Increased INR>3.0 In Patients on Warfarin Therapy Is Associated with Acute Changes In the Serum Creatinine and Increased Mortality Rate

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 819-819 ◽  
Author(s):  
Sergey Brodsky ◽  
Lee Hebert ◽  
Haifeng Wu ◽  
James Liu ◽  
Kyle Ware ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Warfarin Therapy ◽  
Conflicts Of Interest ◽  
Clinical Care ◽  
Anticoagulation Therapy ◽  
Kidney Injury ◽  
Risk Of Death ◽  
Renal Complication

Abstract Abstract 819 Recently we reported that an excessive anticoagulation with warfarin (INR>3.0) can result in acute kidney injury (AKI). Morphologic findings included glomerular hemorrhage and renal tubular obstruction by red blood cell (RBC) casts. The clinical outcome in these patients was unfavorable; more than half of them did not recover from acute kidney injury even after normalization of INR. Later we analyzed serum creatinine (SC) and INR in patients with chronic kidney disease (CKD) on warfarin therapy. We found that 46% of patients had increase in SC levels >0.3 mg/dl associated with INR>3.0. SC remained elevated above baseline after the first episode of abnormal INR. The slope of the following SC increase was higher after this abnormal INR episode. We called this condition warfarin related nephropathy (WRN). The current study is based on medical records of 4059 consecutive patients who were on warfarin therapy at the Ohio State Medical Center for a 5-year period. Of these, 838 (21%) experienced an increase in SC>0.3 mg/dl within 1 week after INR>3.0 (WRN group). The remaining 3221 patients (79%) were designated no-WRN. The WRN group had a 5-year mortality rate of 42%, as compared to 27% for the no-WRN group (p<.001). The highest risk of death in the WRN cohort occurred within the 1st month after INR>3.0 (hazard ratio =2.15). For both WRN and no-WRN groups, the 5-year mortality rate was consistently higher in those with CKD compared to those with no-CKD (50.8% vs. 37.0% for the WRN cohort; 39.7% vs. 24.5% for the no-WRN cohort; p<.0001). Compared to no-WRN patients, WRN patients tended to be older (63.7±14.7 years vs. 61.7±15.6 years, p=.025), diabetic (47% vs 37%, p<.0001), hypertensive (82% vs 72%, p<.001) and had a history of heart failure (62% vs 42%, p<.001). Preliminary models indicate that WRN still is a significant predictor of death even after adjusting for these factors. We conclude that WRN is associated with increased mortality rate in the elderly, the diabetic, and those with CKD and cardiovascular diseases. The possible pathophysiologic mechanisms may be glomerular hematuria and formation of occlusive RBC casts. Physicians, involved in the clinical care of patients on systemic anticoagulation therapy, should be aware of this serious renal complication of warfarin overdose and carefully monitor the kidney function and coagulation parameters in these patients Disclosures: No relevant conflicts of interest to declare.

scholarly journals In-Hospital Outcomes of Acute ST Elevation Myocardial Infarction in Patients with Acute Kidney Injury

2018 ◽  
Vol 11 (1) ◽  
pp. 59-66
Author(s):  
Md Mosharul Haque ◽  
M Atahar Ali ◽  
Mustafizul Aziz ◽  
Mohammad Ullah ◽  
Mohammad Anowar Hossain ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Hospital Mortality ◽  
Independent Predictor ◽  
Kidney Injury ◽  
Group I ◽  
St Elevation ◽  
Group Ii

