scholarly journals Associations of Fluid Amount, Type, and Balance and Acute Kidney Injury in Patients Undergoing Major Surgery

2018 ◽  
Vol 46 (1) ◽  
pp. 79-87 ◽  
Author(s):  
L. Weinberg ◽  
M. H. G. Li ◽  
L. Churilov ◽  
A. Armellini ◽  
M. Gibney ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Chloride Content ◽  
Fluid Administration ◽  
Major Surgery ◽  
Confounding Effect ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
Independent Association

Fluid administration has been reported to be associated with an increased risk of acute kidney injury (AKI). We assessed whether, after correction for fluid balance, amount and chloride content of fluids administered have an independent association with AKI. We performed an observational study in patients after major surgery assessing the independent association of AKI with volume, chloride content and fluid balance, after adjustment for Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) score, age, elective versus emergency surgery, and duration of surgery. We studied 542 consecutive patients undergoing major surgery. Of these, 476 patients had renal function tested as part of routine clinical care and 53 patients (11.1%) developed postoperative AKI. After adjustments, a 100 ml greater mean daily fluid balance was artificially associated with a 5% decrease in the instantaneous hazard of AKI: adjusted Hazard Ratio (aHR) 0.951, 95% confidence intervals (CI) 0.935 to 0.967, P <0.001. However, after adjustment for the proportion of chloride-restrictive fluids, mean daily fluid amounts and balances, POSSUM morbidity, age, duration and emergency status of surgery, and the confounding effect of fluid balance, every 5% increase in the proportion of chloride-liberal fluid administered was associated with an 8% increase in the instantaneous hazard of AKI (aHR 1.079, 95% CI 1.032 to 1.128, P=0.001), and a 100 ml increase in mean daily fluid amount given was associated with a 6% increase in the instantaneous hazard of AKI (aHR 1.061, 95% CI 1.047 to 1.075, P <0.001). After adjusting for key risk factors and for the confounding effect of fluid balance, greater fluid administration and greater administration of chloride-rich fluid were associated with greater risk of AKI.

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

scholarly journals Association of endothelial and glycocalyx injury biomarkers with fluid administration, development of acute kidney injury, and 90-day mortality: data from the FINNAKI observational study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Nina Inkinen ◽  
◽  
Ville Pettilä ◽  
Päivi Lakkisto ◽  
Anne Kuitunen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Fluid Administration ◽  
Mortality Data ◽  
Linear Regression Models ◽  
Soluble Thrombomodulin ◽  
Icu Admission ◽  
Increased Risk ◽  
Icu Discharge ◽  
Vascular Adhesion

Abstract Background Injury to endothelium and glycocalyx predisposes to vascular leak, which may subsequently lead to increased fluid requirements and worse outcomes. In this post hoc study of the prospective multicenter observational Finnish Acute Kidney Injury (FINNAKI) cohort study conducted in 17 Finnish intensive care units, we studied the association of Syndecan-1 (SDC-1), Angiopoetin-2 (Ang-2), soluble thrombomodulin (sTM), vascular adhesion protein-1 (VAP-1) and interleukin-6 (IL-6) with fluid administration and balance among septic critical care patients and their association with development of acute kidney injury (AKI) and 90-day mortality. Results SDC-1, Ang-2, sTM, VAP-1 and IL-6 levels were measured at ICU admission from 619 patients with sepsis. VAP-1 decreased (p < 0.001) and IL-6 increased (p < 0.001) with increasing amounts of administered fluid, but other biomarkers did not show differences according to fluid administration. In linear regression models adjusted for IL-6, only VAP-1 was significantly associated with fluid administration on day 1 (p < 0.001) and the cumulative fluid balance on day 5/ICU discharge (p = 0.001). Of 415 patients admitted without AKI, altogether 112 patients (27.0%) developed AKI > 12 h from ICU admission (AKI>12 h). They had higher sTM levels than patients without AKI, and after multivariable adjustment log, sTM level was associated with AKI>12 h with OR (95% CI) of 12.71 (2.96–54.67), p = 0.001). Ninety-day non-survivors (n = 180; 29.1%) had higher SDC-1 and sTM levels compared to survivors. After adjustment for known confounders, log SDC-1 (OR [95% CI] 2.13 [1.31–3.49], p = 0.002), log sTM (OR [95% CI] 7.35 [2.29–23.57], p < 0.001), and log Ang-2 (OR [95% CI] 2.47 [1.44–4.14], p = 0.001) associated with an increased risk for 90-day mortality. Finally, patients who had high levels of all three markers, namely, SDC-1, Ang-2 and sTM, had an adjusted OR of 5.61 (95% CI 2.67–11.79; p < 0.001) for 90-day mortality. Conclusions VAP-1 and IL-6 associated with fluid administration on the first ICU day. After adjusting for confounders, sTM was associated with development of AKI after 12 h from ICU admission. SDC-1, Ang-2 and sTM were independently associated with an increased risk for 90-day mortality.

