Effect of ionized serum calcium on outcomes in acute kidney injury needing renal replacement therapy: secondary analysis of the acute renal failure trial network study

Abstract Background Albumin (ALB) levels are negatively associated with mortality in patients with sepsis. However, among sepsis patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT), there has been no similar study on the correlation between ALB levels and mortality alone. This study tested the hypothesis that ALB levels are negatively associated with mortality among such patients. Methods We conducted a secondary analysis of 794 patients with sepsis who were diagnosed with AKI and underwent CRRT in South Korea. For the Kaplan–Meier survival analysis, Cox proportional hazards models were used to study the hypotheses, with adjustments for the pertinent covariables. Results The ALB level was an independent prognostic factor for death at 28 and 90 days after CRRT initiation (HR=0.75, 95% CI: 0.62–0.90, P=0.0024 for death at 28 days and HR=0.73, 95% CI: 0.63–0.86, P<0.0001 for death at 90 days). A nonlinear association was not identified between ALB levels and the endpoints. Subgroup analyses and tests for interactions indicated that patients with low HCO3 levels (<22 mmol/L) had a higher rate of death at 28 days (P for interaction=0.0235), and there was a significantly increased mortality at 90 days among patients with high CRP levels (P for interaction=0.0195). Conclusion A 1 g/dL increase in ALB levels was independently associated with a 25% and 27% decrease in the risk of death at 28 and 90 days, respectively. It is feasible to predict mortality using ALB levels in sepsis patients with AKI undergoing CRRT.

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Predictors of Health Utility among 60-Day Survivors of Acute Kidney Injury in the Veterans Affairs/National Institutes of Health Acute Renal Failure Trial Network Study

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.02570310 ◽

2010 ◽

Vol 5 (8) ◽

pp. 1366-1372 ◽

Cited By ~ 59

Author(s):

Kirsten L. Johansen ◽

Mark W. Smith ◽

Mark L. Unruh ◽

Andrew M. Siroka ◽

Theresa Z. O'Connor ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Kidney Injury ◽

Health Utility ◽

Veterans Affairs ◽

National Institutes Of Health ◽

Trial Network

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Safety of Argatroban in critically ill patients with acute kidney injury and renal replacement therapy after cardiac surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269141 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

M Klingele ◽

A Lerner-Gräber ◽

D Fliser ◽

HJ Schäfers ◽

H Groesdonk

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Critically Ill ◽

Critically Ill Patients ◽

Kidney Injury

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Preoperative Low Serum Albumin Levels Increase the Requirement of Renal Replacement Therapy after Cardiac Surgery

The Heart Surgery Forum ◽

10.1532/hsf.1577 ◽

2016 ◽

Vol 19 (3) ◽

pp. 123 ◽

Cited By ~ 7

Author(s):

Orhan Findik ◽

Ufuk Aydin ◽

Ozgur Baris ◽

Hakan Parlar ◽

Gokcen Atilboz Alagoz ◽

...

Keyword(s):

Acute Kidney Injury ◽

Regression Analysis ◽

Cardiac Surgery ◽

Renal Replacement Therapy ◽

Serum Albumin ◽

Replacement Therapy ◽

Kidney Injury ◽

Preoperative Serum ◽

Group I ◽

Group Ii

Background: Acute kidney injury is a common complication of cardiac surgery that increases morbidity and mortality. The aim of the present study is to analyze the association of preoperative serum albumin levels with acute kidney injury and the requirement of renal replacement therapy after isolated coronary artery bypass graft surgery (CABG). Methods: We retrospectively reviewed the prospectively collected data of 530 adult patients who underwent isolated CABG surgery with normal renal function. The perioperative clinical data of the patients included demographic data, laboratory data, length of stay, in-hospital complications and mortality. The patient population was divided into two groups: group I patients with preoperative serum albumin levels <3.5 mg/dL; and group II pateints with preoperative serum albumin levels ≥3.5 mg/dL. Results: There were 413 patients in group I and 117 patients in group II. Postoperative acute kidney injury (AKI) occured in 33 patients (28.2%) in group I and in 79 patients (19.1%) in group II. Renal replacement therapy was required in 17 patients (3.2%) (8 patients from group I; 9 patients from group II; P = .018). 30-day mortality occurred in 18 patients (3.4%) (10 patients from group I; 8 patients from group II; P = .037). Fourteen of these patients required renal replacement therapy. Logistic regression analysis revealing the presence of lower serum albumin levels preoperatively was shown to be associated with increased incidence of postoperative AKI (OR: 1.661; 95% CI: 1.037-2.661; P = .035). Logistic regression analysis also revealed that DM (OR: 3.325; 95% CI: 2.162-5.114; P = .000) was another independent risk factor for AKI after isolated CABG. Conclusion: Low preoperative serum albumin levels result in severe acute kidney injury and increase the rate of renal replacement therapy and mortality after isolated CABG.

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Faculty Opinions recommendation of Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725624320.793513409 ◽

2016 ◽

Author(s):

Claudio Ronco ◽

Zaccaria Ricci

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Kidney Injury

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ACUTE KIDNEY INJURY IN ELDERLY PATIENTS

Wiadomości Lekarskie ◽

10.36740/wlek201908109 ◽

2019 ◽

Vol 72 (8) ◽

pp. 1466-1472

Author(s):

Grażyna Kobus ◽

Jolanta Małyszko ◽

Hanna Bachórzewska-Gajewska

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Acute Renal Failure ◽

Elderly Patients ◽

Older Patients ◽

Age Groups ◽

Kidney Injury ◽

The Elderly ◽

Younger Patients ◽

Common Cause

Introduction: In the elderly, impairment of kidney function occurs. Renal diseases overlap with anatomic and functional changes related to age-related involutionary processes. Mortality among patients with acute renal injury is approximately 50%, despite advances in treatment and diagnosis of AKI. The aim: To assess the incidence of acute kidney injury in elderly patients and to analyze the causes of acute renal failure depending on age. Materials and methods: A retrospective analysis included medical documentation of patients hospitalized in the Nephrology Clinic during the 6-month period. During this period 452 patients were hospitalized in the clinic. A group of 77 patients with acute renal failure as a reason for hospitalization was included in the study. Results: The prerenal form was the most common cause of AKI in both age groups. In both age groups, the most common cause was dehydration; in the group of patients up to 65 years of age, dehydration was 29.17%; in the group of people over 65 years - 43.39%. Renal replacement therapy in patients with AKI was used in 14.29% of patients. In the group of patients up to 65 years of age hemodialysis was 16.67% and above 65 years of age. -13.21% of patients. The average creatinine level in the group of younger patients at admission was 5.16 ± 3.71 mg / dl, in the group of older patients 3.14 ± 1.63 mg / dl. The size of glomerular filtration GFR in the group of younger patients at admission was 21.14 ± 19.54 ml / min, in the group of older patients 23.34 ± 13.33 ml / min. Conclusions: The main cause of acute kidney injury regardless of the age group was dehydration. Due to the high percentage of AKI in the elderly, this group requires more preventive action, not only in the hospital but also at home.

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