Acute Kidney Injury Patterns Following Transplantation of Steatotic Liver Allografts

Background: Steatotic grafts are increasingly being used for liver transplant (LT); however, the impact of graft steatosis on renal function has not been well described. Methods: A total of 511 allografts from Mayo Clinic Arizona and Minnesota were assessed. We evaluated post-LT acute kidney injury (AKI) patterns, perioperative variables and one-year outcomes for patients receiving moderately steatotic allografts (>30% macrovesicular steatosis, n = 40) and compared them to non-steatotic graft recipients. Results: Post-LT AKI occurred in 52.5% of steatotic graft recipients versus 16.7% in non-steatotic recipients (p < 0.001). Ten percent of steatotic graft recipients required new dialysis post-LT (p = 0.003). At five years, there were no differences for AKI vs. no AKI patient survival (HR 0.95, 95% CI 0.08–10.6, p = 0.95) or allograft survival (HR 1.73, 95% CI 0.23–13.23, p = 0.59) for those using steatotic grafts. Lipopeliosis on biopsy was common in those who developed AKI (61.0% vs. 31.6%, p = 0.04), particularly when the Model for End-Stage Liver Disease (MELD) was ≥20 (88.9%; p = 0.04). Lipopeliosis was a predictor of post-LT AKI (OR 6.0, 95% CI 1.1–34.6, p = 0.04). Conclusion: One-year outcomes for moderately steatotic grafts are satisfactory; however, a higher percentage of post-LT AKI and initiation of dialysis can be expected. Presence of lipopeliosis on biopsy appears to be predictive of post-LT AKI.

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Incidence of Acute Kidney Injury among Patients Treated with Piperacillin-Tazobactam or Meropenem in Combination with Vancomycin

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00264-18 ◽

2018 ◽

Vol 62 (7) ◽

Cited By ~ 17

Author(s):

W. Cliff Rutter ◽

David S. Burgess

Keyword(s):

Acute Kidney Injury ◽

Alternative Therapy ◽

Kidney Injury ◽

Limited Data ◽

Inclusion Criteria ◽

University Of Kentucky ◽

Empirical Coverage ◽

End Stage ◽

The University ◽

The Impact

ABSTRACT Acute kidney injury (AKI) increases during empirical antimicrobial therapy with the combination of piperacillin-tazobactam (TZP) and vancomycin (VAN) compared to the number of incidences with monotherapy or the combination of cefepime and VAN. Limited data regarding the impact of meropenem (MEM) combined with VAN exist. This study examined the AKI incidence among patients treated with MEM plus VAN (MEM+VAN) or TZP+VAN. Data were collected from the University of Kentucky Center for Clinical and Translational Science Enterprise Data Trust from September 2007 through October 2015. Adults without previous renal disease who received MEM+VAN or TZP+VAN for at least 2 days were included. AKI was assessed using risk, injury, failure, loss, and end-stage (RIFLE) criteria. Inverse probability of treatment weighting was utilized to control for differences between groups. In total, 10,236 patients met inclusion criteria, with 9,898 receiving TZP+VAN and 338 receiving MEM+VAN. AKI occurred in 15.4% of MEM+VAN patients and in 27.4% of TZP+VAN patients ( P < 0.001). TZP+VAN was associated with increased AKI compared to the level with MEM+VAN (odds ratio [OR], 2.53; 95% confidence interval [CI], 1.82 to 3.52), after controlling for confounders. Use of MEM+VAN should be considered an appropriate alternative therapy to TZP+VAN if nephrotoxicity is a major concern. The results of this study demonstrate that judicial use of TZP+VAN for empirical coverage of infection is needed.

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Abstract 13975: Association of In-Hospital Acute Kidney Injury With Long-term Outcomes in Survivors of Acute Myocardial Infarction: Insight From the NCDR

Circulation ◽

10.1161/circ.132.suppl_3.13975 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Purav Mody ◽

