The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: The EACG study

To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province. This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Univariate and multivariate logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. (2) Logistic regression analysis showed that sex, age, AKI stage, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time, and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury ( p < 0.05). Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Trial registration: the Chinese Clinical Trial Registry number is ChiCTR1800016945. Date of registration: 4 July 2018.

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Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit

Annals of Intensive Care ◽

10.1186/s13613-018-0373-y ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 13

Author(s):

Dana Y. Fuhrman ◽

Sandra Kane-Gill ◽

Stuart L. Goldstein ◽

Priyanka Priyanka ◽

John A. Kellum

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Adult Intensive Care Unit ◽

Injury Epidemiology

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Acute Kidney Injury Associated with Combination Antimicrobial Therapy in the Medical Information Mart for Intensive Care (MIMIC) III Database

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.821 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S344-S344

Author(s):

W Cliff Rutter ◽

David S Burgess

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Hepatorenal Syndrome ◽

Medical Information ◽

Kidney Injury ◽

Rifle Criteria ◽

Multivariable Logistic Regression

Abstract Background Increased acute kidney injury (AKI) incidence is linked with coadministration of vancomycin (VAN) and piperacillin-tazobactam (TZP) in the general hospital population when compared with VAN and cefepime (FEP); however, this phenomenon was not found in critically ill patients. Methods Patients receiving VAN in combination with FEP or TZP for at least 48 hours during an intensive care unit stay were included in this retrospective review. AKI was defined with the Risk, Injury, Failure, Loss, and End-stage (RIFLE) criteria. Exposure to common nephrotoxins was captured within 24 hours of combination therapy initiation through the entire treatment window. Basic descriptive statistics were performed, along with bivariable and multivariable logistic regression models of AKI odds. Results In total, 2230 patients were included, with 773 receiving FEP+VAN and 1457 receiving TZP+VAN. The groups were well balanced at baseline in most covariates, with the exception of hepatorenal syndrome diagnosis (TZP+VAN 1.4% vs. FEP+VAN 0.3%, P = 0.02) and vasopressor exposure (TZP+VAN 26.2% vs 21.5%, P = 0.01) being more common in the TZP+VAN group. Patients in the FEP+VAN group had a higher underlying severity of disease (Charlson comorbidity index [CCI] 2.7 vs. 2.3, P =0.0002). AKI incidence was higher in the TZP+VAN cohort (35.1% vs. 26.5%, P = 0.00004), with each stratification of the RIFLE criteria being higher. The time until onset of AKI was similar between groups (TZP+VAN median 1 [0–3] days vs. FEP+VAN 1 [0–4] days, P =0.2). After multivariable logistic regression, TZP+VAN therapy was associated with an adjust odds ratio (aOR) of AKI of 1.54 (95% confidence interval [CI] 1.25–1.89) compared with FEP+VAN. Other variables associated with increased odds of AKI included: age >= 65, duration of antibiotic therapy, higher baseline renal function, sepsis, endocarditis, hepatorenal syndrome, thiazide diuretic exposure, and increased CCI. Conclusion Treatment with TZP+VAN is associated with significant increases in AKI incidence among critically ill patients, independent of other risks for AKI. Disclosures All authors: No reported disclosures.

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The epidemiology of acute kidney injury in critically ill patients in the Gansu Province: the EACG Study

10.21203/rs.2.24635/v1 ◽

2020 ◽

Author(s):

Yu Chen ◽

Fang Feng ◽

Xueni Chang ◽

Dong Liu ◽

Yuan Yuan ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Mechanical Ventilation ◽

