Epidemiology of Acute Kidney Injury

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist.

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Epidemiology of Acute Kidney Injury

10.2310/nephro.12033 ◽

2017 ◽

Author(s):

Verônica Torres Costa e Silva ◽

Renato Antunes Caires ◽

Elerson Carlos Costalonga ◽

Emmanuel A. Burdmann

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Low Income ◽

Rural Areas ◽

Hospital Admissions ◽

De Novo ◽

Residual Disease ◽

Multiorgan Failure ◽

Kidney Injury ◽

Low Income Countries

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Prevalence and access to care for cardiovascular risk factors in older people in Sierra Leone: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2020-038520 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038520

Author(s):

Maria Lisa Odland ◽

Tahir Bockarie ◽

Haja Wurie ◽

Rashid Ansumana ◽

Joseph Lamin ◽

...

Keyword(s):

Risk Factors ◽

Access To Care ◽

Sierra Leone ◽

Low Income ◽

Rural Areas ◽

Urban Areas ◽

Disease Risk ◽

Cardiovascular Disease Risk ◽

Health System Strengthening ◽

Low Income Countries

IntroductionPrevalence of cardiovascular disease risk factors (CVDRFs) is increasing, especially in low-income countries. In Sierra Leone, there is limited empirical data on the prevalence of CVDRFs, and there are no previous studies on the access to care for these conditions.MethodsThis study in rural and urban Sierra Leone collected demographic, anthropometric measurements and clinical data from randomly sampled individuals over 40 years old using a household survey. We describe the prevalence of the following risk factors: diabetes, hypertension, dyslipidaemia, overweight or obesity, smoking and having at least one of these risk factors. Cascades of care were constructed for diabetes and hypertension using % of the population with the disease who had previously been tested (‘screened’), knew of their condition (‘diagnosed’), were on treatment (‘treated’) or were controlled to target (‘controlled’). Multivariable regression was used to test associations between prevalence of CVDRFs and progress through the cascade for hypertension with demographic and socioeconomic variables. In those with recognised disease who did not seek care, reasons for not accessing care were recorded.ResultsOf 2071 people, 49.6% (95% CI 49.3% to 50.0%) of the population had hypertension, 3.5% (3.4% to 3.6%) had diabetes, 6.7% (6.5% to 7.0%) had dyslipidaemia, 25.6% (25.4% to 25.9%) smoked and 26.5% (26.3% to 26.8%) were overweight/obese; a total of 77.1% (76.6% to 77.5%) had at least one CVDRF. People in urban areas were more likely to have diabetes and be overweight than those living in rural areas. Moreover, being female, more educated or wealthier increased the risk of having all CVDRFs except for smoking. There is a substantial loss of patients at each step of the care cascade for both diabetes and hypertension, with less than 10% of the total population with the conditions being screened, diagnosed, treated and controlled. The most common reasons for not seeking care were lack of knowledge and cost.ConclusionsIn Sierra Leone, CVDRFs are prevalent and access to care is low. Health system strengthening with a focus on increased access to quality care for CVDRFs is urgently needed.

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Impact of Acute Kidney Injury on Outcomes of Hospitalizations for Heat Stroke in the United States

Diseases ◽

10.3390/diseases8030028 ◽

2020 ◽

Vol 8 (3) ◽

pp. 28

Author(s):

Charat Thongprayoon ◽

Fawad Qureshi ◽

Tananchai Petnak ◽

Wisit Cheungpasitporn ◽

Api Chewcharat ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Resource Utilization ◽

Hospital Admissions ◽

Heat Stroke ◽

Kidney Injury ◽

Length Of Hospital Stay ◽

The United States

This study aims to evaluate the risk factors and the association of acute kidney injury with treatments, complications, outcomes, and resource utilization in patients hospitalized for heat stroke in the United States. Hospitalized patients from years 2003 to 2014 with a primary diagnosis of heat stroke were identified in the National Inpatient Sample dataset. End stage kidney disease patients were excluded. The occurrence of acute kidney injury during hospitalization was identified using the hospital diagnosis code. The associations between acute kidney injury and clinical characteristics, in-hospital treatments, outcomes, and resource utilization were assessed using multivariable analyses. A total of 3346 hospital admissions were included in the analysis. Acute kidney injury occurred in 1206 (36%) admissions, of which 49 (1.5%) required dialysis. The risk factors for acute kidney injury included age 20–39 years, African American race, obesity, chronic kidney disease, congestive heart failure, and rhabdomyolysis, whereas age <20 or ≥60 years were associated with lower risk of acute kidney injury. The need for mechanical ventilation and blood transfusion was higher when acute kidney injury occurred. Acute kidney injury was associated with electrolyte and acid-base derangements, sepsis, acute myocardial infarction, ventricular arrhythmia or cardiac arrest, respiratory, circulatory, liver, neurological, hematological failure, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher in acute kidney injury patients. Approximately one third of heat stroke patients developed acute kidney injury during hospitalization. Acute kidney injury was associated with several complications, and higher mortality and resource utilization.