Tracy Wang ◽

Robert McNamara ◽

Sandeep Das ◽

Dharam Kumbhani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Risk Model ◽

Kidney Injury ◽

Dependent Manner ◽

Long Term Outcomes ◽

Mdrd Equation ◽

One Year ◽

The Impact

Background: Chronic kidney disease (CKD) and acute kidney injury (AKI) have both been associated with adverse short-term outcomes after MI. However, the impact of AKI on long-term outcomes and the interaction of AKI with baseline renal function have not been well described. Methods: ACTION Registry®-GWTGTM records from 2008-2012 were linked to Medicare data yielding a population of 76,500 acute MI patients from 581 hospitals who survived to hospital discharge. We excluded patients with cardiogenic shock, cardiac arrest, and those undergoing CABG or currently on dialysis. CKD status was defined using the Kidney Disease Outcome Quality Initiative criteria based on admission GFR estimated using the MDRD equation. No, mild, moderate and severe AKI were defined as changes in creatinine (Cr) from baseline to peak of < 0.3, 0.3 to < 0.5, 0.5 to < 1.0 and ≥ 1.0 mg/dl respectively. Cox proportional hazard modeling was used to examine associations between AKI and 1-year mortality. Covariates for risk adjustment were adapted from the CRUSADE long-term mortality risk model. Results: The median age was 77 years, 30% had STEMI and 78% underwent diagnostic angiography.The incidence of mild, moderate and severe AKI was 7.5%, 6.0% and 3.0%. CKD stages 3, 4, and 5 were present in 41.2%, 6.7%, and 1.0% of patients. Both CKD and AKI were significantly associated with 1-year mortality (p< 0.0001 for each). A significant interaction was noted between CKD and AKI with respect to 1-year mortality (p-interaction<0.0001). Adjusted 1-year mortality increased in a dose-dependent manner across increasing severity of AKI, but this association was attenuated among individuals with more severe baseline CKD (Figure). Conclusion: One-year mortality increased in proportion to severity of AKI, with even a small increase in Cr associated with worse outcomes. The association of AKI with outcomes was modified by baseline Cr, with a greater impact of AKI observed among patients with higher baseline eGFR.

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Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis: Two Years’ Experience at a Tertiary Hospital in Rwanda

BioMed Research International ◽

10.1155/2018/1716420 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Grace Igiraneza ◽

Benedicte Ndayishimiye ◽

Menelas Nkeshimana ◽

Vincent Dusabejambo ◽

Onyema Ogbuagu

Keyword(s):

Acute Kidney Injury ◽

Clinical Presentation ◽

Multivariate Analyses ◽

Patient Survival ◽

Kidney Injury ◽

Tertiary Hospital ◽

Clinical Profile ◽

Patient Demographics ◽

And Gender ◽

The Impact

Introduction. Acute kidney injury (AKI) requiring renal replacement therapy is associated with high mortality. The study assessed the impact of the introduction of hemodialysis (HD) on outcomes of patients with AKI in Rwanda. Methods. A single center retrospective study that evaluated the clinical profile and survival outcomes of patients with AKI requiring HD [AKI-D] at a tertiary hospital in Rwanda. Data was collected on patients who received HD for AKI from September 2014 to December 2016. Patient demographics, comorbidities, clinical presentation, laboratory tests, and mortality were reviewed and analyzed. Predictors of mortality were assessed using age and gender adjusted multivariate analyses. Results. Of the 82 eligible patients, median age was 38 years (IQR 28–57 years). Males comprised 51% of the cohort. Infectious diseases including malaria, pneumonia, and sepsis (35.1%) and pregnancy-related conditions (26.9%) were the most frequent comorbidities. Pulmonary oedema (54.9%) and uremic encephalopathy (50%) were top indications for HD. Mortality was 34.1%. On multivariate analysis, receipt of <5 sessions of HD (OR = 4.01, 95% CI 1.185–13.61, P=0.026) and hyperkalemia (OR = 3.23, 95% CI 1.040–10.065, P=0.043) were associated with mortality. Conclusion. The availability of acute hemodialysis in Rwanda has resulted in improved patient survival and persistent hyperkalemia predicted higher mortality.

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SUN-178 The Impact of Acute Kidney Injury Requiring Haemodialysis on Patient Survival: 10 Years of Prospective Data

Kidney International Reports ◽

10.1016/j.ekir.2019.05.580 ◽

2019 ◽

Vol 4 (7) ◽

pp. S232

Author(s):

B. TALBOT ◽

P. Sagar ◽

R. Lin ◽

M. Jun ◽

S. Sen ◽

...

Keyword(s):

Acute Kidney Injury ◽

Patient Survival ◽

Kidney Injury ◽

Prospective Data ◽

The Impact

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A study of factors determining outcome of acute kidney injury patients requiring hemodialysis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183389 ◽

2018 ◽

Vol 6 (9) ◽

pp. 2974

Author(s):

Vasanth G. ◽

Surendrakumar P. ◽

Catherine P. ◽

Venu G.

