scholarly journals The incidence, mortality and renal outcomes of acute kidney injury in patients with suspected infection at the emergency department

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260942
Author(s):  
Meriem Khairoun ◽  
Jan Willem Uffen ◽  
Gurbey Ocak ◽  
Romy Koopsen ◽  
Saskia Haitjema ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Cox Regression ◽  
Kidney Injury ◽  
Major Health Problem ◽  
Renal Function Decline ◽  
Suspected Infection ◽  
Renal Outcomes ◽  
One Year

Background Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. Studies on clinical outcomes and mortality of AKI in the emergency department are scarce. The aim of this study is to assess incidence, mortality and renal outcomes after AKI in patients with suspected infection at the emergency department. Methods We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which included consecutive patients that presented to the emergency department of the internal medicine with suspected infection. Hazard ratios (HR) were assessed using Cox regression to investigate the association between AKI, 30-days mortality and renal function decline up to 1 year after AKI. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort, we included 1716 patients who fulfilled the inclusion criteria. Of these patients, 10.8% had an AKI episode. Mortality was 12.4% for the AKI group and 4.2% for the non-AKI patients. The adjusted HR for all-cause mortality at 30-days in AKI patients was 2.8 (95% CI 1.7–4.8). Moreover, the cumulative incidence of renal function decline was 69.8% for AKI patients and 39.3% for non-AKI patients. Patients with an episode of AKI had higher risk of developing renal function decline (adjusted HR 3.3, 95% CI 2.4–4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with 30-days mortality and renal function decline one year after AKI.

MO356THE INCIDENCE, MORTALITY AND RENAL OUTCOMES OF ACUTE KIDNEY INJURY IN PATIENTS WITH SUSPECTED INFECTION AT THE EMERGENCY DEPARTMENT

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Meriem Khairoun ◽  
Jan Willem Uffen ◽  
Gurbey Ocak ◽  
Romy Koopsen ◽  
Saskia Haitjema ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Emergency Department Visit ◽  
Kidney Injury ◽  
Renal Function Decline ◽  
Suspected Infection ◽  
Renal Outcomes ◽  
All Cause Mortality ◽  
One Year

Abstract Background and Aims Acute kidney injury (AKI) is a major health problem associated with considerable mortality and morbidity. The epidemiology of AKI in hospitalized and critically ill patients at the Intensive Care Unit with severe infection and sepsis has been well described, however data on mortality and clinical outcomes of AKI at the emergency department in patients with suspected infection are scarce. In this study, we investigated the incidence, mortality and renal outcomes after AKI up to one year after initial AKI-episode patients with suspected infection at the emergency department. Method We used data from the SPACE-cohort (SePsis in the ACutely ill patients in the Emergency department), which consisted of all consecutive patients that presented to the emergency department of the internal medicine with suspected infection in the period between 2016 and 2018 at the University Medical Center Utrecht. Clinical and laboratory data were prospectively collected of all patients. AKI was defined according to the Kidney Disease: Improving Global Outcomes criteria. Outcomes were 1-year all-cause mortality and renal function. Hazards ratios were assessed using Cox regression to investigate the association between AKI, 1-year mortality and renal function decline after AKI. HRs were adjusted for potential confounders including age, gender, Charlson Comorbidity Index, immune status, smoking status, medication use (diuretics, proton-pump inhibitors, non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin converting enzyme inhibitors (ACEi)), disease severity, diagnosis in the emergency department. Decline of renal function after AKI episode at emergency department visit was defined as Serum Creatinine (SCr) level ≥30% above baseline. Survival in patients with and without AKI was assessed using Kaplan-Meier analyses. Results Of the 3105 patients in the SPACE-cohort with suspected infection, we included 1716, who fulfilled the inclusion criteria and had a baseline SCr measurement. Patients without SCr at baseline (401 patients), at emergence department visit (113 patients), during follow-up (33 patients), on renal replacement therapy (66 patients) or had a repeated emergency department visit (776 patients) were excluded. Of the 1716 patients presenting with suspected infection patients (median age 62y, 52.9% male), 185 patients (10.8%) had an AKI episode. Mortality was 23.8% for the AKI group and 20.4% for the non-AKI group. The adjusted HR for all-cause mortality at 1-year after presentation at the emergency department in AKI patients was 2.1 (95% CI 1.5 – 3.1). Moreover, the cumulative incidence of renal function decline was 69.8% for patients with AKI and 39.3% for patients without AKI. Patients with an episode of AKI had higher risks of developing renal function decline (adjusted HR 3.3, 95% CI 2.4-4.5) at one year after initial AKI-episode at the emergency department. Conclusion Acute kidney injury is common in patients with suspected infection in the emergency department and is significantly associated with mortality and renal function decline one year after AKI.

