Acute Kidney Injury Following Rhabdomyolysis in Critically Ill Patients

Abstract Introduction Rhabdomyolysis, which resulted from the rapid breakdown of damaged skeletal muscle, potentially leads to acute kidney injury. Aim To determine the incidence and associated risk of kidney injury following rhabdomyolysis in critically ill patients. Methods All critically ill patients admitted from January 2016 to December 2017 were screened. A creatinine kinase level of > 5 times the upper limit of normal (> 1000 U/L) was defined as rhabdomyolysis, and kidney injury was determined based on the Kidney Disease Improving Global Outcome (KDIGO) score. In addition, trauma, prolonged surgery, sepsis, antipsychotic drugs, hyperthermia were included as risk factors for kidney injury. Results Out of 1620 admissions, 149 (9.2%) were identified as having rhabdomyolysis and 54 (36.2%) developed kidney injury. Acute kidney injury, by and large, was related to rhabdomyolysis followed a prolonged surgery (18.7%), sepsis (50.0%) or trauma (31.5%). The reduction in the creatinine kinase levels following hydration treatment was statistically significant in the non- kidney injury group (Z= -3.948, p<0.05) compared to the kidney injury group (Z= -0.623, p=0.534). Significantly, odds of developing acute kidney injury were 1.040 (p<0.001) for mean BW >50kg, 1.372(p<0.001) for SOFA Score >2, 5.333 (p<0.001) for sepsis and the multivariate regression analysis showed that SOFA scores >2 (p<0.001), BW >50kg (p=0.016) and sepsis (p<0.05) were independent risk factors. The overall mortality due to rhabdomyolysis was 15.4% (23/149), with significantly higher incidences of mortality in the kidney injury group (35.2%) vs the non- kidney injury (3.5%) [ p<0.001]. Conclusions One-third of rhabdomyolysis patients developed acute kidney injury with a significantly high mortality rate. Sepsis was a prominent cause of acute kidney injury. Both sepsis and a SOFA score >2 were significant independent risk factors.

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Factors Determining Nephrotoxicity and Mortality in Critical Care Patients Receiving Colistin

The Journal of Infection in Developing Countries ◽

10.3855/jidc.9443 ◽

2018 ◽

Vol 11 (12) ◽

pp. 912-917 ◽

Cited By ~ 1

Author(s):

Ali Ciftci ◽

Seval Izdes ◽

Neriman Defne Altintas

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Demographic Data ◽

Kidney Injury ◽

Apache Ii ◽

Factors Affecting ◽

Acute Kidney Injury Group ◽

Injury Group ◽

Independent Risk Factors ◽

Critical Patients

Introduction: We aimed to determine risk factors for nephrotoxicity and factors affecting mortality in patients who received colistin. Methodology: Critical patients who received colistin were enrolled. Pregnancy, age < 18 years, basal creatinine level > 2 mg/dL, colistin use for < 48 hours, and previous renal replacement therapy were exclusion criteria. KDIGO stages were determined according to creatinine levels. Patients were grouped as those with no acute kidney injury (Group N0) and those with acute kidney injury (Group N). Their demographic data, APACHE II and SOFA scores, treatments, and laboratory results were recorded. Results: A total of 91 patients were included: 27 in Group N0 and 64 in Group N. Demographic data were similar between groups; however, higher admission APACHE-II scores (OR:1.179, 95% CI:1.033-1.346, p = 0.015) and need for vasopressors (OR:5.486, 95% CI:1.522–19.769, p = 0.009) were found to be independent risk factors for nephrotoxicity. Higher APACHE II scores (OR:1.253, %95 CI:1.093-1.437, p = 0.001), presence of coronary artery disease (OR:7.720, % 95 CI: 1.613-36.956, p = 0.011), need for vasopressors (OR: 4.587, % 95 CI: 1.224 – 17.241, p = 0.024), hypoalbuminemia (OR: 4.721, % 95 CI: 1.088 – 20.469, p = 0.038), and higher direct bilirubin levels (OR: 1.806, % 95 CI: 1.055 – 3.092, p = 0.031) were independent risk factors for mortality. Conclusion: When use of colistin is considered in ICU patients, presence of modifiable risk factors for nephrotoxicity such as hypoalbuminemia, nephrotoxic drug administration, and presence of shock should be determined and managed to prevent nephrotoxicity.

