scholarly journals RIFLE serum creatinine and urine output criteria combined is superior to RIFLE serum creatinine criterion alone in predicting Acute Kidney Injury (AKI) in critically ill patients: A prospective observational study

2020 ◽  
Vol 8 (1) ◽  
pp. 17-23
Author(s):  
Amina Sultana ◽  
Mohammad Omar Faruq ◽  
ASM Areef Ahsan ◽  
Uzzwal Kumar Mallick ◽  
Mohammad Asaduzzaman ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Urine Output ◽  
Data Entry ◽  
Kidney Injury ◽  
Adult Patients ◽  
Icu Admission

Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality. Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days). Design: Prospective observational cohort study. Duration of the study was one year (01 year), from January 2014 to December 2014 Method: All adult patients admitted into department of critical care medicine, BIRDEM General Hospital, DHAKA who received treatment for 48 hours and fulfilled the inclusion and exclusion criteria was included in the study. Representative serum creatinine value was obtained either from the day of admission in hospital, day of admission into or transfer to ICU or any document within last six months. The lesser of pre-ICU admission serum creatinine (SCr) and ICU admission SCr would serve as baseline renal function. Weight in kilogram, representative serum urea/BUN, co-morbidities and reason for ICU admission were incorporated in it. Patient’s daily data entry of renal replacement therapy, daily creatinine value, urinary output over 6 hours, 12 hours, and 24 hours, episode of anuria over 12 hours, if present were documented. Data collected on renal replacement therapy at the time of discharge, if any and outcome in terms of loss and ESRD status were collected. APACHE II data and SAPS II data were calculated and analyzed. Result: Total 236 adult patients were enrolled in the study to assess their renal function status using RIFLE (Risk, Injury, Failure, Loss, End Stage Renal Disease). Serum creatinine was estimated daily for seven days. Those patients who fulfilled the creatinine criteria for RIFLE were categorized into RIFLE serum creatinine (Scr) group. Those patients who met both the criteria for urine output and serum creatinine according to RIFLE was designated as RIFLE serum creatinine and urine output criteria Combined (Scr+ UO) group. In our study, mean of number of days needed for diagnosis of AKI using RIFLE creatinine (Scr) was 3.25 (±1.24) and using RIFLE combined (Scr+uo) criteria was 2.84(±1.03). Conclusion: The present study concludes that RIFLE serum creatinine criterion (Scr) alone delays the diagnosis of AKI in comparison to RIFLE serum creatinine and urine output criteria combined (Scr+UO). AKI should be graded using both the criteria of RIFLE serum creatinine and urine output criteria combined (Scr+UO). Urine output should not be underestimated in AKI diagnosis in ICU patients. Bangladesh Crit Care J March 2020; 8(1): 17-23

scholarly journals The Clinical Utility of Kinetic Glomerular Filtration Rate in the Assessment of Renal Function and Prediction of Outcomes Among Critically Ill Patients With Acute Kidney Injury: A Single-Center Retrospective Cohort Study

2021 ◽  
Vol 5 (1) ◽  
pp. 611-620
Author(s):  
Shari Ann Atanacio ◽  
Maria Rachel Uy
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Glomerular Filtration Rate ◽  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Urine Output ◽  
Filtration Rate ◽  
Kidney Injury

Objective: To determine the discriminatory ability of kinetic glomerular filtration rate (kGFR) to detect acute kidney injury (AKI) when compared with established GFR equations and criteria and relating it to mortality, renal replacement therapy initiation and renal recovery. Methods: This was a retrospective analysis using data from chart review of 109 intensive care unit (ICU) patients at the University of Santo Tomas Hospital (USTH). The renal function estimates using Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi), modification of diet in renal disease (MDRD), Kidney Disease Improving Global Outcomes Acute Kidney Injury (KDIGO AKI), as well as kinetic GFR equations were compared and correlated with renal and cardiovascular outcomes. Results: The renal function assessed by kGFR, CKD-Epi, MDRD and KDIGO staging based on serum creatinine (SCr) showed no significant association with mortality outcomes. However, AKI diagnosed based on urine output (UO), and combined SCr and urine output (KDIGO) showed association with all-cause mortality. The UO detected severe stages of AKI while SCr (based on KDIGO) better identified the earlier stages of AKI. The criteria for KDIGO AKI when combined also shows mortality prediction since it joins together the effects of SCr and UO. There was a remarkable 3.5 times increase  in hemodialysis initiation (p=0.0001) and 12.89 times increase in peritoneal dialysis initiation (p=0.01) for every stage increase in the KDIGO classification. kGFR, CKD-Epi and MDRD have 5%, 6%, and 6% decrease, respectively in the odds of initiating hemodialysis. There was however, no association for peritoneal dialysis. Conclusion: kGFR was the least able in detecting AKI and KDIGO AKI criteria remains to be the standard in identifying AKI in the critical care setting. Increase in SCr was a sensitive tool in diagnosing AKI due to its ability to detect AKI based on a small increase in SCr regardless of the baseline renal function. Decreasing UO, however, is the prognosticating variable in KDIGO AKI criteria, in that it portends higher probability of initiation of renal replacement therapy (RRT) and ultimately higher mortality when present.

