Comparison of Static and Dynamic Baseline Creatinine Surrogates for Defining Acute Kidney Injury

Background: “Dynamic” baseline serum creatinine (sCr), based on a rolling 48-h window, and a static baseline sCr (previous outpatient sCr) were used to define acute kidney injury (AKI). Methods: Retrospective cohort study of adult admissions to the University of Alabama (UAB) Health System hospitals for years 2016–2018. Included admissions had >1- and <180-day length of stay, >2 inpatient sCr measurements, and an averaged estimated glomerular filtration rate >15 mL/min/1.73 m2. The final cohort of 62,380 patients included 100,570 admissions, 3,509 inpatient deaths, and 1,916 admissions with inpatient dialysis. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria and a static or dynamic baseline sCr. Discrimination was evaluated with area under receiver operator curves (AUC), logistic regression, and net reclassification improvement (NRI). Results: Preadmission outpatient “static” sCr values were available for 43,433 admissions. The lowest sCr value during a rolling 48-h window before each inpatient sCr defined a “dynamic” baseline sCr. Using point-wise comparisons, the dynamic baseline sCr performed better than static baseline sCr for inpatient mortality (AUC [0.819 vs. 0.741; p < 0.001] and NRI ≥0.306 [p < 0.001]) and inpatient dialysis (AUC [0.903 vs. 0.864; p < 0.001] and NRI ≥0.317 [p < 0.001]). Conclusions: The dynamic baseline sCr is available without reference to preadmission sCr values and avoids confounding associated with missing outpatient sCr values. AKI defined with the dynamic baseline sCr significantly improved discrimination of risk for inpatient mortality and dialysis compared to static baseline sCr.

Download Full-text

Impact of total body weight on rate of acute kidney injury in patients treated with piperacillin–tazobactam and vancomycin

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz120 ◽

2019 ◽

Vol 76 (16) ◽

pp. 1211-1217 ◽

Cited By ~ 5

Author(s):

W Cliff Rutter ◽

Ronald G Hall ◽

David S Burgess

Keyword(s):

Acute Kidney Injury ◽

Body Weight ◽

Combination Therapy ◽

Kidney Injury ◽

Total Body Weight ◽

University Of Kentucky ◽

Baseline Creatinine ◽

Total Body ◽

Using Data ◽

The University

Abstract Purpose Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin–tazobactam and vancomycin are reported. Methods A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science’s Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded. Results A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28–1.66]). Conclusion Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin–tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.

Download Full-text

A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfp159 ◽

2009 ◽

Vol 24 (9) ◽

pp. 2739-2744 ◽

Cited By ~ 136

Author(s):

S. M. Bagshaw ◽

S. Uchino ◽

D. Cruz ◽

R. Bellomo ◽

H. Morimatsu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Baseline Creatinine

Download Full-text

P0199 : Acute kidney injury in cirrhosis: Baseline serum creatinine predicts patient outcomes

Journal of Hepatology ◽

10.1016/s0168-8278(15)30418-9 ◽

2015 ◽

Vol 62 ◽

pp. S380 ◽

Cited By ~ 2

Author(s):

F. Wong ◽

J.G. O’Leary ◽

K.R. Reddy ◽

G. Garcia-Tsao ◽

M.B. Fallon ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Patient Outcomes ◽

Kidney Injury ◽

Baseline Serum ◽

Baseline Serum Creatinine

Download Full-text

Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.02060221 ◽

2021 ◽

pp. CJN.02060221

Author(s):

Yvelynne Kelly ◽

Kavita Mistry ◽

Salman Ahmed ◽

Shimon Shaykevich ◽

Sonali Desai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Kidney Injury ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Controlled Study ◽

Control Group ◽

Inpatient Mortality ◽

Icu Length Of Stay ◽

Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

Download Full-text

MO388DEVELOPMENT OF ACUTE KIDNEY INJURY DURING A RHABDOMYOLYSIS EPISODE: DIFFERENCES IN LONG-TERM KIDNEY FUNCTION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0042 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Sara Núñez Delgado ◽

Miren Iriarte-Abril ◽

Júlia Farrera-Núñez ◽

Sergi Pascual-Sánchez ◽

Laia Sans-Atxer ◽

...

Keyword(s):

