Abstract 16748: Stent Type and Outcomes in Patients With Malignancy Undergoing Percutaneous Coronary Intervention

Background: Coronary artery disease and cancer share some of the same risk factors, so it is not uncommon to find them in same patient. So PCI is increasingly performed in these patients. However type of stent and its impact on mortality is largely unknown. Methods: Nationwide Inpatient Sample (HCUP-NIS) database was utilized to identify patient who have underwent BMS or DES placement and had active cancer. Appropriate ICD 9 codes was used to identify lung, colon, breast, prostrate, hematological, liver, brain and kidney cancer as well as metastatic cancer. Patient were randomly assigned in 1:1 ratio to BMS and DES group. Propensity score analysis was performed using neighborhood matching to baseline co-variates and reduce confounding bias. Percentage of patients getting BMS and DES were analyzed and compared to general population. While comparing DES and BMS group, outcomes included in-hospital mortality, stent thrombosis, length of stay, acute kidney injury and bleeding complications.R esults: A total of 8755 patients were selected in BMS group and 11,611 patients were selected in DES group. Following propensity matching, 4313 patients were selected in both groups and randomly assigned 1:1 ratio to BMS and DES. As compared to general population (BMS 23.2%, DES 76.8%), there is high use of BMS stent in cancer patient (BMS 43.0%, DES 57.2%). When comparing BMS to DES group, there is no statistically significant difference in mortality (4.7 vs 3.8 percent p=0.097), acute kidney injury (11.3 in BMS vs 10.6 in DES p = 0.425), bleeding complications (3.50 in BMS vs 3.45 in DES p = 0.914) and length of stay (5.4 in BMS vs 5.2 in DES p = 0.119). There is increased incidence of stent thrombosis in DES group (4.26% vs 3.01%, p-value 0.02). Among the cancers, adjusted for type of stent placed, liver and pancreatic cancer was associated with significant increase in stent thrombosis Conclusion: In patients with active malignancy, there is higher incidence of BMS placement as compared to general population. There is high incidence of stent thrombosis is DES without increase in mortality. Among the cancers, adjusted for type of stent placed, liver and pancreatic cancer was associated with significant increase in stent thrombosis

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113 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Elderly Hip Fracture Patients

Age and Ageing ◽

10.1093/ageing/afab030.74 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

pp. i12-i42

Author(s):

C McCann ◽

A Hall ◽

J Min Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Length Of Stay ◽

Kidney Injury ◽

Ward Round ◽

Fluid Administration ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

Abstract Background Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of >62.5 mL/Hr for hip fracture patients. However, audits have shown that many patients still receive inadequate IV fluids. Methods Three prospective audits, each including 100 consecutive acute hip fracture patients aged >55, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included a revised checklist for admissions with a structured ward round tool for post-take ward round and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively. Results Cycle 1: 64/100 (64%) patients received adequate fluids. No significant difference in developing AKI post operatively was seen in patients given adequate fluids (2/64, 3.1%) compared to inadequate fluids (4/36, 11.1%; p = 0.107). More patients with pre-operative AKI demonstrated resolution of AKI with appropriate fluid prescription (5/6, 83.3%, vs 0/4, 0%, p < 0.05) Cycle 2: Fewer patients were prescribed adequate fluids (54/100, 54%). There was no significant difference in terms of developing AKI post operatively between patients with adequate fluids (4/54, 7.4%) or inadequate fluids (2/46, 4.3%; p = 0.52). Resolution of pre-operative AKI was similar in patients with adequate or inadequate fluid administration (4/6, 67% vs 2/2, 100%). Cycle 3: More patients received adequate fluids (79/100, 79%, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI than those receiving inadequate fluids (2/79, 2.5% vs 3/21, 14.3%; p < 0.05). Discussion This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.

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896 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients

British Journal of Surgery ◽

10.1093/bjs/znab134.504 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

C McCann ◽

A Hall ◽

J M Leow ◽

A Harris ◽

N Hafiz ◽

...

