A Cohort Study of Acute Kidney Injury in Egyptian Neonates; Etiology, Risk Factors, Diagnosis and Three Months Follow Up.

(1) Background: Sepsis-associated acute kidney injury (AKI) can lead to permanent kidney damage, although the long-term prognosis in patients with septic shock remains unclear. This study aimed to identify risk factors for the development of chronic kidney disease (CKD) in septic shock patients with AKI. (2) Methods: A single-site, retrospective cohort study was conducted using a registry of adult septic shock patients. Data from patients who had developed AKI between January 2011 and April 2017 were extracted, and 1-year follow-up data were analysed to identify patients who developed CKD. (3) Results: Among 2208 patients with septic shock, 839 (38%) had AKI on admission (stage 1: 163 (19%), stage 2: 339 (40%), stage 3: 337 (40%)). After one year, kidney function had recovered in 27% of patients, and 6% had progressed to CKD. In patients with stage 1 AKI, 10% developed CKD, and mortality was 13% at one year; in patients with stage 2 and 3 AKI, the CKD rate was 6%, and the mortality rate was 42% and 47%, respectively. Old age, female, diabetes, low haemoglobin levels and a high creatinine level at discharge were seen to be risk factors for the development of CKD. (4) Conclusions: AKI severity correlated with mortality, but it did not correlate with the development of CKD, and patients progressed to CKD, even when initial AKI stage was not severe. Physicians should focus on the recovery of renal function, and ensure the careful follow-up of patients with risk factors for the development of CKD.

Download Full-text

Risk factors, predictions, and progression of acute kidney injury in hospitalized COVID-19 patients: An observational retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0257253 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257253

Author(s):

Maryam N. Naser ◽

Rana Al-Ghatam ◽

Abdulla H. Darwish ◽

Manaf M. Alqahtani ◽

Hajar A. Alahmadi ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cohort Study ◽

Serum Albumin ◽

Troponin I ◽

Cardiac Injury ◽

Kidney Injury ◽

Multivariate Regression Analysis ◽

Observational Cohort

Objectives Studies have shown that acute kidney injury (AKI) occurrence post SARS-CoV-2 infection is complex and has a poor prognosis. Therefore, more studies are needed to understand the rate and the predications of AKI involvement among hospitalized COVID-19 patients and AKI’s impact on prognosis while under different types of medications. Patients and methods This study is a retrospective observational cohort study conducted at Bahrain Defence Force (BDF) Royal Medical Services. Medical records of COVID-19 patients admitted to BDF hospital, treated, and followed up from April 2020 to October 2020 were retrieved. Data were analyzed using univariate and multivariate logistic regression with covariate adjustment, and the odds ratio (OR) and 95% confidence (95% CI) interval were reported. Results Among 353 patients admitted with COVID-19, 47.6% developed AKI. Overall, 51.8% of patients with AKI died compared to 2.2% of patients who did not develop AKI (p< 0.001 with OR 48.6 and 95% CI 17.2–136.9). Besides, deaths in patients classified with AKI staging were positively correlated and multivariate regression analysis revealed that moderate to severe hypoalbuminemia (<32 g/L) was independently correlated to death in AKI patients with an OR of 10.99 (CI 95% 4.1–29.3, p<0.001). In addition, 78.2% of the dead patients were on mechanical ventilation. Besides age as a predictor of AKI development, diabetes and hypertension were the major risk factors of AKI development (OR 2.04, p<0.01, and 0.05 for diabetes and hypertension, respectively). Also, two or more comorbidities substantially increased the risk of AKI development in COVID-19 patients. Furthermore, high levels upon hospital admission of D-Dimer, Troponin I, and ProBNP and low serum albumin were associated with AKI development. Lastly, patients taking ACEI/ARBs had less chance to develop AKI stage II/III with OR of 0.19–0.27 (p<0.05–0.01). Conclusions The incidence of AKI in hospitalized COVID-19 patients and the mortality rate among AKI patients were high and correlated with AKI staging. Furthermore, laboratory testing for serum albumin, hypercoagulability and cardiac injury markers maybe indicative for AKI development. Therefore, clinicians should be mandated to perform such tests on admission and follow-up in hospitalized patients.

