0.33). The majority of discordant instances led to higher dosing recommendations when using MDRD and CKD-EPI equations compared with C-G variants. Dosing discordance exceeded 18% between the different C-G variants, with the highest discordance (36%) observed between total body weight and ideal body weight variants. Conclusion and Relevance: Dosing discordance between renal estimating equations is widespread. Practitioners and institutions should be aware of these differences when dosing medications and implementing renal dosing policies.

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 Incidence, Risk Factors and Mortality Outcome in Patients with Acute Kidney Injury in COVID-19: A Single-Center Observational Study

2020 ◽  
Author(s):  
Alfano Gaetano ◽  
Ferrari Annachiara ◽  
Fontana Francesco ◽  
Mori Giacomo ◽  
Magistroni Riccardo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cox Regression ◽  
Case Fatality ◽  
Kidney Injury ◽  
Serum Levels ◽  
University Hospital ◽  
Hospital Death ◽  
Cox Regression Analysis ◽  
Incidence Risk

AbstractBackgroundAcute kidney injury (AKI) is a recently recognized complication of coronavirus disease-2019 (COVID-19). This study aims to evaluate the incidence, risk factors and case-fatality rate of AKI in patients with documented COVID-19.MethodsWe reviewed the health medical records of 307 consecutive patients hospitalized for symptoms of COVID-19 at the University Hospital of Modena, Italy.ResultsAKI was diagnosed in 69 out of 307 (22.4%) patients. The stages of AKI were stage 1 in 57.9%, stage 2 in 24.6% and stage 3 in 17.3%. Hemodialysis was performed in 7.2% of the subjects. AKI patients had a mean age of 74.7±9.9 years and higher serum levels of the main marker of inflammation and organ involvement (lung, liver, hearth and liver) than non-AKI patients. AKI events were more frequent in subjects with severe lung comprise. Two peaks of AKI events coincided with in-hospital admission and death of the patients. Kidney injury was associate with a higher rate of urinary abnormalities including proteinuria (0.448±0.85 vs 0.18±0.29; P=<0.0001) and hematuria (P=0.032) compared to non-AKI patients. At the end of follow-up, 65.2% of the patients did not recover their renal function after AKI. Risk factors for kidney injury were age, male sex, CKD and non-renal SOFA. Adjusted Cox regression analysis revealed that AKI was independently associated with in-hospital death (hazard ratio [HR]=3.74; CI 95%, 1.34-10.46) compared to non-AKI patients. Groups of patients with AKI stage 2-3 and failure to recover kidney function were associated with the highest risk of in-hospital mortality. Lastly, long-hospitalization was positively associated with a decrease of serum creatinine, likely due to muscle depletion occurred with prolonged bed rest.ConclusionsAKI was a dire consequence of patients with COVID-19. Identification of patients at high-risk for AKI and prevention of kidney injury by avoiding dehydration and nephrotoxic agents is imperative in this vulnerable cohort of patients.

scholarly journals Elevated serum iron level is a predictor of prognosis in severe patients with acute kidney injury

2020 ◽  
Author(s):  
Jie Shu ◽  
Yufeng HU ◽  
Xueshu Yu ◽  
Jiaxiu Chen ◽  
Wenwei Xu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Intensive Care ◽  
Serum Iron ◽  
Cox Regression ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Iron Level ◽  
Serum Iron Level ◽  
Cox Regression Analysis

Abstract Background: Accumulation of iron is associated with oxidative stress (OS), inflammation and regulated cell death. The above three reactions contribute to the development of acute kidney injury (AKI). Here we aimed to investigate the association between the serum iron level and prognosis in severe patients with AKI.Methods: A total of 483 patients with AKI defined by Kidney Disease: Improving Global Guidelines (KIDGO) were included in this retrospective study. The data was extracted from the single-center Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database. The max serum iron concentration measured after Intensive Care Unit (ICU) admission was defined as the serum iron in the study and divided into three groups (Low group, Middle group, High group). We plotted boxplots and Kaplan–Meier curves and used cox regression analysis to analyze data.Results: In univariable Cox regression analysis, serum iron levels were significantly correlated to the prognosis of AKI patients. After adjusting for confounding variables, higher serum iron level was remained to associate with the increase in 90-day mortality in the multivariable Cox regression analysis. Moreover, the risk of 90-day mortality stepwise increased as the groups of serum iron levels increased in AKI patients.Conclusions: From our study, we investigated that high serum iron level was associated with the increased mortality in severe patients with AKI. Serum iron levels on admission can be a predictor for predicting the prognosis of AKI patients.

scholarly journals Impact of Acute Kidney Injury on Survival in Patients With Chronic Hepatitis C

2020 ◽  
Author(s):  
Hankyu Jeon ◽  
Jae Heon Kim ◽  
Sang Soo Lee ◽  
Hee Jin Kim ◽  
Ra Ri Cha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Chronic Hepatitis C ◽  
Cox Regression ◽  
Kidney Injury ◽  
Hcv Infection ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Overall Mortality

