Acute Kidney Injury related to intravenous Colistin Use in Lebanese Hospitalized Patients: Incidence and Associated Factors

2021 ◽  
Vol 16 ◽  
Author(s):  
Malak Khalifeh ◽  
Abdalla El-Lakany ◽  
Lama Soubra
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
University Hospital ◽  
P Value ◽  
Limiting Factor ◽  
Factors Associated ◽  
Several Variables ◽  
Nephrotoxic Drugs ◽  
Comorbidity Index ◽  
Serum Albumen

Introduction: Colistin use has risen because of the emergence of Gram-negative resistant infections. Acute kidney injury (AKI) remains a treatment-limiting factor for widespread colistin clinical use. This study aimed to determine the incidence and the factors associated with the development of colistin-induced AKI. Method: A retrospective observational study was conducted by reviewing files of adult patients, with normal kidneys function between January 2015 to March 2019 at a university hospital located in Beirut city. AKI was defined based on KDIGO criteria. Several variables were tested to determine independent factors that were associated with colistin induced AKI. Results: A total of 113 patients were included in this study. AKI occurred in 53 patients (46.9%). The Charlson Comorbidity Index (CCI) was significantly higher in the AKI group (2.26, P-value = 0.026). In the multivariate analysis, low serum albumen was found as an independent significant predictor for AKI (OR=.065, 95%CI: .013-.337, P-value=0.001). Moreover, the risk for AKI increased by 2 folds (OR=2.019, 95%CI: 1.094-3.728, P-value: 0.025), when two or more nephrotoxic agents were administered simultaneously with colistin. Patient’s age was also found as significant predictor for AKI (OR=1.034, 95% CI:1-1.07), with a cut-off value of 58.5 year-old. Conclusion: This study demonstrated that the use of concomitant use of two or more nephrotoxic drugs, patient’s age of 58.5 or more, and the presence of hypoalbuminemia were independent factors for the development of colistin-induced AKI. These factors should be therefore taken into consideration when prescribing colistin in clinical practice to reduce the risk of AKI.

scholarly journals Factors Affecting Inpatient Mortality in Elderly People with Acute Kidney Injury

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Muhammad Abdul Mabood Khalil ◽  
Safia Awan ◽  
Rabeea Azmat ◽  
Muhammad Ashhad Ullah Khalil ◽  
Nazish Naseer ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Elderly People ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Stage I ◽  
Stage Ii ◽  
University Hospital ◽  
Stage Iii ◽  
Inpatient Mortality ◽  
Factors Associated

Background. Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI. Objective. This study was done to know more about factors associated with inpatient mortality in EP with AKI. Methods. We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI. Results. 431 patients had AKI, with 341 (79.1%) having stage I AKI, 56 (13%) having stage II AKI, and 34 (7.9%) having stage III AKI. Out of 431 patients, 142 (32.9%) died. Mortality increased with increasing severity of AKI. Mortality was 50% (17/34) in AKI stage III, 44.6% (25/56) in AKI stage II, and 29.3% (100/341) in AKI stage I. Factors associated with increased inpatients mortality were presence of stage III AKI (OR: 3.20, P=0.04, 95% CI: 1.05–9.72), presence of oliguria (OR: 3.42, P=0.006, 95% CI: 1.42–8.22), and need for vasopressors (OR: 6.90, P<0.001, 95% CI: 2.42–19.65). Median bicarbonate 18 versus 17 between those who survived and those who died was associated with less mortality (OR: 0.94, P=0.02, 95% CI: 0.89–0.99). History of hypertension (OR: 0.49, P=0.03, 95% CI: 0.25–0.95) and high admission creatinine (OR: 0.68, P=0.01, 95% CI: 0.50–0.91) were also associated with less mortality. Conclusion. Mortality in EP increases with increasing severity of AKI. Presence of stage III AKI, oliguria, and hemodynamic instability needing vasopressor are associated with increased mortality. Increased median bicarbonate, presence of hypertension, and high admission creatinine were various factors associated with decreased inpatient mortality. Increasing age and need for dialysis did not increase mortality in elderly population.

