scholarly journals Robust Association between Acute Kidney Injury after Radical Nephrectomy and Long-term Renal Function

2020 ◽  
Vol 9 (3) ◽  
pp. 619
Author(s):  
Won Ho Kim ◽  
Kyung Won Shin ◽  
Sang-Hwan Ji ◽  
Young-Eun Jang ◽  
Ji-Hyun Lee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Serum Creatinine ◽  
Radical Nephrectomy ◽  
Primary Outcome ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Creatinine Ratio ◽  
New Onset

The association between acute kidney injury (AKI) and long-term renal function after radical nephrectomy has not been evaluated fully. We reviewed 558 cases of radical nephrectomy. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. Values of estimated glomerular filtration rate (eGFR) were collected up to 36 months (median 35 months) after surgery. The primary outcome was new-onset chronic kidney disease (CKD) stage 3a or higher or all-cause mortality within three years after nephrectomy. The functional change ratio (FCR) of eGFR was defined as the ratio of the most recent GFR (24–36 months after surgery) to the new baseline during 3–12 months. A multivariable Cox proportional hazard regression analysis for new-onset CKD and a multivariable linear regression analysis for FCR were performed to evaluate the association between AKI and long-term renal outcomes. A correlation analysis was performed with the serum creatinine ratio and used to determine AKI and FCR. AKI occurred in 43.2% (n = 241/558) and our primary outcome developed in 40.5% (n = 226/558) of patients. The incidence of new-onset CKD was significantly higher in patients with AKI than those without at all follow-up time points after surgery. The Cox regression analysis showed a graded association between AKI and our primary outcome (AKI stage 1: Hazard ratio 1.71, 95% confidence interval 1.25–2.32; AKI stage 2 or 3: Hazard ratio 2.72, 95% confidence interval 1.78–4.10). The linear regression analysis for FCR showed that AKI was significantly associated with FCR (β = −0.168 ± 0.322, p = 0.011). There was a significant negative correlation between the serum creatinine ratio and FCR. In conclusion, our analysis demonstrated a robust and graded association between AKI after radical nephrectomy and long-term renal functional deterioration.

scholarly journals Acute Kidney Injury Adjusted for Parenchymal Mass Reduction and Long-Term Renal Function after Partial Nephrectomy

2019 ◽  
Vol 8 (9) ◽  
pp. 1482
Author(s):  
Hyun-Kyu Yoon ◽  
Ho-Jin Lee ◽  
Seokha Yoo ◽  
Sun-Kyung Park ◽  
Yongsuk Kwon ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Serum Creatinine ◽  
Partial Nephrectomy ◽  
Functional Recovery ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Mass Reduction ◽  
Baseline Serum

We sought to evaluate the association of postoperative acute kidney injury (AKI) adjusted for parenchymal mass reduction with long-term renal function in patients undergoing partial nephrectomy. A total of 629 patients undergoing partial nephrectomy were reviewed. Postoperative AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria, by using either the unadjusted or adjusted baseline serum creatinine level, accounting for renal parenchymal mass reduction. Estimated glomerular filtration rates (eGFRs) were followed up to 61 months (median 28 months) after surgery. The primary outcome was the functional change ratio (FCR) of eGFR calculated by the ratio of the most recent follow-up value, at least 24 months after surgery, to eGFR at 3–12 months after surgery. Multivariable linear regression analysis was performed to evaluate whether unadjusted or adjusted AKI was an independent predictor of FCR. As a sensitivity analysis, functional recovery at 3–12 months after surgery compared to the preoperative baseline was analyzed. Median parenchymal mass reduction was 11%. Unadjusted AKI occurred in 16.5% (104/625) and adjusted AKI occurred in 8.6% (54/629). AKI using adjusted baseline creatinine was significantly associated with a long-term FCR (β = −0.129 ± 0.026, p < 0.001), while unadjusted AKI was not. Adjusted AKI was also a significant predictor of functional recovery (β = −0.243 ± 0.106, p = 0.023), while unadjusted AKI was not. AKI adjusted for the parenchymal mass reduction was significantly associated with a long-term functional decline after partial nephrectomy. A creatinine increase due to remaining parenchymal ischemic injury may be important in order to predict long-term renal functional outcomes after partial nephrectomy.

