Early identification of acute kidney injury in the ICU with real-time urine output monitoring: a clinical investigation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dafna Willner ◽  
Aliza Goldman ◽  
Hagar Azran ◽  
Tal Stern ◽  
Dvora Kirshenbom ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Real Time ◽  
Early Identification ◽  
Urine Output ◽  
Electronic Monitoring ◽  
Clinical Investigation ◽  
Medical Center ◽  
Kidney Injury ◽  
Icu Admission ◽  
Output Monitoring

Abstract Background KDIGO (Kidney Disease: Improving Global Outcomes) provides two sets of criteria to identify and classify acute kidney injury (AKI): serum creatinine (SCr) and urine output (UO). Inconsistencies in the application of KDIGO UO criteria, as well as collecting and classifying UO data, have prevented an accurate assessment of the role this easily available biomarker can play in the early identification of AKI. Study goal To assess and compare the performance of the two KDIGO criteria (SCr and UO) for identification of AKI in the intensive care unit (ICU) by comparing the standard SCr criteria to consistent, real-time, consecutive, electronic urine output measurements. Methods Ninety five catheterized patients in the General ICU (GICU) of Hadassah Medical Center, Israel, were connected to the RenalSense™ Clarity RMS™ device to automatically monitor UO electronically (UOelec). UOelec and SCr were recorded for 24–48 h and up to 1 week, respectively, after ICU admission. Results Real-time consecutive UO measurements identified significantly more AKI patients than SCr in the patient population, 57.9% (N = 55) versus 26.4% (N = 25), respectively (P < 0.0001). In 20 patients that had AKI according to both criteria, time to AKI identification was significantly earlier using the UOelec criteria as compared to the SCr criteria (P < 0.0001). Among this population, the median (interquartile range (IQR)) identification time of AKI UOelec was 12.75 (8.75, 26.25) hours from ICU admission versus 39.06 (25.8, 108.64) hours for AKI SCr. Conclusion Application of KDIGO criteria for AKI using continuous electronic monitoring of UO identifies more AKI patients, and identifies them earlier, than using the SCr criteria alone. This can enable the clinician to set protocol goals for earlier intervention for the prevention or treatment of AKI.

scholarly journals Early Identification of Acute Kidney Injury in the Icu With Real-time Urine Output Monitoring: A Clinical Investigation

2021 ◽  
Author(s):  
Dafna Willner ◽  
Aliza Goldman ◽  
Hagar Azran MSc ◽  
Tal Stern ◽  
Dvora Kirshenbom ◽  
...  
Keyword(s):  
Real Time ◽  
Early Identification ◽  
Urine Output ◽  
Electronic Monitoring ◽  
Clinical Investigation ◽  
Medical Center ◽  
Kidney Injury ◽  
Icu Admission ◽  
Standard Scr ◽  
Output Monitoring

Abstract BackgroundThe inconsistencies in classifying AKI according to the KDIGO (Kidney Disease: Improving Global Outcomes) urine output (UO) criteria have prevented an accurate assessment of the role this easily available biomarker can play in the early identification of AKI. Study goal: To assess and compare the performance of the two KDIGO criteria (SCr and UO) for early identification of AKI in the intensive care unit (ICU) by comparing the standard SCr criteria to real-time, consecutive, electronic urine output measurements. Methods95 catheterized patients in the GICU of Hadassah Medical Center, Israel were connected to The RenalSense™ Clarity RMS™ sensor kit to monitor UO electronically (UOelec). UOelec and SCr were recorded between 24-48 hours and up to one week, respectively, after ICU admission. ResultsReal-time consecutive UO measurements identified significantly more AKI patients than SCr in the patient population, 57.9% (N=55) versus 26.4% (N=25), respectively (P<0.0001). In 20 patients that had AKI according to both criteria, time to AKI identification was significantly earlier by the UOelec criteria as compared to the SCr criteria (P<0.0001). Among this population, the median (IQR) identification time of AKI UOelec was 12.75 (8.75, 26.25) hours from ICU admission and 39.06 (25.8, 108.64) hours for AKI SCr. ConclusionApplication of KDIGO criteria for AKI using continuous electronic monitoring of UO identifies more AKI patients, and identifies them earlier, than using the SCr criteria alone. This application can enable the clinician to set protocol goals for earlier intervention of the treatment of AKI.