scholarly journals “I don’t get no respect”: the role of chloride in acute kidney injury

2019 ◽  
Vol 316 (3) ◽  
pp. F587-F605 ◽  
Author(s):  
Joshua L. Rein ◽  
Steven G. Coca
Keyword(s):  
Acute Kidney Injury ◽  
Chloride Concentration ◽  
Kidney Injury ◽  
Chloride Content ◽  
Tubuloglomerular Feedback ◽  
Renal Physiology ◽  
Major Public Health Problem ◽  
Serum Chloride ◽  
Increased Risk

Acute kidney injury (AKI) is a major public health problem that complicates 10–40% of hospital admissions. Importantly, AKI is independently associated with increased risk of progression to chronic kidney disease, end-stage renal disease, cardiovascular events, and increased risk of in-hospital and long-term mortality. The chloride content of intravenous fluid has garnered much attention over the last decade, as well as its association with excess use and adverse outcomes, including AKI. Numerous studies show that changes in serum chloride concentration, independent of serum sodium and bicarbonate, are associated with increased risk of AKI, morbidity, and mortality. This comprehensive review details the complex renal physiology regarding the role of chloride in regulating renal blood flow, glomerular filtration rate, tubuloglomerular feedback, and tubular injury, as well as the findings of clinical research related to the chloride content of intravenous fluids, changes in serum chloride concentration, and AKI. Chloride is underappreciated in both physiology and pathophysiology. Although the exact mechanism is debated, avoidance of excessive chloride administration is a reasonable treatment option for all patients and especially in those at risk for AKI. Therefore, high-risk patients and those with “incipient” AKI should receive balanced solutions rather than normal saline to minimize the risk of AKI.

scholarly journals Impact of Cumulative Fluid Balance During Continuous Renal Replacement Therapy on Mortality in Patients With Septic Acute Kidney Injury: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jin Lin ◽  
Hai Zhou Zhuang ◽  
De Yuan Zhi ◽  
Zhili Qi ◽  
Jing Bai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Continuous Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Fluid Balance ◽  
Kidney Injury ◽  
Septic Acute Kidney Injury ◽  
Increased Risk ◽  
Tertiary Teaching ◽  
All Cause Mortality

Background: The clinicians often use continuous renal replacement therapy (CRRT) for the fluid management of patients with septic acute kidney injury (AKI). However, there is limited knowledge of the effects of changes in fluid balance (FB) on CRRT and its association with outcomes in patients with septic AKI.Objective: This study aimed to determine the association of cumulative FB (CFB) during treatment with 28-day all-cause mortality in the patients with septic AKI who require CRRT.Methods: This retrospective observational study examined patients who received CRRT due to septic AKI in a mixed intensive care unit (ICU) of a tertiary teaching hospital between January 2015 and December 2018. The patients were divided into three groups—negative FB, even FB, and positive FB—based on the CFB during CRRT. The primary outcome was 28-day all-cause mortality.Results: We examined 227 eligible patients and the mean age was 62.4 ± 18.3 years. The even FB group had a significantly lower 28-day mortality (43.0%, p = 0.007) than the positive FB group (72.7%) and the negative FB group (54.8%). The unadjusted and adjusted Cox regression models indicated that the positive FB group had an increased risk for 28-day all-cause mortality relative to the even FB group. A restricted cubic splines model indicated a J-shaped association between the CFB and 28-day all-cause mortality in the unadjusted model.Conclusion: Among the critically ill patients with septic AKI who require CRRT, those with positive FB had a higher mortality rate than those with even FB.

scholarly journals Variability of CVP and Fluid Overload are Associated with Sepsis-associated Acute Kidney Injury: a case-control study

2019 ◽  
Author(s):  
Minqiang Huang ◽  
Wei Han ◽  
Ming Han ◽  
Lei Kuang
Keyword(s):  
Acute Kidney Injury ◽  
Fluid Balance ◽  
Medical Information ◽  
Venous Pressure ◽  
Kidney Injury ◽  
Fluid Accumulation ◽  
Increased Risk ◽  
Baseline Factors ◽  
Prospective Trials ◽  
New Onset