Abstract Background: Acute kidney injury (AKI) is expected to occur commonly in patients with chronic hepatitis C. In addition, AKI may affect the survival of patients with chronic hepatitis C. However, few studies are available on this topic. We aimed to evaluate the incidence of AKI in patients with chronic hepatitis C and investigate the factors related to overall mortality. Methods: Between January 2005 and December 2018, 1252 patients with chronic hepatitis C virus (HCV) infection were retrospectively enrolled at two centers. Of them, 1008, 123, and 121 patients had chronic hepatitis (CH), compensated cirrhosis (Com-LC), and decompensated cirrhosis (Decom-LC) or hepatocellular carcinoma (HCC) at entry, respectively. Results: Over a mean follow-up period of 5.2 years, 285 patients developed AKI, with an incidence rate of 4.35 per 100 person-years. The incidence of AKI increased gradually with progression of chronic hepatitis C: CH (3.32 per 100 person-years), Com-LC (5.86 per 100 person-years), and Decom-LC or HCC (17.28 per 100 person-years). Patients without AKI showed a better survival rate than patients with AKI (P < 0.001). In multivariate Cox regression analysis, AKI (hazard ratio, 6.66; 95% confidence interval, 4.26–10.41) remained an independent risk factor for overall mortality. Conclusion: AKI is common in patients with chronic HCV infection and is associated with significant overall mortality. Therefore, clinicians should carefully monitor the occurrence of AKI, which is an important predictor of mortality in patients with chronic hepatitis C.

scholarly journals Urine Output Calculated Using Actual Body Weight may Result in Overestimation of Acute Kidney Injury for Obese Patients

2020 ◽  
Author(s):  
Jun Jiang ◽  
Jing Zhang ◽  
Ye Liu ◽  
Dongxue Xu ◽  
Zhi-Yong Peng
Keyword(s):  
Acute Kidney Injury ◽  
Body Weight ◽  
Actual Body ◽  
Urine Output ◽  
Kidney Injury ◽  
Ideal Body Weight ◽  
Hospital Death ◽  
Reference Ranges ◽  
Actual Body Weight ◽  
Criteria For Diagnosis

Abstract Background: The derived hourly urine output (UO) indexed by body weight is one of the major criteria for diagnosis of acute kidney injury (AKI). However, it is unknown whether actual body weight (ABW) or ideal body weight (IBW) should be used. This study aims to explore whether UO calculation based on ABW might lead to overestimation of AKI.Methods: AKI patients identified in the MIMIC database by different components of the KDIGO guidelines and different definitions of body weight were retrospectively studied. We compared hospital and 90-day mortality to decide whether AKI patients diagnosed by ABW- or IBW-normalized UO had the same outcome.Results: In the cohort of 14,725 patients, AKI was identified in 4,298 (29.19%) and 3,060 (20.78%) patients respectively when ABW or IBW was used to calculate hourly UO (p < 0.001). AKI stages differed between these patients (p < 0.001) with a kappa of 0.87 (95% CI, 0.86 ~ 0.88) and an agreement percentage of 90.40%. Multivariate logistic regression revealed AKI patients identified by UO calculated from ABW had similar hospital and 90-day mortality to that of patients with no evidence of AKI. Whereas AKI patients identified by SCr or by both ABW and IBW had over twice higher the risks of hospital death, 1.7 and 1.4 times higher the risks of 90-day death respectively compared with patients with no evidence of AKI. Results were confirmed in sensitivity analysis where patients whose admission creatinine levels were within the normal reference ranges and sepsis patients were studied.Conclusions: Calculating hourly body weight normalized UO using ABW may lead to underestimation of UO and overestimation of AKI.

scholarly journals A Comparison Between Two Definitions of Contrast-Associated Acute Kidney Injury for Long-Term Mortality in Elderly and Non-elderly Patients After Elective Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Haoming He ◽  
Zhebin You ◽  
Xueqin Lin ◽  
Chen He ◽  
Sicheng Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly Patients ◽  
Cox Regression ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Cox Regression Analysis ◽  
Percutaneous Coronary ◽  
Definition Of ◽  
Long Term Mortality

