Correlation between the Incidence and Attributable Mortality Fraction of Acute Kidney Injury: A Systematic Review

Introduction: The incidence of acute kidney injury (AKI) as diagnosed by international standardized criteria as well as its mortality has undergone extreme variations. Although AKI is a significant worsening mortality factor, a higher prevalence may lead to better patient management, thereby lowering mortality. We investigated the correlation between AKI incidence and its associated mortality. Methods: We conducted a systematic review of studies on AKI reporting its incidence and mortality. Literature searches were performed in MEDLINE, EMBASE, and Cochrane Library, within the time frame of 2004–2018. Studies with small number of participants (<500 for adult cohorts, 50 for pediatric cohorts) were excluded. The correlation among AKI incidence, mortality, and AKI-attributable fraction of mortality was evaluated using a regression model. The trend test was used to analyze the effect of publication year and country gross domestic product (GDP). Results: A total of 4,694 manuscripts were screened, from which 287 cohorts were eligible (adults: 203 cohorts comprising 7,076,459 patients; children: 84 comprising 69,677 patients). Within adult cohorts, AKI patients’ mortality increased (R2 = 0.023, β = 0.12, p = 0.03) but the attributable fraction of mortality decreased (R2 = 0.27, β = –0.43, p < 0.001) with the increasing AKI incidence. Both more recent publications and higher GDP countries had a lower crude AKI patients’ mortality, although AKI-attributable fraction did not decrease. Conclusions: Cohorts with high AKI incidence had a relatively low AKI-attributable mortality fraction, which suggests an advantage of more experienced AKI management. Further study is needed, however, to address the heterogeneity of included cohorts and to confirm the causality. (Registered in prospective register of systematic reviews database; CRD 42019129322.)

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Rates, predictors and mortality of sepsis-associated acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v3 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Cumulative Number

Abstract Objective:The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method: A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result: Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion: A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Protein-Energy Wasting Assessment and Clinical Outcomes in Patients with Acute Kidney Injury: A Systematic Review with Meta-Analysis

Nutrients ◽

10.3390/nu12092809 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2809

Author(s):

Ban-Hock Khor ◽

Hui-Ci Tiong ◽

Shing Cheng Tan ◽

Raha Abdul Rahman ◽

Abdul Halim Abdul Gafor

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Clinical Outcomes ◽

Nutritional Assessment ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Protein Energy Wasting ◽

Nutritional Parameters ◽

Protein Energy

Nutritional assessment is essential to identify patients with acute kidney injury (AKI) who are protein-energy wasting (PEW) and at risk of poor clinical outcomes. This systematic review aimed to investigate the relationship of nutritional assessments for PEW with clinical outcomes in patients with AKI. A systematic search was performed in PubMed, Scopus, and Cochrane Library databases using search terms related to PEW, nutrition assessment, and AKI to identify prospective cohort studies that involved AKI adult patients with at least one nutritional assessment performed and reported relevant clinical outcomes, such as mortality, length of stay, and renal outcomes associated with the nutritional parameters. Seventeen studies reporting eight nutritional parameters for PEW assessment were identified and mortality was the main clinical outcome reported. A meta-analysis showed that PEW assessed using subjective global assessment (SGA) was associated with greater mortality risk (RR: 1.99, 95% CI: 1.36–2.91). Individual nutrition parameters, such as serum chemistry, body mass, muscle mass, and dietary intakes, were not consistently associated with mortality. In conclusion, SGA is a valid tool for PEW assessment in patients with AKI, while other nutrition parameters in isolation had limited validity for PEW assessment.

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Prevalence of acute kidney injury after cardiac surgery:A systematic review and meta-analysis on risk factors and different diagnostic criterias(AKIN,RIFLE,KDIGO)

10.21203/rs.2.17474/v1 ◽

2019 ◽

Author(s):