Background: Acute kidney injury (AKI) is a risk factor for long-term adverse outcomes, including acute myocardial infarction and death. The objective of this study was to find out in-hospital outcomes in patients with acute ST elevation myocardial infarction with acute kidney injury.Methods: A total 190 patients were included in this study and were equally divided into two groups, Group-I (with AKI) and Group-II (without AKI), according to absolute changes of serum creatinine level. AKI was defined as absolute changes in serum creatinine (SCr. at 48 hours’ minus admission SCr) and categorized as mild AKI (increase of 0.3 to <0.5 mg/d), moderate AKI (increase of 0.5 to <1.0 mg/dl), and severe AKI (increase of e”1.0 mg/dl) using Acute Kidney Injury Network (AKIN) criteria.Results: Overall in-hospital mortality rate was 14.7% in Group-I (mortality rate for those with mild, moderate, and severe AKI were 7%, 13.3%, and 31.8%) compared with 5.3% in Group-II. Regarding inhospital morbidities, significant arrhythmia (29.5%) was the most common complication followed by acute heart failure (18.9%), cardiogenic shock (12.6%), and mechanical complications (4.2%) which were more in Group-I compared to patients with Group-II. After adjustment of other risk variables, the multivariate logistic regression analysis revealed AKI remained an independent predictor of in-hospital mortality with adjusted odds ratios (OR) was 4.991 (95% confidence interval, 1.873-13.301).Conclusions: AKI is an independent predictor of in-hospital mortality and morbidity. It emphasizes the importance of efforts to identify risk factors and to prevent AKI during in-hospital management of acute STEMI patients.Cardiovasc. j. 2018; 11(1): 59-66

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

2020 ◽  
pp. 089686082097085
Author(s):  
Watanyu Parapiboon ◽  
Thosapol Chumsungnern ◽  
Treechada Chamradpan
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Intermittent Hemodialysis ◽  
Risk Of Death ◽  
Risk Of Mortality

Background: Literature regarding the outcomes of lower dosage peritoneal dialysis (PD) in treating acute kidney injury (AKI) among resource-limited setting is sparse. This study aims to compare the risk of mortality in patients with AKI receiving lower PD dosage and conventional intermittent hemodialysis (IHD) in Thailand. Methods: In a tertiary center in Thailand, a matched case–control study using propensity scores in patients with AKI was conducted to compare the outcomes between lower PD dosage (18 L per day for first two sessions, weekly Kt/ V 2.2) and IHD (three times a week) from February 2015 to January 2016. The primary outcome was a 30-day in-hospital mortality rate. Secondary outcomes included dialysis dependence at 90 days. Results: Eighty-four patients were included (28 PD and 56 IHD). Patient characteristics were comparable between two treatment groups. Overall, the mean age was 58 years. Most of the patients were critically ill (87% need mechanical ventilator; mean acute physiological and chronic health evaluation (APACHE II) score: 25). The 30-day in-hospital mortality rate was similar between the PD and IHD patients (57% vs. 46%, p = 0.36). The dialysis dependence rate was also comparable at 90 days. The risk of death among AKI patients was higher in those with respiratory failure, higher APACHE II score, and starting dialysis with blood urea nitrogen greater than 70 mg dL−1. Conclusion: Clinical outcomes, including risk of mortality and 90-day dialysis dependence among patients with AKI, appear to be comparable between lower dosage PD and IHD.

Rapid Anuric Acute Kidney Injury After the Administration of IV Anti-D in a Teenager

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4691-4691
Author(s):  
L. Kristy Haggett ◽  
Kanyalakshmi Ayyanar ◽  
Larry Shoemaker
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Conflicts Of Interest ◽  
Rare Complication ◽  
White Cell Count ◽  
Kidney Injury ◽  
Risk Of Death ◽  
Idiopathic Thrombocytopenia Purpura ◽  
Anuric Renal Failure ◽  
Brown Urine

Abstract Abstract 4691 Introduction: A 16 year old male developed dark brown urine and prolonged anuric renal failure requiring hemodialysis after receiving IV anti-D. He was diagnosed with idiopathic thrombocytopenia purpura (ITP) after presenting with diffuse petechiae and a platelet count of 7000/μl, about a week after onset of viral prodrome that had resolved 2 days before. The white cell count, hemoglobin, PT, PTT, INR, and direct Coomb’s screen (IgG and complement) values were normal/negative at initial presentation, as were plasma chemistries, including LDH and uric acid levels. Except for small ketones and small heme reactions, the initial urinalysis was also unremarkable. Following IV anti-D, the patient developed intravascular coagulation concurrent with hemolysis and renal failure. Method: In this case report we describe a teenager who presented with ITP and rapidly developed severe anuric acute kidney injury (AKI) associated with mild intravascular hemolysis and coagulopathy. We review previous reports of IV Anti-D associated AKI, in order to identify common risk factors that may be used as a pre-treatment screen. Result: Anuric renal failure following IV anti-D has previously been reported and is a profoundly rare complication associated with a high risk of death. There is no reliable screening test, as this case illustrates. The clinical and laboratory course in this teenager, as well as from other reported cases, lead us to speculate that while hemolysis following IV-anti D infusion is necessary for the development of acute renal failure, it is insufficient unless there is a concurrent or antecedent intravascular coagulopathy. We suggest that the D-dimers assay should be formally evaluated as a screen prior to IV anti-D therapy to identify those individuals at risk for this life-threatening adverse reaction. Conclusion: IV anti-D is a good option for the treatment of ITP but the risks should be seriously considered prior to administration. A preliminary workup should be initiated prior to therapy. Other forms of treatment may be necessary in patients with evidence of renal insufficiency, hemolysis, recent EBV infection, known positive C-antigen or evidence of coagulopathy. We are planning a prospective study to evaluate the usefulness of obtaining a D-dimer in ITP patients prior to treatment. This will elicit information that is currently unavailable regarding the frequency of positive D-Dimers in patients with ITP prior to treatment. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Impact of timing of initiation of dialysis on mortality of patients with acute kidney injury