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Kidney Injury ◽

Inpatient Mortality ◽

Short Term ◽

Worse Prognosis

Abstract Background and Aims Acute renal failure (AKI) associated to rhabdomyolysis conditions a worse prognosis in short-term, its implication in the long-term renal function has been less evaluated. Method Retrospective analysis of patients diagnosed with rhabdomyolysis defined by creatinine kinase > 5000 IU/L between 2015-2019. Basal and 12-month renal function was evaluated. AKI was classified as either non-severe (AKI-KDIGO 1/2) or severe (AKI-KDIGO 3). Results Eighty-seven patients were included, 25 (28.74%) had some degree of chronic kidney disease (CKD) on admission. 56 (64.37%) had AKI on admission, 17 of which were severe (6 required hemodialysis). The patients with AKI had more cardiovascular disease (CVD) and worse analytical parameters on admission (table). Patients with severe AKI showed no difference in CVD from those with non-severe AKI but were younger and had more hyperkalemia. There were no significant differences between patients with severe AKI who required hemodialysis and those who did not. Inpatient mortality was 8%, higher in patients with AKI but without differences according to severity. In 45 patients kidney function was available 12 months after the episode, loss of eGF was -4.90 ± 14.35 ml/min-1.73m2 (p=0.007). There was no difference between patients who developed AKI and those who did not (-4.10 ± 14.4 vs. -5.39 ± 14.57 ml/min-1.73m2; p=0.67), nor between non-severe and severe AKI (-5.50 ± 14.76 vs. -5.12 ± 15.08ml/min-1.73m2; p=0.98). Of the 33 patients without previous CKD, 5 developed CKD, with greater decrease in eGF than those who did not (-22.69 ± 6.04 vs. -2.63 ± 13.92 ml/min-1.73m2; p=0.003). Female sex (60% vs. 12%; p=0.031) and previous basal eGF (72.22 ± 4.37 vs. 95.6±19.97 ml/min-1.72m2; p=0.016) were related to this deterioration. Conclusion After an episode of rhabdomyolysis, the loss of eGF is similar in patients who develop AKI compared to those who do not.

Download Full-text

Influence of β-Lactam Infusion Strategy on Acute Kidney Injury

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00871-17 ◽

2017 ◽

Vol 61 (10) ◽

Cited By ~ 10

Author(s):

Sarah E. Cotner ◽

W. Cliff Rutter ◽

Donna R. Burgess ◽

Katie L. Wallace ◽

Craig A. Martin ◽

...

Keyword(s):

Acute Kidney Injury ◽

Medical Center ◽

Academic Medical Center ◽

Kidney Injury ◽

Intermittent Infusion ◽

Prolonged Infusion ◽

Infusion Group ◽

Academic Medical ◽

Baseline Creatinine ◽

End Stage

ABSTRACT Limited literature is available assessing nephrotoxicity with prolonged β-lactam infusions. This study compared the incidence of acute kidney injury (AKI) associated with a prolonged β-lactam infusion or an intermittent infusion. This was a retrospective, matched-cohort study at an academic medical center from July 2006 to September 2015. Adult patients who received piperacillin-tazobactam (TZP), cefepime (FEP), or meropenem (MEM) for at least 48 h were evaluated. Patients were excluded for preexisting renal dysfunction or pregnancy. The primary outcome was difference in incidence of AKI evaluated using the RIFLE (risk, injury, failure, loss, and end-stage) criteria. Patients in the intermittent group were matched 3:1 to patients in the prolonged-infusion group based on the following: β-lactam agent, age, gender, Charlson comorbidity index, baseline creatinine clearance, hypotension, receipt of vancomycin, and treatment in an intensive care unit. A total of 2,390 patients were included in the matched analysis, with 1,700 receiving intermittent infusions and 690 receiving prolonged infusion. The incidence of AKI was similar in the prolonged-infusion group to that in the intermittent-infusion group (21.6% versus 18.6%; P = 0.1). After multivariate regression, prolonged infusion was not associated with increased odds of AKI (odds ratio [OR], 1.07; 95% confidence interval [95% CI], 0.83 to 1.39). Independent predictors of AKI included TZP therapy, concomitant nephrotoxins, hypotension, and heart failure. Although AKIs were numerically more common in patients receiving prolonged β-lactam infusions than those receiving intermittent infusions, prolonged infusion was not an independent risk factor for AKI.

Download Full-text

Neutrophil-Gelatinase Associated Lipocalin (N-GAL) to Assess Perioperative Acute Kidney Injury in Hand-Assisted Laparoscopic Donor Nephrectomy: A Pilot Study

BANTAO Journal ◽

10.1515/bj-2015-0008 ◽

2015 ◽

Vol 13 (1) ◽

pp. 39-41

Author(s):

Emma Aitken ◽

Alex Vesey ◽

Julie Glen ◽

Mark Steven ◽

Marc Clancy

Keyword(s):

Acute Kidney Injury ◽

Pilot Study ◽

Fluid Management ◽

Kidney Injury ◽

Donor Nephrectomy ◽

Live Donor ◽

Baseline Serum ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Live Donor Nephrectomy ◽

