scholarly journals Retrospective Analysis of Outcomes in Acute Myeloid Leukemia (AML) Patients Exposed to Intravenous Contrast Prior to Stem Cell Transplantation

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5179-5179
Author(s):  
Gayathri Ravi ◽  
Yazan Abou-Ismail ◽  
Margaret Rothgery ◽  
Anjali Shekar ◽  
Sophie Golec ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Regression Models ◽  
Kidney Injury ◽  
Hematologic Malignancies ◽  
Ct Imaging ◽  
Increased Risk ◽  
Contrast Exposure ◽  
Contrast Group ◽  
Contrast Ct

Abstract Background: Patients with AML are inherently at increased risk of Acute Kidney Injury (AKI) due to multiple reasons including chemotherapy, antibiotics and risk of tumor lysis syndrome (TLS). Prolonged hospital admissions and persistent neutropenia with increased risk of infections necessitate diagnostic testing including computed tomography (CT) scans with contrast. Contrast induced nephropathy (CIN) is a well-known risk of contrast exposure and is a leading cause of hospital acquired AKI. Acute kidney injury is increasingly being recognized as an independent risk factor for survival in patients with hematologic malignancies. To our knowledge, the incidence of CIN in AML patients and its impact on subsequent cancer management has not been studied. Methods: Retrospective chart review of all newly diagnosed AML patients who received inpatient chemotherapy at Seidman Cancer Center from 2004-2017 were included. Out of the 432 patients screened, 223 were excluded as they did not receive any CT imaging. Serum creatinine (S.cr) was documented prior to receiving chemotherapy for induction, consolidation and/or re-induction for relapsed disease. We recorded the highest S.cr during the 2-7 days after undergoing CT with and without contrast, as per the definition of CIN. Outcomes evaluated include hospital length of stay (LOS), transfer to intensive care unit (ICU), need for renal replacement therapy (RRT) and need for changing subsequent management of AML. We also compared the yield of CT without contrast to CT with contrast. Continuous outcomes were evaluated with univariate generalized linear regression models and binary outcomes were evaluated with univariate logistic regression models. Results: Out of the 209 patients included in the study, 255 cycles of chemotherapy were identified where the patient had a diagnostic CT. This includes 191 inductions, 20 consolidations and 39 relapse inductions. Out of the 255 encounters,136 were CT with contrast and 119 without contrast. LOS, transfer to medical ICU, RRT and need for change in AML management was compared in both groups for induction, consolidation and relapse. Baseline characteristics of patients are summarized in Table 1. The co-morbidities contributing to renal dysfunction and concomitant use of nephrotoxic medications were equally prevalent in both groups. Patients with higher creatinine at presentation predominantly had non-contrast CT done (p <0.001). Average length of stay was 36.6 days in non-contrast group compared to 37.0 days in contrast group (p 0.878). There was a slightly increased need for ICU transfer among the patients who received contrast when compared to non contrast group (22 vs 17 days respectively) however this was not statistically significant (p 0.699). There was no significant change in creatinine post contrast exposure compared to the non-contrast group. Interestingly, need for permanent RRT was noticed to be increased in patients who had non-contrast CT compared to the contrast group (4.2% vs 0.7%, respectively). Subsequent treatment change was needed in 9 patients (6.6%) who received contrast and 7 patients (5.9%) in non-contrast group (p 0.822). CT scan was able to yield positive results half the time (50%) in both contrast and non-contrast group. Of note, patients who had non-contrast CT had a slightly higher need for repeat imaging with IV contrast. Conclusion: CT imaging remains the standard of care for diagnosing many of the complications associated with hematologic malignancies such as pulmonary embolus, atypical pulmonary infection and neutropenic enteritis. Patients with AML are prone to develop AKI for numerous reasons. It is important to note that even if it was only a small number of patients who had a need for permanent RRT in our study it was higher in the setting of no contrast exposure, emphasizing the vulnerability of this subgroup of patients to AKI. Even though no permanent unfavorable outcome was associated with IV contrast exposure in our study, any intervention that could potentially increase the risk of AKI still warrants caution and it may be reasonable to start with a non-contrast CT as an initial diagnostic tool. Disclosures No relevant conflicts of interest to declare.