Alii Alidadii ◽

Morteza Salarzaei ◽

Fatem Parooe

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Kidney Injury ◽

Cardiac Surgery ◽

Meta Analysis ◽

Kidney Injury ◽

World Health ◽

Cochrane Library ◽

Common Symptom ◽

Total Prevalence

Abstract Objective: This systematic review and meta-analysis aimed to determine the incidence and some of risk factors of AKI after cardiac surgery using all three diagnostic criteria (AKIN,RIFLE, and KIDGO).Method: We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID) , KoreaMed and LILACS, and we searched OpenGrey (www.opengrey.eu/) and the World Health Organization Clinical Trials Registry (who.int/ictrp) for unpublished literature and ongoing studies.To ensure the literature saturation, the list of the included research references or the relevant reviews found by searching was studied(MS). The keywords used in the search strategy were Acute kidney injury,acute renal failure, creatinine,cardiac surgery,heart surgury, Coronary artery bypass grafting(CABG),valve replacement,RIFLE (risk, injury, failure, loss, end-stage renal disease) ,Acute Kidney Injury Network (AKIN),KDIGO (Kidney Disease: Improving Global Outcomes) , which were combined using the AND, OR, and NOT operators.Results: A total of 33298 patients who had undergone the cardiac surgery were studied. Based on the random effect model the total prevalence of AKI in 33298 patients undergone the heart surgery was 26.3% (95% confidence interval[CI]:26.1%,26.6%, I2=99.5%). the total prevalence of AKI in patients undergone cardiac surgery based on AKIN criteria was 21.6% (95% CI –21.2%, 22.1%,I2=98.5%) of whom 21.6% (95% CI-21.2%,22.1%,I2=98.5%) were classified as AKIN stage 1, whereas 3% (95% CI-2.7%%,3.4%%,I2=90.6%) were classified as AKIN stage 2, and 3.2% (95% CI-3.0%%,3.4%%,I2=97.2%) were classified as AKIN stage 3. the total prevalence of AKI in patients undergone cardiac surgery based on RIFLE criteria was 26.0%% (95% CI –25.6%, 26.5%,I2=99.4%). total prevalence of AKI in patients undergone cardiac surgery based on KDIGO criteria was 34.7% (95% CI –33.8%, 35.7%,I2=98.4%). the highest prevalence of AKI in patients undergone cardiac surgery was in Brazil 45.7% (95% CI –43.6%, 47.8%) based on 3 articles included followed by USA with a prevalence of 29.6%(95% CI –28.7%, 29.4%) based on 7 articles included, Uruguay with a prevalence of 36.1%(95% CI –35%, 37.2%) based on 1 article, Canada with a prevalence of 16.7%(95% CI –15.7%, 17.6%) based on 4 articles included and Italy with a prevalence of 10.6%(95% CI –9.8%, 11.3%) based on 3 articles included.Conclusion: AKI after cardiac surgery is a common symptom, although most often more severe in elderly patients. The prevalence of AKI after cardiac surgery based on KDIGO criteria was found to be higher than RIFLE and AKIN. The prevalence of AKI regardless of the definition used showed a decreasing trend from 2009 to 2019. Our findings pointed to the superiority of the KDIGO criterion over RIFLE and AKIN for diagnosing and evaluating AKI after cardiac surgery. However, the widespread acceptance of consensus definitions ( RIFLE and AKIN criteria) for AKI is still reflected in the studies. In order to progress further, establishment of a uniform definition for AKI seems necessary.

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Inverse Correlation Between Incidence and Mortality of Acute Kidney Injury in Critically Ill Patients: A Systematic Review

Shock ◽

10.1097/shk.0000000000001511 ◽

2020 ◽

Vol 54 (3) ◽

pp. 280-284

Author(s):

Yohei Komaru ◽

Ryota Inokuchi ◽

Masao Iwagami ◽

Yoshifumi Hamasaki ◽

Masaomi Nangaku ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Inverse Correlation ◽

Incidence And Mortality

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Incidence and mortality of acute kidney injury in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

QJM ◽

10.1093/qjmed/hcaa072 ◽

2020 ◽

Vol 113 (9) ◽

pp. 621-632 ◽

Cited By ~ 5

Author(s):

S R Kanduri ◽

W Cheungpasitporn ◽

C Thongprayoon ◽

T Bathini ◽

K Kovvuru ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Stem Cell ◽

Hematopoietic Stem Cell ◽

Mortality Risk ◽

Meta Analysis ◽

Kidney Injury ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Incidence And Mortality

Abstract Background While acute kidney injury (AKI) is commonly reported following hematopoietic stem cell transplant (HCT), the incidence and impact of AKI on mortality among patients undergoing HCT are not well described. We conducted this systematic review to assess the incidence and impact of AKI on mortality risk among patients undergoing HCT. Methods Ovid MEDLINE, EMBASE and the Cochrane Databases were searched from database inceptions through August 2019 to identify studies assessing the incidence of AKI and mortality risk among adult patients who developed AKI following HCT. Random-effects and generic inverse variance method of DerSimonian–Laird were used to combine the effect estimates obtained from individual studies. Results We included 36 cohort studies with a total of 5144 patients undergoing HCT. Overall, the pooled estimated incidence of AKI and severe AKI (AKI Stage III) were 55.1% (95% confidence interval (CI) 46.6–63.3%) and 8.3% (95% CI 6.0–11.4%), respectively. The pooled estimated incidence of AKI using contemporary AKI definitions (RIFLE, AKIN and KDIGO criteria) was 49.8% (95% CI 41.6–58.1%). There was no significant correlation between study year and the incidence of AKI (P = 0.12) or severe AKI (P = 0.97). The pooled odds ratios of 3-month mortality and 3-year mortality among patients undergoing HCT with AKI were 3.05 (95% CI 2.07–4.49) and 2.23 (95% CI 1.06–4.73), respectively. Conclusion The incidence of AKI among patients who undergo HCT remains high, and it has not changed over the years despite advances in medicine. AKI after HCT is associated with increased short- and long-term mortality.

