Clinical Characteristics and Outcomes of Community-Acquired versus Hospital-Acquired Acute Kidney Injury: A Meta-Analysis

Background: The different clinical characteristics of community-acquired acute kidney injury (CA-AKI) versus hospital-acquired AKI (HA-AKI) have remained inconclusive, and thus, a meta-analysis was conducted to summarize and quantify the clinical significance distinguishing the 2 types of AKI. Methods: We identified observational studies reporting the clinical characteristics and prognosis of HA-AKI and CA-AKI. ORs and mean differences (MDs) were extracted for each outcome and the results aggregated. The primary outcome was defined as the mortality rate; renal recovery, oliguria incidence, dialysis, intensive care unit (ICU) requirement, and length of hospital stay were secondary outcomes. Results: Fifteen eligible studies involving 46,157 patients (22,791 CA-AKI patients and 23,366 HA-AKI patients) were included. Mortality was significantly lower in CA-AKI than in HA-AKI patients, with an OR of 0.43 (95% CI 0.35–0.53). The incidence of oliguria and need for ICU were also lower in CA-AKI patients (OR 0.58, 95% CI 0.38–0.88; OR 0.24, 95% CI 0.14–0.40, respectively). CA-AKI patients had a shorter hospital stay (MD –9.42, 95% CI –13.73 to –5.12). The renal recovery rate and dialysis need between CA- and HA-AKI were similar (OR 1.27, 95% CI 0.53–3.02; OR 1.05, 95% CI 0.82–1.34, respectively). Conclusions: CA-AKI showed better clinical manifestations with a lower incidence of oliguria, reduced risk of ICU treatment, and shorter hospital stay. Mortality associated with CA-AKI was lower compared with HA-AKI, indicating a better prognosis. The rate of renal recovery and need for dialysis showed no significant difference between the 2 groups.

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Intermittent Convective Therapies in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Blood Purification ◽

10.1159/000515641 ◽

2021 ◽

pp. 1-12

Author(s):

Jean Maxime Côté ◽

Louis Pinard ◽

Jean-Francois Cailhier ◽

Renée Lévesque ◽

Patrick T. Murray ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Observational Studies ◽

Meta Analysis ◽

Kidney Injury ◽

Renal Recovery ◽

Cochrane Library ◽

Significant Difference ◽

Short Term Mortality ◽

Circuit Loss

Introduction: In critically ill patients requiring intermittent renal replacement therapy (RRT), the benefits of convective versus diffusive clearance remain uncertain. We conducted a systematic review and meta-analysis to determine the safety, clinical efficacy, and clearance efficiency of hemofiltration (HF) and hemodiafiltration (HDF) compared to hemodialysis (HD) in patients with acute kidney injury (AKI) receiving intermittent RRT. Method: We searched Medline, Embase, Cochrane Library, and PROSPERO. We included clinical trials and observational studies that reported the use of intermittent HF or HDF in adult patients with AKI. The following outcomes were included: mortality, renal recovery, clearance efficacy, intradialytic hemodynamic stability, circuit loss, and inflammation modulation. Results: A total of 3,169 studies were retrieved and screened. Four randomized controlled trials and 4 observational studies were included (n: 615 patients). Compared with conventional HD, intermittent convective therapies had no effect on in-hospital mortality (relative risk, 1.23; 95% confidence interval (CI), 0.76–1.99), renal recovery at 30 days (RR, 0.98; 95% CI, 0.82–1.16), time-to-renal recovery (mean difference [MD], 0.77; 95% CI, −6.56 to 8.10), and number of dialysis sessions until renal recovery (MD, −1.34; 95% CI, −3.39 to 0.72). The overall quality of included studies was low, and dialysis parameters were suboptimal for all included studies. Conclusion: This meta-analysis suggests that there is no significant difference in short-term mortality and renal recovery in patients with severe AKI when treated with intermittent HF or HDF compared to conventional HD. This systematic review emphasizes the need for further trials evaluating optimal convective parameters in AKI patients treated with intermittent dialysis.

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Clinical characteristics and prognosis of postpartum acute kidney injury

Journal of International Medical Research ◽

10.1177/0300060520988388 ◽

2021 ◽

Vol 49 (2) ◽

pp. 030006052098838

Author(s):

Hong Shu ◽

Fang Nie

Keyword(s):

