scholarly journals Circulating Proenkephalin, Acute Kidney Injury, and Its Improvement in Patients with Severe Sepsis or Shock

2018 ◽  
Vol 64 (9) ◽  
pp. 1361-1369 ◽  
Author(s):  
Pietro Caironi ◽  
Roberto Latini ◽  
Joachim Struck ◽  
Oliver Hartmann ◽  
Andreas Bergmann ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Kidney Injury ◽  
Baseline Serum

Abstract BACKGROUND Acute kidney injury (AKI) occurs in many critically ill patients and is associated with high mortality. We examined whether proenkephalin could predict incident AKI and its improvement in septic patients. METHODS Plasma proenkephalin A 119–159 (penKid) was assayed in 956 patients with sepsis or septic shock enrolled in the multicenter Albumin Italian Outcome Sepsis (ALBIOS) trial to test its association with incident AKI, improvement of renal function, need for renal replacement therapy (RRT), and mortality. RESULTS Median [Q1–Q3] plasma penKid concentration on day 1 [84 (20–159) pmol/L[ was correlated with serum creatinine concentration (r = 0.74); it was higher in patients with chronic renal failure and rose progressively with the renal Sequential Organ Failure Assessment subscore. It predicted incident AKI within 48 h (adjusted odds ratio, 3.3; 95% CI, 2.1–5.1; P < 0.0001) or 1 week [adjusted hazard ratio, 2.1 (1.7–2.8); P < 0.0001] and future RRT during the intensive care unit stay [odds ratio, 4.0 (3.0–5.4)]. PenKid was also associated with improvements in renal function in patients with baseline serum creatinine >2 mg/dL, both within the next 48 h [adjusted odds ratio, 0.31 (0.18–0.54), P < 0.0001] and 1 week [0.23 (0.12–0.45)]. The time course of penKid concentrations predicted AKI and 90-day mortality. CONCLUSIONS Early measurement and the trajectory of penKid predict incident AKI, improvement of renal function, and the need for RRT in the acute phase after intensive care unit admission during sepsis or septic shock. PenKid measurement may be a valuable tool to test early therapies aimed at preventing the risk of AKI in sepsis.

scholarly journals Prevention of acute kidney injury and protection of renal function in the intensive care unit

2009 ◽  
Vol 36 (3) ◽  
pp. 392-411 ◽  
Author(s):  
Michael Joannidis ◽  
Wilfred Druml ◽  
Lui G. Forni ◽  
A. B. Johan Groeneveld ◽  
Patrick Honore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury

scholarly journals Systolic Blood Pressure Reduction and Acute Kidney Injury in Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 3030-3038
Author(s):  
Adnan I. Qureshi ◽  
Wei Huang ◽  
Iryna Lobanova ◽  
Daniel F. Hanley ◽  
Chung Y. Hsu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Kidney Injury ◽  
Intracerebral Hemorrhage ◽  
Serum Creatinine ◽  
Systolic Blood Pressure ◽  
Odds Ratio ◽  
Blood Pressure Reduction ◽  
Kidney Injury ◽  
Pressure Reduction ◽  
Baseline Serum

Background and Purpose: We determined the rates and predictors of acute kidney injury (AKI) and renal adverse events (AEs), and effects of AKI and renal AEs on death or disability in patients with intracerebral hemorrhage. Methods: We analyzed data from a multicenter trial which randomized 1000 intracerebral hemorrhage patients with initial systolic blood pressure ≥180 mm Hg to intensive (goal 110–139 mm Hg) over standard (goal 140–179 mm Hg) systolic blood pressure reduction within 4.5 hours of symptom onset. AKI was identified by serial assessment of daily serum creatinine for 3 days post randomization. Results: AKI and renal AEs were observed in 149 patients (14.9%) and 65 patients (6.5%) among 1000 patients, respectively. In multivariate analysis, the higher baseline serum creatinine (≥110 μmol/L) was associated with AKI (odds ratio 2.4 [95% CI, 1.2–4.5]) and renal AEs (odds ratio 3.1 [95% CI, 1.2–8.1]). Higher area under the curve for intravenous nicardipine dose was associated with AKI (odds ratio 1.003 [95% CI, 1.001–1.005]) and renal AEs (odds ratio 1.003 [95% CI, 1.001–1.006]). There was a higher risk to death (relative risk 2.6 [95% CI, 1.6–4.2]) and death or disability (relative risk 1.5 [95% CI, 1.3–1.8]) at 90 days in patients with AKI but not in those with renal AEs. Conclusions: Intracerebral hemorrhage patients with higher baseline serum creatinine and those receiving higher doses of nicardipine were at higher risk for AKI and renal AEs. Occurrence of AKI was associated higher rates of death or disability at 3 months. Registration: URL: https://clinicaltrials.gov . Unique identifier: NCT01176565.