Acute Kidney Injury ◽

Logistic Regression ◽

Cardiac Output ◽

Intensive Care ◽

Kidney Injury ◽

Gansu Province ◽

Sepsis And Septic Shock

Abstract Objective: To investigate the epidemiology of acute kidney injury and to clarify the risk factors associated with the prognosis of acute kidney injury in critically ill patients in the Gansu Province.Methods : This was a multicenter, retrospective study. The clinical data of all patients from January 1, 2017, to December 31, 2019, in the intensive care unit of the selected hospitals were screened. Descriptive statistical analysis was performed first, and then the patients were divided into a survival group and a nonsurvival group based on survival status at discharge. Logistic regression analyses were used to determine the risk factors for in-hospital mortality in patients with acute kidney injury. RESULTS : (1) Among the 8106 patients admitted, a total of 3019 patients were excluded according to the exclusion criteria. Among the included patients, 890 patients met the diagnostic criteria for AKI, with an incidence of 17.5% and mortality of 41.3%. The etiology of acute kidney injury was 64% prerenal, 33% renal, and 2.7% postrenal. Prerenal AKI was the most common, among which cases caused by sepsis and septic shock accounted for 44.7%. Among the selected AKI patients, AKI stage I accounted for 22.02%, AKI stage II accounted for 31.01%, AKI stage III accounted for 46.97%, and 35.8% of the AKI patients received renal replacement therapy. (2) Logistic regression analysis showed that sex , age, AKI stage, RRT, infection, cardio-pulmonary resuscitation, cardiac output, mechanical ventilation, diuretics, white blood cells, platelets, blood urea nitrogen, prothrombin time and activated partial thromboplastin time were significantly associated with the prognosis of acute kidney injury (P <0.05). Further analysis showed that male sex, old age, high AKI stage, RRT treatment, low cardiac output, mechanical ventilation, elevated leukocyte count, reduced platelet count and reduced serum albumin were independent risk factors for a poor prognosis of acute kidney injury.Conclusions : Large-scale epidemiological data from several representative general hospitals in the Gansu Province showed that the incidence and mortality of acute kidney injury in intensive care units were still very high. Sepsis and septic shock are the main causes of AKI.

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Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

Journal of the Intensive Care Society ◽

10.1177/1751143718762685 ◽

2018 ◽

Vol 19 (4) ◽

pp. 313-318 ◽

Cited By ~ 1

Author(s):

Prashant Parulekar ◽

Ed Neil-Gallacher ◽

Alex Harrison

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Point Of Care ◽

Kidney Injury ◽

Diagnostic Quality ◽

The Core ◽

Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

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Association Between Serum Osmolality and Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.745803 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jie Yang ◽

Yisong Cheng ◽

Ruoran Wang ◽

Bo Wang

Keyword(s):

Acute Kidney Injury ◽

Logistic Regression ◽

Critically Ill ◽

Critically Ill Patients ◽

Retrospective Cohort ◽

Kidney Injury ◽

High Serum ◽

Serum Osmolality ◽

Multivariate Logistic Regression ◽

Low Serum

Purposes: Acute kidney injury (AKI) is a common complication in critically ill patients and is usually associated with poor outcomes. Serum osmolality has been validated in predicting critically ill patient mortality. However, data about the association between serum osmolality and AKI is still lacking in ICU. Therefore, the purpose of the present study was to investigate the association between early serum osmolality and the development of AKI in critically ill patients.Methods: The present study was a retrospective cohort analysis based on the medical information mart for intensive care III (MIMIC-III) database. 20,160 patients were involved in this study and divided into six subgroups according to causes for ICU admission. The primary outcome was the incidence of AKI after ICU admission. The association between early serum osmolality and AKI was explored using univariate and multivariate logistic regression analyses.Results: The normal range of serum osmolality was 285–300 mmol/L. High serum osmolality was defined as serum osmolality >300 mmol/L and low serum osmolality was defined as serum osmolality <285 mmol/L. Multivariate logistic regression indicated that high serum osmolality was independently associated with increased development of AKI with OR = 1.198 (95% CL = 1.199–1.479, P < 0.001) and low serum osmolality was also independently associated with increased development of AKI with OR = 1.332 (95% CL = 1.199–1.479, P < 0.001), compared with normal serum osmolality, respectively.Conclusions: In critically ill patients, early high serum osmolality and low serum osmolality were both independently associated with an increased risk of development of AKI.