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The Links between Microbiome and Uremic Toxins in Acute Kidney Injury: Beyond Gut Feeling—A Systematic Review

Toxins ◽

10.3390/toxins12120788 ◽

2020 ◽

Vol 12 (12) ◽

pp. 788

Author(s):

Alicja Rydzewska-Rosołowska ◽

Natalia Sroka ◽

Katarzyna Kakareko ◽

Mariusz Rosołowski ◽

Edyta Zbroch ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Targeted Therapy ◽

Experimental Studies ◽

Kidney Injury ◽

Uremic Toxins ◽

Cochrane Library ◽

Microbiota Composition ◽

Ongoing Trial

The last years have brought an abundance of data on the existence of a gut-kidney axis and the importance of microbiome in kidney injury. Data on kidney-gut crosstalk suggest the possibility that microbiota alter renal inflammation; we therefore aimed to answer questions about the role of microbiome and gut-derived toxins in acute kidney injury. PubMed and Cochrane Library were searched from inception to October 10, 2020 for relevant studies with an additional search performed on ClinicalTrials.gov. We identified 33 eligible articles and one ongoing trial (21 original studies and 12 reviews/commentaries), which were included in this systematic review. Experimental studies prove the existence of a kidney-gut axis, focusing on the role of gut-derived uremic toxins and providing concepts that modification of the microbiota composition may result in better AKI outcomes. Small interventional studies in animal models and in humans show promising results, therefore, microbiome-targeted therapy for AKI treatment might be a promising possibility.

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Risk Factors for Acute Kidney Injury in Critically Ill Neonates: A Systematic Review and Meta-Analysis

Frontiers in Pediatrics ◽

10.3389/fped.2021.666507 ◽

2021 ◽

Vol 9 ◽

Author(s):

Qian Hu ◽

Shao-Jun Li ◽

Qian-Ling Chen ◽

Han Chen ◽

Qiu Li ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Kidney Injury ◽

Critically Ill ◽

Apgar Score ◽

Meta Analysis ◽

Kidney Injury ◽

Cochrane Library ◽

Increased Risk ◽

Critically Ill Neonates

Background and Objective: Acute kidney injury (AKI) is recognized as an independent risk factor for mortality and long-term poor prognosis in neonates. The objective of the study was to identify the risk factors for AKI in critically ill neonates to provide an important basis for follow-up research studies and early prevention.Methods: The PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang Med, SinoMed, and VIP Data were searched for studies of risk factors in critically ill neonates. Studies published from the initiation of the database to November 19, 2020, were included. The quality of studies was assessed by the Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality (AHRQ) checklist. The meta-analysis was conducted with Stata 15 and drafted according to the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.Results: Seventeen studies (five cohort studies, ten case-control studies, and two cross-sectional studies) were included in meta-analysis, with 1,627 cases in the case group and 5,220 cases in the control group. The incidence of AKI fluctuated from 8.4 to 63.3%. Fifteen risk factors were included, nine of which were significantly associated with an increased risk of AKI in critically ill neonates: gestational age [standardized mean difference (SMD) = −0.31, 95%CI = (−0.51, −0.12), P = 0.002], birthweight [SMD = −0.37, 95%CI = (−0.67, −0.07), P = 0.015], 1-min Apgar score [SMD = −0.61, 95%CI = (−0.78, −0.43), P = 0.000], 5-min Apgar score [SMD = −0.71, 95%CI = (−1.00, −0.41), P = 0.000], congenital heart disease (CHD) [odds ratio (OR) = 2.94, 95%CI = (2.08, 4.15), P = 0.000], hyperbilirubinemia [OR = 2.26, 95%CI = (1.40, 3.65), P = 0.001], necrotizing enterocolitis (NEC) [OR = 6.32, 95%CI = (2.98, 13.42), P = 0.000], sepsis [OR = 2.21, 95%CI = (1.25, 3.89), P = 0.006], and mechanical ventilation [OR = 2.37, 95%CI = (1.50, 3.75), P = 0.000]. Six of them were not significantly associated with AKI in critically ill neonates: age [SMD = −0.25, 95%CI = (−0.54, 0.04), P = 0.095], male sex [OR = 1.10, 95%CI =(0.97, 1.24), P = 0.147], prematurity [OR = 0.90, 95%CI(0.52, 1.56), P = 0.716], cesarean section [OR = 1.52, 95%CI(0.77, 3.01), P = 0.234], prenatal hemorrhage [OR = 1.41, 95%CI = (0.86, 2.33), P = 0.171], and vancomycin [OR = 1.16, 95%CI = (0.71, 1.89), P = 0.555].Conclusions: This meta-analysis provides a preliminary exploration of risk factors in critically ill neonatal AKI, which may be useful for the prediction of AKI.Systematic Review Registration: PROSPERO (CRD42020188032).

