Abstract 356: Hospital Safety Net Status and Clinical Outcomes After Trans-catheter Aortic Valve Replacement

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Muhammad A Sheikh ◽  
Salil V Deo ◽  
Haris Riaz ◽  
Shahzeb Khan ◽  
Sajjad Raza ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Valve Replacement ◽  
Low Income ◽  
Hospital Admissions ◽  
Large Population ◽  
Kidney Injury ◽  
Safety Net ◽  
Preliminary Evidence ◽  
Risk Scores ◽  
Procedural Outcomes

Introduction: Safety-net hospitals (SNH) treat a large population of un-insured and low income patients; several prior studies report worse outcome at these centers. Trans-catheter valve replacement (TAVR) is emerging as first-line therapy for aortic stenosis irrespective of surgical risk scores. However, results of TAVR performed at these centers is limited. Objective: To determine whether post-procedural outcomes of TAVR are comparable at safety-net (SNH) and non-safety net hospitals (non-SNH). Methods: We conducted a retrospective, cohort study with propensity-matched analysis. Complex survey data from the Agency for Healthcare Quality and Research containing weighted sample of all hospital admissions nationwide was utilized for this study. Adults undergoing TAVR at US hospitals participating in the National In-patient sample (NIS) database from January 2014 - December 2015 were included. A 1:1 propensity-matched cohort of patients operated at safety-net hospitals (SNH) and non-SNH institutions was analyzed. Propensity-matching was performed on the basis of sixteen demographic and clinical confounding co-variates. Main outcome studied was all-cause post-procedural mortality. Secondary outcomes compared were stroke, acute kidney injury and length of post-operative stay. Results: Between 2014 - 2015, 41410 patients (mean age 80 +/- 0.11 years, 46% female) underwent TAVR at 731 centers nationwide; 6996 (16.80 %) procedures were performed at safety net centers. SNH comprised 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49 % vs 46 %, p <0.001); admitted emergently (31% vs 21%; p <0.001) and at the lowest quartile for household income (25% % vs 20 %; p <0.001). A large proportion of SNH patients were minorities (Blacks 5.9% vs 3.9%; Hispanic 7.2% vs 3.2%). Adjusted logistic regression was performed on 6995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99 (0.98 - 1.007); p = 0.43], stroke [OR 1.009 (0.99-1.02); p = 0.08], and acute kidney injury [OR 0.99 (0.96 - 1.01); p = 0.5] were comparable in both cohorts. Overall length of stay was also similar (6.9 +/- 0.1 vs 7.1 +/- 0.2 days; p = 057). Conclusion: Post-procedural outcomes after TAVR at SNH are comparable to national outcomes. Our study provides preliminary evidence that wider adoption of TAVR may not adversely influence outcomes at SNH.

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

scholarly journals Acute kidney injury electronic alerts in primary care ‐ findings from a large population cohort

QJM ◽  
2017 ◽  
Vol 110 (9) ◽  
pp. 577-582 ◽  
Author(s):  
J. Holmes ◽  
N. Allen ◽  
G. Roberts ◽  
J. Geen ◽  
J.D. Williams ◽  
...  
Keyword(s):  
Primary Care ◽  
Acute Kidney Injury ◽  
Large Population ◽  
Kidney Injury ◽  
Population Cohort ◽  
Electronic Alerts ◽  
Large Population Cohort

scholarly journals Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

2012 ◽  
Vol 3 (4) ◽  
pp. 278 ◽  
Author(s):  
Xue-zhong Xing ◽  
Hai-jun Wang ◽  
Chu-lin Huang ◽  
Quan-hui Yang ◽  
Shi-ning Qu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cancer Patients ◽  
Critically Ill ◽  
Injury Risk ◽  
Kidney Injury ◽  
Risk Scores

scholarly journals MO371TIME AND THE ETIOLOGY OF ACUTE KIDNEY INJURY DEFINE PROGNOSIS IN THE COURSE OF COVID-19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Nurhan Seyahi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Admissions ◽  
Inflammatory Marker ◽  
Kidney Injury ◽  
Disease Stage ◽  
Immunologic Response ◽  
Electrolyte Disturbances ◽  
Incidence And Mortality ◽  
Depth Analysis ◽  
D Dimer

Abstract Background and Aims Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. There have been previous studies focusing on incidence and mortality of AKI in COVID-19 but none has made in depth analysis in relation to the background pathophysiology. Based on previous observations, we hypothesized that all AKIs seen in COVID-19 are not uniform and we aimed to analyze the etiologies and prognosis of AKI among hospitalized COVID-19 patients in relation to the time of AKI during different phases of the disease. Method A total of 1056 patients were admitted to the designated COVID-19 clinics from March to July in 2020. 77 Patients who were younger than 18 years old and 7 kidney transplant patients were excluded from the study. 427 of the remaining patients were confirmed by real time polymerase chain reaction (RT-PCR) test.). As eGFR below 60 mL/min/1,73 m2 was already shown to be related to mortality, these patients (44) were also excluded. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed. Results 89 of the 383 included COVID-19 patients developed AKI. 24% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Patients who died had significantly higher ferritin and d-dimer levels upon their hospital admissions (p=0,000). Electrolyte disturbances, metabolic acidosis and mortality were also higher in patients who developed AKI later. Hypernatremia (OR: 6,5, 95% CI: 3 – 13,9) and phosphorus disturbances (both hyperphosphatemia (OR: 3,3; 95%CI: 1,6 – 6,9) and hypophosphatemia (OR: 3,9; 95% CI: 2,0-7,9)) were related to mortality. Conclusion Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies

scholarly journals KDIGO-based acute kidney injury criteria operate differently in hospitals and the community—findings from a large population cohort

2016 ◽  
Vol 31 (6) ◽  
pp. 922-929 ◽  
Author(s):  
Simon Sawhney ◽  
Nick Fluck ◽  
Simon D. Fraser ◽  
Angharad Marks ◽  
Gordon J. Prescott ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Large Population ◽  
Kidney Injury ◽  
Injury Criteria ◽  
Population Cohort ◽  
Large Population Cohort

Acute kidney injury (AKI)

2021 ◽  
pp. 490-525
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Low Income ◽  
Urine Output ◽  
Incidental Finding ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Electrolyte Disorders ◽  
Severe Condition ◽  
Renal Replacement Therapies

Acute kidney injury (AKI) can generally be considered as sudden reduction in kidney function occurring over hours to days, and is commonly but not always associated with a reduction in urine output. Its definition was based on rises in serum creatinine and reductions in urine output criteria. Its incidence, prevalence, and aetiology vary according to the country/region profile (low income, high income, tropical, etc.), age (children, adult, or elderly), and clinical setting (outpatients versus inpatient, hospital versus intensive care unit). The incidence of AKI is increasing in the hospital setting, and is more common with increasing age, male sex, pre-existing CKD, and comorbidity (congestive cardiac failure, diabetes, hypertension). The majority of cases result from multiple insults: dehydration, drugs in conjunction with inflammation and/or sepsis. AKI may have a spectrum of being an incidental finding with no signs or symptoms to a moderate to severe condition with increased morbidity and mortality due to accumulation of nitrogenous waste products and fluid–electrolyte disorders. The aetiologies of AKI are numerous and can broadly be classified as pre-renal, intrinsic renal, and post-renal (obstructive). A thorough evaluation of the patients with AKI for diagnosis and treatment are required. There are no specific treatments, but eliminating aetiological reasons and protection from further kidney function loss are crucial. A balanced haemodynamic management along with a balanced fluid–electrolyte replacement and arranging drug dosages are important. Various modes of renal replacement therapies may be used for treating severe cases.

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