Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury

2021 ◽  
pp. CJN.02060221
Author(s):  
Yvelynne Kelly ◽  
Kavita Mistry ◽  
Salman Ahmed ◽  
Shimon Shaykevich ◽  
Sonali Desai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Controlled Study ◽  
Control Group ◽  
Inpatient Mortality ◽  
Icu Length Of Stay ◽  
Kidney Replacement Therapy

Background: Acute kidney injury (AKI) requiring kidney replacement therapy (KRT) is associated with high mortality and utilization. We evaluated the use of an AKI-Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes including mortality, hospital and ICU length of stay. Methods: We conducted a 12-month controlled study in the ICUs of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a "sham" control form in 4-6-week blocks. The primary outcome was risk of inpatient mortality. Pre-specified secondary outcomes included 30-day mortality, 60-day mortality and hospital and ICU length of stay. Generalized estimating equations were used to estimate the impact of the AKI-SCAMP on mortality and length of stay. Results: There were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% vs 47% control). AKI-SCAMP use was associated with significantly reduced ICU length of stay (mean 8 (95% CI 8-9) vs 12 (95% CI 10-13) days; p = <0.0001) and hospital length of stay (mean 25 (95% CI 22-29) vs 30 (95% CI 27-34) days; p = 0.02). Patients in the AKI-SCAMP group less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% vs 7%, p=0.003). Conclusions: Use of the AKI-SCAMP tool for AKI-KRT was not significantly associated with inpatient mortality but was associated with reduced ICU and hospital length of stay and use of KRT in cases of physician-perceived treatment futility.

Effect of acute kidney injury on hospital-based outcomes in patients with multiple myeloma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e20006-e20006
Author(s):  
Muhammad Usman Zafar ◽  
Zahid Tarar ◽  
Ghulam Ghous ◽  
Umer Farooq ◽  
Bradley Walter Lash
Keyword(s):  
Heart Failure ◽  
Multiple Myeloma ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Teaching Hospitals ◽  
Inpatient Mortality ◽  
History Of

e20006 Background: Multiple Myeloma, a cancer of plasma cells, is treatable, but incurable. 5-year survival rate is about 54% depending upon the stage. Studies have suggested that up to 50% of the patients experience acute kidney injury or chronic kidney disease at some point in their disease course. Approximately 3% of the patients will end up on hemodialysis. In this study we utilize the National Inpatient Sample (NIS) to understand the effect of acute kidney injury (AKI) on inpatient mortality in multiple myeloma patients. Methods: This is a retrospective study utilizing the data obtained from the NIS for the year 2018. We queried this NIS database for ICD-10 codes for multiple myeloma or plasmacytoma that had not achieved remission or was in relapse. We also looked at codes for acute kidney injury as secondary diagnosis. Primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay and cost utilization. We then ran multivariate logistic regression analysis in STATA MP 16.1. Various comorbidities were accounted for by adding them into the analysis. These included previous history of coronary artery disease, congestive heart failure, stroke, smoking, hyperlipidemia, stem cell transplant, neutropenia and chemotherapy. Results: The population of multiple myeloma patients under investigation were all adults more than 18 years of age and numbered in 3944 patients. The mean age was 65.71 years. Among these 45% were females. While examining inpatient mortality we see that for patients that had AKI the odds of inpatient mortality are higher (Odds Ratio (OR) 1.75, p = 0.003, 95% Confidence Interval (CI) 1.21 – 2.56). History of Heart Failure (OR 2.28, 95% CI 1.59 – 3.28), and increasing age (OR 1.02, 95% CI 1.01 – 1.04) also appear to contribute towards higher odds of mortality. The effect of other comorbidities was not statistically significant. Among demographical characteristics being of Native American heritage or not belonging to any descriptive race predicted higher odds of mortality. Mean LOS was 11 days. Patients with AKI stayed in the hospital longer by ̃1.4 days (Coef. 1.39, 95% CI 0.41 – 2.37). LOS was higher in patients with a history of heart failure (2.61, 95% CI 0.89 – 4.34 and in those with a history of neutropenia (5.52, 95% CI 4.42 – 6.62). LOS was lower in patients with a history of smoking by 1 day. Age lowered the LOS by a clinically insignificant amount. Teaching hospitals had higher LOS by ̃4 days. The total charge for hospitalizations from AKI is higher by $31019 (95% CI 14444.23 – 47594.37). Other factors incurring higher cost include history of neutropenia, and teaching hospitals. Hospitals in the Midwest had lower cost compared to hospitals in the Northeast. Conclusions: Among patients that present with a principal diagnosis of multiple myeloma, having acute kidney injury, adversely affects inpatient outcomes that include, mortality, hospital length of stay and total hospitalization cost.