Keyword(s):

Emergency Department ◽

Acute Kidney Injury ◽

Hip Fracture ◽

Data Collection ◽

Length Of Stay ◽

Fluid Therapy ◽

Kidney Injury ◽

Ward Staff ◽

Intravenous Fluid Therapy ◽

Significant Difference

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212. Acute Kidney Injury with Piperacillin-tazobactam versus Cefepime in Combination with Vancomycin

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.256 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S109-S109

Author(s):

Phuong Khanh Nguyen ◽

Thuong Tran ◽

Kristy Jetsupphasuk ◽

Nina Wang ◽

Patricia Chun ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Length Of Stay ◽

Propensity Score ◽

Propensity Score Matching ◽

Kidney Injury ◽

Hospital Length Of Stay ◽

Increased Risk ◽

Significant Difference ◽

Time To Onset

Abstract Background Drug-induced nephrotoxicity in the form of acute kidney injury (AKI) is a potential adverse effect of vancomycin, which is commonly prescribed empirically with an antipseudomonal agent. It is unclear if combinations with certain antipseudomonal agents (e.g., piperacillin-tazobactam) are associated with more AKI relative to others. Methods This retrospective cohort study conducted at two Veterans Affairs (VA) Medical Centers with differing preferred empiric vancomycin-antipseudomonal regimens aimed to assess the incidence of AKI in patients receiving vancomycin and piperacillin-tazobactam (VPT) at VA Greater Los Angeles Healthcare System (HCS) versus vancomycin and cefepime (VC) at VA Long Beach HCS. Patients who received VPT or VC for at least 48 hours in 2016–2018 were included. AKI definitions were derived from 2012 Kidney Disease Improving Global Outcomes guidelines. Secondary assessments included hospital length of stay, 90-day mortality, and incidence of Clostridioides difficile infection (CDI) within 90 days. Patients who developed AKI were further assessed for time-to-onset of AKI, development of chronic kidney disease (CKD) within 90 days, and hemodialysis (HD) dependence within 1 year. Statistical analysis was performed using Fisher’s exact and Mann-Whitney U tests where appropriate. Propensity score matching using logistic regression with nearest-neighbor matching was performed to control for potential confounding baseline characteristics. Results 21/120 patients receiving VPT developed AKI vs. 4/120 receiving VC (17.5% vs. 3.3%, p=0.0005). After propensity score matching, AKI incidence remained significantly higher for VPT patients (15.2% vs. 4.0%, p=0.01). Median length of stay was significantly longer for VPT patients (10 days vs. 8 days, p=0.03). There was no significant difference in time-to-onset of AKI, 90-day mortality, or CDI. No significant difference was found in the development of CKD within 90 days nor the requirement of HD within 1 year. Conclusion VPT combination therapy was associated with increased incidence of AKI compared to VC, though 90-day mortality and other outcomes were similar. Advising prescribers about potentially increased risk of AKI with VPT is a viable stewardship intervention. Disclosures All Authors: No reported disclosures

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P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT

British Journal of Surgery ◽

10.1093/bjs/znab117.092 ◽

2021 ◽

Vol 108 (Supplement_1) ◽

Author(s):

Keyword(s):

Acute Kidney Injury ◽

Quality Improvement ◽

Colorectal Surgery ◽

Prognostic Score ◽

Univariate Analysis ◽

Kidney Injury ◽

Elective Colorectal Surgery ◽

National Quality ◽

Significant Difference ◽

The Uk

Abstract Introduction The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p<0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.

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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.

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The Significance of “Fractional Excretion of Urea” in The Differential Diagnosis of Acute Kidney Injury in Cirrhotic Patients

QJM ◽

10.1093/qjmed/hcab100.028 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Sameh Mohamed Ghaly ◽

Moataz Serry Seyam ◽

Mohamed Osama Aly ◽

Ahmed Mohamed Hesham Abdelfattah ◽

Ahmed R. Mashaal

Keyword(s):