scholarly journals The impact of COVID-19 on morbidity and mortality in neck of femur fracture patients

2020 ◽  
Vol 1 (11) ◽  
pp. 669-675
Author(s):  
Alex E. Ward ◽  
Daniel Tadross ◽  
Fiona Wells ◽  
Lawrence Majkowski ◽  
Umna Naveed ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Bacterial Pneumonia ◽  
Femur Fracture ◽  
Kidney Injury ◽  
High Rate ◽  
Neck Of Femur ◽  
Increased Risk ◽  
Neck Of Femur Fracture ◽  
The Impact

Aims Within the UK, around 70,000 patients suffer neck of femur (NOF) fractures annually. Patients presenting with this injury are often frail, leading to increased morbidity and a 30-day mortality rate of 6.1%. COVID-19 infection has a broad spectrum of clinical presentations with the elderly, and those with pre-existing comorbidities are at a higher risk of severe respiratory compromise and death. Further increased risk has been observed in the postoperative period. The aim of this study was to assess the impact of COVID-19 infection on the complication and mortality rates of NOF fracture patients. Methods All NOF fracture patients presenting between March 2020 and May 2020 were included. Patients were divided into two subgroup: those with or without clinical and/or laboratory diagnosis of COVID-19. Data were collected on patient demographics, pattern of injury, complications, length of stay, and mortality. Results Overall, 132 patients were included. Of these, 34.8% (n = 46) were diagnosed with COVID-19. Bacterial pneumonia was observed at a significantly higher rate in those patients with COVID-19 (56.5% vs 15.1%; p =< 0.000). Non respiratory complications such as acute kidney injury (30.4% vs 9.3%; p =0.002) and urinary tract infection (10.9% vs 3.5%; p =0.126) were also more common in those patients with COVID-19. Length of stay was increased by a median of 21.5 days in patients diagnosed with COVID-19 (p < 0.000). 30-day mortality was significantly higher in patients with COVID-19 (37.0%) when compared to those without (10.5%; p <0.000). Conclusion This study has shown that patients with a neck of femur fracture have a high rate of mortality and complications such as bacterial pneumonia and acute kidney injury when diagnosed with COVID-19 within the perioperative period. We have demonstrated the high risk of in hospital transmission of COVID-19 and the association between the infection and an increased length of stay for the patients affected. Cite this article: Bone Joint Open 2020;1-11:669–675.

scholarly journals An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

2020 ◽  
Vol 10 (4) ◽  
pp. 250-256
Author(s):  
J. Tyler Haller ◽  
Keaton Smetana ◽  
Michael J. Erdman ◽  
Todd A. Miano ◽  
Heidi M. Riha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Matched Cohort ◽  
Increased Risk ◽  
The Relationship

Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

scholarly journals Impact of diabetes mellitus on short-term prognosis, length of stay, and costs in patients with acute kidney injury: A nationwide survey in China

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250934
Author(s):  
Lishan Tan ◽  
Li Chen ◽  
Yan Jia ◽  
Lingyan Li ◽  
Jinwei Wang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Nationwide Survey ◽  
Renal Recovery ◽  
Short Term ◽  
Increased Risk ◽  
Male Preponderance