Acute Kidney Injury ◽

Clinical Characteristics ◽

Survival Rates ◽

Kidney Injury ◽

Renal Recovery ◽

Replacement Treatment ◽

Elevated Liver Enzymes ◽

Recovery Times ◽

Low Platelet Count ◽

Lost To Follow Up

Objective To investigate the clinical characteristics and prognoses of patients with postpartum acute kidney injury (PPAKI). Methods We retrospectively reviewed the clinical presentations, laboratory examinations, treatments, and outcomes of patients with PPAKI admitted to our hospital from January 2013 to December 2017. We then analyzed the clinical characteristics and prognoses of the mothers and their infants. Results Of 37 patients diagnosed with PPAKI, 26 (70.3%) received treatment in the intensive care unit, mainly for hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome (28/37, 75.7%), pre-eclampsia (26/37, 70.3%), and postpartum hemorrhage (22/37, 59.5%). Twenty patients required renal replacement treatment (RRT), but renal recovery times were similar in the RRT and non-RRT groups. Renal function recovered completely in 30 patients (81.1%) and partially in one patient (2.7%), and was not re-examined in two patients (5.4%). Three patients (8.1%) were lost to follow-up. Only one patient (2.7%) remained dialysis-dependent, and no maternal deaths occurred. The preterm birth, low birth weight, and infant survival rates were 70.7% (29/41), 68.3% (28/41), and 78.0% (32/41), respectively. Conclusion RRT does not reduce renal recovery time compared with non-RRT. Overall, the prognoses of both mothers and their fetuses are good following treatment for PPAKI.

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Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis

Urologia Internationalis ◽

10.1159/000506716 ◽

2020 ◽

pp. 1-7

Author(s):

Zhenhua Gu ◽

Yucheng Yang ◽

Rui Ding ◽

Meili Wang ◽

Jianming Pu ◽

...

Keyword(s):

Hospital Stay ◽

Percutaneous Nephrolithotomy ◽

Kidney Stones ◽

Operative Time ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Clinical Results ◽

Retrograde Intrarenal Surgery ◽

Alternative Approach ◽

Significant Difference

Background: Advances in micro-percutaneous nephrolithotomy (PCNL) for kidney stones have made it an alternative approach to the retrograde intrarenal surgery (RIRS) approach. Nevertheless, the superiority of micro-PCNL over RIRS is still under debate. The results are controversial. Objectives: The purpose of this study was to systematically evaluate the clinical results in patients presenting with kidney stones treated with micro-PCNL or RIRS. Methods: A literature search was done for electronic databases to identify researches that compared micro-PCNL and RIRS till December 2019. The clinical outcome included complications, stone-free rates (SFRs), hemoglobin reduction, length of hospital stay, and operative time. Results: Five articles were included in our study. The pooled results revealed no statistical difference in the rate of complications (OR = 0.99, 95% CI = 0.57–1.74, p = 0.99), length of hospital stay (MD = −0.29, 95% CI = −0.82 to 0.24, p = 0.28), and operative time (MD = −6.63, 95% CI = −27.34 to 14.08, p = 0.53) between the 2 groups. However, significant difference was present in hemoglobin reduction (MD = −0.43, 95% CI = −0.55 to 0.30, p < 0.001) and the SFRs (OR = 0.59, 95% CI = 0.36–0.98, p = 0.04) when comparing RIRS with micro-PCNL. Conclusions: Compared with micro-PCNL to treat kidney stones, RIRS is associated with better stone clearance and bearing higher hemoglobin loss. As the advantages of both technologies have been shown in some fields, the continuation of well-designed clinical trials may be necessary.

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Meta-Analysis: Urinary Calprotectin for Discrimination of Intrinsic and Prerenal Acute Kidney Injury

Journal of Clinical Medicine ◽

10.3390/jcm8010074 ◽

2019 ◽

Vol 8 (1) ◽

pp. 74 ◽

Cited By ~ 2

Author(s):

Jia-Jin Chen ◽

Pei-Chun Fan ◽

George Kou ◽

Su-Wei Chang ◽

Yi-Ting Chen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Pediatric Population ◽

Meta Analysis ◽

Positive Likelihood Ratio ◽

Kidney Injury ◽

Diagnostic Odds Ratio ◽

Summary Receiver Operating Characteristic ◽

Significant Difference

Background: Urinary calprotectin is a novel biomarker that distinguishes between intrinsic or prerenal acute kidney injury (AKI) in different studies. However, these studies were based on different populations and different AKI criteria. We evaluated the diagnostic accuracy of urinary calprotectin and compared its diagnostic performance in different AKI criteria and study populations. Method: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Embase, and the Cochrane database up to September 2018. The diagnostic performance of urinary calprotectin (sensitivity, specificity, predictive ratio, and cutoff point) was extracted and evaluated. Result: This study included six studies with a total of 502 patients. The pooled sensitivity and specificity were 0.90 and 0.93, respectively. The pooled positive likelihood ratio (LR) was 15.15, and the negative LR was 0.11. The symmetric summary receiver operating characteristic (symmetric SROC) with pooled diagnostic accuracy was 0.9667. The relative diagnostic odds ratio (RDOC) of the adult to pediatric population and RDOCs of different acute kidney injury criteria showed no significant difference in their diagnostic accuracy. Conclusion: Urinary calprotectin is a good diagnostic tool for the discrimination of intrinsic and prerenal AKI under careful inspection after exclusion of urinary tract infection and urogenital malignancies. Its performance is not affected by different AKI criteria and adult or pediatric populations.