scholarly journals Catalytic iron and acute kidney injury

2016 ◽  
Vol 311 (5) ◽  
pp. F871-F876 ◽  
Author(s):  
David E. Leaf ◽  
Dorine W. Swinkels
Keyword(s):  
Acute Kidney Injury ◽  
Animal Models ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Redox Cycling ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Translational Studies ◽  
Labile Iron

Acute kidney injury (AKI) is a common and often devastating condition among hospitalized patients and is associated with markedly increased hospital length of stay, mortality, and cost. The pathogenesis of AKI is complex, but animal models support an important role for catalytic iron in causing AKI. Catalytic iron, also known as labile iron, is a transitional pool of non-transferrin-bound iron that is readily available to participate in redox cycling. Initial findings related to catalytic iron and animal models of kidney injury have only recently been extended to human AKI. In this review, we discuss the role of catalytic iron in human AKI, focusing on recent translational studies in humans, assay considerations, and potential therapeutic targets for future interventional studies.

scholarly journals In Nonagenarians, Acute Kidney Injury Predicts In-Hospital Mortality, while Heart Failure Predicts Hospital Length of Stay

PLoS ONE ◽  
2013 ◽  
Vol 8 (11) ◽  
pp. e77929 ◽  
Author(s):  
Chia-Ter Chao ◽  
Yu-Feng Lin ◽  
Hung-Bin Tsai ◽  
Nin-Chieh Hsu ◽  
Chia-Lin Tseng ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay

scholarly journals Prophylactic Fibrinogen Decreases Postoperative Bleeding but Not Acute Kidney Injury in Patients Undergoing Heart Transplantation

2017 ◽  
Vol 24 (6) ◽  
pp. 998-1004 ◽  
Author(s):  
Alireza Jahangirifard ◽  
Zargham Hossein Ahmadi ◽  
Farah Naghashzadeh ◽  
Babak Sharif-Kashani ◽  
Farin Rashid-Farokhi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Heart Transplantation ◽  
Postoperative Bleeding ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Packed Red Blood Cells ◽  
Complete Reversal

The present study is the premier clinical attempt to scrutinize the practicability of prophylactic fibrinogen infusion in patients undergoing heart transplantation (HT). A total of 67 consecutive patients who had undergone HT between January 2012 and December 2014 were assessed. After exclusion of some patients, 23 patients were given preoperative 2 g fibrinogen concentrate over a period of 15 minutes after the termination of cardiopulmonary bypass pump and complete reversal of heparin, and 30 patients were not given. Some laboratories were measured before general anesthesia and at 6 and 24 hours after surgery. In addition, major adverse events were also evaluated during hospitalization. The mean age of the patients was 39.5 ± 11.4 years, with a predominance of male sex (77.4%). All laboratories at baseline were comparable between groups. The length of hospital stay was longer in the control group compared to the fibrinogen group (20 [16-22] vs 16 [12-19] days; P = .005). There was a trend for patients in the fibrinogen group to have more acute kidney injury (AKI) after surgery (10% vs 30.4%) and less reoperation for bleeding (20% vs 8.7%). The amount of postoperative bleeding was significantly higher in the control group compared to the fibrinogen group ( P < .001). The number of packed red blood cell transfused during 24 hours after surgery was significantly lower in the fibrinogen group ( P < .001). The transfusion of fibrinogen in patients undergoing HT may be associated with reductions in postoperative bleeding, the number of packed red blood cells, and hospital length of stay; however, it may enhance postoperative AKI.

scholarly journals An Association Between Hyperchloremia and Acute Kidney Injury in Patients With Acute Ischemic Stroke