scholarly journals Comparison of the Effects of Denosumab and Alendronate on Cardiovascular and Renal Outcomes in Osteoporotic Patients

2019 ◽  
Vol 8 (7) ◽  
pp. 932 ◽  
Author(s):  
Tsuen-Wei Hsu ◽  
Chien-Ning Hsu ◽  
Shih-Wei Wang ◽  
Chiang-Chi Huang ◽  
Lung-Chih Li
Keyword(s):  
Renal Function ◽  
Kidney Injury ◽  
Protective Effects ◽  
Medical Organization ◽  
Renal Function Decline ◽  
Renal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
Myocardial Infraction ◽  
Cox Proportional Hazard Regression

A correlation between impaired bone metabolism, chronic kidney disease, and cardiovascular diseases (CVD) has been suggested. This study aimed to compare the effects of denosumab and alendronate, two anti-resorptive agents, on cardiovascular and renal outcomes in osteoporotic patients. Propensity score-matched cohort study comparing denosumab to alendronate users between January 2005 and December 2017 was conducted from a large medical organization in Taiwan. Risks of CVD development and renal function decline were estimated using Cox proportional hazard regression. A total 2523 patients were recruited in each group. No significant difference in cardiovascular events was found between the two groups over a 5-year study period. Stratified analysis results showed that denosumab was likely to exert protective effects against composite CVD in patients with medication possession rate ≥60% (adjusted hazard ratio (AHR), 0.74; p = 0.0493) and myocardial infraction (AHR, 0.42; p = 0.0415). Denosumab was associated with increased risk of renal function decline in male patients (AHR, 1.78; p = 0.0132), patients with renal insufficiency (AHR, 1.5; p = 0.0132), and patients with acute kidney injury during the study period (AHR, 1.53; p = 0.0154). Conclusively, denosumab may exert cardiovascular benefits in patients with good adherence but may have renal disadvantages in certain conditions and thus must be used with caution.

scholarly journals Acute kidney injury strongly influences renal function after radical nephroureterectomy for upper tract urothelial carcinoma: A single-centre experience

2021 ◽  
Vol 93 (1) ◽  
pp. 9-14
Author(s):  
Alessandro Tafuri ◽  
Katia Odorizzi ◽  
Giacomo Di Filippo ◽  
Clara Cerrato ◽  
Giulia Fassio ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Serum Creatinine ◽  
Urothelial Carcinoma ◽  
Clinical Evaluation ◽  
Kidney Injury ◽  
Radical Nephroureterectomy ◽  
Clinical Factors ◽  
Renal Function Decline

Objective: The aim of our study was to investigate frequency and predictors both of postoperative acute kidney injury (AKI) and renal function decline in a population of consecutive upper tract urothelial carcinoma (UTUC) patients who underwent radical nephroureterectomy (RNU). Materials and methods: Between October 2014 and February 2020, 93 patients underwent RNU at our Institution. After considered exclusion criteria, 89 patients were selected. Perioperative clinical factors were retrospectively collected. Estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKDEPI) equation. We defined AKI as an increase in serum creatinine by ≥ 0.3 mg/dl or a 1.5-1.9-fold increase in serum creatinine from baseline to I post-operative day (POD). A significant renal function reduction was defined as an eGFR reduction of 40% from baseline at discharge and at last clinical evaluation. Frequency of AKI and eGFR decline was investigated. Association between perioperative clinical factors and AKI and eGFR reduction at discharged and last follow-up was studied using univariate and multivariate models. Results: AKI was detected at I POD in 45 patients. On multivariate analysis, pre-operative eGFR was an independent predictor of AKI (OR 1.03; p = 0.042). Further, AKI was found to be a significant predictor of eGFR reduction ≥ 40% at discharge at univariate analysis (OR 19.42; p = 0.005) and at multivariate analysis (OR 12.49; p = 0.02). In a multivariate logistic regression model post-operative AKI (OR 5.18; p = 0.033), lack of ipsilateral preoperative hydronephrosis (OR 0.17; p = 0.016), preoperative eGFR (OR 1.04; p = 0.047) and antiplatelet therapy (OR 5.14; p = 0.018) were found to be independent predictors of an eGFR reduction higher than 40% at last clinical evaluation made at a median of 15 (IQR 5-30) months. Conclusions: In our cohort, AKI was present in almost 50% of patients after RNU and it was a strong predictor of renal function decline after RNU.

scholarly journals Acute kidney disease and long-term outcomes in critically ill acute kidney injury patients with sepsis: a cohort analysis

2020 ◽  
Author(s):  
Joana Gameiro ◽  
Carolina Carreiro ◽  
José Agapito Fonseca ◽  
Marta Pereira ◽  
Sofia Jorge ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Disease ◽  
Hospital Discharge ◽  
Kidney Injury ◽  
Renal Outcomes ◽  
Acute Kidney Disease ◽  
Long Term Mortality