scholarly journals Intermittent Hemodialysis For Patients With Acute Kidney Injury (AKI): Outcome In A Tertiary Level Hospital

2018 ◽  
Vol 17 (1) ◽  
pp. 25-30
Author(s):  
Arun Sharma ◽  
Binod Karki ◽  
Ajay Rajbhandari
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Acute Gastroenteritis ◽  
Kidney Injury ◽  
Tertiary Level ◽  
Intermittent Hemodialysis ◽  
The Mean ◽  
Level Hospital

INTRODUCTION: Acute kidney injury (AKI) is the sudden loss of renal function with accumulation of nitrogenous waste compounds. In developing countries, community acquired AKI is common than AKI in hospitalized septic patients. With conservative management many patients recover renal function however few require renal support with intermittent Hemodialysis (HD). We conducted a study to find out the etiology and outcome of the patients presenting with AKI who required dialysis.METHODS: This is a descriptive follow up study of the patients who needed renal replacement therapy in the form of HD presenting to our Nephrology unit of the hospital over a period of two years. Patients were followed up for three months post discharge. Data were tabulated and analyzed using SPSS software.RESULTS: Total 50 patients were included in study with 67% male. The commonest etiologies were urinary tract infection (30%) and  acute gastroenteritis (24%).The mean creatinine at the time of nephrology consultation, maximum level and at the time of discharge were 6.5(SD± 2.62), 7.3(SD ±2.13) and 2.2(SD ±1.75) respectively. Uremia with anuria was the most common reason for the initiation of HD in 54% cases. The mean number of intermittent HD used was 3.36. Complete recovery was seen in 68%, death in 26% and CKD in 6%.CONCLUSION: UTI followed by acute gastroenteritis are the leading cause of AKI in our tertiary level hospital. Timely initiated renal replacement therapy in the form of intermittent HD could lead to substantial renal recovery in almost three fourth of patients.

Sodium Bicarbonate and Renal Function after Cardiac Surgery

2015 ◽  
Vol 122 (2) ◽  
pp. 294-306 ◽  
Author(s):  
Michael Bailey ◽  
Shay McGuinness ◽  
Michael Haase ◽  
Anja Haase-Fielitz ◽  
Rachael Parke ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Sodium Bicarbonate ◽  
Replacement Therapy ◽  
Primary Outcome ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Double Blind

Abstract Background: The effect of urinary alkalinization in cardiac surgery patients at risk of acute kidney injury (AKI) is controversial and trial findings conflicting. Accordingly, the authors performed a prospectively planned individual patient data meta-analysis of the double-blind randomized trials in this field. Methods: The authors studied 877 patients from three double-blind, randomized controlled trials enrolled to receive either 24 h of intravenous infusion of sodium bicarbonate or sodium chloride. The primary outcome measure was a postoperative increase in serum creatinine concentration of greater than 25% or 0.5 mg/dl (> 44 μm/L) within the first five postoperative days. Secondary outcomes included the raw change in serum creatinine, greater than 50% and greater than 100% rises in serum creatinine, developing AKI (Acute Kidney Injury Network criteria), initiation of renal replacement therapy, morbidity, and mortality. Results: Patients were similar in demographics, comorbidities, and cardiac procedures. Sodium bicarbonate increased plasma bicarbonate (P < 0.001) and urine pH (P < 0.001). There were no differences in the development of the primary outcome (Bicarbonate 45% [39–51%] vs. Saline 42% [36–48%], P = 0.29). This result remained unchanged when controlling for study and covariates (odds ratio [OR], 99% confidence interval [CI]: Bicarbonate vs. Control, 1.11 [0.77–1.60], P = 0.45). There was, however, a significant study-adjusted benefit in elective coronary artery bypass surgery patients in terms of renal replacement therapy (Bicarbonate vs. Control, OR: 0.38 [99% CI: 0.25–0.58], P < 0.0001) and the development of an Acute Kidney Injury Network grade = 3 (Bicarbonate vs. Control, OR: 0.45 [99% CI: 0.43–0.48], P < 0.0001). Conclusions: Urinary alkalinization using sodium bicarbonate infusion is not associated with an overall lower incidence of AKI; however, it reduces severe AKI and need for renal replacement therapy in elective coronary artery bypass patients.

scholarly journals Acute Poisoning with Rhabdomyolysis in the Intensive Care Unit: Risk Factors for Acute Kidney Injury and Renal Replacement Therapy Requirement