Download Full-text

MO348CLINICAL TRAJECTORIES AND IMPACT OF ACUTE KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT: A 5-YEAR SINGLE-CENTER COHORT STUDY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.002 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Arthur Orieux ◽

Mathilde Prezelin-Reydit ◽

Christian Combe ◽

Renaud Prevel ◽

Alexandre Boyer ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cohort Study ◽

Kidney Disease ◽

Kidney Injury ◽

Proportional Hazard ◽

Acute Kidney Disease ◽

Incidence Of Ckd ◽

Stage 1

Abstract Background and Aims Acute kidney injury (AKI) is observed in more than 50% of patients admitted in intensive care units (ICU) and more than 10% of them require renal replacement therapy (RRT) Acute kidney disease (AKD) has been recently proposed to describe a highly vulnerable period with pathophysiological process following AKI during which the patient could experience a decline in glomerular filtration and finally developed CKD. Patients suffering from AKI in ICU could have various renal trajectories and outcomes (early, late, or absence of recovery; early or late relapse; acute kidney disease (AKD); or chronic kidney disease (CKD)) after discharge. No cohort study described them accurately. Aims were to assess the various clinical trajectories after AKI in ICU and to determine risk factors for developing CKD taking into account the new concept of AKD and to assess the long-term incidence of CKD. Method We conducted a prospective five-year follow-up study in a medical ICU in Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI (defined by KDIGO criteria) from September 2013 to May 2015 were included. We excluded the patients with a previous estimated glomerular filtration rate (eGFR) of <90mL/min/1.73m2. AKD was defined as a condition wherein the criteria for AKI stage 1 or greater persists ≥7 days after exposure. CKD was defined by an eGFR of <60ml/min/1.73m2 at least 90 days after the AKI. Renal recovery was defined by serum creatinine ≤125% of serum basal creatinine. Using the Aalen-Johansen estimator to account for competing risks, we estimated the cumulative incidence of CKD. To estimate adjusted hazard ratios (HRs) we used standard Cox proportional hazard models adjusted for age, sex, hypertension, diabetes, cardiovascular history, SOFA and AKI stage. Proportional hazard assumptions were checked using Schoenfeld residuals. Violation of proportional hazard assumption for AKD was handled by using appropriate interaction terms with time, resulting in time-dependent HR. Results 232 patients were enrolled. The age was 62 ± 16 years, 142/232 (61%) were male. AKI stage 1 was present in 62/232 (27%) patients, AKI stage 2 in 50/232 (21%), and AKI stage 3 in 120/232 (52%). Among patients with AKI, 65/232 (28%) recovered before day 7. At day 7, 106/232 (46%) had been progressing to AKD. AKD also developed secondary in 3/65 because of a second episode of AKI without recovery. Among the AKD patients, 21/109 (19%) recovered before day 90, 41/109 (38%) dead and 47/109 (43%) progressed to CKD (figure). The cumulative incidence of CKD was 17 [12-21]% at 1-year follow-up and 30 [24-36] % at 5-years follow-up. This incidence was higher in AKD-patients (44 [35-54]%, and 48 [39-58]%) than in non-AKD patients (9 [1-16]% and 22 [10-34]%) after 1 and 5 years of follow-up, respectively (p=6.10-5). The risk of developing CKD in AKD-patients was increased up to six months compared to those without AKD (HR 27.1 [7.9-93.5]; p<0.0001). Six months after AKI, the risk of progression to CKD was not statistically different between AKD patients and non-AKD patients (HR 2.45 [0.68 – 8.85]; p = 0.17). In this model only gender (male sex: HR 0.5 [0.3-0.9]; p= 0.02) was also significantly associated with CKD. Conclusion There were many clinical trajectories after AKI in ICU. Risk for developing CKD remained during the 5 years of follow-up. AKD was the main risk factors for developing CKD only in the first 6 months. After, the risk was similar in AKD or non-AKD patients. Female gender was associated with CKD during all the follow-up. These patients need a specific follow-up after ICU discharge.

Download Full-text

Incidence and risk factors of acute kidney injury in the Japanese trauma population: A prospective cohort study

Injury ◽

10.1016/j.injury.2017.08.022 ◽

2017 ◽

Vol 48 (10) ◽

pp. 2145-2149 ◽

Cited By ~ 12

Author(s):

Jun Fujinaga ◽

Akira Kuriyama ◽

Noriaki Shimada

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Kidney Injury ◽

Trauma Population

Download Full-text

Risk factors for acute kidney injury in a pediatric intensive care unit: a retrospective cohort study

Medwave ◽

10.5867/medwave.2017.03.6940 ◽

2017 ◽

Vol 17 (03) ◽

pp. e6940-e6940 ◽

Cited By ~ 1

Author(s):

Lina María Serna-Higuita ◽

John Fredy Nieto-Ríos ◽

Jorge Eduardo Contreras-Saldarriaga ◽

Juan Felipe Escobar-Cataño ◽

Luz Adriana Gómez-Ramírez ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Cohort Study ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Kidney Injury ◽

Pediatric Intensive Care

Download Full-text

Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2018-0240 ◽

2019 ◽

Vol 41 (4) ◽

pp. 462-471 ◽

Cited By ~ 4

Author(s):

Kellen Hyde Elias Pinheiro ◽

Franciana Aguiar Azêdo ◽

Kelsy Catherina Nema Areco ◽

Sandra Maria Rodrigues Laranja

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Mortality Rates ◽

Icu Patients ◽

Septic Acute Kidney Injury ◽

Observational Cohort ◽

Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

Download Full-text