Background: Contrast-associated acute kidney injury (CA-AKI) is responsible for a substantial proportion of the observed mortality that occurs after percutaneous coronary intervention (PCI), particularly in elderly patients. However, there has been significant and debate over whether the optimal definition of CA-AKI persists over prolonged periods due to variations in the prevalence and effects on prognosis. In this study, we aimed to identify whether different definitions of CA-AKI exert differential impacts on long-term mortality when compared between elderly and non-elderly patients receiving elective PCI.Methods: We prospectively investigated 5,587 consenting patients undergoing elective PCI between January 2012 and December 2018. We considered two classical definitions of CA-AKI from the European Society of Urogenital Radiology (ESUR) and the Acute Kidney Injury Network (AKIN). Multivariable Cox regression analysis was used to investigate the association between CA-AKI and long-term mortality. We also performed interaction and stratified analyses according to age (≤75 or &gt;75 years).Results: The incidence of CA-AKI according to the ESUR and AKIN definitions was 18.7 and 6.1%, respectively. After a median follow-up of 2.1 years, multivariable Cox regression analysis indicated that CA-AKI according to the AKIN definition was a risk factor for long-term mortality in the overall population [hazard ratio (HR) = 2.20; 95% confidential interval (CI): 1.51–3.22; p &lt; 0.001]; however, this was not the case for the ESUR definition (HR = 1.27; 95% CI: 0.92–1.76; p = 0.153). Further interaction analysis identified a significant interaction between age and the ESUR definition (p = 0.040). Stratified analyses also found an association between the ESUR definition and long-term mortality in patients &gt;75 years of age (p = 0.011), but not in patients ≤75 years of age (p = 0.657).Conclusion: As a stringent definition of CA-AKI, the AKIN definition was significantly associated with long-term mortality in both non-elderly and elderly patients. However, in elderly patients, the more lenient definition provided by the ESUR was also significantly correlated with long-term mortality, which could sensitively identify high-risk elderly patients and may provide a better alternative.

scholarly journals Vancomycin-ResistantEnterococcus faeciumBacteremia in a Tertiary Care Hospital: Epidemiology, Antimicrobial Susceptibility, and Outcome

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Regis G. Rosa ◽  
Alexandre V. Schwarzbold ◽  
Rodrigo P. dos Santos ◽  
Eduardo E. Turra ◽  
Denise P. Machado ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cox Regression ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Apache Ii Score ◽  
Care Hospital ◽  
Tertiary Referral Hospital

Vancomycin-resistantEnterococcus faecium(VREF) has emerged as a relevant multidrug-resistant pathogen and potentially lethal etiology of health care associated infections worldwide. The objective of this retrospective cohort study was to assess factors associated with mortality in patients with VREF bacteremia in a major tertiary referral hospital in Southern Brazil. All documented cases of bacteremia identified between May 2010 and July 2012 were evaluated. Cox regression was performed to determine whether the characteristics related to the host or antimicrobial treatment were associated with the all-cause 30-day mortality. In total, 35 patients with documented VREF bacteremia were identified during the study period. The median APACHE-II score of the study population was 26 (interquartile range: 10). The overall 30-day mortality was 65.7%. All VREF isolates were sensitive to linezolid, daptomycin, and quinupristin-dalfopristin. Linezolid was the only antimicrobial agent within vitroactivity against VREF that was administered to the cohort. After multivariate analysis, linezolid treatment (HR, 0.08; 95% CI, 0.02–0.27) and presence of acute kidney injury at the onset of bacteremia (HR, 4.01; 95% CI, 1.62–9.94) were independently associated with mortality. Presentation with acute kidney injury and lack of treatment with an effective antibiotic poses risk for mortality in patients with VREF bacteremia.

scholarly journals Acute Kidney Injury Is Associated With In-hospital Mortality in Older Patients With COVID-19

2020 ◽  
Author(s):  
Qi Yan ◽  
Peiyuan Zuo ◽  
Ling Cheng ◽  
Yuanyuan Li ◽  
Kaixin Song ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Older Patients ◽  
Cox Regression ◽  
Demographic Data ◽  
Tertiary Care ◽  
Kidney Injury ◽  
University Hospital ◽  
Cox Regression Analysis ◽  
Risk Of Death

Abstract Background The epidemic of COVID-19 presents a special threat to older adults. However, information on kidney damage in older patients with COVID-19 is limited. Acute kidney injury (AKI) is common in hospitalized adults and associated with poor prognosis. We sought to explore the association between AKI and mortality in older patients with COVID-19. Methods We conducted a retrospective, observational cohort study in a large tertiary care university hospital in Wuhan, China. All consecutive inpatients older than 65 years with COVID-19 were enrolled in this cohort. Demographic data, laboratory values, comorbidities, treatments, and clinical outcomes were all collected. Data were compared between patients with AKI and without AKI. The association between AKI and mortality was analyzed. Results Of 1764 in-hospital patients, 882 older adult cases were included in this cohort. The median age was 71 years (interquartile range: 68–77), 440 (49.9%) were men. The most presented comorbidity was cardiovascular diseases (58.2%), followed by diabetes (31.4%). Of 882 older patients, 115 (13%) developed AKI and 128 (14.5%) died. Patients with AKI had higher mortality than those without AKI (68 [59.1%] vs 60 [7.8%]; p &lt; .001). Multivariable Cox regression analysis showed that increasing odds of in-hospital mortality are associated with higher interleukin-6 on admission, myocardial injury, and AKI. Conclusions Acute kidney injury is not an uncommon complication in older patients with COVID-19 but is associated with a high risk of death. Physicians should be aware of the risk of AKI in older patients with COVID-19.

Sign in / Sign up

Export Citation Format

Share Document