Acute kidney injury subphenotypes based on creatinine trajectory identifies patients at increased risk of death

Relevance. Acute kidney injury (AKI) is one of the leading causes of death worldwide. However, the epidemiology of AKI is not well understood. In Russia, toxic kidney damage plays a significant role in the nosological structure of AKI — 12.2%.Aim of study. To study the features of AKI in patients with acute chemical poisoning.Material and methods. We analyzed 26 case histories of patients with acute chemical poisoning with AKI (according to KDIGO). The comparison group included 25 patients with acute chemical poisoning without AKI. All patients were hospitalized in a toxicological center on the basis of the emergency department of the Ryazan Region State Budgetary Institution “City Clinical Emergency Hospital” (SBI RR “CCH EMC”) in 2016–2018. The analysis of the annual reports of the chief toxicologist of the Ministry of Health of the Ryazan Region for 2016–2018 was carried out. Data processing was performed using Microsoft Office Excel 2013 and on the website medstatistic.ru (Pearson’s chi-square test and Fisher’s exact test).Results. In most patients AKI developed during poisoning with cauterizing action substances - 38.4% (23% - vinegar essence, 15.4% - unidentified cauterizing action substance). The poisoning with alcohol substitutes (12%) took the 2nd place, with narcotic substances (8%) – the 3 rd place. Also, isolated cases of AKI (4% each) were reported in case of poisoning with pregabalin, tramadol, ketorol and ethanol. Poisoning with an unknown toxicant was noted in 29.6% of cases. Most patients (69.2%.) had stage 3 AKI. The second stage was registered in 7.7% of patients, the first — in 23.1%. Proteinuria was detected in all patients who underwent common urine test (CUT). Infusion therapy using crystalloids was performed in 100% of cases.Conclusion. Acute renal injury most often develops in acute poisoning with cauterizing poisons. The development of acute kidney injury in acute chemical poisoning leads to an increased risk of death. Acute kidney injury is the second most common immediate cause of death in acute chemical poisoning. Infusion therapy is an integral part of the management of toxicological patients with acute kidney injury.

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Association of Proteinuria and Hematuria with Acute Kidney Injury and Mortality in Hospitalized Patients with COVID-19

Kidney & Blood Pressure Research ◽

10.1159/000511946 ◽

2020 ◽

Vol 45 (6) ◽

pp. 1018-1032

Author(s):

Imran Chaudhri ◽

Richard Moffitt ◽

Erin Taub ◽

Raji R. Annadi ◽

Minh Hoai ◽

...

Keyword(s):

Acute Kidney Injury ◽

Invasive Mechanical Ventilation ◽

Multivariable Analysis ◽

Kidney Injury ◽

Hospitalized Patients ◽

Hospital Death ◽

Study Cohort ◽

Icu Admission ◽

Risk Of Death ◽

Increased Risk

Introduction: Acute kidney injury (AKI) is strongly associated with poor outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19), but data on the association of proteinuria and hematuria are limited to non-US populations. In addition, admission and in-hospital measures for kidney abnormalities have not been studied separately. Methods: This retrospective cohort study aimed to analyze these associations in 321 patients sequentially admitted between March 7, 2020 and April 1, 2020 at Stony Brook University Medical Center, New York. We investigated the association of proteinuria, hematuria, and AKI with outcomes of inflammation, intensive care unit (ICU) admission, invasive mechanical ventilation (IMV), and in-hospital death. We used ANOVA, t test, χ2 test, and Fisher’s exact test for bivariate analyses and logistic regression for multivariable analysis. Results: Three hundred patients met the inclusion criteria for the study cohort. Multivariable analysis demonstrated that admission proteinuria was significantly associated with risk of in-hospital AKI (OR 4.71, 95% CI 1.28–17.38), while admission hematuria was associated with ICU admission (OR 4.56, 95% CI 1.12–18.64), IMV (OR 8.79, 95% CI 2.08–37.00), and death (OR 18.03, 95% CI 2.84–114.57). During hospitalization, de novo proteinuria was significantly associated with increased risk of death (OR 8.94, 95% CI 1.19–114.4, p = 0.04). In-hospital AKI increased (OR 27.14, 95% CI 4.44–240.17) while recovery from in-hospital AKI decreased the risk of death (OR 0.001, 95% CI 0.001–0.06). Conclusion: Proteinuria and hematuria both at the time of admission and during hospitalization are associated with adverse clinical outcomes in hospitalized patients with COVID-19.