Continuous Real-Time Urine Output Monitoring for Early Detection of Acute Kidney Injury

2011 ◽  
pp. 194-200 ◽  
Author(s):  
Anthi Panagiotou ◽  
Francesco Garzotto ◽  
Silvia Gramaticopolo ◽  
Pasquale Piccinni ◽  
Chiara Trentin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Early Detection ◽  
Real Time ◽  
Urine Output ◽  
Kidney Injury ◽  
Output Monitoring

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257558
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals Automated versus manual urine output monitoring in the intensive care unit

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joni Minor ◽  
Ali Smith ◽  
Frederic Deutsch ◽  
John A. Kellum
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Urine Output ◽  
Kidney Injury ◽  
University Hospital ◽  
Intensive Care Patients ◽  
The Mean ◽  
Output Monitoring ◽  
Observation Period

AbstractAcute kidney injury (AKI) is defined by changes in serum creatinine and urine output (UO). Significant limitations exist regarding accurate ascertainment of urine output even within the intensive care unit. We sought to evaluate an automated urine output collections system and compare it to nursing measurements. We prospectively collected urine output using an electronic urine monitoring system and compared it to charted hourly UO in 44 patients after cardiac surgery at a single university hospital ICU. We calculated UO and oliguria rates and compared them to data from the sensor and from nursing charting. A total of 187 hourly UO measurements were obtained and on average, UO was reported 47 min late, with a median of 18 min, and a maximum of almost 6 h. Patients had a mean hourly UO of 76.3 ml over the observation period. Compared to manual measurements by study personnel, nurses significantly overestimated hourly UO by 19.9 ml (95% CI: 10.3; 29.5; p =  < 0.001). By contrast, the mean difference between the UO measured with the sensor and by study personnel was 2.29 ml (95% CI: − 6.7; 11.3), p = 0.61. Electronic UO monitoring is significantly more accurate than nurse-performed manual measurements in actual intensive care patients. Furthermore, timely ascertainment of UO is difficult to achieve with manual technique, resulting in important delays in detecting oliguria perhaps leading to missed cases of AKI.

scholarly journals RIFLE serum creatinine and urine output criteria combined is superior to RIFLE serum creatinine criterion alone in predicting Acute Kidney Injury (AKI) in critically ill patients: A prospective observational study

2020 ◽  
Vol 8 (1) ◽  
pp. 17-23
Author(s):  
Amina Sultana ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Uzzwal Kumar Mallick ◽  
Mohammad Asaduzzaman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Urine Output ◽  
Data Entry ◽  
Kidney Injury ◽  
Adult Patients ◽  
Icu Admission

Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality. Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days). Design: Prospective observational cohort study. Duration of the study was one year (01 year), from January 2014 to December 2014 Method: All adult patients admitted into department of critical care medicine, BIRDEM General Hospital, DHAKA who received treatment for 48 hours and fulfilled the inclusion and exclusion criteria was included in the study. Representative serum creatinine value was obtained either from the day of admission in hospital, day of admission into or transfer to ICU or any document within last six months. The lesser of pre-ICU admission serum creatinine (SCr) and ICU admission SCr would serve as baseline renal function. Weight in kilogram, representative serum urea/BUN, co-morbidities and reason for ICU admission were incorporated in it. Patient’s daily data entry of renal replacement therapy, daily creatinine value, urinary output over 6 hours, 12 hours, and 24 hours, episode of anuria over 12 hours, if present were documented. Data collected on renal replacement therapy at the time of discharge, if any and outcome in terms of loss and ESRD status were collected. APACHE II data and SAPS II data were calculated and analyzed. Result: Total 236 adult patients were enrolled in the study to assess their renal function status using RIFLE (Risk, Injury, Failure, Loss, End Stage Renal Disease). Serum creatinine was estimated daily for seven days. Those patients who fulfilled the creatinine criteria for RIFLE were categorized into RIFLE serum creatinine (Scr) group. Those patients who met both the criteria for urine output and serum creatinine according to RIFLE was designated as RIFLE serum creatinine and urine output criteria Combined (Scr+ UO) group. In our study, mean of number of days needed for diagnosis of AKI using RIFLE creatinine (Scr) was 3.25 (±1.24) and using RIFLE combined (Scr+uo) criteria was 2.84(±1.03). Conclusion: The present study concludes that RIFLE serum creatinine criterion (Scr) alone delays the diagnosis of AKI in comparison to RIFLE serum creatinine and urine output criteria combined (Scr+UO). AKI should be graded using both the criteria of RIFLE serum creatinine and urine output criteria combined (Scr+UO). Urine output should not be underestimated in AKI diagnosis in ICU patients. Bangladesh Crit Care J March 2020; 8(1): 17-23

