Renal replacement therapy is independently associated with a lower risk of death in patients with severe acute kidney injury treated with targeted temperature management after out-of-hospital cardiac arrest

Background: Development of acute kidney injury (AKI) after out-of-hospital cardiac arrest (OHCA) is associated with mortality and poor neurological outcome. However, the effect of recovery from AKI after OHCA is uncertain. This study investigates whether recovery from AKI was associated with the rate of survival and neurological outcome at 30 days after OHCA. Methods: This is a prospective multicentre observational cohort study of adult OHCA patients treated with targeted temperature management (TTM) across five hospitals in South Korea between February 2019 and July 2020. AKI was diagnosed using the Kidney Disease: Improving Global Outcomes criteria. The primary outcome was the rate of survival at 30 days, and the secondary outcome was the rate of survival with a favourable neurological outcome at 30 days, defined by a score of 3 or less on the modified Rankin scale. Results: Among the 2,018 patients with OHCA, 79 were treated with TTM. After excluding two patients with incomplete data on outcomes, 77 were analysed. AKI developed in 43 (56%) patients. Among them, 22 (51%) recovered from AKI. Although the rate of survival at 30 days for the recovery group was superior to the non-recovery group (82% vs. 24%, P < 0.001), the rate of survival with a favourable neurological outcome at 30 days for the recovery group was not different than that for the non-recovery group (32% vs. 10%, P = 0.132). Recovery from AKI was an independent predictor of survival at 30 days after OHCA in the multivariate analysis (adjusted odds ratio, 22.737; 95% confidence interval, 3.814-135.533; P = 0.001); however, it was not associated with a favourable neurological outcome at 30 days after OHCA in the multivariate analysis. Conclusion: Recovery from AKI was an independent predictor of survival at 30 days only after OHCA who were treated by TTM.

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Albumin Levels Predict Mortality In Sepsis Patients With Acute Kidney Injury Undergoing Continuous Renal Replacement Therapy: A Secondary Analysis Based On A Retrospective Cohort Study

10.21203/rs.3.rs-504330/v1 ◽

2021 ◽

Author(s):

Song Sheng ◽

Ye Huang

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Continuous Renal Replacement Therapy ◽

Replacement Therapy ◽

Proportional Hazards ◽

Secondary Analysis ◽

Kidney Injury ◽

Cox Proportional Hazards ◽

Negatively Associated ◽

Risk Of Death

Abstract Background Albumin (ALB) levels are negatively associated with mortality in patients with sepsis. However, among sepsis patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), there has been no similar study on the correlation between ALB levels and mortality alone. This study tested the hypothesis that ALB levels are negatively associated with mortality among such patients. Methods We conducted a secondary analysis of 794 patients with sepsis who were diagnosed with AKI and underwent CRRT in South Korea. For the Kaplan–Meier survival analysis, Cox proportional hazards models were used to study the hypotheses, with adjustments for the pertinent covariables. Results The ALB level was an independent prognostic factor for death at 28 and 90 days after CRRT initiation (HR=0.75, 95% CI: 0.62–0.90, P=0.0024 for death at 28 days and HR=0.73, 95% CI: 0.63–0.86, P<0.0001 for death at 90 days). A nonlinear association was not identified between ALB levels and the endpoints. Subgroup analyses and tests for interactions indicated that patients with low HCO3 levels (<22 mmol/L) had a higher rate of death at 28 days (P for interaction=0.0235), and there was a significantly increased mortality at 90 days among patients with high CRP levels (P for interaction=0.0195). Conclusion A 1 g/dL increase in ALB levels was independently associated with a 25% and 27% decrease in the risk of death at 28 and 90 days, respectively. It is feasible to predict mortality using ALB levels in sepsis patients with AKI undergoing CRRT.