MO423PROENKEPHALIN AS A BIOMARKER OF KIDNEY FILTRATION IN ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Camila Lima ◽  
Etienne Macedo
Keyword(s):  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Kidney Disease ◽  
Linear Regression ◽  
Serum Creatinine ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Multivariate Linear Regression Analysis ◽  
Serum Cystatin ◽  
Blood Samples

Abstract Background and Aims In the last decades, clinical research biomarker (BM) to improve assessment of kidney function have been intensive, and proenkephalin (PENK) has been identified as a new BM of filtration. We hypothesized whether PENK would have a better accuracy for the diagnosis of severe AKI than serum cystatin (CYS) and the serum creatinine (Scr). We evaluate patient in the peri op of liver transplant (LT). Method Blood samples were collected during the pre and post (until 48 hours) operative (op.) period of LT in 57 eligible patients. Where was analyzed PENK (Sphingotest®), CYS (Milipex) and Scr (Quimioluminence). AKI diagnosis was based on the Kidney Disease International Global Outcomes (KDIGO) criteria using Scr. KDIGO 1 was subclassified according to the International Club of Ascites (ICA). Results Of the 57 patients undergoing LT, 50 (88%) developed AKI according to the KDIGO criteria in the first week after LT. Twenty-one patients without AKI and with KDIGO 1-A (37%) were summarized as the no AKI/mild AKI group, whereas 36 patients with KDIGO 1-B, 2 and 3 (63%) were summarized as the severe AKI group. Before the intra - operative insult only PENK was significantly higher in patients that developed severe AKI, median 55 [P25-75(44,25 – 94,55)] in no AKI/mild AKI versus 90,16 [P25-75(64,70 – 135,76)] pmol/l in severe AKI p 0,021, an AUC 0,685 (CI 0,536 – 0,833), with a cutoff 55 pmol/l, sensibility of 0,86 and specificity 0,52, accuracy 0,75 to severe AKI. Scr levels in pre-op. were non- significantly higher in severe AKI; p=0,088. The CYS in the pre-op was similar within the groups. Pos-operative 48 hours after LT, PENK was significantly higher in severe AKI, median 81 [P25-75(61,25 – 101,50)] versus 161,45 [P25-75(122,85 – 294,03)] in severe AKI - p &lt;0,0001 an AUC 0,83 (CI 0,72 - 0,94) with a cutoff 119,05 pmol/l, sensibility of 0,80 and specificity 0,90, accuracy 0,84 to severe AKI. Scr levels in post-op achieve an AUC 0,77 (CI 0,63 - 0,92) with a cutoff 1,49mg/dl, sensibility of 0,94, specificity 0,67 and accuracy 0,82. In a multivariate linear regression analysis adjusted for age, anestesia time, urine output and fluid balance, the PENK only was independently associated of severe AKI in pre-op. with OR 4,40 (CI 1,40 – 13,88) – p0,001 and the post-op. with OR 44,64 (CI 5,40 – 368,5) – p&lt;0,0001. Conclusion PENK is a promisor filtration biomarker and showed a better acuracy to severe AKI in pre-operative than standard AKI diagnostic by Scr. Prediction of severe AKI in pre-operative period by PENK can help the management of these patients in the future.

scholarly journals Perioperative use of serum creatinine and postoperative acute kidney injury: a single-centre, observational retrospective study to explore physicians’ perception and practice

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward the use of perioperative serum creatinine (sCr) for the identification of patients at risk for PO-AKI and long-term CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease. Methods Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single-centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding the use of sCr perioperatively and its relationship with PO-AKI. Results A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow-up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high risk for PO-AKI and LT-KDys. Conclusion PO-AKI after major surgery for malignant disease is common, but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients. Trial registration ClinicalTrials.gov, NCT04341974.

Snake envenomation-induced acute kidney injury: prognosis and long-term renal outcomes

2021 ◽  
pp. postgradmedj-2020-139021
Author(s):  
Manoj Kumar ◽  
Maasila Arcot Thanjan ◽  
Natarajan Gopalakrishnan ◽  
Dhanapriya Jeyachandran ◽  
Dineshkumar Thanigachalam ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Long Term Outcomes ◽  
Urine Protein ◽  
Renal Outcomes ◽  
Snake Envenomation ◽  
The Mean ◽  
New Onset

BackgroundSnake bite continues to be a significant cause of acute kidney injury (AKI) in India. There is paucity of data regarding long-term outcomes of such patients. In this study, we aim to assess the prognosis and long-term renal outcomes of such patients.MethodsWe analysed the hospital records of snake envenomation-induced AKI from January 2015 to December 2018. Predictors of in-hospital mortality were assessed. Survivors were advised to visit follow-up clinic to assess their kidney function.ResultsThere were 769 patients with evidence of envenomation and of them, 159 (20.7%) had AKI. There were 112 (70.4%) males. Mortality occurred in 9.4% of patients. Logistic regression analysis identified shock (OR 51.949, 95% CI 4.297 to 628.072) and thrombocytopenia (OR 27.248, 95% CI 3.276 to 226.609) as predictors of mortality. Forty-three patients attended the follow-up. The mean follow-up duration was 30.4±15.23 months. Adverse renal outcomes (eGFR <60 mL/min/1.73 m2 or new-onset hypertension (HTN) or pre-HTN or urine protein creatinine ratio >0.3) occurred in 48.8% of patients. Older age (mean age (years) 53.3 vs 42.8, p=0.004) and longer duration on dialysis (median duration (days) 11.5 vs 5, p=0.024) were significantly associated with adverse renal outcomes.ConclusionsThe incidence of AKI in snake envenomation was 20.7%. The presence of shock and thrombocytopenia were associated with mortality. Adverse renal outcomes occurred in 48.8% of patients in the long term.