2020 ◽  
Vol 7 (1) ◽  
pp. e07-e07
Author(s):  
Reginaldo Passoni dos Santos ◽  
Letícia Giroldo Vieira ◽  
Danielle Fernanda Miner de Oliveira ◽  
Raissa Fritz Schmitt ◽  
Vinicius Ferreira de Barros ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Significant Risk ◽  
Kidney Injury ◽  
Significant Risk Factor ◽  
Median Number ◽  
Bivariate Analysis ◽  
Initiation Of Dialysis ◽  
Timing Of Initiation

Introduction: In Brazil, primary studies on this issue are still limited and the ideal timing of initiation of dialysis in severe acute kidney injury (AKI) still generates disagreements among experts. Objectives: To assess if the timing of initiation of dialysis is associated with the mortality of patients with AKI in intensive care unit (ICU). Patients and Methods: We retrospectively analyzed medical records of patients that developed severe AKI in the ICU. Bivariate analysis was carried out to compare data between groups of patients who underwent early dialysis (ED - initiated up to two days after the AKI diagnosis) and late dialysis (LD – initiated more than two days after the AKI diagnosis), while multivariate logistic regression was applied to identify factors associated with mortality. Results: Of the 76 patients included in the study, 27 (35.5%) were allocated in the ED group and 49 (64.5%) in the LD group. LD group had a higher frequency of sepsis [26 (53%) vs. 12 (44%); P = 0.472], while the ED group had a higher median number of dialysis sessions (6 vs. 3; P = 0.477) and higher total median time on dialysis (17.5 h vs. 13 h; P = 0.629). The overall mortality rate was 61.8% (n = 47) and of 76% (n = 22) in the ED group. The patients’ serum creatinine level at admission in the ICU was the only statistically significant risk factor for death [OR= 0.453 (95% CI= 0.257–0.801); P = 0.006]. Conclusion: The overall and in the ED group mortality rate was elevated, however, the timing of initiation of dialysis did not show statistically significant association with death. The serum creatinine at ICU admission seems to be an important mortality predictor.

scholarly journals Acute Kidney Injury Classified by Serum Creatinine and Urine Output in Critically Ill Cancer Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Bertha M. Córdova-Sánchez ◽  
Ángel Herrera-Gómez ◽  
Silvio A. Ñamendys-Silva
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cancer Patients ◽  
Critically Ill ◽  
Urine Output ◽  
Cohort Analysis ◽  
Kidney Injury ◽  
Risk Of Death ◽  
Increased Risk ◽  
Stage 1

Acute kidney injury (AKI) is common in critically ill patients and is associated with higher mortality. Cancer patients are at an increased risk of AKI. Our objective was to determine the incidence of AKI in our critically ill cancer patients, using the criteria of serum creatinine (SCr) and urine output (UO) proposed by the Kidney Disease: Improving Global Outcomes (KDIGO).Methods.We performed a retrospective cohort analysis of a prospectively collected database at the intensive care unit (ICU) of the Instituto Nacional de Cancerología from January 2013 to March 2015.Results.We classified AKI according to the KDIGO definition. We included 389 patients; using the SCr criterion, 192 (49.4%) had AKI; using the UO criterion, 219 (56.3%) had AKI. Using both criteria, we diagnosed AKI in 69.4% of patients. All stages were independently associated with six-month mortality; stage 1 HR was 2.04 (95% CI 1.14–3.68,p=0.017), stage 2 HR was 2.73 (95% CI 1.53–4.88,p=0.001), and stage 3 HR was 4.5 (95% CI 2.25–8.02,p<0.001). Patients who fulfilled both criteria had a higher mortality compared with patients who fulfilled just one criterion (HR 3.56, 95% CI 2.03–6.24,p<0.001).Conclusion.We diagnosed AKI in 69.4% of patients. All AKI stages were associated with higher risk of death at six months, even for patients who fulfilled just one AKI criterion.