Acute Kidney Injury

2020 ◽  
Keyword(s):  
Acute Kidney Injury ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Serum Creatinine ◽  
Early Identification ◽  
Urine Output ◽  
Congenital Heart ◽  
Kidney Injury ◽  
Key Points

Key Points Awareness and early identification are important. Serum creatinine and urine output are key to assessing acute kidney injury. Congenital heart disease, sepsis, and nephrotoxic medications are major causes.

scholarly journals Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

2020 ◽  
Author(s):  
Ruey-Hsing Chou ◽  
Chuan-Tsai Tsai ◽  
Ya-Wen Lu ◽  
Jiun-Yu Guo ◽  
Chi-Ting Lu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Elevated Serum ◽  
Kidney Injury ◽  
The Body ◽  
Icu Admission ◽  
Increased Risk

Abstract Background: Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically ill patients remains unclear.Methods: From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into three equally sized groups according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, >71 ng/ml). All patients were followed for 90 days or until death.Results: Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels.Conclusion: Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

scholarly journals Association between Hyperglycemia at Hospital Presentation and Hospital Outcomes in COVID-19 Patients with and without Type 2 Diabetes: A Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2199
Author(s):  
Nipith Charoenngam ◽  
Sara M. Alexanian ◽  
Caroline M. Apovian ◽  
Michael F. Holick
Keyword(s):  
Type 2 Diabetes ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Severe Sepsis ◽  
Medical Center ◽  
Demographic Data ◽  
Kidney Injury ◽  
Hospital Outcomes ◽  
Icu Admission

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.

Urine Output during Cardiopulmonary Bypass Predicts Acute Kidney Injury after Coronary Artery Bypass Grafting

2016 ◽  
Vol 19 (6) ◽  
pp. 289 ◽  
Author(s):  
Mehmet Yilmaz ◽  
Rezan Aksoy ◽  
Vildan Kilic Yilmaz ◽  
Canan Balci ◽  
Cagri Duzyol ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Urine Output ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Urinary Output ◽  
Bypass Grafting

Objective: This study evaluated the relationship between the amount of urinary output during cardiopulmonary bypass and acute kidney injury in the postoperative period of coronary artery bypass grafting.Methods: Two hundred patients with normal preoperative serum creatinine levels, operated on with isolated CABG between 2012-2014 were investigated retrospectively. The RIFLE (Risk, injury, failure, loss of function, and end-stage renal disease) risk scores were calculated for each patient in the third postoperative day. Patients were distributed into two groups in relation to the presence of acute kidney injury or not and these two groups were compared.Results: The urinary output (mL/kg/hour) during cardiopulmonary bypass in the acute kidney injury negative group was significantly higher than in the acute kidney injury positive group (P = .022). In case of a urinary output value 3.70 and lower to predict acute kidney injury positivity, sensitivity was detected as 71.43%. Results of the analysis for urinary output predict positivity of acute kidney injury.Conclusion: We suggest that urine output during cardiopulmonary bypass is a significant criteria that could predict acute kidney injury following coronary artery bypass grafting with cardiopulmonary bypass. Attempts to increase the urine output during cardiopulmonary bypass could help to maintain the renal functions during and after surgery.

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