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Assessment of cardiovascular risk among adults in a rural area of Kancheepuram district, Tamil Nadu

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20180253 ◽

2018 ◽

Vol 5 (2) ◽

pp. 698

Author(s):

Velavan A. ◽

Jyothi Vasudevan ◽

Arun S. ◽

Anil J. Purty ◽

Vincent A.

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Diseases ◽

Low Income ◽

Rural Areas ◽

Tamil Nadu ◽

Low Cost ◽

Low Income Countries ◽

Cross Sectional ◽

Cooking Oils

Background: Increasing longevity of the world’s population has resulted in a shift in the disease patterns prevalent hitherto. The worst affected are the middle and low- income countries including India. The genetic make-up of Indians render them highly susceptible to cardiovascular diseases and diabetes at a much earlier age with resultant higher mortality rates. Thus, low- cost early detection, and innovative, customized preventive strategies are the need of the hour. Methods: In this cross- sectional study, we have used the WHO/ISH risk prediction charts tailor – made for the SEAR D region, to assess the cardiovascular risk of a rural population aged above 40 years. Data regarding multiple cardiovascular risk factors were collected using a pre- defined and pre-tested questionnaire, from 400 participants, including other variables like BP and anthropometric measurements. The data were entered in Microsoft excel and analysed using SPSS- ver16. Results: We found that 14.5% of the population had more than 10% risk of cardiovascular diseases and 41.5% were in stage I or II hypertension. People who belonged to the class II SES, use of oral tobacco, saturated cooking oils and sedentary lifestyle was found to be associated with high CV risk. However the association of CV risk with other risk factors like smoking and BMI was inconsistent. Conclusions: There is an increasing trend of cardiovascular risk in rural areas of Tamil Nadu and risk factors like higher socio economic class, use of oral tobacco, saturated cooking oils and sedentary occupation were found to be associated with high CV risk.

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MO383COVID - 19 AND AKUTE KIDNEY INJURY- A SINGLE CENTER EXPERIENCE

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab082.0037 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Ana Bulatovic ◽

Jelena Bjedov ◽

Vesna Maslarevic Radovic ◽

Nada Dimkovic ◽

Radomir Naumovic

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Wide Spectrum ◽

Multiorgan Failure ◽

Fatal Outcome ◽

Kidney Tissue ◽

Significant Risk ◽

Kidney Injury ◽

Wide Range ◽

D Dimer

Abstract Background and Aims The new coronavirus disease (COVID 19) has become a worldwide health emergency with a wide spectrum of clinical presentation, from common cold symptoms to multiorgan failure. A great number of medical centers have reported that patients with COVID-19 have developed acute kidney injury. The kidney is a target organ for SARS - COV2 because of ACE2 receptor, the binding site for this virus, is expressed in kidney tissue. The potential mechanisms for kidney injury are direct kidney injury, inflammation, activation of coagulation and complement cascades. Data from centers worldwide reported a wide range of AKI incidence, from 0,5% in China to 46% in USA. The aim of this study was to analyze incidence, risk factors and outcomes of AKI in hospitalized patients with COVID 19 who were treated from 01.04. to 01.06.2020. at Nephrology Department of University Clinical Center Zvezdara, which was at the time transformed into COVID hospital. Method This retrospective observational study included 51 patients who had normal kidney function before the infection with SARS COV2, and 7 of them developed dialysis non-dependent AKI. Analysis included data collection from the patients’ history including demographic, clinical and administrative data. Statistical analysis has been performed using SPSS software version 20 (IBM Corporation, New York, USA). Results Out of 51 patients 7 (13.7%) developed AKI, mean age was 59 + 16 years and 53% were male. Diabetes mellitus was present in 27 of patients with AKI, hypertension in 6/7, obesity in 3/7, coronary artery disease in 1/7 and 1 of 7 patients was smoker. These risk factors except obesity (p= 0.05) didn’t vary significantly between two groups (AKI and non AKI patients with COVID-19). Our results showed significant correlation between AKI development and obesity (p= 0.05, OR 4.75), Charlston index score (p=0.01), D dimer score (p=0.01), and CT COVID score (p=0.03). Regarding the outcome, COVID 19 patients with AKI showed 7-fold higher risk for fatal outcome (p= 0.046). Conclusion Obesity, higher D dimer values, worse CT findings and higher Charlston comorbidity score index were associated with acute kidney injury in patients with COVID 19. AKI proved to be significant risk factor for fatal outcome in patients with SARS COV2 infection.