Overall outcomes of acute kidney injury

2018 ◽  
Author(s):  
Norbert Lameire ◽  
Wim Van Biesen ◽  
Raymond Vanholder
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Kidney Injury ◽  
Underlying Disease ◽  
Population Based ◽  
Absolute Increase ◽  
Baseline Serum ◽  
Risk Of Death ◽  
Co Morbidity ◽  
Patient Groups

This chapter describes the overall short- and long-term, mainly non-renal outcomes of patients who suffer from acute kidney injury (AKI). Despite increasing age and greater burden of co-morbidity at the occurrence of AKI, patient mortality shows an overall decline over time. However, relatively ‘mild’ forms of AKI (i.e. defined as an absolute increase in serum creatinine of at least 0.3 mg/dL (26.4 µmol/L)) are associated with statistically significant decreased patient survival. The absolute mortality rates of AKI vary according to the different patient groups studied (intensive care unit, hospital, and population based), differences in parameters used for the criteria of AKI, differences in acquisition of baseline serum creatinine, differences between need of renal replacement therapy or not, and timing of endpoints (in-hospital mortality, 30 days, 60 days, or longer). In many instances, particularly in critically ill patients, AKI occurs in the setting of other diseases, such as sepsis, which are associated with a significant mortality risk. In such cases, AKI appears to amplify the risk of death associated with the underlying disease.

scholarly journals The effect of recombinant human soluble thrombomodulin on renal function and mortality in septic disseminated intravascular coagulation patients with acute kidney injury: a retrospective study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Masayuki Akatsuka ◽  
Yoshiki Masuda ◽  
Hiroomi Tatsumi ◽  
Tomoko Sonoda
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Disseminated Intravascular Coagulation ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Soluble Thrombomodulin ◽  
Icu Discharge ◽  
Recombinant Human Soluble Thrombomodulin

Abstract Background Clinical evidence showing the effectiveness of recombinant human soluble thrombomodulin (rhTM) for treating sepsis-induced disseminated intravascular coagulation (DIC) and organ dysfunction (particularly renal injury) is limited because of differences in the inclusion criteria and disease severity among patients. This study aimed to assess the association between rhTM and outcomes in septic DIC patients with acute kidney injury (AKI). Methods This retrospective observational study analyzed the data of patients who were admitted to the intensive care unit (ICU) of a single center between January 2012 and December 2018, and diagnosed with sepsis-induced DIC and AKI. Data were extracted as follows: patients’ characteristics; DIC score, as calculated by the Japanese Association for Acute Medicine and the International Society of Thrombosis and Hemostasis criteria; serum creatinine levels; and ICU and 28-day mortality rates. The primary outcome was the dependence on renal replacement therapy (RRT) at ICU discharge. The propensity score (PS) was calculated using the following variables: age, sex, septic shock at admission, DIC score, and KDIGO classification. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcome. Results In total, 97 patients were included in this study. Of these, 52 (53.6%) patients had received rhTM. The dependence on RRT at ICU discharge was significantly lower in the rhTM than in the non-rhTM group (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.19–0.97; P = 0.043). The serum creatinine levels at ICU discharge (OR, 0.31; 95% CI, 0.13–0.72; P = 0.007) and hospital discharge (OR, 0.25; 95% CI, 0.11–0.60; P = 0.002, respectively), and the 28-day mortality rate (OR, 0.40; 95% CI, 0.17–0.93; P = 0.033) were significantly lower in the rhTM than in the non-rhTM group. Moreover, the Kaplan–Meier survival curve revealed significantly lower mortality rates in the rhTM than in the non-rhTM group (P = 0.009). No significant differences in the DIC score and AKI severity were observed between the groups. Conclusions Among sepsis-induced DIC patients with AKI, rhTM administration was associated with lower dependence on RRT at ICU discharge, improvement in renal function, and lower 28-day mortality rate.