Acute Kidney Injury ◽

Differential Diagnosis ◽

Kidney Injury ◽

Fractional Excretion ◽

Final Diagnosis ◽

Good Alternative ◽

Decompensated Cirrhosis ◽

Eligibility Criteria ◽

Significant Difference ◽

Cirrhotic Patients

Abstract Background Patients with cirrhosis are more susceptible to develop AKI than the non-cirrhotic individuals. AKI has an estimated prevalence of approximately 20% to 50% among hospitalized patients with cirrhosis. Physicians caring for patients with cirrhosis should recognize the acute or chronic character of renal disease, the causes of renal injury, the clinical conditions leading concomitantly to AKI and liver dysfunction, and the prognostic factors associated with the progression of AKI. Hypovolemia (due to diuretics, hemorrhage and diarrhea), acute tubular necrosis (ATN), sepsis, nephrotoxic agents (such as nonsteroidal anti-inflammatory drugs, aminoglycosides and/or radiological contrasts) and hepatorenal syndrome (HRS)-type 1 are the most common causes of AKI in cirrhotic patients. Objective To evaluate the sensitivity of fractional excretion of urea (FEUrea) vas a diagnostic biomarker for different causes of acute kidney injury in liver cirrhosis. Patients and Methods This study was conducted in co-operation between Tropical Medicine Department, Ain-Shams University and the Gastroenterology and Hepatology Department, Theodor Bilharz Research Institute between July 2019 to January 2020. It included 70 adult Egyptian patients admitted for treatment of complications of cirrhosis who fulfilled the eligibility criteria and compared to 10 cirrhotic patients without renal impairment. All patients were subjected to; full history taking, thorough clinical examination, laboratory investigations, Child-Pugh score was calculated for admission and urine samples were collected for urinary urea and creatinine levels to calculate FEUrea. Results Concerning the gender distribution in this study, male to female percent was 40 (57.10%) males and 30 (42.90%) females for gender, respectively. As regards to the causes of AKI, there were 24 (34.30%) PRA, 7 (10.00%) HRS and 39 (55.70%) ATN for final diagnosis. In the current study, there was significant difference (P = 0.0001; P < 0.05) in FE urea % among PRA, HRS and ATN groups (26.28±2.89, 11.76±3.44, and 47.37±10.53, respectively). Findings showed a higher FEUrea cut-off for ATN (>33%) compared to lower cut-off values for PRA (<33% and >21%) and HRS (<21%). Conclusion FEUrea was found to be an excellent simple tool for the differential diagnosis of AKI in patients with decompensated cirrhosis and ascites. FEUrea has also proven to be a useful “tubular injury” marker by differentiating ATN from non-ATN with high diagnostic accuracy (Sensitivity and Specificity exceeding >90%). FEUrea was found to be a good alternative and noninvasive tool for differentiating causes of AKI in cirrhotic patients instead of other non-available or expensive markers.

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Rhabdomyolysis-induced acute kidney injury in a cancer patient exposed to denosumab and abiraterone: a case report

BMC Nephrology ◽

10.1186/s12882-015-0113-6 ◽

2015 ◽

Vol 16 (1) ◽

Cited By ~ 12

Author(s):

Javier A. Neyra ◽

Natalia A. Rocha ◽

Rhea Bhargava ◽

Omkar U. Vaidya ◽

Allen R. Hendricks ◽

...

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Cancer Patient ◽

Kidney Injury

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Acute Kidney Injury in Pediatric Acute Respiratory Distress Syndrome

Journal of Intensive Care Medicine ◽

10.1177/0885066620944042 ◽

2020 ◽

pp. 088506662094404

Author(s):

Shubhi Kaushik ◽

Sindy Villacres ◽

Ruth Eisenberg ◽

Shivanand S. Medar

Keyword(s):

Acute Kidney Injury ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Kidney Injury ◽

Oxygenation Index ◽

Significant Difference

Objectives: To describe the incidence of and risk factors for acute kidney injury (AKI) in children with acute respiratory distress syndrome (ARDS) and study the effect of AKI on patient outcomes. Design: A single-center retrospective study. Setting: A tertiary care children’s hospital. Patients: All patients less than 18 years of age who received invasive mechanical ventilation (MV) and developed ARDS between July 2010 and July 2013 were included. Acute kidney injury was defined using p-RIFLE (risk, injury, failure, loss, and end-stage renal disease) criteria. Interventions: None. Measurements and Main Results: One hundred fifteen children met the criteria and were included in the study. Seventy-four children (74/115, 64%) developed AKI. The severity of AKI was risk in 34 (46%) of 74, injury in 19 (26%) of 74, and failure in 21 (28%) of 74. The presence of AKI was associated with lower Pao 2 to Fio 2 (P/F) ratio ( P = .007), need for inotropes ( P = .003), need for diuretics ( P = .004), higher oxygenation index ( P = .03), higher positive end-expiratory pressure (PEEP; P = .01), higher mean airway pressure ( P = .008), and higher Fio 2 requirement ( P = .03). Only PEEP and P/F ratios were significantly associated with AKI in the unadjusted logistic regression model. Patients with AKI had a significantly longer duration of hospital stay, although there was no significant difference in the intensive care unit stay, duration of MV, and mortality. Recovery of AKI occurred in 68% of the patients. A multivariable model including PEEP, P/F ratio, weight, need for inotropes, and need for diuretics had a better receiver operating characteristic (ROC) curve with an AUC of 0.75 compared to the ROC curves for PEEP only and P/F ratio only for the prediction of AKI. Conclusions: Patients with ARDS have high rates of AKI, and its presence is associated with increased morbidity and mortality.