scholarly journals Characteristics of Acute Kidney Injury in the Intensive Care Unit of Dr. Soetomo General Hospital, Surabaya

2021 ◽  
Vol 5 (3) ◽  
pp. 96-99
Author(s):  
Putu Laksmi Febriyani ◽  
Bambang Pujo Semedi ◽  
Widodo Widodo
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Septic Shock ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Kidney Injury ◽  
Developed Countries ◽  
Primary Diagnosis ◽  
Exposure Factor ◽  
Age Range

Acute Kidney Injury (AKI) is one of the causes of morbidity and mortality among people in both developing and developed countries in the intensive care unit (ICU). In Indonesia, the incidence rate is 0.2% while for the Surabaya, AKI research has not been widely carried out and published. This study aims to determine the characteristics of AKI patients in ICU of Dr. Soetomo hospital covers the data distribution of sociodemographic, risk factors, and mortality. This descriptive study involving 23 inpatients at the ICU with AKI as the sample. Samples were selected using total sampling method. Data were collected from medical records with data collection sheets. The results were then analyzed descriptively and tested bivariate using logistic regression. The results showed that 82.6% of the patients were male with the highest age range of 50-56 years old (30.43%). AKI mortality rate in the intensive care unit was 30.43%. The primary diagnosis was diabetes mellitus (34.78%) and the highest exposure factor was a septic shock (38.70%). Factors associated with AKI mortality were diabetes mellitus (p = 0.000) and exposure to septic shock (p = 0.005). Keywords: acute kidney injury; intensive care unit

scholarly journals Acute Peritoneal Dialysis During the COVID-19 Pandemic at Bellevue Hospital in New York City

2020 ◽  
Author(s):  
Nina J Caplin ◽  
Olga Zhdanova ◽  
Manish Tandon ◽  
Nathan Thompson ◽  
Dhwanil Patel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
New York ◽  
Acute Kidney Injury ◽  
New York City ◽  
Renal Function ◽  
Intensive Care ◽  
Peritoneal Dialysis ◽  
Kidney Injury ◽  
Bellevue Hospital ◽  
Kidney Replacement Therapy

The COVID-19 pandemic created an unprecedented strain on hospitals in New York City. Although practitioners focused on the pulmonary devastation, resources for the provision of dialysis proved to be more constrained. To deal with these shortfalls, NYC Health and Hospitals/Bellevue, NYU Brooklyn, NYU Medical Center and the New York Harbor VA Healthcare System, put together a plan to offset the anticipated increased needs for kidney replacement therapy. Prior to the pandemic, peritoneal dialysis was not used for acute kidney injury at Bellevue Hospital. We were able to rapidly establish an acute peritoneal dialysis program at Bellevue Hospital for acute kidney injury patients in the intensive care unit. A dedicated surgery team was assembled to work with the nephrologists for bedside placement of the peritoneal dialysis catheters. A multi-disciplinary team was trained by the lead nephrologist to deliver peritoneal dialysis in the intensive care unit. Between April 8, 2020 and May 8, 2020, 39 peritoneal dialysis catheters were placed at Bellevue Hospital. 38 patients were successfully started on peritoneal dialysis. As of June 10, 2020, 16 patients recovered renal function. One end stage kidney disease patient was converted to peritoneal dialysis and was discharged. One catheter was poorly functioning, and the patient was changed to hemodialysis before recovering renal function. There were no episodes of peritonitis and nine incidents of minor leaking, which resolved. Some patients received successful peritoneal dialysis while being ventilated in the prone position. In summary, despite severe shortages of staff, supplies and dialysis machines during the COVID-19 pandemic, we were able to rapidly implement a de novo peritoneal dialysis program which enabled provision of adequate kidney replacement therapy to all admitted patients who needed it. Our experience is a model for the use of acute peritoneal dialysis in crisis situations.

scholarly journals Erratum to: Prevention of acute kidney injury and protection of renal function in the intensive care unit

2010 ◽  
Vol 36 (4) ◽  
pp. 727-727
Author(s):  
Michael Joannidis ◽  
Wilfred Druml ◽  
Lui G. Forni ◽  
A. B. Johan Groeneveld ◽  
Patrick Honore ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Kidney Injury

scholarly journals P0562DIFFERENT POTENTIAL INTERPRETATIONS OF CRITERIA FOR AKI WHEN USING AUTOMATED DECISION SUPPORT: IMPACT ON ASSOCIATED MORTALITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Wim Van Biesen ◽  
Johan Steen ◽  
Johan Decruyenaere ◽  
Dominique Benoit ◽  
Eric Adriaan J Hoste ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Serum Creatinine ◽  
Mortality Risk ◽  
Sofa Score ◽  
Kidney Injury ◽  
Baseline Serum ◽  
Icu Admission ◽  
Definition Of ◽  
The Impact