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Acute Kidney Injury in Hospitalized Patients Infected with COVID-19 from Wuhan, China: A Retrospective Study

BioMed Research International ◽

10.1155/2021/6655185 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yujie Dai ◽

Zhifen Liu ◽

Xingguo Du ◽

Honglan Wei ◽

Yang Wu ◽

...

Keyword(s):

Risk Factors ◽

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Kidney Disease ◽

Hospital Admissions ◽

Kidney Injury ◽

Outcome Data ◽

Study Results ◽

Significant Difference ◽

Novel Coronavirus

Background. Since the first diagnosed case of infection with the novel coronavirus (SARS-CoV-2), there has been a rapid spread of the disease with an increasing number of cases confirmed every day, as well as a rising death toll. An association has been reported between acute kidney injury (AKI) and mortality in patients infected with SARS-CoV-2. Therefore, our study was conducted to explore possible risk factors of AKI as well as whether AKI was a risk factor for worse outcome, especially mortality among patients with coronavirus disease (COVID-19). Methods. We included all hospital admissions with confirmed or clinically diagnosed COVID-19 from January 29 to February 25, 2020. We collected demographic and epidemiological information, past medical history, symptoms, laboratory tests, treatments, and outcome data from electronic medical records. A total of 492 patients with diagnosed or clinically diagnosed COVID-19 were included in this study. Results. The prevalence rate of AKI was 7.32%. Among the factors associated with AKI, males versus females (aOR 2.73), chronic kidney disease (aOR 42.2), hypertension (aOR 2.82), increased leucocytes (aOR 6.08), and diuretic use (aOR 7.89) were identified as independent risk factors for AKI among patients infected by SARS-CoV-2. There was a significant difference in hospital fees and death in patients with and without AKI ( p < 0.05 ). The mortality rate in patients with AKI was 63.9%. Conclusions. AKI was widespread among patients with COVID-19. The risk factors of AKI in COVID-19 patients included sex, chronic kidney disease, hypertension, infection, and diuretic use. AKI may be associated with a worse outcome, especially mortality in COVID-19 patients.

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Abstract 356: Hospital Safety Net Status and Clinical Outcomes After Trans-catheter Aortic Valve Replacement

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/hcq.13.suppl_1.356 ◽

2020 ◽

Vol 13 (Suppl_1) ◽

Author(s):

Muhammad A Sheikh ◽

Salil V Deo ◽

Haris Riaz ◽

Shahzeb Khan ◽

Sajjad Raza ◽

...

Keyword(s):

Acute Kidney Injury ◽

Valve Replacement ◽

Low Income ◽

Hospital Admissions ◽

Large Population ◽

Kidney Injury ◽

Safety Net ◽

Preliminary Evidence ◽

Risk Scores ◽

Procedural Outcomes

Introduction: Safety-net hospitals (SNH) treat a large population of un-insured and low income patients; several prior studies report worse outcome at these centers. Trans-catheter valve replacement (TAVR) is emerging as first-line therapy for aortic stenosis irrespective of surgical risk scores. However, results of TAVR performed at these centers is limited. Objective: To determine whether post-procedural outcomes of TAVR are comparable at safety-net (SNH) and non-safety net hospitals (non-SNH). Methods: We conducted a retrospective, cohort study with propensity-matched analysis. Complex survey data from the Agency for Healthcare Quality and Research containing weighted sample of all hospital admissions nationwide was utilized for this study. Adults undergoing TAVR at US hospitals participating in the National In-patient sample (NIS) database from January 2014 - December 2015 were included. A 1:1 propensity-matched cohort of patients operated at safety-net hospitals (SNH) and non-SNH institutions was analyzed. Propensity-matching was performed on the basis of sixteen demographic and clinical confounding co-variates. Main outcome studied was all-cause post-procedural mortality. Secondary outcomes compared were stroke, acute kidney injury and length of post-operative stay. Results: Between 2014 - 2015, 41410 patients (mean age 80 +/- 0.11 years, 46% female) underwent TAVR at 731 centers nationwide; 6996 (16.80 %) procedures were performed at safety net centers. SNH comprised 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49 % vs 46 %, p <0.001); admitted emergently (31% vs 21%; p <0.001) and at the lowest quartile for household income (25% % vs 20 %; p <0.001). A large proportion of SNH patients were minorities (Blacks 5.9% vs 3.9%; Hispanic 7.2% vs 3.2%). Adjusted logistic regression was performed on 6995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99 (0.98 - 1.007); p = 0.43], stroke [OR 1.009 (0.99-1.02); p = 0.08], and acute kidney injury [OR 0.99 (0.96 - 1.01); p = 0.5] were comparable in both cohorts. Overall length of stay was also similar (6.9 +/- 0.1 vs 7.1 +/- 0.2 days; p = 057). Conclusion: Post-procedural outcomes after TAVR at SNH are comparable to national outcomes. Our study provides preliminary evidence that wider adoption of TAVR may not adversely influence outcomes at SNH.

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