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Increased risk of death and de novo chronic kidney disease following reversible acute kidney injury

Kidney International ◽

10.1038/ki.2011.405 ◽

2012 ◽

Vol 81 (5) ◽

pp. 477-485 ◽

Cited By ~ 298

Author(s):

Ion D. Bucaloiu ◽

H Lester Kirchner ◽

Evan R. Norfolk ◽

James E. Hartle ◽

Robert M. Perkins

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

De Novo ◽

Kidney Injury ◽

Risk Of Death ◽

Increased Risk

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

BioMed Research International ◽

10.1155/2016/6805169 ◽

2016 ◽

Vol 2016 ◽

pp. 1-7 ◽

Cited By ~ 6

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.

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Does Erythrocyte Blood Transfusion Prevent Acute Kidney Injury?

Anesthesiology ◽

10.1097/aln.0b013e181f70f56 ◽

2010 ◽

Vol 113 (5) ◽

pp. 1126-1133 ◽

Cited By ~ 8

Author(s):

Milo Engoren

Keyword(s):

Acute Kidney Injury ◽

Acute Lung Injury ◽

Lung Injury ◽

Fluid Management ◽

Kidney Injury ◽

Adverse Outcomes ◽

Data Sets ◽

Erythrocyte Transfusion ◽

Risk Of Death ◽

Increased Risk

Background Acute kidney injury is a common occurrence in intensive care unit patients with a reported incidence of 11-67% and is associated with an increased risk of death. In other patient populations, erythrocyte transfusion has been associated with increased risk of adverse outcomes including sepsis, multisystem organ dysfunction, and death. The purpose of this study was to determine the effect of erythrocyte transfusion on the development of acute kidney injury. Methods This was a retrospective analysis of prospectively collected data that used propensity matched transfused and nontransfused patients. Propensity matching was done using semiparsimonious logistic regression. McNemar test for nonindependent data sets was used to compare groups. Results Four hundred two patients from a trial on fluid management in patients with acute lung injury were matched. 38% of transfused patients had a rise in creatinine the day after transfusion compared with 33% of their nontransfused matches (P = 0.315). By day 7, creatinine had increased in 51% of transfused patients compared with 52% in nontransfused patients (P = 0.832). The incidences of renal risk, injury, and failure were 39 (19%), 27 (13%), and 11 (5%) in the transfused group and 38 (19%), 24 (12%), and 11 (5%) in the nontransfused group, P = 1.00, 0.785, and 1.00, respectively. Conclusions Transfusion of erythrocytes to patients with acute lung injury had no effect on the development of acute kidney injury.

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The Role and Mechanism of Histone Deacetylases in Acute Kidney Injury

Frontiers in Pharmacology ◽

10.3389/fphar.2021.695237 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xun Zhou ◽

Hui Chen ◽

Yingfeng Shi ◽

Xiaoyan Ma ◽

Shougang Zhuang ◽

...

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Cell Survival ◽

Histone Deacetylases ◽

Kidney Injury ◽

Atp Production ◽

Risk Of Death ◽

Pathophysiological Process ◽

Increased Risk ◽

Epigenetic Regulations

Acute kidney injury (AKI) is a common clinical complication with an incidence of up to 8–18% in hospitalized patients. AKI is also a complication of COVID-19 patients and is associated with an increased risk of death. In recent years, numerous studies have suggested that epigenetic regulation is critically involved in the pathophysiological process and prognosis of AKI. Histone acetylation, one of the epigenetic regulations, is negatively regulated by histone deacetylases (HDACs). Increasing evidence indicates that HDACs play an important role in the pathophysiological development of AKI by regulation of apoptosis, inflammation, oxidative stress, fibrosis, cell survival, autophagy, ATP production, and mitochondrial biogenesis (MB). In this review, we summarize and discuss the role and mechanism of HDACs in the pathogenesis of AKI.