Keyword(s):

Acute Kidney Injury ◽

High Mortality ◽

Hepatorenal Syndrome ◽

Kidney Injury ◽

Demographic Variables ◽

Acute Glomerulonephritis ◽

Severe Renal Failure ◽

One Year ◽

Stage Renal Disease ◽

End Stage

Background: High mortality rate in acute kidney injury (AKI) has interested many authors to conduct studies about factors predicting its outcome. The need for both dialysis and ICU care defines a group of critically ill patients who may have poor prognosis and consume vast amounts of resources. In this study we determine the variables predicting the outcome of patients with severe acute kidney failure requiring haemodialysis and to ascertain the aetiology of acute kidney injury in this group.Methods: We prospectively analysed 114 patients admitted with severe renal failure requiring renal replacement therapy over a period of one year. The influence of various factors such as demographic variables, pre morbidities, details of admission, clinical presentation and extent of organ dysfunction on the clinical outcome such as mortality and progression to end stage kidney disease were statistically analyzed using SPSS version 12 (SPSS Inc., Chicago, Ill).Results: Univariate and multivariate analysis showed that parameters such as chronic liver disease, preexisting heart disease, mechanical ventilation and vasopressor requirement, oliguria, sepsis, hepatorenal syndrome, cardiogenic shock and admission in ICU were associated with high mortality (p<0.05). Of the 114 patients, 49 died (42.98%), 61 (53.5%) were dialysis independent and 4 patients (3.5%) progressed to end stage renal disease (ESRD).Conclusions: AKI patients requiring hemodialysis were associated with high hospital mortality. Patients who were diagnosed to have acute glomerulonephritis especially rapidly progressing glomerulonephritis as the cause of AKI were more prone to ESRD. Most survivors were dialysis independent at the time of discharge.

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Outcomes of Kidney Transplant Recipients with Sickle Cell Disease: An Analysis of the 2000–2019 UNOS/OPTN Database

Journal of Clinical Medicine ◽

10.3390/jcm10143063 ◽

2021 ◽

Vol 10 (14) ◽

pp. 3063

Author(s):

Napat Leeaphorn ◽

Charat Thongprayoon ◽

Pradeep Vaitla ◽

Panupong Hansrivijit ◽

Caroline C. Jadlowiec ◽

...

Keyword(s):

Kidney Transplant ◽

Graft Survival ◽

Patient Survival ◽

Transplant Recipients ◽

Cell Disease ◽

Kidney Transplant Recipients ◽

Allograft Survival ◽

End Stage Kidney Disease ◽

Kidney Recipients ◽

End Stage

Background: Lower patient survival has been observed in sickle cell disease (SCD) patients who go on to receive a kidney transplant. This study aimed to assess the post-transplant outcomes of SCD kidney transplant recipients in the contemporary era. Methods: We used the OPTN/UNOS database to identify first-time kidney transplant recipients from 2010 through 2019. We compared patient and allograft survival between recipients with SCD (n = 105) vs. all other diagnoses (non-SCD, n = 146,325) as the reported cause of end-stage kidney disease. We examined whether post-transplant outcomes improved among SCD in the recent era (2010–2019), compared to the early era (2000–2009). Results: After adjusting for differences in baseline characteristics, SCD was significantly associated with lower patient survival (HR 2.87; 95% CI 1.75–4.68) and death-censored graft survival (HR 1.98; 95% CI 1.30–3.01), compared to non-SCD recipients. The lower patient survival and death-censored graft survival in SCD recipients were consistently observed in comparison to outcomes of recipients with diabetes, glomerular disease, and hypertension as the cause of end-stage kidney disease. There was no significant difference in death censored graft survival (HR 0.99; 95% CI 0.51–1.73, p = 0.98) and patient survival (HR 0.93; 95% CI 0.50–1.74, p = 0.82) of SCD recipients in the recent versus early era. Conclusions: Patient and allograft survival in SCD kidney recipients were worse than recipients with other diagnoses. Overall SCD patient and allograft outcomes in the recent era did not improve from the early era. The findings of our study should not discourage kidney transplantation for ESKD patients with SCD due to a known survival benefit of transplantation compared with remaining on dialysis. Urgent future studies are needed to identify strategies to improve patient and allograft survival in SCD kidney recipients. In addition, it may be reasonable to assign risk adjustment for SCD patients.

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Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond

Journal of Clinical Medicine ◽

10.3390/jcm10061175 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1175

Author(s):

Emaad M. Abdel-Rahman ◽

Faruk Turgut ◽

Jitendra K. Gautam ◽

Samir C. Gautam

Keyword(s):

Acute Kidney Injury ◽

Kidney Disease ◽

Kidney Injury ◽

Complete Recovery ◽

Severe Form ◽

Clinical Syndrome ◽

Current Evidence ◽

Clinical Predictors ◽

End Stage

Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.