FC 044THE LONG-TERM EFFECTS OF ACUTE KIDNEY INJURY ON INTESTINAL OXALATE-DEGRADING BACTERIA IN RATS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Natalia Stepanova ◽  
Ganna Tolstanova ◽  
Valentyn Nepomnyashchii ◽  
Iryna Akulenko ◽  
Svitlana Savchenko ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Interstitial Fibrosis ◽  
Kidney Injury ◽  
Fecal Microbiota ◽  
Long Term Effects ◽  
Renal Interstitial Fibrosis ◽  
Degrading Bacteria ◽  
Group 1

Abstract Background and Aims Gut microbiota is considered an important factor affecting oxalate handling in the intestine. It has been demonstrated that intestinal oxalate secretion provides a complementary route of excretion, and it becomes more evident when kidney function declines. A diversity of gut oxalate-degrading bacteria (ODB) has been hypothesized to play a role in this process. However, there is a general lack of research on the long-term effects of acute kidney injury (AKI) on ODB and their total oxalate-degrading activity (ODA) in fecal microbiota. In this study, we evaluated whether renal dysfunction could affect intestinal ODB and their total ODA in a rat model of glycerol-induced AKI. Method The Male Wistar rats (200-300 g, n=20) on oxalate-free diet were randomly divided into 2 groups. After 24-h of water deprivation, Group 1 (n=10) received an intramuscular injection of 50% glycerol (10 ml/kg of body weight), and Group 2 (n=10) served as control. The numbers of ODB (incubated in a highly selective Oxalate Medium and determined using culture method) and total fecal ODA were measured after injection on days 7 and 70. The method of redoximetric titration with a KMnO4 solution was adopted to evaluate total ODA in fecal microbiota; the results were expressed as % of oxalate degradation per 0.01 g of feces. Renal injury was assessed by histopathological examination, serum creatinine and daily proteinuria levels after removing the animals from the experiment on day 70. Cortical interstitial fibrosis was measured by computerized image analysis on sections stained with picrosirius red. The median (Me) and the interquartile ranges (Q25; Q75) were calculated and compared using the nonparametric Mann-Whitney test. The Spearman correlation coefficient was used to evaluate association between the examined parameters. Results The obtained results demonstrated: 1) after glycerol injection on day 7, no differences were found in the numbers of ODB and total fecal ODA between the experimental and control groups: 5.9 (5.4-6.0) vs 6.0 (5.4-6.4) CFU/g, p=0.65 and 2.0 (0.1-5.0) vs 2.5 (2.0-9.0) %/0.01g, p=0.24, respectively; 2) after AKI initiation on day 70, the numbers of ODB and total fecal ODA were significantly lower in Group I compared with control Group II (Fig. 1); 3) the higher percentage of renal interstitial fibrosis was, the higher total fecal ODA occurred in the experimental rats (Fig. 2). In addition, the number of ODB in feces in Group 1 had an inverse association with serum creatinine (r=-0.52, p=0.006) and 24-h proteinuria levels (r=-0.86, p&lt;0.0001). Conclusion AKI had the long-term negative effects on the quantitative and qualitative characteristics of ODB in fecal microbiota in rats. Moreover, the results of our study confirmed an increasing trend in total fecal ODA according to the aggravation of renal interstitial fibrosis in rats.

Perioperative Use of Serum Creatinine and Postoperative Acute Kidney Injury: a Single Centre, Observational Retrospective Study to Explore Physicians’ Perception and Practice.