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The influence of prolonged temperature management on acute kidney injury after out-of-hospital cardiac arrest: A post hoc analysis of the TTH48 trial

Resuscitation ◽

10.1016/j.resuscitation.2020.01.039 ◽

2020 ◽

Vol 151 ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Kristian Strand ◽

Eldar Søreide ◽

Hans Kirkegaard ◽

Fabio Silvio Taccone ◽

Anders Morten Grejs ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Arrest ◽

Kidney Injury ◽

Temperature Management ◽

Post Hoc Analysis ◽

Post Hoc ◽

Hospital Cardiac Arrest

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Long-term outcomes following vehicle trauma related acute kidney injury requiring renal replacement therapy: a nationwide population study

Scientific Reports ◽

10.1038/s41598-020-77556-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Chieh-Kai Chan ◽

Chun-Yi Chi ◽

Tai-Shuan Lai ◽

Tao-Min Huang ◽

Nai-Kuan Chou ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury ◽

Research Database ◽

Long Term Outcomes ◽

Term Survival ◽

Risk Of Death ◽

Long Term Mortality

AbstractAcute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of vehicle-traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients who were suffered from vehicle accidents developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of ESKD, 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. 546 vehicle-traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0–64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, vehicle-traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5–34) days vs. 6 (3–11) days; p < 0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Vehicle-traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.473; 95% CI, 0.392–0.571; p < 0.001), but similar rates of ESKD (HR, 1.166; 95% CI, 0.829–1.638; p = 0.377) and short-term risk of death (HR, 1.134; 95% CI, 0.894–1.438; p = 0.301) as non-traumatic AKI-RRT patients. In competing risk models that focused on ESKD, vehicle-traumatic AKI-RRT patients were associated with lower ESKD rates (HR, 0.552; 95% CI, 0.325–0.937; p = 0.028) than non-traumatic AKI-RRT patients. Despite severe injuries, vehicle-traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after vehicle-traumatic AKI-RRT.

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Renal replacement therapy for acute kidney injury in intensive care

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.8.c124 ◽

2019 ◽

Vol 80 (8) ◽

pp. C124-C128

Author(s):

Thomas W Davies ◽

Marlies Ostermann ◽

Edward Gilbert-Kawai

Keyword(s):

Acute Kidney Injury ◽

Intensive Care ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Care Management ◽

Kidney Injury ◽

Common Occurrence ◽

Intensive Care Management ◽

Risk Of Death ◽

Basic Understanding

Acute kidney injury is a common occurrence on the intensive care unit and is associated with incremental risk of death and chronic kidney disease. Renal replacement therapy has become an essential tool in the intensive care management of patients with severe acute kidney injury and its use is rising. A basic understanding of renal replacement therapy is essential for all doctors treating acutely unwell patients. This article provides a brief overview of the principles and important considerations for the provision of renal replacement therapy for critically ill patients with acute kidney injury.

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P6383Cardiac output during targeted temperature management and renal function after out-of-hospital cardiac arrest

European Heart Journal ◽

10.1093/eurheartj/ehz746.0979 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Grand ◽