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Rates, predictors and mortality of sepsis-induced acute kidney injury: systematic review and meta-analysis

10.21203/rs.3.rs-18145/v2 ◽

2020 ◽

Author(s):

Jie feng Liu ◽

Hebin Xie ◽

ziwei ye ◽

Lesan Wang

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Septic Shock ◽

Acute Kidney Injury ◽

Meta Analysis ◽

Kidney Injury ◽

Predisposing Factors ◽

Cochrane Library ◽

Patient Specific ◽

Cumulative Number

Abstract Objective The incidence and mortality of sepsis-induced acute kidney injury is high. Many studies have explored the causes of sepsis-induced acute kidney injury (AKI). However, its predictors are still uncertain; additionally, a complete overview is missing. A systematic review and a meta-analysis were performed to determine the predisposing factors for sepsis-induced AKI. Method A systematic literature search was performed in the Medline, Embase, Cochrane Library, PubMed and Web of Science databases, with an end date parameter of May 25, 2019. Valid data were retrieved in compliance with the inclusion and exclusion criteria. Result Forty-seven observational studies were included for analysis. A cumulative number of 55911sepsis patients were evaluated. The incidence of AKI caused by septic shock is the highest. 30 possible risk factors were included in the meta-analysis. The results showed that 20 factors were found to be significant. The odds ratio(OR),95% confidence interval (CI) and Prevalence of the most prevalent predisposing factors for sepsis-induced AKI were as the following: Septic shock[2.88(2.36-3.52), 60.47%], Hypertension[1.43(1.20-1.70),38.39%), Diabetes mellitus[1.59(1.47-1.71),27.57%],Abdominal infection[1.44(1.32-1.58),30.87%], Vasopressors use[2.95(1.67-5.22),64.61%],vasoactive drugs use [3.85(1.89-7.87),63.22%], Mechanical ventilation[1.64(1.24-2.16),68.00%), Positive blood culture[1.60(1.35-1.89), 41.19%], Smoke history[1.60(1.09-2.36),43.09%]. Other risk factors include cardiovascular, coronary artery disease, liver disease, unknow infection, diuretics use, ACEI or ARB, gram-negative bacteria and organ transplant. Conclusion A large number of factors are associated with AKI development in sepsis patients. Our review can guide risk-reducing interventions, clinical prediction rules, and patient-specific treatment and management strategies for sepsis-induced acute kidney injury.

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Risk Factors for Acute Kidney Injury in COVID-19 Patients: A Systematic Review

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5846 ◽

2021 ◽

Vol 9 (F) ◽

pp. 118-123

Author(s):

Dian Daniella ◽

Yenny Kandarini ◽

Gede Wira Mahadita

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Acute Kidney Injury ◽

Sofa Score ◽

Selection Process ◽

Kidney Injury ◽

Flow Diagram ◽

Systematic Research ◽

Cochrane Central Register ◽

Incidence And Mortality

BACKGROUND: Acute kidney injury (AKI) in coronavirus disease-19 (COVID-19) has high incidence and mortality. Risk factors for AKI in COVID-19 patients are not well explored. This systematic review provides a combination of available evidence regarding risk factors of AKI in COVID-19 patients. METHODS: A systematic research was performed in Medline, Cochrane Central Register of Controlled Trials, and ScienceDirect journal databases from 2019 to August 2020. The study selection process was plotted using a Preferred Reporting Items for Systematic Review and Meta-Analyses flow diagram. RESULTS: Out of 553 studies found, four full-text studies met the inclusion criteria and were included in qualitative analysis. There are 2205 COVID-19 patients with AKI (36.44%) from 6051 COVID-19 patients. Age was a risk factors for AKI in two studies (odds ratio [OR] 1.03 [p < 0.001], OR 1.03 [p < 0.007]). Critical condition of patient is risk factors for AKI (OR 8.155 [p = 0.006]). Hirsch et al. stated that diabetes mellitus (OR 1.74 [p < 0.001]), cardiovascular disease (OR 1.48 [p < 0.001]), and hypertension (OR 1.25 [p = 0.02]) are also risk factors. Laboratory results such as elevated procalcitonin (PCT) and estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 showed positive association to AKI in COVID-19 patients (OR 4.822 [p = 0.037]; OR 13.451 [p = 0.016]). A higher sequential organ failure assessment (SOFA) score at admission is one of the risk factors (OR 1.498 [p = 0.027]). CONCLUSION: Demographics, clinical classification of COVID-19, comorbidities, SOFA score, PCT, and eGFR can help clinicians predict AKI in COVID-19 patients.

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