Toxics ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 79
Author(s):  
Pierre-François Rogliano ◽  
Sebastian Voicu ◽  
Laurence Labat ◽  
Nicolas Deye ◽  
Isabelle Malissin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Replacement Therapy ◽  
Predictive Factors ◽  
Kidney Injury ◽  
Major Complication ◽  
Female Gender ◽  
Acute Poisoning ◽  
Serum Phosphate

Acute kidney injury (AKI) is the major complication of rhabdomyolysis. We aimed to identify the predictive factors for AKI and renal replacement therapy (RRT) requirement in poisoning-associated rhabdomyolysis. We conducted a cohort study including 273 successive poisoned patients (median age, 41 years) who developed rhabdomyolysis defined as creatine kinase (CK) >1000 IU/L. Factors associated with AKI and RRT requirement were identified using multivariate analyses. Poisonings mainly involved psychotropic drugs. AKI occurred in 88 patients (37%) including 43 patients (49%) who required RRT. Peak serum creatinine and CK were weakly correlated (R2 = 0.17, p < 0.001). Death (13%) was more frequent after AKI onset (32% vs. 2%, p < 0.001). On admission, lithium overdose (OR, 44.4 (5.3–371.5)), serum calcium ≤2.1 mmol/L (OR, 14.3 (2.04–112.4)), female gender (OR, 5.5 (1.8–16.9)), serum phosphate ≥1.5 mmol/L (OR, 2.0 (1.0–4.2)), lactate ≥ 3.3 mmol/L (OR, 1.2 (1.1–1.4)), serum creatinine ≥ 125 µmol/L (OR, 1.05 (1.03–1.06)) and age (OR, 1.04 (1.01–1.07)) independently predicted AKI onset. Calcium-channel blocker overdose (OR, 14.2 (3.8–53.6)), serum phosphate ≥ 2.3 mmol/L (OR, 1.6 (1.1–2.6)), Glasgow score ≤ 5 (OR, 1.12; (1.02–1.25)), prothrombin index ≤ 71% (OR, 1.03; (1.01–1.05)) and serum creatinine ≥ 125 µmol/L (OR, 1.01; (1.00–1.01)) independently predicted RRT requirement. We identified the predictive factors for AKI and RRT requirement on admission to improve management in poisoned patients presenting rhabdomyolysis.

The Urine Protein NGAL Predicts Renal Replacement Therapy, but Not Acute Kidney Injury or 90-Day Mortality in Critically Ill Adult Patients

2014 ◽  
Vol 119 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Sara Nisula ◽  
Runkuan Yang ◽  
Kirsi-Maija Kaukonen ◽  
Suvi T. Vaara ◽  
Anne Kuitunen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adult Patients ◽  
Urine Protein

scholarly journals Acetate Ringer's solution versus 0.9% saline for septic patients: study protocol for a randomized controlled multicenter crossover trial

2020 ◽  
Author(s):  
Fang Liu ◽  
Jing Zhang ◽  
Yuan Zhu ◽  
Lianjiu Su ◽  
Yiming Li ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Intravenous Infusion ◽  
Crossover Trial ◽  
Kidney Injury ◽  
Hospital Death ◽  
Ringer’S Solution

Abstract Background: The previous study demonstrated that there were no significant differences between saline and balanced crystalloid solution infused in critical illness. However, the sepsis subgroup analysis showed the statistical difference. Thus, we will specifically focus on septic patients in this study to compare the effects of saline and balanced solution. We hypothesize that effects of saline on acute kidney injury (AKI) are related to the underline AKI severity and total volumes of infusion. Methods/design: The investigators designed a pragmatic, multi-centered crossover trial recruiting 312 patients who are diagnosed as sepsis/septic shock in the intensive care unit (ICU) and will be assigned with either acetate Ringer's solution or saline in the corresponding month. Patients with an end-stage renal disease (ESRD) or who need renal replacement therapy (RRT) prior to or at the time of enrollment are excluded. Enrolled patients will be regarded as with mild, moderate or severe sepsis on the basis of the severity of their illness, and will be divided into subgroups according to their initial renal function and various intravenous infusion volumes when being analyzed. The primary outcome is major adverse kidney events (MAKE), including the composite of in-hospital death, receipt of new renal replacement therapy, or persistent renal dysfunction. Secondary outcomes include 28 days-mortality, internal environment disturbance, incidence and duration of vasoactive drug treatment, duration of mechanical ventilation, duration of RRT and ICU and hospital length of stay. Results and Conclusions: To our knowledge, this study will be the first to focus on septic patients and provide credible and evident data on the comparison of outcome between acetate Ringer’s solution and saline for intravenous infusion in adult septic patients on the basis of baseline renal function and infusion volumes taken into consideration. Trial registration: ClinicalTrials.gov, identifiers: NCT03685214. Registered on August 15, 2018. https://clinicaltrials.gov/ct2/show/NCT03685214 Keywords: sepsis; septic shock; acute kidney injury; saline; acetate Ringer's solution.