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Neutrophil gelatinase associated lipocalin, an early biomarker for diagnosis of acute kidney injury after percutaneous coronary intervention

Turkish Journal of Biochemistry ◽

10.1515/tjb-2017-0004 ◽

2017 ◽

Vol 43 (1) ◽

pp. 15-21 ◽

Cited By ~ 1

Author(s):

Nakhshab Choudhry ◽

Amna Ihsan ◽

Sadia Mahmood ◽

Fahim Ul Haq ◽

Aamir Jamal Gondal

Keyword(s):

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Serum Creatinine ◽

Kidney Injury ◽

Coronary Intervention ◽

Diagnostic Biomarker ◽

Elective Percutaneous Coronary Intervention ◽

Percutaneous Coronary ◽

Significant Difference ◽

The Mean

AbstractObjectives:This study was designed to find the reliability of serum NGAL as an early and better diagnostic biomarker than that of serum creatinine for acute kidney injury after percutaneous coronary intervention in Pakistani population.Materials and methods:One hundred and fifty-one patients undergoing elective percutaneous coronary intervention were included and demographic data were recorded. Blood was drawn by venipuncture in clot activator vacutainers and serum was separated and stored at 4°C. Sample was drawn before the percutaneous procedure and subsequently sampling was done serially for 5 days.Results:The mean±SD serum NGAL pre-PCI (39.92± 10.35 μg/L) and 4 h post-PCI (100.42±26.07 μg/L) showed highly significant difference (p<0.001). The mean±SD serum creatinine pre-PCI (70.1±11.8 μmol/L) and post-PCI (71.2±11.6 μmol/L) showed significant difference (p=0.005) on day 2 onwards but mean microalbumin showed insignificant results (p=0.533). The serum NGAL predicted CI-AKI with sensitivity of 95.8% and specificity of 97.6% for a cut off value of 118 μg/L.Conclusion:Our results suggest that NGAL is an excellent early diagnostic biomarker for acute kidney injury in patients undergoing elective percutaneous coronary intervention.

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Preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in cardiac surgery patients

Medicinski pregled ◽

10.2298/mpns2002005g ◽

2020 ◽

Vol 73 (1-2) ◽

pp. 5-12

Author(s):

Miodrag Golubovic ◽

Andrej Preveden ◽

Ranko Zdravkovic ◽

Jelena Vidovic ◽

Bojan Mihajlovic ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Uric Acid ◽

Cardiac Surgery ◽

Kidney Injury ◽

C Reactive Protein ◽

Reactive Protein ◽

Preoperative Hemoglobin ◽

Significant Difference ◽

Acute Kidney Injury Development

Introduction. Acute kidney injury associated with cardiac surgery is a common and significant postoperative complication. With a frequency of 9 - 39% according to different studies, it is the second most common cause of acute kidney injury in intensive care units, and an independent predictor of mortality. This study aimed to investigate the importance of preoperative hemoglobin and uric acid levels as risk factors for acute kidney injury in the postoperative period in cardiac surgery patients. Material and Methods. The study included a total of 118 patients who were divided into two groups. Each group included 59 patients; the fist group included patients who developed acute kidney injury and required renal replacement therapy, and the second included patients without acute kidney injury. Types of cardiac surgery included coronary, valvular, combined, aortic dissection, and others. All necessary data were collected from patient medical records and the electronic database. Results. A statistically significant difference was found between the groups in preoperative hemoglobin levels (108.0 vs. 143.0 g/l, p = 0.0005); postoperative urea (26.4 vs. 5.8 mmol/l, p = 0.0005) and creatinine (371.0 vs. 95.0 ?mol/l, p = 0.0005), acute phase inflammatory reactants C-reactive protein (119.4 vs. 78.9 mg/l, p = 0.002) and procalcitonin (7.0 vs. 0.2 ng/ml, p = 0.0005), creatine kinase myocardial band isoenzyme (1045.0 vs. 647.0 mg/l, p = 0.014); duration of extracorporeal circulation (103.5 vs. 76.0 min, p = 0.0005) and ascending aortic clamp during cardiac surgery (89.0 vs. 67.0 min, p = 0.0005). The exception was the preoperative uric acid level, where there was no statistically significant difference (382.0 vs. 364.0 ?mol/l, p = 0.068). There was a statistically significant correlation between the use of inotropic agents and acute kidney injury development. Conclusion. There is a correlation between the preoperative low hemoglobin levels and postoperative acute kidney injury. There is no statistically significant correlation between the preoperative levels of uric acid and postoperative acute kidney injury.

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