scholarly journals Serum sodium trajectory during AKI and mortality risk

2021 ◽  
Author(s):  
Jonathan Samuel Chavez-Iñiguez ◽  
Pablo Maggiani-Aguilera ◽  
Helbert Rondon-Berrios ◽  
Kianoush Kashani ◽  
Christian Pérez-Flores ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Serum Sodium ◽  
Prospective Cohort ◽  
Sodium Level ◽  
Serum Sodium Level ◽  
Kidney Injury ◽  
Primary Role ◽  
Acute Kidney Injury Stage ◽  
Kidney Replacement Therapy

Abstract Introduction: Kidneys play a primary role in electrolyte homeostasis. The association between serum sodium level and mortality or the need for kidney replacement therapy during acute kidney injury has not been adequately explored. Methods: In this prospective cohort study, we enrolled patients admitted to the Civil Hospital of Guadalajara from August 2017 to March 2020. We divided patients into five groups based on the serum sodium level trajectories up to ten days following hospitalization, 1) stable normonatremia (serum sodium 135 and 145 mEq/L), 2) fluctuating serum sodium levels (increased/decreased in and out of normonatremia), 3) uncorrected hyponatremia, 4) corrected hyponatremia, and 5) uncorrected hypernatremia. We assessed the association of serum sodium trajectories with mortality and the need for kidney replacement therapy (secondary objective). Results: A total of 288 patients were included. The mean age was 55±18 years, and 175 (60.7%) were male. Acute kidney injury stage 3 was present in 145 (51%). Kidney replacement therapy started in 72 (25%) patients, and 45 (15.6%) died. After adjusting for confounders, 10-day hospital mortality was significantly higher in group 5 (HR, 3.12; 95% CI, 1.05 to 9.24, p = 0.03), and kidney replacement therapy initiation was higher in group 3 (HR, 2.44; 95% CI, 1.04 to 5.70, p = 0.03) compared with group 1. Conclusion: In our prospective cohort, most patients with acute kidney injury had alterations in serum sodium. Uncorrected hypernatremia was associated with death, and uncorrected hyponatremia was correlated with the need for kidney replacement therapy.

MO417NEPHROLOGIST INTERVENTION TO AVOID KIDNEY REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jonathan Chávez ◽  
Pablo Maggiani-Aguilera ◽  
Andres De la Torre-Quiroga ◽  
Alejandro Martínez-Gallardo Gonzalez ◽  
Ramón Medina-González ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Prospective Cohort ◽  
Kidney Injury ◽  
Primary Objective ◽  
Early Interventions ◽  
Kidney Replacement Therapy ◽  
The Impact ◽  
First Time ◽  
Antibiotic Dose

Abstract Background and Aims Based on the pathophysiology of acute kidney injury (AKI) it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression and death. Method In a prospective cohort at Hospital Civil of Guadalajara, we followed-up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment and removal of hyperchloremic solutions) after propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3 and death (secondary objectives). Results From 2017 to 2020 we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (OR 0.58, 95% CI 0.48-0.70, p = <0.001) and AKI progression to stage 3 (OR 0.59, 95% CI 0.49-0.71, p = <0.001). Receiving vasopressors and KRT were associated with mortality, but neither of these interventions reduced these risks. Conclusion In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment was associated with a reduction in the risk of starting KRT and progression to AKI stage 3.

scholarly journals Nephrologist Interventions to Avoid Kidney Replacement Therapy in Acute Kidney Injury

2021 ◽  
pp. 1-10
Author(s):  
Jonathan S. Chávez-Íñiguez ◽  
Pablo Maggiani-Aguilera ◽  
Christian Pérez-Flores ◽  
Rolando Claure-Del Granado ◽  
Andrés E. De la Torre-Quiroga ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Prospective Cohort ◽  
Kidney Injury ◽  
Primary Objective ◽  
Early Interventions ◽  
Risk Of Death ◽  
Kidney Replacement Therapy ◽  
The Impact ◽  
First Time

<b><i>Background:</i></b> Based on the pathophysiology of acute kidney injury (AKI), it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression, and death. <b><i>Methods:</i></b> In a prospective cohort at the Hospital Civil of Guadalajara, we followed up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment, and removal of hyperchloremic solutions) after the propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3, and death (secondary objectives). <b><i>Results:</i></b> From 2017 to 2020, we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48–0.70, and <i>p</i> ≤ 0.001) and AKI progression to stage 3 (OR: 0.59, 95% CI: 0.49–0.71, and <i>p</i> ≤ 0.001). Receiving vasopressors and KRT were associated with mortality. None of the interventions studied was associated with reducing the risk of death. <b><i>Conclusions:</i></b> In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment were associated with lower risk of starting KRT and progression to AKI stage 3.

scholarly journals Derivation and External Validation of a Risk Index for Predicting Acute Kidney Injury Requiring Kidney Replacement Therapy After Noncardiac Surgery

2021 ◽  
Vol 4 (8) ◽  
pp. e2121901
Author(s):  
Todd A. Wilson ◽  
Lawrence de Koning ◽  
Robert R. Quinn ◽  
Kelly B. Zarnke ◽  
Eric McArthur ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Risk Index ◽  
External Validation ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Kidney Replacement Therapy

Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy

2021 ◽  
Author(s):  
Rupesh Raina ◽  
Ronith Chakraborty ◽  
Andrew Davenport ◽  
Patrick Brophy ◽  
Sidharth Sethi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Kidney Replacement Therapy

scholarly journals COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

2020 ◽  
Author(s):  
Mitra K. Nadim ◽  
Lui G. Forni ◽  
Ravindra L. Mehta ◽  
Michael J. Connor ◽  
Kathleen D. Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Acute Disease ◽  
Future Research ◽  
Hospital Death ◽  
Kidney Involvement ◽  
Kidney Replacement Therapy ◽  
Hospital Resources ◽  
Underlying Processes

AbstractKidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

scholarly journals High rates of long-term renal recovery in survivors of coronavirus disease 2019–associated acute kidney injury requiring kidney replacement therapy

2021 ◽  
Author(s):  
Helena Stockmann ◽  
Jan-Hendrik Bernhard Hardenberg ◽  
Annette Aigner ◽  
Christian Hinze ◽  
Inka Gotthardt ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Kidney Replacement Therapy
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