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Differences in characteristics and outcomes between community- and hospital-acquired acute kidney injury: A systematic review and meta-analysis

Clinical Nephrology ◽

10.5414/cn109011 ◽

2017 ◽

Vol 88 (10) ◽

pp. 167-182 ◽

Cited By ~ 11

Author(s):

Ryota Inokuchi ◽

Yoshitaka Hara ◽

Hideo Yasuda ◽

Noritomo Itami ◽

Yoshio Terada ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Hospital Acquired

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High-dose versus low-dose haemofiltration for the treatment of critically ill patients with acute kidney injury: an updated systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2016-014171 ◽

2017 ◽

Vol 7 (10) ◽

pp. e014171 ◽

Cited By ~ 7

Author(s):

Peng Li ◽

Li-ping Qu ◽

Dong Qi ◽

Bo Shen ◽

Yi-mei Wang ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Stay ◽

Critically Ill ◽

Critically Ill Patients ◽

Low Dose ◽

Meta Analysis ◽

Kidney Injury ◽

High Dose

ObjectiveThe purpose of this study was to perform a systematic review and meta-analysis to evaluate the effect of high-dose versus low-dose haemofiltration on the survival of critically ill patients with acute kidney injury (AKI). We hypothesised that high-dose treatments are not associated with a higher risk of mortality.DesignMeta-analysis.SettingRandomised controlled trials and two-arm prospective and retrospective studies were included.ParticipantsCritically ill patients with AKI.InterventionsContinuous renal replacement therapy.Primary and secondary outcome measuresPrimary outcomes: 90-day mortality, intensive care unit (ICU) mortality, hospital mortality; secondary outcomes: length of ICU and hospital stay.ResultEight studies including 2970 patients were included in the analysis. Pooled results showed no significant difference in the 90-mortality rate between patients treated with high-dose or low-dose haemofiltration (pooled OR=0.90, 95% CI 0.73 to 1.11, p=0.32). Findings were similar for ICU (pooled OR=1.12, 95% CI 0.94 to 1.34, p=0.21) and hospital mortality (pooled OR=1.03, 95% CI 0.81 to 1.30, p=0.84). Length of ICU and hospital stay were similar between high-dose and low-dose groups. Pooled results are not overly influenced by any one study, different cut-off points of prescribed dose or different cut-off points of delivered dose. Meta-regression analysis indicated that the results were not affected by the percentage of patients with sepsis or septic shock.ConclusionHigh-dose and low-dose haemofiltration produce similar outcomes with respect to mortality and length of ICU and hospital stay in critically ill patients with AKI.This study was not registered at the time the data were collected and analysed. It has since been registered on 17 February 2017 athttp://www.researchregistry.com/, registration number: reviewregistry211.

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No Difference in Risk of Acute Kidney Injury Between Adult Patients Receiving Different Types of Extracorporeal Membrane Oxygenation

10.1101/2020.03.25.20043950 ◽

2020 ◽

Author(s):

Zhixiang Mou ◽

Xu Zhang

Keyword(s):

Acute Kidney Injury ◽

Extracorporeal Membrane Oxygenation ◽

Web Of Science ◽

Meta Analysis ◽

Kidney Injury ◽

Adult Patients ◽

Membrane Oxygenation ◽

Significant Difference ◽

Different Types ◽

Va Ecmo

AbstractAcute kidney injury (AKI) has been reported as one of the most common complications in patients receiving extracorporeal membrane oxygenation (ECMO), yet the risk of AKI on different types of ECMO remains unclear. This meta-analysis aimed to compare risk of AKI among adult patients requiring different types of ECMO. Two authors independently performed a literature search using PubMed, Web of Science, and Embase, encompassing publications up until Arpril 20, 2020 (inclusive). The number of AKI patients, non-AKI patients, patients required RRT and patients not required RRT receiving different types of ECMO were derived and analyzed by STATA. The results indicated there was no significant difference in risk of AKI (OR, 1.54; 95% CI: 0.75-3.16; P= 0.235) and severe AKI required RRT (OR, 1.0; 95% CI: 0.66-1.5, P= 0.994) in patients receiving different types of ECMO. In Conclusion, no difference in risk of AKI and severe AKI required RRT between patients receiving VA ECMO and VV ECMO. More studies are required to support the findings.