2020 ◽  
Vol 10 (4) ◽  
pp. 250-256
Author(s):  
J. Tyler Haller ◽  
Keaton Smetana ◽  
Michael J. Erdman ◽  
Todd A. Miano ◽  
Heidi M. Riha ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Matched Cohort ◽  
Increased Risk ◽  
The Relationship

Background and Purpose: While an association between hyperchloremia and worse outcomes, such as acute kidney injury and increased mortality, has been demonstrated in hemorrhagic stroke, it is unclear whether the same relationship exists after acute ischemic stroke. This study aims to determine the relationship between moderate hyperchloremia (serum chloride ≥115 mmol/L) and acute kidney injury in patients with ischemic stroke. Methods: This is a multicenter, retrospective, propensity-matched cohort study of adults admitted for acute ischemic stroke. The primary objective was to determine the relationship between moderate hyperchloremia and acute kidney injury, as defined by the Acute Kidney Injury Network criteria. Secondary objectives included mortality and hospital length of stay. Results: A total of 407 patients were included in the unmatched cohort (332 nonhyperchloremia and 75 hyperchloremia) and 114 patients (57 in each group) were matched based upon propensity scores. In the matched cohort, hyperchloremia was associated with an increased risk of acute kidney injury (relative risk 1.91 [95% confidence interval 1.01-3.59]) and a longer hospital length of stay (16 vs 12 days; P = .03). Mortality was higher in the hyperchloremia group (19.3% vs 10.5%, P = .19), but this did not reach statistical significance. Conclusions: In this study, hyperchloremia after ischemic stroke was associated with increased rates of acute kidney injury and longer hospital length of stay. Further research is needed to determine which interventions may increase chloride levels in patients with acute ischemic stroke and the association between hyperchloremia and clinical outcomes.

scholarly journals 50. Comparative Incidence of Acute Kidney Injury in Septic Patients Treated with Vancomycin in Combination with Piperacillin/Tazobactam vs. Cefepime

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S47-S47
Author(s):  
Erin Deja ◽  
Monica Schmidt ◽  
Jeremy J Frens ◽  
Ankit Nanavati
Keyword(s):  
Acute Kidney Injury ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Unknown Origin ◽  
Hospital Length Of Stay ◽  
Empiric Antibiotic Therapy ◽  
Variable Cost ◽  
Inpatient Mortality ◽  
Rifle Criteria ◽  
Comorbidity Burden

Abstract Background Empiric antibiotic therapy for sepsis of unknown origin is typically broad spectrum and covers P. aeruginosa and methicillin-resistant S. aureus (MRSA). Nephrotoxicity is a well-known adverse event of IV vancomycin and literature suggests that combination with piperacillin/tazobactam may increase risk for acute kidney injury (AKI) as compared to combination with other beta-lactams. However, evidence is conflicting. The primary outcome of this study was to compare incidence of AKI in septic patients treated with IV vancomycin and piperacillin/tazobactam (VZ) vs. cefepime (VC). Secondary outcomes include hospital length of stay, inpatient mortality, and impact to direct variable cost. Methods Adult patients discharged with a sepsis diagnosis code who received VZ or VC for ≥24 hours in 2012–2019 were retrospectively identified. AKI was defined using RIFLE criteria. Patients were excluded for ESRD on HD, AKI occurring &lt; 48 hours after treatment initiation or &gt;7 days after discontinuation, pregnancy, febrile neutropenia, or meningitis. Statistical analysis controlled for many factors including age, race, gender, Elixhauser comorbidity burden, hours to first antibiotic dose, length of stay, and receipt of concomitant nephrotoxins. Results A total of 12,405 patients were evaluated; 7,818 received VZ and 3,096 received VC. Patients given VC had a 40% reduction in risk of AKI compared to those given VZ (IRR 0.600; 95% CI 0.46–0.78). These patients also had a 4% reduction in risk of having one additional inpatient day (IRR 0.961; 95% CI 0.937–0.985). Patients who received VZ and experienced AKI were 82.3% more likely to die inpatient compared to patients that did not (IRR 1.822; 95% CI 1.50–2.21). Patients treated with VC incurred less in average direct variable cost than those treated with VZ (p = 0.034) and those who suffered AKI also incurred more on average than those without AKI (p = 0.005). Conclusion Compared to septic patients treated with VZ, those treated with VC had significantly decreased risk of AKI as defined by RIFLE criteria. Patients who received VZ were at higher risk for a longer hospital stay and, if they also experienced AKI, inpatient mortality. VZ was associated with higher direct variable cost and patients with AKI incurred more dollars per encounter than those without AKI. Disclosures All Authors: No reported disclosures

scholarly journals Serum Creatine Kinase Levels are not Associated with an Increased Need for Continuous Renal Replacement Therapy in Patients with Acute Kidney Injury Following Rhabdomyolysis