Abstract Background and Aims The reported associated mortality risks of Acute Kidney Injury (AKI) in the intensive care unit (ICU) are variable. Although the Kidney Disease Improving Global Outcome (K-DIGO) improved harmonisation of the definition, there is remaining variability in the actual implementation of this AKI definition, with variable use of the urinary output (UO) criterion, and different interpretations of the baseline serum creatinine (Screa). This hampers progress of our understanding of the clinical concept AKI and leads to confusion and unclarity when interpreting models to predict AKI associated outcomes. With the advent of big data and artificial intelligence based decision algorithms, this problem will only become more of interest, as the user will not know what exactly the construct AKI in the application used means. Therefore, we intended to explore the impact of different interpretations of the Screa and the UO criterium as presented in the K-DIGO definition on the associated ICU mortality risk of AKI stage 2 in the ICU. Method We included all patients of an electronic health data system applied in a tertiary ICU between 2013 and 2017. Sequential Organ Failure Assessment (SOFA) score was calculated, and gender, age, weight and mortality at ICU and in hospital were extracted. All serum creatinine (sCrea) values during ICU stay and hospitalisation were extracted, as were UO data, with their time stamps. In addition, all Screa data up to 1 year before ICU admission were retrieved from a dataset external to ICU. AKI was defined according to KDIGO stage 2, using different possible interpretations of the Screa and/or the UO criterion. For the evolution of Screa as compared to a baseline value, we either used a value directly available to ICU staff (def 1), a presumed eGFR of 75ml/min (def 2), the first available value after admission to ICU (def 3), the lowest value during the current hospitalisation before ICU admission (def 4), the lowest value before the hospitalisation episode as found in an external dataset (def 5). For the UO criterion, we used either (in line with K-DIGO stage 2) a UO below 6ml/kg during a 12 hour block (def 6) or a UO below 0.5ml/kg/hour during each of 12 consecutive one hour intervals (def 7). Definition 8 and 9 identified patients who complied with at least one out of the Screa criteria 1-5 (def 8) or out of the UO criteria (def 9). Definition 10 identified patients who complied both with at least one Screa and one UO criterium. Results Our dataset comprised 16433 admissions (34.7% female, age 60.7±16.4 years). Overall, 8.1% of patients died in Intensive Care Unit (ICU). The SOFA score at admission was 6.9±4.1. The mortality risk associated with AKI according to the stage 2 definition of K-DIGO varied according to the interpretation of the diagnostic criteria (table). Most important, associated mortality risk was comparable whether a UO (RR 2.31, 95% CI 1.90-2.81) or a Screa (RR 2.00, 95% CI 1.57-2.55) criterium was used, and was highest in patients who complied with both at least one UO and one Screa criterium (RR 7.28, 95% CI 6.12-8.65). Conclusion Unclarity on the actual interpretation of the Screa and UO criteria used in the K-DIGO definition of AKI leads to substantial differences in AKI associated mortality risk. Omitting the UO criterium leads to substantial underestimation of associated risk.

Acute Kidney Injury and COVID-19: A Picture from an Intensive Care Unit

2021 ◽  
pp. 1-5
Author(s):  
Francesco Alessandri ◽  
Valentina Pistolesi ◽  
Chiara Manganelli ◽  
Franco Ruberto ◽  
Giancarlo Ceccarelli ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Icu Stay ◽  
Renal Function Recovery ◽  
Tertiary Teaching

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is a frequent complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care unit (ICU) for severe respiratory failure. The aim is to evaluate the rate of AKI, defined according to Kidney Disease: Improving Global Outcome guidelines, in a series of critical COVID-19 patients admitted to the ICU of a single tertiary teaching hospital. <b><i>Methods:</i></b> From April to May 2020, all consecutive critically ill COVID-19 patients admitted to the ICU who did not meet exclusion criteria (length of ICU stay &#x3c;48 h, ESRD requiring dialysis, and patients still hospitalized in ICU at the time of data analysis) were enrolled in this study. Patients were stratified according to the highest AKI stage attained during ICU stay. <b><i>Results:</i></b> Sixty-one patients were included in the analysis. AKI was observed in 35/61 patients (57.4%): 25/35 episodes (71.4%) were observed within the first 7 days. AKI was classified as follows: 17.1% stage 1, 25.7% stage 2, and 57.2% stage 3. Fourteen out of 20 stage-3 patients required continuous renal replacement therapy (CRRT), mostly related to persistent oliguria. The overall ICU mortality was 68.9%, and it was higher in patients developing AKI if compared to no-AKI patients (<i>p</i> = 0.006). Renal function recovery of any grade was observed in 14 out of 35 AKI patients (40%). Among patients undergoing CRRT, 13 patients were still dialysis dependent at the time of death. <b><i>Conclusion:</i></b> In critical COVID-19 patients, ICU mortality is particularly high, especially in patients developing AKI. An accurate monitoring of renal function in early phases of respiratory failure should be ensured in order to timely apply any strategy aimed at limiting renal complications during ICU stay.

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