scholarly journals Anticoagulant Related Nephropathy Only Partially Develops in C57BL/6 Mice: Hematuria Is Not Accompanied by Red Blood Cell Casts in the Kidney

2021 ◽  
Vol 7 ◽  
Author(s):  
Ajay K. Medipally ◽  
Min Xiao ◽  
Shahzeb Qaisar ◽  
Anjali A. Satoskar ◽  
Iouri Ivanov ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Blood Cell ◽  
Serum Creatinine ◽  
Red Blood Cell ◽  
Murine Model ◽  
Anticoagulation Therapy ◽  
Kidney Injury ◽  
Ablative Surgery ◽  
Remnant Kidney

Anticoagulant-related nephropathy (ARN) may develop in patients that are on anticoagulation therapy. Rats with 5/6 nephrectomy treated with different anticoagulants showed acute kidney injury (AKI) and red blood cell (RBC) casts in the tubules similar to ARN in humans. The aim of the current study was to investigate the feasibility of inducing ARN in mice. C57BL/6 5/6 nephrectomy mice were treated with warfarin and dabigatran 3 weeks after ablative surgery for 7 days. Two doses of each anticoagulant were used. All anticoagulants resulted in serum creatinine and hematuria increase. Mortality was 63% in 5.0 mg/kg/day of warfarin but only 13% in 2.5 mg/kg/day of warfarin or in 400 mg/kg/day of dabigatran and 0% in 200 mg/kg/day of dabigatran. In spite of increasing hematuria, RBC tubular casts were not seen in mice treated with any anticoagulant. The 5/6 nephrectomy murine model in C57BL/6 mice only partially reproduced ARN in terms of increasing serum creatinine and hematuria, but there were no RBC tubular casts in the remnant kidney.

scholarly journals Thymosin Beta 4 as an Early Biomarker in Sepsis Induced Acute Kidney Injury

2021 ◽  
Author(s):  
Jiahao Zhang ◽  
Minghui Long ◽  
Zhongyi Sun ◽  
Cheng Yang ◽  
Xiaofang Jiang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Laboratory Findings ◽  
Risk Of Death ◽  
Thymosin Beta 4 ◽  
Sepsis Model ◽  
Kaplan Meier ◽  
Increased Risk ◽  
Early Biomarker

Abstract Background: The incidence of sepsis is high among patients in the intensive care units (ICU) and acute kidney injury (AKI) is a common complication of sepsis that contributes to increased mortality. Thymosin beta-4 (Tβ4) is an actin-sequestering protein that can prevent inflammation and fibrosis in several tissues. However, its functions in septic AKI remain unknown.Methods: 98 consecutive hospitalized patients with confirmed sepsis were enrolled. Demographics, comorbidities, laboratory findings, and outcomes were collected and analyzed. Serum Tβ4 levels at ICU admission were measured and analyzed for evaluating the probability of AKI using the logistic regression. In addition, the effects of exogenous Tβ4 on kidney injury was also conducted in mice where a sepsis model was induced by lipopolysaccharide (LPS) intraperitoneal injection. Results: Of the 98 patients with sepsis, 47 (48%) developed AKI. Patients with hypertension, diabetes, higher body mass index (BMI) and Sequential Organ Failure Assessment (SOFA) score were more likely to develop AKI. Among patients with AKI, hemoglobin, and Tβ4 were significantly decreased. Multivariate analysis showed decreased Tβ4, high SOFA, and high BMI to be independent risk factors for AKI in patients with sepsis. The overall mortality rate of the 98 septic patients was 20.4%, and the mortality rate of those with AKI was 29.8%. Kaplan-Meier analysis demonstrated that patients with AKI had a significantly higher risk of death. In particular, increasing AKI severity was associated with an increased risk of death. Furthermore, exogenous Tβ4 could reduce renal apoptosis and attenuated renal dysfunction, as well as reducing systemic inflammatory response through the prevention of the activation of NF-κB pathway in the sepsis model.Conclusions: The combination of Tβ4, SOFA, and BMI could allow for timely detection of septic AKI. Exogenous Tβ4 could prevent kidney injury in sepsis.

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