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INCIDENCE, RISK FACTORS AND SURVIVAL OF CRITICALLY-ILL PATIENTS WITH ACUTE KIDNEY INJURY

Texto & Contexto - Enfermagem ◽

10.1590/s0104-07072021000100387 ◽

2021 ◽

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Incidence Risk

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Risk Factors For Kidney Damage In COVID-19 Patients Admitted To The Intensive Care Unit

Russian Open Medical Journal ◽

10.15275/rusomj.2021.0203 ◽

2021 ◽

Vol 10 (2) ◽

Author(s):

Diana K. Sarkisian ◽

Natalia V. Chebotareva ◽

Valerie McDonnell ◽

Armen V. Oganesyan ◽

Tatyana N. Krasnova ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Kidney Damage ◽

Elderly Age ◽

Total Blood ◽

Independent Risk Factors

Background — Acute kidney injury (AKI) reaches 29% in the intensive care unit (ICU). Our study aimed to determine the prevalence, features, and the main AKI factors in critically ill patients with coronavirus disease 2019 (COVID-19). Material and Methods — The study included 37 patients with COVID-19. We analyzed the total blood count test results, biochemical profile panel, coagulation tests, and urine samples. We finally estimated the markers of kidney damage and mortality. Result — All patients in ICU had proteinuria, and 80.5% of patients had hematuria. AKI was observed in 45.9% of patients. Independent risk factors were age more than 60 years, increased C-reactive protein (CRP) level, and decreased platelet count. Conclusion — Kidney damage was observed in most critically ill patients with COVID-19. The independent risk factors for AKI in critically ill patients were elderly age, a cytokine response with a high CRP level.

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Elevated serum galectin-1 concentrations are associated with increased risks of mortality and acute kidney injury in critically ill patients

PLoS ONE ◽

10.1371/journal.pone.0257558 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257558

Author(s):

Ruey-Hsing Chou ◽

Chuan-Tsai Tsai ◽

Ya-Wen Lu ◽

Jiun-Yu Guo ◽

Chi-Ting Lu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Sofa Score ◽

Critically Ill Patients ◽

Medical Center ◽

Elevated Serum ◽

Kidney Injury ◽

The Body ◽

Icu Admission ◽

Increased Risk

Background Galectin-1 (Gal-1), a member of the β-galactoside binding protein family, is associated with inflammation and chronic kidney disease. However, the effect of Gal-1 on mortality and acute kidney injury (AKI) in critically-ill patients remain unclear. Methods From May 2018 to March 2020, 350 patients admitted to the medical intensive care unit (ICU) of Taipei Veterans General Hospital, a tertiary medical center, were enrolled in this study. Forty-one patients receiving long-term renal replacement therapy were excluded. Serum Gal-1 levels were determined within 24 h of ICU admission. The patients were divided into tertiles according to their serum Gal-1 levels (low, serum Gal-1 < 39 ng/ml; median, 39–70 ng/ml; high, ≥71 ng/ml). All patients were followed for 90 days or until death. Results Mortality in the ICU and at 90 days was greater among patients with elevated serum Gal-1 levels. In analyses adjusted for the body mass index, malignancy, sepsis, Sequential Organ Failure Assessment (SOFA) score, and serum lactate level, the serum Gal-1 level remained an independent predictor of 90-day mortality [median vs. low: adjusted hazard ratio (aHR) 2.11, 95% confidence interval (CI) 1.24–3.60, p = 0.006; high vs. low: aHR 3.21, 95% CI 1.90–5.42, p < 0.001]. Higher serum Gal-1 levels were also associated with a higher incidence of AKI within 48 h after ICU admission, independent of the SOFA score and renal function (median vs. low: aHR 2.77, 95% CI 1.21–6.34, p = 0.016; high vs. low: aHR 2.88, 95% CI 1.20–6.88, p = 0.017). The results were consistent among different subgroups with high and low Gal-1 levels. Conclusion Serum Gal-1 elevation at the time of ICU admission were associated with an increased risk of mortality at 90 days, and an increased incidence of AKI within 48 h after ICU admission.

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Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit

Annals of Intensive Care ◽

10.1186/s13613-018-0373-y ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 13

Author(s):

Dana Y. Fuhrman ◽

Sandra Kane-Gill ◽

Stuart L. Goldstein ◽

Priyanka Priyanka ◽

John A. Kellum

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

Adult Intensive Care Unit ◽

Injury Epidemiology

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Survival in Critically Ill Patients with Acute Kidney Injury Treated with Early Hemodiafiltration

The International Journal of Artificial Organs ◽

10.1177/039139881203501202 ◽

2012 ◽

Vol 35 (12) ◽

pp. 1039-1046 ◽

Cited By ~ 3

Author(s):

Nicolas Boussekey ◽

Benoit Capron ◽

Pierre-Yves Delannoy ◽

Patrick Devos ◽

Serge Alfandari ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Mortality Risk ◽