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In-hospital outcomes of self-expanding and balloon-expandable transcatheter heart valves in Germany

Clinical Research in Cardiology ◽

10.1007/s00392-021-01928-6 ◽

2021 ◽

Author(s):

Peter Stachon ◽

Philip Hehn ◽

Dennis Wolf ◽

Timo Heidt ◽

Vera Oettinger ◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Propensity Score ◽

Hospital Mortality ◽

Hospital Stay ◽

Major Bleeding ◽

Postoperative Delirium ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Hospital Outcomes

Abstract Introduction The effect of valve type on outcomes in transfemoral transcatheter aortic valve replacement (TF-TAVR) has recently been subject of debate. We investigate outcomes of patients treated with balloon-expanding (BE) vs. self-expanding (SE) valves in in a cohort of all these procedures performed in Germany in 2018. Methods All patients receiving TF-TAVR with either BE (N = 9,882) or SE (N = 7,413) valves in Germany in 2018 were identified. In-hospital outcomes were analyzed for the endpoints in-hospital mortality, major bleeding, stroke, acute kidney injury, postoperative delirium, permanent pacemaker implantation, mechanical ventilation > 48 h, length of hospital stay, and reimbursement. Since patients were not randomized to the two treatment options, logistic or linear regression models were used with 22 baseline patient characteristics and center-specific variables as potential confounders. As a sensitivity analysis, the same confounding factors were taken into account using the propensity score methods (inverse probability of treatment weighting). Results Baseline characteristics differed substantially, with higher EuroSCORE (p < 0.001), age (p < 0.001) and rate of female sex (p < 0.001) in SE treated patients. After risk adjustment, no marked differences in outcomes were found for in-hospital mortality [risk adjusted odds ratio (aOR) for SE instead of BE 0.94 (96% CI 0.76;1.17), p = 0.617] major bleeding [aOR 0.91 (0.73;1.14), p = 0.400], stroke [aOR 1.13 (0.88;1.46), p = 0.347], acute kidney injury [OR 0.97 (0.85;1.10), p = 0.621], postoperative delirium [aOR 1.09 (0.96;1.24), p = 0.184], mechanical ventilation > 48 h [aOR 0.98 (0.77;1.25), p = 0.893], length of hospital stay (risk adjusted difference in days of hospitalization (SE instead of BE): − 0.05 [− 0.34;0.25], p = 0.762) and reimbursement [risk adjusted difference in reimbursement (SE instead of BE): − €72 (− €291;€147), p = 0.519)] There is, however, an increased risk of PPI for SE valves (aOR 1.27 [1.15;1.41], p < 0.001). Similar results were found after application of propensity score adjustment. Conclusions We find broadly equivalent outcomes in contemporary TF-TAVR procedures, regardless of the valve type used. Incidence of major complications is very low for both types of valve.

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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Incidence and Risk Factors for Early Acute Kidney Injury in Nonsurgical Patients: A Cohort Study

International Journal of Nephrology ◽

10.1155/2017/5241482 ◽

2017 ◽

Vol 2017 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Javier Enrique Cely ◽

Elkin José Mendoza ◽

Carlos Roberto Olivares ◽

Oscar Julián Sepúlveda ◽

Juan Sebastián Acosta ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Hospital Stay ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

Epidemiological Data ◽

Hospital Death ◽

Prehospital Treatment ◽

Nephrotoxic Drugs ◽

Nonsurgical Patients

Introduction. Detecting acute kidney injury (AKI) in the first days of hospitalization could prevent potentially fatal complications. However, epidemiological data are scarce, especially on nonsurgical patients.Objectives. To determine the incidence and risk factors associated with AKI within five days of hospitalization (EAKI).Methods. Prospective cohort of patients hospitalized in the Internal Medicine Department.Results. A total of 16% of 400 patients developed EAKI. The associated risk factors were prehospital treatment with nephrotoxic drugs (2.21 OR; 95% CI 1.12–4.36,p=0.022), chronic kidney disease (CKD) in stages 3 to 5 (3.56 OR; 95% CI 1.55–8.18,p<0.003), and venous thromboembolism (VTE) at admission (5.05 OR; 95% CI 1.59–16.0,p<0.006). The median length of hospital stay was higher among patients who developed EAKI (8 [IQR 5–14] versus 6 [IQR 4–10],p=0.008) and was associated with an increased requirement for dialysis (4.87 OR 95% CI 2.54 to 8.97,p<0.001) and in-hospital death (3.45 OR; 95% CI 2.18 to 5.48,p<0.001).Conclusions. The incidence of EAKI in nonsurgical patients is similar to the worldwide incidence of AKI. The risk factors included CKD from stage 3 onwards, prehospital treatment with nephrotoxic drugs, and VTE at admission. EAKI is associated with prolonged hospital stay, increased mortality rate, and dialysis requirement.

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