scholarly journals Acute Kidney Injury in COVID-19: 90 Days of the Pandemic in a Brazilian Public Hospital

2021 ◽  
Vol 8 ◽  
Author(s):  
Welder Zamoner ◽  
Camilla Andrade da Silva Santos ◽  
Luís Eduardo Magalhães ◽  
Paula Gabriela Sousa de Oliveira ◽  
André Luis Balbi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Severe Disease ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Apache Ii ◽  
University Hospital ◽  
Apache Ii Score ◽  
Disease Manifestation ◽  
Factors Associated

Renal involvement is frequent in COVID-19 (4–37%). This study evaluated the incidence and risk factors of acute kidney injury (AKI) in hospitalized patients with COVID-19.Methodology: This study represents a prospective cohort in a public and tertiary university hospital in São Paulo, Brazil, during the first 90 days of the COVID-19 pandemic, with patients followed up until the clinical outcome (discharge or death).Results: There were 101 patients hospitalized with COVID-19, of which 51.9% were admitted to the intensive care unit (ICU). The overall AKI incidence was 50%; 36.8% had hematuria or proteinuria (66.6% of those with AKI), 10.2% had rhabdomyolysis, and mortality was 36.6%. Of the ICU patients, AKI occurred in 77.3% and the mortality was 65.4%. The mean time for the AKI diagnosis was 6 ± 2 days, and Kidney Disease Improving Global Outcomes (KDIGO) stage 3 AKI was the most frequent (58.9%). Acute renal replacement therapy was indicated in 61.5% of patients. The factors associated with AKI were obesity [odds ratio (OR) 1.98, 95% confidence interval (CI) 1.04–2.76, p &lt; 0.05] and the APACHE II score (OR 1.97, 95% CI 1.08–2.64, p &lt; 0.05). Mortality was higher in the elderly (OR 1.03, 95% CI 1.01–1.66, p &lt; 0.05), in those with the highest APACHE II score (OR 1.08, 95% CI 1.02–1.98, p &lt; 0.05), and in the presence of KDIGO stage 3 AKI (OR 1.11, 95% CI 1.05–2.57, p &lt; 0.05).Conclusion: AKI associated with severe COVID-19 in this Brazilian cohort was more frequent than Chinese, European, and North American data, and the risk factors associated with its development were obesity and higher APACHE II scores. Mortality was high, mainly in elderly patients, in those with a more severe disease manifestation, and in those who developed KDIGO stage 3 AKI.

scholarly journals Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5405
Author(s):  
Danielly Botelho Soares ◽  
Juliana Vaz de Melo Mambrini ◽  
Gabriela Rebouças Botelho ◽  
Flávia Fialho Girundi ◽  
Fernando Antonio Botoni ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Intensive Care ◽  
Drug Therapy ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Nephrotoxic Drugs

Background Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. Methods This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (SCr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Results Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0–69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05–1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity. Discussion Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety.

scholarly journals Predictive capacity of prognostic scores for kidney injury, dialysis, and death in intensive care units

2021 ◽  
Vol 55 ◽  
Author(s):  
Geferson Messias Teles Vasconcelos ◽  
Marcia Cristina da Silva Magro ◽  
Cassiane Dezoti da Fonseca ◽  
Jussiely Cunha Oliveira ◽  
Eduesley Santana-Santos
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Kidney Injury ◽  
Prognostic Scores ◽  
P Value ◽  
Predictive Capacity ◽  
Saps 3 ◽  
Intensity Of Care ◽  
Comorbidity Index