Background International data suggest that people with diabetes mellitus (DM) are at increased risk for worse acute kidney injury (AKI) outcomes; however, the data in China are limited. Therefore, this study aimed to describe the association of DM with short-term prognosis, length of stay, and expenditure in patients with AKI. Methods This study was based on the 2013 nationwide survey in China. According to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) and expanded criteria of AKI, 7604 patients with AKI were identified, and 1404 and 6200 patients were with and without DM, respectively. Clinical characteristics, outcomes, length of stay, and costs of these patients were compared. Multivariate regression analyses were conducted to evaluate the association of DM with mortality, failed renal recovery, length of stay, and costs. Results Patients with AKI and DM were older, had higher male preponderance (61.9%), presented with more comorbidities, and had higher serum creatinine levels compared with those without DM. An apparent increase in all-cause in-hospital mortality, length of stay, and costs was found in patients with DM. DM was not independently associated with failed renal recovery (adjusted OR (95%CI): 1.08 (0.94–1.25)) and in-hospital mortality (adjusted OR (95%): 1.16 (0.95–1.41)) in multivariate models. However, the diabetic status was positively associated with the length of stay (β = 0.06, p<0.05) and hospital expenditure (β = 0.10, p<0.01) in hospital after adjusting for possible confounders. Conclusion In hospitalized AKI patients, DM (vs. no DM) is independently associated with longer length of stay and greater costs, but is not associated with an increased risk for failed renal recovery and in-hospital mortality.

scholarly journals Incidence of Contrast Induced Acute Kidney Injury, Its Risk Factors and In-Hospital Outcomes in Patients Undergoing Coronary Angiography and Angioplasty

2020 ◽  
Vol 42 (2) ◽  
pp. 59-63
Author(s):  
Prashun Upadhaya ◽  
Pradeep Thapa ◽  
Ratna M Gajurel ◽  
Mahesh R Sigdel
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Statistical Analysis ◽  
Coronary Angiography ◽  
Logistic Regression Analysis ◽  
Kidney Injury ◽  
Increased Risk ◽  
Contrast Exposure

Introduction Contrast-induced acute kidney injury (CI-AKI) is a serious complication of angiographic procedures with significant morbidity and mortality. We aimed to find the incidence, risk factors and outcomes of CI-AKI in patients who have undergone coronary angiography/angioplasty in a referral hospital in Nepal. MethodsIt was a descriptive observational study of consenting consecutive patients above 18 years undergoing coronary angiography/angioplasty at Manmohan Cardiothoracic Vascular and Transplant Centre, Nepal from July 2015 to September 2017. CI AKI was defined as an elevation of serum creatinine of >25% or ≥0.5 mg/dl (44 μmol/L) from baseline within 48 hour of exposure to contrast. Statistical analysis was performed using SPSS 18 software. Statistical analysis was completed using Student’s t-test, chi-square test and multivariable logistic regression analysis. ResultsOut of 240 patients, 156 (65%) were male, mean age was 60.36±11.29 years. Eighteen patients (7.5%) developed CI-AKI. Incidence of CI-AKI was 20% in patients with chronic kidney disease (CKD), 5.4% in diabetics, 13.6% in patients >70 years, 12.79 % in patients with anaemia and 12.3% in patients with prior contrast exposure. Multivariate logistic regression analysis found smoking and history of prior contrast exposure to be independent predictors for development of CI-AKI. Among patients with CI-AKI, one (5.88%) required dialysis and one (5.88%) died. ConclusionIncidence of CI-AKI after coronary angiography/angioplasty was 7.5%. Patients with prior contrast exposure and smoking were at significantly increased risk of CI-AKI; higher trend of CI-AKI was seen in patients with CKD, diabetes, elderly and anaemia.

scholarly journals Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
◽  
S K Mallipattu ◽  
R Jawa ◽  
R Moffitt ◽  
J Hajagos ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cohort Study ◽  
Length Of Stay ◽  
Regression Models ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models

Abstract Background The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally. Methods This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients’ residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients. Results The median age of the study cohort (interquartile range [IQR]) was 62 (49–75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (rs = 0.235; P = .004), with noted “hot spots” in the region. Study patients were predominantly hypertensive (MAP &gt; 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate &lt; 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5–29.5] days) was significantly longer than that of nonsurvivors (15 [10–23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV. Conclusions This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

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

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

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.

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.

Sign in / Sign up

Export Citation Format

Share Document