Abstract Background Acute kidney injury (AKI) is frequent during hospitalization and may contribute to adverse short- and long-term consequences. Acute kidney disease (AKD) reflects the continuing pathological processes and adverse events developing after AKI. We aimed to evaluate the association of AKD, long-term adverse renal function and mortality in a cohort of patients with sepsis. Methods We performed a retrospective analysis of adult patients with septic AKI admitted to the Division of Intensive Medicine of the Centro Hospitalar Lisboa Norte (Lisbon, Portugal) between January 2008 and December 2014. Patients were categorized according to the development of AKI using the Kidney Disease: Improving Global Outcomes (KDIGO) classification. AKI was defined as an increase in absolute serum creatinine (SCr) ≥0.3 mg/dL or by a percentage increase in SCr ≥50% and/or by a decrease in urine output to <0.5 mL/kg/h for >6 h. AKD was defined as presenting at least KDIGO Stage 1 criteria for >7 days after an AKI initiating event. Adverse renal outcomes (need for long-term dialysis and/or a 25% decrease in estimated glomerular filtration rate after hospital discharge) and mortality after discharge were evaluated. Results From 256 selected patients with septic AKI, 53.9% developed AKD. The 30-day mortality rate was 24.5% (n = 55). The mean long-term follow-up was 45.9 ± 43.3 months. The majority of patients experience an adverse renal outcome [n = 158 (61.7%)] and 44.1% (n = 113) of patients died during follow-up. Adverse renal outcomes, 30-day mortality and long-term mortality after hospital discharge were more frequent among AKD patients [77.5 versus 43.2% (P < 0.001), 34.1 versus 6.8% (P < 0.001) and 64.8 versus 49.1% (P = 0.025), respectively]. The 5-year cumulative probability of survival was 23.2% for AKD patients, while it was 47.5% for patients with no AKD (log-rank test, P < 0.0001). In multivariate analysis, AKD was independently associated with adverse renal outcomes {adjusted hazard ratio [HR] 2.87 [95% confidence interval (CI) 2.0–4.1]; P < 0.001} and long-term mortality [adjusted HR 1.51 (95% CI 1.0–2.2); P = 0.040]. Conclusions AKD after septic AKI was independently associated with the risk of long-term need for dialysis and/or renal function decline and with the risk of death after hospital discharge.

scholarly journals O63: POST-OPERATIVE ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING MAJOR GASTROINTESTINAL SURGERY— AN OBSERVATIONAL COHORT STUDY AND EXTERNAL VALIDATION OF A PROGNOSTIC MODEL

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Cox Regression ◽  
Gastrointestinal Surgery ◽  
Kidney Injury ◽  
One Year ◽  
Postoperative Aki

Abstract Introduction Acute kidney injury (AKI) is well-recognised as a significant cause of morbidity and mortality. Due to limited evidence on the longer-term implications, this study aimed to explore the association of postoperative AKI one-year survival and renal function in patients undergoing major gastrointestinal and liver surgery. Method Patients undergoing major gastrointestinal surgery in the prospective Outcomes of Kidney Injury after Surgery (OAKS) study across UK and Ireland were followed up at one-year postoperatively. The primary outcome was survival at 1-year and secondary outcomes included the composite “Major Adverse Kidney Events” outcome at day 365 (MAKE-365), with respective multivariable Cox-regression and logistic regression analysis performed. Result Of 62.2% of OAKS patients (n=3,575/5,745) with 1-year follow-up, there were no significant differences compared to those without follow-up. Among the follow-up cohort, 8.0% (n=269) patients died. On univariate analysis, patients experiencing 7-day postoperative AKI had a significantly higher hazard of death between 30 to 365 days postoperatively (HR: 2.10, 95% CI: 1.50-2.94, p<0.001) compared to patients who did not. This persisted on multivariable Cox-regression (HR: 1.67, 95% CI: 1.17-2.40, p=0.005). Furthermore, 9.1% (n=305) patients met the MAKE-365 endpoint. Multilevel logistic regression analysis demonstrated that the MAKE-365 endpoint was independently associated with both stage 1 (OR: 1.78, 95% CI: 1.22-2.61, p=0.003) and stage 2-3 7-day postoperative AKI (OR: 6.13, 95% CI: 3.97-9.45, p<0.001). Conclusion Post-operative AKI is associated with significantly higher rate of 1-year mortality and MAKE-365 endpoints. Improved monitoring of these patients may be warranted to identify and facilitate potential avenues for intervention Take-home message Post-operative AKI is associated with significantly higher rate of 1-year mortality. Hence, early detection and improved monitoring of patients with AKI with improve long-term outcomes of these patients.

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