ABSTRACT Objective: To assess the capacity of Charlson, SAPS 3 and SOFA scores to predict acute kidney injury, need for dialysis, and death in intensive care unit patients. Method: Prospective cohort, with 432 individuals admitted to four intensive care units. Clinical characteristics at admission, severity profile, and intensity of care were analyzed using association and correlation tests. The scores sensitivity and specificity were assessed using the ROC curve. Results: The results show that patients with acute kidney injury were older (65[27] years vs. 60[25] years, p = 0.019) and mostly are from the emergency department (57.9% vs. 38.0 %, p < 0.001), when compared to those in the group without acute kidney injury. For dialysis prediction, the results of SAPS 3 and SOFA were AUC: 0.590; 95%CI: 0.507–0.674; p-value: 0.032 and AUC: 0.667; 95%CI: 0.591–0.743; p-value: 0.000, respectively. All scores performed well for death. Conclusion: The prognostic scores showed good capacity to predict acute kidney injury, dialysis, and death. Charlson Comorbidity Index showed good predictive capacity for acute kidney injury and death; however, it did not perform well for the need for dialysis.

scholarly journals Frailty status among older critically ill patients with severe acute kidney injury

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
William Beaubien-Souligny ◽  
Alan Yang ◽  
Gerald Lebovic ◽  
Ron Wald ◽  
Sean M. Bagshaw
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Frailty Scale ◽  
Factors Associated ◽  
Frailty Status ◽  
Physiological Variables

Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

scholarly journals Association between preoperative level of hemoglobin A1c and the incidence of acute kindey injury after coronary artery bypass grafting surgery: a cohort study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Ghada Mohamed Samir ◽  
Omar Mohamed Ali Mohamed Omar ◽  
Madiha Metwally Zidan ◽  
Hazem Abd El Rahman Fawzy ◽  
Marwa Mamdouh Mohamed El Far
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Hemoglobin A1c ◽  
Artery Bypass ◽  
Kidney Injury ◽  
P Value ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Background The development of acute kidney injury (AKI) is an important indicator of clinical outcomes after cardiac surgery. Elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. This study will investigate the association of preoperative HbA1c levels with AKI after isolated coronary artery bypass grafting (CABG). Results Forty patients undergoing elective CABG were enrolled in this cohort study. Patients are divided into 2 equal groups who underwent isolated coronary artery bypass grafting (CABG): patients with preoperative HbA1c 5.7–6.4% (group A) (prediabetics) and patients with preoperative HbA1c > or = 6.5% (group B) (diabetics). Acute kidney injury according to the Kidney Disease: Improving Global Outcomes criteria developed in 11 patients (27.5%). There was a significant difference between the two groups as regards postoperative urinary NGAL, creatinine level on the 1st day, creatinine level on the 2nd day, urine output on the 1st day, and urine output on the 2nd day (p value was 0.001, 0.002, 0.006, 0.0002, and 0.012 respectively). Postoperative ICU stay duration was statistically significant in the diabetic group (P value 0.009). The need for renal replacement therapy was higher in the diabetic group, but it was not statistically significant between the two groups. Roc analysis shows AUC 0.922 with a significant p value (< 0.0001) and cut of value (≥ 7) with sensitivity 81.82 and specificity 93.10. Conclusion This study revealed that elevated preoperative HbA1c level above 7% showed an increase in incidence of post CABG acute kidney injury along with increase length of postoperative ICU stay.

scholarly journals Association of Blood Type on Clinical Outcomes in Black/African Americans Hospitalized for COVID-19 Infection

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-14
Author(s):  
Yan Cheng ◽  
Sharif Mohammed ◽  
Alexis Okoh ◽  
Ki (Steve) Lee ◽  
Corinne Raczek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
African Americans ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Type A ◽  
Blood Type ◽  
P Value ◽  
Single Center ◽  
Black African ◽  
O 31