Critically Ill Patients ◽

Kidney Injury ◽

Icu Patients ◽

Impact On Survival ◽

Baseline Characteristics ◽

The Moment

Purpose Early renal replacement therapy (RRT) initiation should theoretically influence many physiological disorders related to acute kidney injury (AKI). Currently, there is no consensus about RRT timing in intensive care unit (ICU) patients. Methods We performed a retrospective analysis of all critically ill patients who received RRT in our ICU during a 3 year-period. Our goal was to identify mortality risk factors and if RRT initiation timing had an impact on survival. RRT timing was calculated from the moment the patient was classified as having acute kidney injury in the RIFLE classification. Results A hundred and ten patients received RRT. We identified four independent mortality risk factors: need for mechanical ventilation (OR = 12.82 (1.305 - 125.868, p = 0.0286); RRT initiation timing >16 h (OR = 5.66 (1.954 - 16.351), p = 0.0014); urine output on admission <500 ml/day (OR = 4.52 (1.666 - 12.251), p = 0.003); and SAPS II on admission >70 (OR = 3.45 (1.216 - 9.815), p = 0.02). The RRT initiation <16 h and RRT initiation >16 h groups presented the same baseline characteristics, except for more severe gravity scores and kidney failure in the early RRT group. Conclusions Early RRT in ICU patients with acute kidney injury or failure was associated with increased survival.

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Incidence and risk factors of acute kidney injury associated with continuous intravenous high-dose vancomycin in critically ill patients

Medicine ◽

10.1097/md.0000000000006023 ◽

2017 ◽

Vol 96 (7) ◽

pp. e6023 ◽

Cited By ~ 6

Author(s):

Guillaume Lacave ◽

Vincent Caille ◽

Fabrice Bruneel ◽

Catherine Palette ◽

Stéphane Legriel ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury ◽

High Dose

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The Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients Undergoing Emergency Surgery: A Prospective Observational Study

10.21203/rs.3.rs-78039/v1 ◽

2020 ◽

Author(s):

Linhui Hu ◽

Lu Gao ◽

Danqing Zhang ◽

Yating Hou ◽

Yujun Deng ◽

...

Keyword(s):

Risk Factors ◽

Critically Ill ◽

Critically Ill Patients ◽

Emergency Surgery ◽

Kidney Injury ◽

Apache Ii Score ◽

Incidence Risk ◽

Postoperative Serum ◽

Independent Risk Factors ◽

Postoperative Aki

Abstract BackgroundPostoperative acute kidney injury (AKI) is associated with higher morbidity, mortality, and economic burden. However, there is a lack of evaluation of postoperative AKI in highly heterogeneous critically ill patients undergoing emergency surgery. To explore the incidence, risk factors, and prognosis, to clarify the epidemiological status, and to improve the early identification and diagnosis of postoperative AKI, this study was taken.MethodsA prospective observational study was conducted in the general intensive care units of Guangdong Provincial People's Hospital from January 2014 to March 2018. Preoperative variables, intraoperative variables, postoperative variables, and postoperative prognosis data were collected. The diagnosis and staging of postoperative AKI were based on the Kidney Disease: Improving Global Outcomes criteria. They were divided into two groups according to whether postoperative AKI occurred: AKI group and non-AKI group. The baseline characteristics, postoperative AKI incidence, AKI stage, and in-hospital prognosis in all enrolled patients were analyzed prospectively. Multivariate logistic forward stepwise (odds ratio, OR) regression was used to determine the independent risk factors of postoperative AKI. Results were presented using the OR with 95% confidence intervals (CIs).ResultsA total of 383 critically ill patients undergoing emergency surgery, 151 (39.4%) patients among them developed postoperative AKI. Postoperative reoperation, postoperative Acute Physiology and Chronic Health Evaluation (APACHE II) score, postoperative serum lactic acid (LAC), postoperative serum creatinine (sCr) were independent risk factors for postoperative AKI in critically ill patients undergoing emergency surgery, with the adjusted OR (ORadj) of 1.854 ( 95% CI, 1.091 - 3.152), 1.059 ( 95% CI, 1.018 - 1.102), 1. 239 (95% CI, 1.047 - 1.467), and 3.934 (95% CI, 2.426 - 6.382), respectively. Duration of mechanical ventilation, renal replacement therapy, ICU and hospital mortality, ICU and hospital length of stay, total ICU and hospital costs were higher in the AKI group than in the non-AKI group.ConclusionsThe independent risk factors which included postoperative reoperation, postoperative APACHE II score, postoperative LAC, and postoperative sCr could improve the early diagnosis and prevention of postoperative AKI and identify the higher risk of adverse outcomes in critically ill patients undergoing emergency surgery.

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