2021 ◽  
Author(s):  
Luniu Xiao ◽  
Xiao Ran ◽  
Yanxia Zhong ◽  
Yue Le ◽  
Shusheng Li
Keyword(s):  
Acute Kidney Injury ◽  
Creatine Kinase ◽  
Renal Replacement Therapy ◽  
Length Of Stay ◽  
Kidney Injury ◽  
Hospital Length ◽  
Serum Creatine Kinase ◽  
Hospital Length Of Stay ◽  
Renal Functions ◽  
Experimental Group

Abstract BackgroudRhabdomyolysis is a syndrome caused by the breakdown and necrosis of skeletal muscle tissues. As a result, there is leakage of various intercellular myocyte contents into the circulating blood stream. Severe rhabdomyolysis can lead to acute kidney injury (AKI) and cause potentially permanent kidney damage. Previous studies have reported benefit from continuous renal replacement therapy (CRRT) for rhabdomyolysis-associated AKI. For patients with AKI, the termination of CRRT often depends on the patient’s renal functions. Here, we asked whether serum creatine kinase (CK) levels should be considered for CRRT termination in patients with AKI following rhabdomyolysis.MethodsWe compared different CK levels in patients after CRRT termination and we observed the correlation between CK levels and clinical outcomes. For a retrospective study, we collected 86 cases with confirmed rhabdomyolysis-associated AKI, who had received CRRT from January 1st of 2012 to December 31th of 2020 in Tongji Hospital. Patients’ renal functions were assessed within 24 hours of intermission, and patients with urine output ≥ 1,000 mL and serum creatinine ≤ 265 umol/L were considered for CRRT termination. Following CRRT termination, patients were divided into a CK > 5,000 U/L group (experimental group) and a CK < 5,000 U/L group (control group). The outcomes, such as in-hospital mortality and in-hospital length of stay, were compared between two groups.ResultsThirty-three (38.37%) patients were classified as having CK > 5,000 U/L, while 53 (61.63%) were categorized as having CK < 5,000 U/L. The majority of laboratory examinations were comparable between the two groups on admission. The higher CK levels, as well as worse renal functions, predicted the necessity of CRRT continuation for patients. After CRRT termination, the in-hospital mortality (27.27% vs 22.64, p = 0.389) and Multiple Organ Dysfunction Syndrome (MODS) incidence (51.52% vs 49.06%, p = 0.064) were similar between two groups, while the experimental group showed a significantly shorter in-hospital length of stay (11.88 ± 1.469 vs 16.42 ± 1.290, p = 0.026) and Intensive Care Unit (ICU) length of stay (7.545 ± 0.866 vs 10.11 ± 0.793, p = 0.038).ConclusionCRRT termination may be independent of s the CK levels for patients with rhabdomyolysis-associated acute kidney injure, providing their renal functions have recovered to an appropriate level. Prospective clinical trials would be needed to more thoroughly investigate the optimal CK range that could be used as a gauge to prevent recurrence of renal impairments after treatments.

scholarly journals Geospatial Distribution and Predictors of Mortality in Hospitalized Patients With COVID-19: A Cohort Study

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
◽  
S K Mallipattu ◽  
R Jawa ◽  
R Moffitt ◽  
J Hajagos ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Cohort Study ◽  
Length Of Stay ◽  
Regression Models ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospitalized Patients ◽  
Hospital Length Of Stay ◽  
Logistic Regression Models