Introduction: Early studies from Wuhan, China have reported an association between blood type and outcomes in COVID-19 infected patients. Conflicting reports in literature have investigated the protective role of blood type O against worst outcomes associated with COVID-19 infections. Approximately 50% of Black/African Americans (AA) have blood group O. Our study is the only study to date looking at the association between Black/AA and blood type. We aimed to determine the association between blood type and Black/AA patients hospitalized for COVID-19. Methods: We retrospectively reviewed data on patients with known blood type, who were admitted for COVID-19 at a single center between March and April 2020. We excluded other races in our study because only about 2% of the population was Caucasian and 8% representing other races, representing a small subset of patients under study whereas Black/AA represented about 90% of our hospitalized patients. Patients were stratified into 4 groups based on their ABO blood type. Baseline demographic, clinical characteristics and clinical course of the disease were compared. The primary end point was in-hospital mortality. Secondary endpoints included admission to the intensive care unit (ICU), acute kidney injury requiring hemodialysis and length of stay (LOS). Results: During the study period, a total of 256 patients were reviewed. Distribution of ABO type was as follows; A: (N=65) 25%, B: (N=62) 24%, AB: (N=9) 4%, O: (N=120) 47%. Compared to blood types A, B and O, AB patients were younger (mean; yrs. 63 vs. 63 vs. 62 vs. 43 yrs. p=0.0242). Blood type B patients were more likely to present with nausea, than groups A, AB, and O. (27% vs. 10% vs. 0% vs. 5%; p=0.017). All other characteristics including baseline inflammatory markers were comparable. There was no difference among groups regarding in-hospital mortality (A: 39% B: 29% AB: 33% O: 31% p value: 0.676) or admission to the ICU (A:31% B: 28% AB: 33% O: 34% p value: 0.840). The incidence of acute kidney injury requiring hemodialysis was higher in blood type A patients compared to B, AB, and O. (31% vs. 0% vs. 23% vs. 19%; p=0.046). In hospital LOS was comparable among all groups. Conclusions: In this single center analysis of black/AA patients admitted for COVID-19, there was no association between blood type and in-hospital mortality or admission to ICU. Blood type A patients had a higher propensity of kidney injury, but this did not translate into worse in-hospital survival. Disclosures Cohen: GBT: Speakers Bureau.

scholarly journals ACUTE KIDNEY INJURY FOLLOWING SURGERY FOR HIP FRACTURE

2020 ◽  
Vol 28 (3) ◽  
pp. 128-130
Author(s):  
PHILIP MCKEAG ◽  
ANDREW SPENCE ◽  
BRIAN HANRATTY
Keyword(s):  
Acute Kidney Injury ◽  
Hip Fracture ◽  
Kidney Injury ◽  
Factors Associated ◽  
Chi Squared ◽  
Student’S T ◽  
Retrospective Comparative Study ◽  
Type Of Surgery ◽  
Preoperative Creatinine ◽  
Student’S T Test

ABSTRACT Objective: An observational study was carried out to determine the rate of acute kidney injury (AKI) following surgery for hip fracture at our institution and to look for factors associated with AKI. Methods: Preoperative creatinine values were compared to post-operative results for all patients who underwent surgery for hip fracture at our institution between 1st January 2015 and 30th September 2016. AKI was defined as an increase in postoperative creatinine, greater than or equal to 1.5 times the preoperative value within 7 days. Chi-squared test and Student’s t-test were used to look for factors associated with AKI. Results: Out of 500 patients, 96 developed an AKI (19.2%). Patients with chronic kidney disease (CKD) were more likely to develop AKI (30.8%) that those without it (17.2%, p = 0.018). Similarly, patients with 2 or more comorbidities were more likely to develop AKI (22.0%) than those without it (12.4%, p = 0.009). No statistically significant association was observed between type of surgery and AKI. Conclusion: A large proportion of patients following surgery for hip fracture developed AKI. Patients with CKD and the presence of 2 or more comorbidities had significantly higher rates of AKI. Level III evidence, Retrospective comparative study.

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