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Survival and Predictors of Mortality in Acute Kidney Injury Patients Treated with Sustained Low Efficiency Dialysis

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.20208 ◽

2020 ◽

Vol 49 (5) ◽

pp. 306-311

Author(s):

Attaphong Phongphitakchai ◽

Ussanee Boonsrirat

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Serum Levels ◽

Tertiary Hospital ◽

Bleeding Complications ◽

Intradialytic Hypotension ◽

Risk Of Death ◽

Increased Risk ◽

Predictive Outcome ◽

Low Efficiency

Introduction: Sustained low efficiency dialysis (SLED) is an increasingly common treatment option for acute kidney injury (AKI) patients, but there are few studies examining the survival and predictive outcome of this therapy. The study aims to evaluate survival, pre-SLED predictors and complications associated with SLED. Materials and Methods: This was a retrospective cohort study of 91 patients with AKI treated with SLED in a tertiary hospital from January 2014 to August 2018. The primary outcomes were in-hospital and 30-day mortality. The secondary outcomes were the clinical and laboratory pre-SLED characteristics that were associated with survival and complication of SLED. Results: Median survival of AKI patients treated with SLED was 17 days and the 30-day mortality rate was 58%. Pre-SLED serum levels of creatinine (adjusted HR 0.82, 95% CI 0.71x0.94), albumin (adjusted HR 0.57, 95% CI 0.4–0.81), potassium (adjusted HR 1.38, 95% CI 1.1–1.73) and number of SLED (adjusted HR 0.95, 95% CI 0.91-1) served as predictors of survival. Arrhythmia was found 3.3% and intradialytic hypotension in 13.2% of patients. No patient had bleeding complications. Conclusions: Our study found similar in-hospital and 30-day mortality for AKI patients treated with SLED. High pre-SLED levels of serum albumin, creatinine and number of SLED were significantly associated with reduced risk of death and high pre-SLED serum potassium was associated with increased risk of death. These results indicate that SLED is safe treatment, with few haemorrhage and haemodynamic complications. Key words: Acute kidney injury, Predictors, Sustained low efficiency dialysis, Survival

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Acute kidney injury and adverse outcomes of critical illness: correlation or causation?

Clinical Kidney Journal ◽

10.1093/ckj/sfz158 ◽

2019 ◽

Vol 13 (2) ◽

pp. 133-141

Author(s):

Benedict J Girling ◽

Samuel W Channon ◽

Ryan W Haines ◽

John R Prowle

Keyword(s):

Acute Kidney Injury ◽

Critical Illness ◽

Kidney Injury ◽

Adverse Outcomes ◽

Short Term ◽

Term Survival ◽

Risk Of Death ◽

Increased Risk ◽

Short Term Mortality ◽

The Relationship

Abstract Critically ill patients who develop acute kidney injury (AKI) are more than twice as likely to die in hospital. However, it is not clear to what extent AKI is the cause of excess mortality, or merely a correlate of illness severity. The Bradford Hill criteria for causality (plausibility, temporality, magnitude, specificity, analogy, experiment & coherence, biological gradient and consistency) were applied to assess the extent to which AKI may be causative in adverse short-term outcomes of critical illness. Plausible mechanisms exist to explain increased risk of death after AKI, both from direct pathophysiological effects of renal dysfunction and mechanisms of organ cross-talk in multiple-organ failure. The temporal relationship between increased mortality following AKI is consistent with its pathophysiology. AKI is associated with substantially increased mortality, an association that persists after accounting for known confounders. A biological gradient exists between increasing severity of AKI and increasing short-term mortality. This graded association shares similar features to the increased mortality observed in ARDS; an analogous condition with a multifactorial aetiology. Evidence for the outcomes of AKI from retrospective cohort studies and experimental animal models is coherent however both of these forms of evidence have intrinsic biases and shortcomings. The relationship between AKI and risk of death is maintained across a range of patient ages, comorbidities and underlying diagnoses. In conclusion many features of the relationship between AKI and short-term mortality suggest causality. Prevention and mitigation of AKI and its complications are valid targets for studies seeking to improve short-term survival in critical care.

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