Abstract Background The global coronavirus disease 2019 (COVID-19) pandemic offers the opportunity to assess how hospitals manage the care of hospitalized patients with varying demographics and clinical presentations. The goal of this study was to demonstrate the impact of densely populated residential areas on hospitalization and to identify predictors of length of stay and mortality in hospitalized patients with COVID-19 in one of the hardest hit counties internationally. Methods This was a single-center cohort study of 1325 sequentially hospitalized patients with COVID-19 in New York between March 2, 2020, to May 11, 2020. Geospatial distribution of study patients’ residences relative to population density in the region were mapped, and data analysis included hospital length of stay, need and duration of invasive mechanical ventilation (IMV), and mortality. Logistic regression models were constructed to predict discharge dispositions in the remaining active study patients. Results The median age of the study cohort (interquartile range [IQR]) was 62 (49–75) years, and more than half were male (57%) with history of hypertension (60%), obesity (41%), and diabetes (42%). Geographic residence of the study patients was disproportionately associated with areas of higher population density (rs = 0.235; P = .004), with noted “hot spots” in the region. Study patients were predominantly hypertensive (MAP &gt; 90 mmHg; 670, 51%) on presentation with lymphopenia (590, 55%), hyponatremia (411, 31%), and kidney dysfunction (estimated glomerular filtration rate &lt; 60 mL/min/1.73 m2; 381, 29%). Of the patients with a disposition (1188/1325), 15% (182/1188) required IMV and 21% (250/1188) developed acute kidney injury. In patients on IMV, the median (IQR) hospital length of stay in survivors (22 [16.5–29.5] days) was significantly longer than that of nonsurvivors (15 [10–23.75] days), but this was not due to prolonged time on the ventilator. The overall mortality in all hospitalized patients was 15%, and in patients receiving IMV it was 48%, which is predicted to minimally rise from 48% to 49% based on logistic regression models constructed to project disposition in the remaining patients on ventilators. Acute kidney injury during hospitalization (odds ratioE, 3.23) was the strongest predictor of mortality in patients requiring IMV. Conclusions This is the first study to collectively utilize the demographics, clinical characteristics, and hospital course of COVID-19 patients to identify predictors of poor outcomes that can be used for resource allocation in future waves of the pandemic.

Acute Kidney Injury in Children With Acute Respiratory Failure

2018 ◽  
Vol 57 (11) ◽  
pp. 1340-1348 ◽  
Author(s):  
Sindy M. Villacrés ◽  
Shivanand S. Medar ◽  
Scott I. Aydin
Keyword(s):  
Acute Kidney Injury ◽  
Respiratory Failure ◽  
Length Of Stay ◽  
Serum Creatinine ◽  
Acute Respiratory Failure ◽  
Kidney Injury ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Critically Ill Children ◽  
Positive End Expiratory Pressure

Background. Acute kidney injury (AKI) is common in critically ill children and develops in association with organ system dysfunction, with acute respiratory failure (ARF) one of the most common. We aim to study AKI in the pediatric ARF population. Methods. Data were retrospectively collected on children aged 1 day to 18 years admitted to the pediatric intensive care unit (PICU) with ARF between 2010 and 2013. Descriptive statistics and multivariate analyses utilizing Mann-Whitney U, Wilcoxon signed rank, χ2, or Fisher’s exact tests were performed to identify risk factors associated with AKI. Results. A total of 186 patients, with median age of 36 months (interquartile range 4-120 months) met the inclusion criteria. ARF was related to pulmonary disease in 49%. AKI was noted in 53% of patients. Patients with AKI had significantly higher serum creatinine ( P < .001) and lower estimated creatinine clearance ( P < .001) compared with those without AKI. Among patients with moderate and severe acute respiratory distress syndrome (ARDS), 64% had AKI versus 46% with mild or no ARDS ( P = .02). Patients with AKI had significantly lower PaO2/FiO2 ratio ( P = .03), longer PICU ( P = .03), and longer hospital length of stay ( P = .01). ARDS patients were less likely to be AKI free on day 7 of hospitalization, as compared with those without ARDS. Multivariate analysis revealed positive end expiratory pressure (odds ratio [OR] = 1.2, confidence interval [CI] = 1.0-1.4; P = .03) and admission serum creatinine (OR = 27.9, CI = 5.2-148.5; P < .001) to be independently associated with AKI. Conclusions. AKI is common in children with ARF. In patients with ARF and AKI, AKI is associated with ARDS and longer PICU and hospital length of stay. Positive end expiratory pressure and serum creatinine are independently associated with AKI.

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