C Hassager ◽

J Bro-Jeppesen ◽

M Wanscher ◽

J Kjaergaard

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Acute Kidney Injury ◽

Cardiac Index ◽

Renal Injury ◽

Kidney Injury ◽

Targeted Temperature Management ◽

Temperature Management ◽

Research Fund ◽

Hospital Cardiac Arrest

Abstract Background After resuscitation from out-of-hospital cardiac arrest (OHCA), renal injury and hemodynamic instability are common. Low blood pressure during targeted temperature management (TTM) is associated with acute renal injury (AKI). The aim of this study is to test the hypothesis, that low cardiac output during TTM is associated with acute kidney injury after OHCA. Methods Single-center substudy of 171 patients included in the prospective, randomized TTM-trial. Hemodynamic evaluation was performed with serial measurements by pulmonary artery catheter. Mean arterial pressure ≥65 mmHg and central venous pressure of 10 to 15 mmHg were hemodynamic treatment goals. Acute kidney injury (AKI) was the primary endpoint and was defined according to the KDIGO-criteria. Differences between groups were tested by repeated measurements mixed models. Measurements and main results Of 152 patients with available hemodynamic data, 49 (32%) had AKI and 21 (14%) had AKI with need for renal replacement therapy (RRT) in the first three days. At admission, cardiac index was higher in the AKI-group (mean (confidence interval): 2.6 (2.2–3.0) L/min/m2 versus 2.2 (2.0–2.3) L/min/m2, p=0.003). During 24 hours of targeted temperature management, patients with AKI had increased heart rate (11 beats/min, pgroup<0.0001) and increased lactate (1 mmol/L, pgroup<0.0001) compared to patients without AKI. However, there was no overall difference in cardiac index (pgroup = 0.25) (Figure). In multivariate models, adjusting for potential confounders including targeted temperature, mean arterial pressure (odds ratio: 0.69 (0.50–0.96) per 5 mmHg increase, p=0.03), heart rate (1.04 (1.01–1.08) per beat/min increase, p=0.01) and lactate (1.59 (1.14–2.2) per mmol/L increase, p=0.006) were independently associated with AKI, but cardiac index remained unrelated with AKI. Figure 1 Conclusions Blood pressure, heart rate and lactate, but not cardiac output, during 24 hours of targeted temperature management were associated with renal injury in comatose OHCA-patients. Acknowledgement/Funding The research fund Gangstedfonden and the Research fund of Rigshospitalet has supported this study with unrestricted salary in Dr. Grand's PhD project.

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Abstract 216: Renal Failure After Cardiac Arrest and the role of Targeted Temperature Management

Circulation ◽

10.1161/circ.138.suppl_2.216 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Abhishek Bhardwaj ◽

Steve Balian ◽

David G Buckler ◽

Benjamin S Abella

Keyword(s):

Cardiac Arrest ◽

Kidney Disease ◽

Kidney Injury ◽

Targeted Temperature Management ◽

Temperature Management ◽

Common Complication ◽

Baseline Serum ◽

Incidence Of Ckd ◽

Hospital Cardiac Arrest

Introduction: While Acute Kidney Injury (AKI) is a common complication of cardiac arrest (CA), the incidence of AKI and Chronic Kidney Disease (CKD) following resuscitation are not well studied. Further, the association of Targeted Temperature Management (TTM) with AKI and CKD incidence has not been extensively studied. Aim: We compared the incidence of post-arrest AKI and CKD among patients who received TTM and those who did not receive TTM. Methods: In this retrospective cohort study, we studied adult patients following resuscitation from out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA). Serum creatinine (Cr) data for post-arrest patients were extracted from the electronic medical record. Baseline serum Cr was defined as the most recent pre-arrest Cr value or the lowest Cr value within 6 hrs of arrest. Using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, AKI was defined as an increase in Cr by > 0.3 mg/dL within 48 hrs or an increase in serum Cr by 1.5x the baseline value within a one-week period. CKD was defined as a GFR of < 60 mL/min per 1.73 m 2 3 months post-arrest. Results: From 1/2005 to 12/2017, 1099 patients had serial post-arrest creatinine values available. Median age at arrest was 63 (IQR 25), 58% were male, survival to discharge was 20%, with a 17 % favorable CPC score of 1 or 2. Of these, 240 patients had documented TTM status (89 received TTM and 151 did not). Of the patients who received TTM, 31% developed AKI compared to 40 % who did not receive TTM (P=NS). The incidence of CKD was 56% in the TTM group and 45% in the non-TTM group. McNemar’s test for CKD at baseline and at 3 months post-arrest showed a significant increase in the incidence of CKD post arrest (45% vs. 49%, p = 0.031). Conclusions: Post cardiac arrest, AKI and CKD are common complications. The use of TTM was not associated with the incidence of AKI or CKD. Further research is needed to study factors that affect AKI and CKD in CA.

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