scholarly journals Clinical Predictors of Mortality of Patients With Acute Kidney Injury Requiring Renal Replacement Therapy

2020 ◽  
Author(s):  
Chitchai Rattananukrom ◽  
Pantipa Tonsawan ◽  
Anupol Panitchote
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Serum Creatinine ◽  
Survival Time ◽  
Replacement Therapy ◽  
Sofa Score ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Clinical Predictors ◽  
Baseline Serum

Abstract Background: Acute kidney injury (AKI) is frequently encountered around 40% in critically ill patients and associate with a high mortality particularly in AKI patients requiring renal replacement therapy (RRT). The objective of this study was to assess the clinical predictors for 28-day mortality in AKI patients requiring RRT.Methods: This is a retrospective cohort study from prospectively collected data over a year (2014-2015). AKI patients requiring RRT were included. We collected demographic and laboratory data of AKI patients requiring RRT within 24 hours before initiation of RRT. We excluded patients with pre-existing chronic kidney disease stage 5 and AKI patients requiring peritoneal dialysis. We compared clinical characteristics and analyzed the predictors of mortality of survivors and non-survivors according to 28-day mortality.Results: We included 122 AKI patients requiring RRT. Mortality rate at day 28 and 90 after AKI diagnosis were 59% (95% confidence interval [CI] 49.7-67.8) and 72.1% (95%CI 63.3-79.9). On multivariable analysis, clinical predictors for 28-day mortality were baseline serum creatinine (hazard ratio [HR] 0.57, 95% CI 0.36-0.90), SOFA score before initiation of RRT (HR 1.08, 95%CI 1.01-1.15), presence of vasopressors before initiation of RRT (HR 3.04, 95%CI 1.12-8.25), serum lactate > 4 mmol/L before initiation of RRT effect <10 days of survival time (HR 2.49, 95%CI 1.17-5.26), and serum lactate > 4 mmol/L before initiation of RRT effect ≥10 days of survival time (HR 1.31, 95%CI 0.47-3.60).Conclusion: A lower baseline serum creatinine was associated with the mortality in AKI patients requiring RRT. SOFA score, presence of vasopressors, and a higher serum lactate before initiation of RRT are useful clinical predictors for the 28-day mortality.

Efficacy of Three Renal Replacement Therapy Modalities for the Treatment of Acute Kidney Injury Caused by Wasp Sting

2021 ◽  
pp. 1-11
Author(s):  
Fugang Li ◽  
Li Liu ◽  
Dezheng Chen ◽  
Yong Zhang ◽  
Mingli Wang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Therapeutic Effects ◽  
Wasp Sting ◽  
Laboratory Results ◽  
Better Than

<b><i>Background/Aim:</i></b> This study mainly aimed to explore the therapeutic effects of 3 renal replacement therapy (RRT) modalities on acute kidney injury (AKI) caused by wasp stings. <b><i>Methods:</i></b> A retrospective study from September 2016 to December 2019 was conducted. Thirty-one patients with AKIs caused by wasp sting were selected and divided into 3 groups according to the initial RRT modality received, namely, (1) the intermittent hemodialysis combined with hemoperfusion (IHD + HP) group, (2) the continuous veno-venous hemodiafiltration (CVVHDF) group, and (3) the CVVHDF combined with HP (CVVHDF + HP) group. The laboratory results were measured and analyzed before treatment on the 3rd, 7th, and 14th days of treatment. The renal function outcomes and survival of the patients were investigated at 3 months follow-up. <b><i>Results:</i></b> The laboratory results of enzyme measures and inflammatory indicators in wasp sting patients increased significantly in the early stage and 3 RRT modalities were effective in reducing these indicators. In addition, continuous RRT modality (CVVHDF and CVVHDF + HP) showed better clearance of myoglobin than IHD + HP. The serum creatinine levels of patients in the 3 groups did not recover to baseline within 14 days after beginning treatment. Nevertheless, the CVVHDF + HP group was better than the CVVHDF group, and CVVHDF was better than the IHD + HP group on the 3rd day. The interleukin (IL)-6 and IL-10 levels in CVVHDF + HP and IHD + HP groups were obviously lower than those in the CVVHDF group on the 3rd day. In the follow-up study, the recovery rate of renal function in CVVHDF and CVVHDF + HP groups was significantly better than that in the IHD + HP group. <b><i>Conclusion:</i></b> Early RRT was effective in the treatment of patients with A KI caused by wasp sting. CVVHDF + HP and CVVHDF modalities were better than the IHD + HP group in venom clearance and renal function recovery.

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