2021 ◽  
Author(s):  
Gianluca Villa ◽  
Silvia De Rosa ◽  
Caterina Scirè Calabrisotto ◽  
Alessandro Nerini ◽  
Thomas Saitta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
High Risk ◽  
Abdominal Surgery ◽  
Serum Creatinine ◽  
Malignant Disease ◽  
Kidney Injury ◽  
Major Surgery ◽  
Single Centre

Abstract Background. Postoperative acute kidney injury (PO-AKI) is a leading cause of short- and long-term morbidity and mortality, as well as progression to chronic kidney disease (CKD). The aim of this study was to explore the physicians’ attitude toward use of serum creatinine (sCr) for identification of patients at risk for PO-AKI and patients who should be reassessed in the long-term for progression toward CKD. We also evaluated the incidence and risk factors associated with PO-AKI and renal function deterioration in patients undergoing major surgery for malignant disease.Methods. Adult oncological patients who underwent major abdominal surgery from November 2016 to February 2017 were considered for this single centre, observational retrospective study. Routinely available sCr values were used to define AKI in the first three postoperative days. Long-term kidney dysfunction (LT-KDys) was defined as a reduction in the estimated glomerular filtration rate by more than 10 ml/min/m2 at 12 months postoperatively. A questionnaire was administered to 125 physicians caring for the enrolled patients to collect information on local attitudes regarding use of sCr perioperatively and its relationship with PO-AKI.Results. A total of 423 patients were observed. sCr was not available in 59 patients (13.9%); the remaining 364 (86.1%) had at least one sCr value measured to allow for detection of postoperative kidney impairment. Among these, PO-AKI was diagnosed in 8.2% of cases. Of the 334 patients who had a sCr result available at 12-month follow up, 56 (16.8%) developed LT-KDys. Data on long-term kidney function were not available for 21% of patients. Interestingly, 33 of 423 patients (7.8%) did not have a sCr result available in the immediate postoperative period or long-term. All the physicians who participated in the survey (83 out of 125) recognised that postoperative assessment of sCr is required after major oncological abdominal surgery, particularly in those patients at high-risk for PO-AKI and LT-KDys.Conclusion. PO-AKI after major surgery for malignant disease is common but clinical practice of measuring sCr is variable. As a result, the exact incidence of PO-AKI and long-term renal prognosis are unclear, including in high-risk patients.Trial registration. Retrospectively registered in Clinicaltrialgov NCT04341974

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 (&gt; 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 &lt; 0.001) and urine pH (P &lt; 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 &lt; 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 &lt; 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 kidney injury following on-pump or off-pump coronary artery bypass grafting in elderly patients: a retrospective propensity score matching analysis

2020 ◽  
Author(s):  
rui wang ◽  
Xian Wang ◽  
Yifan Zhu ◽  
Wen Chen ◽  
Liangpeng Li ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Kidney Injury ◽  
Bypass Grafting ◽  
Long Term Outcomes ◽  
Off Pump ◽  
Stage 1 ◽  
New Onset

Abstract Objectives This single-centre, retrospective propensity score matching (PSM) study designed to study the impact of cardiopulmonary bypass (CPB) on postoperative acute kidney injury (AKI) and the relationship between AKI and long-term outcomes in elderly patients undergoing coronary artery bypass grafting (CABG). Methods After PSM, 466 pairs of patients (A group, on-pump; B group, off-pump) who were aged≥70 years undergoing first isolated CABG surgery from January 2012 to December 2016 entered the study. AKI was defined and classified according to the Acute Kidney Injury Network (AKIN) criteria. The incidence and severity of in-hospital AKI was compared. The impacts of AKI on the long-term outcomes including new onset of dialysis and mortality were analyzed. Results The two PSM groups had similar baseline and procedure except whether the CPB was used or not. In hospital and 30-day mortality was of no difference(χ2=0.051, p=0.821). AKI of any severity occurred in 40.3% of all patients, with stage 1 accounting for most cases. No difference regarding the incidence and severity of AKI could be found: AKIN stage 1: 139 (29.8%) vs 131 (28.1%); AKIN stage 2: 40 (8.6%) vs 35 (7.5%); AKIN stage 3: 18 (3.9%) vs 13 (2.8%), (u=0.543, p=0.532). No difference was observed in the in-hospital new onset of dialysis (χ2=0.312, P=0.576). The use of CPB was not found to influence long-term new onset of dialysis (χ2=0.14, p=0.708) and mortality (χ2=0.099, p=0.753). Comparing with non-AKI patients, AKI patients were associated with an increased rates of new onset of dialysis (χ2=8.153, p=0.004) and mortality (χ2=6.277, p=0.012) during the follow-up. Comparing with non-AKI patients, the HR for long-term new onset of dialysis and mortality in AKI patients was 1.83 and 1.31 respectively (95%CI 1.12-2.86, p=0.007; 95%CI 1.17-2.58, p=0.015). Conclusions For elderly CABG patients, AKI was common, but deterioration of dialysis was a seldom incidence. Comparing with on-pump, off-pump did not decrease the rates or severity of AKI, long-term new onset of dialysis or mortality. AKI was associated with an increased long-term new onset of dialysis and decreased long-term survival.

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