Neutrophil Gelatinase

Abstract Perioperative insults, including hypotension, hypovolaemia and pneumoperitoneum may occur during laparoscopic live donor nephrectomy. These may have deleterious effects to both donor and recipient. The extent and significance of these insults is poorly understood and difficult to quantify. The aim of this study was to evaluate acute kidney injury (AKI) in the donor using the novel biomarker neutrophil-gelatinase associated lipocalin (N-GAL). We report the results of a pilot study of 20 patients undergoing hand-assisted live donor nephrectomy. eGFR and serum NGAL measurements (Triage CardioRenal Panel, Alere) were obtained preoperatively, immediately post-operatively, day 1 and 6 weeks post-operatively. Mean pre-operative eGFR was 105.6+/-10.1ml/min/1.73m2. Mean eGFR 6 weeks postoperatively demonstrated a 29.4+/-8.8% reduction from baseline. Serum N-GAL increased by 34.1+/-16.7% following an overnight fast pre-operatively (day 0) (ΔNGAL 45.1+/-36.0ng/ml), by a further 14.9+/-7.2% following surgery (immediate post-op). The largest ΔNGAL was observed during the pre-operative fasting period. ΔNGAL [day -1 to day 0] and [day -1 to post-op] were found to correlate inversely with eGFR at 6 weeks (p<0.05, r2=0.47 and p<0.001, r2=0.52 respectively). We conclude that clinically significant AKI does occur in the donor following live donor nephrectomy. Optimisation of perioperative fluid management is likely to have a protective role.

Download Full-text

Defining Baseline Creatinine for Identification of Acute Kidney Injury in Population-based Laboratory Databases - A Danish Nationwide Cohort Study

Kidney360 ◽

10.34067/kid.0006082021 ◽

2021 ◽

pp. 10.34067/KID.0006082021

Author(s):

Henriette V. Graversen ◽

Simon K. Jensen ◽

Søren V. Vestergaard ◽

Uffe Heide-Jorgensen ◽

Christian F. Christiansen

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Creatinine Level ◽

Kidney Injury ◽

Population Based ◽

Kaplan Meier ◽

All Cause Mortality ◽

Baseline Creatinine ◽

Creatinine Measurement

Background: The baseline creatinine level is central in the KDIGO criteria of acute kidney injury (AKI), but baseline creatinine is often inconsistently defined or unavailable in AKI research. We examined the rate, characteristics, and 30-day mortality of AKI in five AKI cohorts created using different definitions of baseline creatinine. Methods: This nationwide cohort study included all individuals aged ≥18 in Denmark with a creatinine measurement in year 2017. Applying the KDIGO criteria, we created four AKI cohorts using four different baseline definitions (most recent, mean, or median value of outpatient creatinine 365-8 days before, or median value 90-8 days before if available otherwise median value 365-91 days before) and one AKI cohort not using a baseline value. AKI rate and the distribution of age, sex, baseline creatinine, and comorbidity was described for each AKI cohort, and the 30-day all-cause mortality was estimated using the Kaplan-Meier method. Results: The study included 2,095,850 adults with at least one creatinine measurement in 2017. The four different baseline definitions identified between 61,189 and 62,597 AKI episodes. The AKI rate in these four cohorts was 13-14 per 1,000 person-years, and 30-day all-cause mortality was 17-18%. The cohort created without using a baseline creatinine included 37,659 AKI episodes, corresponding to an AKI rate of 8.2 per 1,000 person-years, and a 30-day mortality of 23%. All five cohorts were similar regarding age, sex, and comorbidity. Conclusions: In a population-based setting with available outpatient baseline creatinine, different baseline creatinine definitions revealed comparable AKI cohorts, while the lack of a baseline creatinine when defining AKI led to a smaller AKI cohort with a higher mortality. These findings underscore the importance of availability and consistent use of an outpatient baseline creatinine, in particular in studies of community-acquired AKI.

Download Full-text

FREQUENCY OF ACUTE KIDNEY INJURY AMONG PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v70isuppl-4.6033 ◽

2021 ◽

Vol 70 (Suppl-4) ◽

pp. S828-32

Author(s):

Sajid Khan ◽

Abdul Hameed Siddiqui ◽

Ariz Samin ◽

Syed Hassan Mustafa ◽

Akhtar Gul ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Serum Creatinine ◽

Study Design ◽

Kidney Injury ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Baseline Serum ◽

Control And Prevention

Objective: To determine the frequency of acute kidney injury among patients undergoing coronary angiography. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Department of Cardiology, Hayatabad Medical Complex, Peshawar, from Jan 2018 to Jul 2018. Methodology: This study was conducted in the in the Department of Cardiology, Hayatabad Medical Complex, Peshawar from 22nd Jan 2018 to 22nd Jul 2018. Through a descriptive cross-sectional study design, a total of 116 patients scheduled for coronary angiography were included in the study in a consecutive manner and baseline / follow up serum creatinine was recorded to detect acute kidney injury. Results: In this study 116 patients were included, 61.2% males and 38.8% females. Mean age of the patients was 55.6 years with a standard deviation of 6.6 years. Mean baseline serum creatinine level was 0.9 ± 0.11mg/dl which was 1.5 ± 0.11 48 hours after coronary angiography (p 0.000). AKI was recorded in 19.8% of patients. Conclusion: Acute kidney injury after coronary angiography is not uncommon in our population. More studies are recommended on its risk factors and complications to draw future directions for its control and prevention.

Download Full-text