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INCIDENCE, RISK FACTORS AND SURVIVAL OF CRITICALLY-ILL PATIENTS WITH ACUTE KIDNEY INJURY

Texto & Contexto - Enfermagem ◽

10.1590/s0104-07072021000100387 ◽

2021 ◽

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Incidence Risk

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Risk Factors For Kidney Damage In COVID-19 Patients Admitted To The Intensive Care Unit

Russian Open Medical Journal ◽

10.15275/rusomj.2021.0203 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Diana K. Sarkisian ◽

Natalia V. Chebotareva ◽

Valerie McDonnell ◽

Armen V. Oganesyan ◽

Tatyana N. Krasnova ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Kidney Damage ◽

Elderly Age ◽

Total Blood ◽

Independent Risk Factors

Background — Acute kidney injury (AKI) reaches 29% in the intensive care unit (ICU). Our study aimed to determine the prevalence, features, and the main AKI factors in critically ill patients with coronavirus disease 2019 (COVID-19). Material and Methods — The study included 37 patients with COVID-19. We analyzed the total blood count test results, biochemical profile panel, coagulation tests, and urine samples. We finally estimated the markers of kidney damage and mortality. Result — All patients in ICU had proteinuria, and 80.5% of patients had hematuria. AKI was observed in 45.9% of patients. Independent risk factors were age more than 60 years, increased C-reactive protein (CRP) level, and decreased platelet count. Conclusion — Kidney damage was observed in most critically ill patients with COVID-19. The independent risk factors for AKI in critically ill patients were elderly age, a cytokine response with a high CRP level.

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SAT-150 ACUTE KIDNEY INJURY IN CRITICALLY ILL PATIENTS IN A SOUTH AFRICAN TERTIARY INTENSIVE CARE UNIT

Kidney International Reports ◽

10.1016/j.ekir.2019.05.182 ◽

2019 ◽

Vol 4 (7) ◽

pp. S68

Author(s):

R. AYLWARD ◽

M. van Niekerk ◽

D. Baker ◽

J. Ensor ◽

S. Pazi ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

South African ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Nephrotoxic drug burden among 1001 critically ill patients: impact on acute kidney injury

Annals of Intensive Care ◽

10.1186/s13613-019-0580-1 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Stephan Ehrmann ◽

◽

Julie Helms ◽

Aurélie Joret ◽

Laurent Martin-Lefevre ◽

...

Keyword(s):

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Drug Prescription ◽

Kidney Injury ◽

Simplified Acute Physiology Score ◽

Severity Of Disease ◽

Lower Severity

Abstract Background Nephrotoxic drug prescription may contribute to acute kidney injury (AKI) occurrence and worsening among critically ill patients and thus to associated morbidity and mortality. The objectives of this study were to describe nephrotoxic drug prescription in a large intensive-care unit cohort and, through a case–control study nested in the prospective cohort, to evaluate the link of nephrotoxic prescription burden with AKI. Results Six hundred and seventeen patients (62%) received at least one nephrotoxic drug, among which 303 (30%) received two or more. AKI was observed in 609 patients (61%). A total of 351 patients were considered as cases developing or worsening AKI a given index day during the first week in the intensive-care unit. Three hundred and twenty-seven pairs of cases and controls (patients not developing or worsening AKI during the first week in the intensive-care unit, alive the case index day) matched on age, chronic kidney disease, and simplified acute physiology score 2 were analyzed. The nephrotoxic burden prior to the index day was measured in drug.days: each drug and each day of therapy increasing the burden by 1 drug.day. This represents a semi-quantitative evaluation of drug exposure, potentially easy to implement by clinicians. Nephrotoxic burden was significantly higher among cases than controls: odds ratio 1.20 and 95% confidence interval 1.04–1.38. Sensitivity analysis showed that this association between nephrotoxic drug prescription in the intensive-care unit and AKI was predominant among the patients with lower severity of disease (simplified acute physiology score 2 below 48). Conclusions The frequently observed prescription of nephrotoxic drugs to critically ill patients may be evaluated semi-quantitatively through computing drug.day nephrotoxic burden, an index significantly associated with subsequent AKI occurrence, and worsening among patients with lower severity of disease.

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