Abstract Background: The relationship between central venous pressure (CVP) and sepsis-associated acute kidney injury is not extensively explored. The study aimed to investigate the association of CVP and new-onset SAKI.Methods: Septic patients with new-onset AKI (SAKI) were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) was used to account for the baseline differences between SAKI and non-SAKIs. In order to estimate association between CVP variability and AKI, we applied the generalize estimate equation (GEE) to adjust for potential confounding such as cumulative fluid balance and in-ICU medication usage. Results: A total of 916 septic patients with new-onset AKI were enrolled in the study, including 458 in the SAKI group and 458 in non-SAKI group. After PS matching, baseline factors such as SOFA, SAOSII, APSIII and LODS score, as well as baseline diseases including hypertension, diabetes, liver and renal disease were balanced between SAKIs and non-SAKIs. SAKI groups showed higher CVP variation (SAKI vs.non-SAKI:0.83 vs.0.68, p=0.03) and accumulative fluid balance (SAKI vs. non-SAKI: Day 1:3449.8 vs.2930.3; Day 2:4801.1 vs. 3916.6; Day 3: 6018.5 vs.5005.8, p=0.007). GEE was further used to estimate the association between CVP variation and SAKI. The model showed that, increased CVP variation (OR=1.14 ,95%CI 1.01-1.28, p=0.03), higher fluid accumulation (OR=1.02 95%CI 1.00-1.05, p=0.04) were associated with increased risk of SAKI. Conclusions: We found that variability of CVP and higher fluid accumulation were associated with higher risk of new-onset SAKI in septic patients in this study. The results need to be verified in further prospective trials.

scholarly journals Association between Latent Trajectories of Fluid Balance and Clinical Outcomes in Critically Ill Patients with Acute Kidney Injury: A Prospective Multicenter Observational Study

2021 ◽  
pp. 1-11
Author(s):  
Meiping Wang ◽  
Bo Zhu ◽  
Li Jiang ◽  
Xuying Luo ◽  
Na Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Fluid Balance ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Increased Risk

<b><i>Introduction:</i></b> We aimed to identify different trajectories of fluid balance (FB) and investigate the effect of FB trajectories on clinical outcomes in intensive care unit (ICU) patients with acute kidney injury (AKI) and the dose-response association between fluid overload (FO) and mortality. <b><i>Methods:</i></b> We derived data from the Beijing Acute Kidney Injury Trial (BAKIT). A total of 1,529 critically ill patients with AKI were included. The primary outcome was 28-day mortality, and hospital mortality, ICU mortality and AKI stage were the secondary outcomes. A group-based trajectory model was used to identify the trajectory of FB during the first 7 days. Multivariable logistic regression was performed to examine the relationship between FB trajectories and clinical outcomes. A logistic regression model with restricted cubic splines was used to examine the dose relationship between FO and 28-day mortality. <b><i>Results:</i></b> Three distinct trajectories of FB were identified: low FB (1,316, 86.1%), decreasing FB (120, 7.8%), and high FB (93, 6.1%). Compared with low FB, high FB was associated with increased 28-day mortality (odds ratio [OR] 1.94, 95% confidence interval [CI] 1.17–3.19) and AKI stage (OR 2.04, 95% CI 1.23–3.37), whereas decreasing FB was associated with a reduction in 28-day mortality by approximately half (OR 0.53, 95% CI 0.32–0.87). Similar results were found for the outcomes of ICU mortality and hospital mortality. We observed a J-shaped relationship between maximum FO and 28-day mortality, with the lowest risk at a maximum FO of 2.8% L/kg. <b><i>Conclusion:</i></b> Different trajectories of FB in critically ill patients with AKI were associated with clinical outcomes. An FB above or below a certain range was associated with an increased risk of mortality. Further studies should explore this relationship and search for the optimal fluid management strategies for critically ill patients with AKI.

scholarly journals A Porthole over AKI: Cell Dynamics in Damage and Repair

Nephron ◽  
2020 ◽  
Vol 144 (12) ◽  
pp. 650-654
Author(s):  
Luca Bordoni ◽  
Donato Sardella ◽  
Ina Maria Schiessl
Keyword(s):  
Acute Kidney Injury ◽  
Renal Cell ◽  
Kidney Injury ◽  
Cell Types ◽  
Cell Interactions ◽  
Intravital Imaging ◽  
Cell Dynamics ◽  
Powerful Technique ◽  
Increased Risk ◽  
Cell Crosstalk

Acute kidney injury (AKI) is associated with an increased risk of CKD. Injury-induced multifaceted renal cell-to-cell crosstalk can either lead to successful self-repair or chronic fibrosis and inflammation. In this mini-review, we will discuss critical renal cell types acting as victims or executioners in AKI pathology and introduce intravital imaging as a powerful technique to further dissect these cell-to-cell interactions.

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