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Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezab044 ◽

2021 ◽

Author(s):

Andrew M Vekstein ◽

Babtunde A Yerokun ◽

Oliver K Jawitz ◽

Julie W Doberne ◽

Jatin Anand ◽

...

Keyword(s):

Acute Kidney Injury ◽

Circulatory Arrest ◽

Aortic Surgery ◽

Multivariable Analysis ◽

Kidney Injury ◽

Deep Hypothermia ◽

Moderate Hypothermia ◽

Bladder Temperature ◽

Increased Risk ◽

The Impact

Abstract OBJECTIVES The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS A total of 85% (n = 645) of patients underwent deep hypothermia (14.1–20.0°C), 11% (n = 83) low-moderate hypothermia (20.1–24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1–28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1–34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.

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Quantification and Dosing of Renal Replacement Therapy in Acute Kidney Injury: A Reappraisal

Blood Purification ◽

10.1159/000475457 ◽

2017 ◽

Vol 44 (2) ◽

pp. 140-155 ◽

Cited By ~ 6

Author(s):

William R. Clark ◽

Martine Leblanc ◽

Zaccaria Ricci ◽

Claudio Ronco

Keyword(s):

Acute Kidney Injury ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Journal Club ◽

Kidney Injury ◽

Accurate Estimation ◽

Stage Renal Disease ◽

End Stage ◽

Dose Assessments ◽

Solute Clearance

Background/Aims: Delivered dialysis therapy is routinely measured in the management of patients with end-stage renal disease; yet, the quantification of renal replacement prescription and delivery in acute kidney injury (AKI) is less established. While continuous renal replacement therapy (CRRT) is widely understood to have greater solute clearance capabilities relative to intermittent therapies, neither urea nor any other solute is specifically employed for CRRT dose assessments in clinical practice at present. Instead, the normalized effluent rate is the gold standard for CRRT dosing, although this parameter does not provide an accurate estimation of actual solute clearance for different modalities. Methods: Because this situation has created confusion among clinicians, we reappraise dose prescription and delivery for CRRT. Results: A critical review of RRT quantification in AKI is provided. Conclusion: We propose an adaptation of a maintenance dialysis parameter (standard Kt/V) as a benchmark to supplement effluent-based dosing of CRRT. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=475457

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Assessment of acute kidney injury risk using a machine-learning guided generalized structural equation model: a cohort study

BMC Nephrology ◽

10.1186/s12882-021-02238-9 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Wen En Joseph Wong ◽

Siew Pang Chan ◽

Juin Keith Yong ◽

Yen Yu Sherlyn Tham ◽

Jie Rui Gerald Lim ◽

...

Keyword(s):

Acute Kidney Injury ◽

High Risk ◽

Hospital Mortality ◽

Structural Equation Model ◽

Structural Equation ◽

Injury Risk ◽

Kidney Injury ◽

Equation Model ◽

Surgical Icu ◽

One Year

Abstract Background Acute kidney injury is common in the surgical intensive care unit (ICU). It is associated with poor patient outcomes and high healthcare resource usage. This study’s primary objective is to help identify which ICU patients are at high risk for acute kidney injury. Its secondary objective is to examine the effect of acute kidney injury on a patient’s prognosis during and after the ICU admission. Methods A retrospective cohort of patients admitted to a Singaporean surgical ICU between 2015 to 2017 was collated. Patients undergoing chronic dialysis were excluded. The outcomes were occurrence of ICU acute kidney injury, hospital mortality and one-year mortality. Predictors were identified using decision tree algorithms. Confirmatory analysis was performed using a generalized structural equation model. Results A total of 201/940 (21.4%) patients suffered acute kidney injury in the ICU. Low ICU haemoglobin levels, low ICU bicarbonate levels, ICU sepsis, low pre-ICU estimated glomerular filtration rate (eGFR) and congestive heart failure was associated with the occurrence of ICU acute kidney injury. Acute kidney injury, together with old age (> 70 years), and low pre-ICU eGFR, was associated with hospital mortality, and one-year mortality. ICU haemoglobin level was discretized into 3 risk categories for acute kidney injury: high risk (haemoglobin ≤9.7 g/dL), moderate risk (haemoglobin between 9.8–12 g/dL), and low risk (haemoglobin > 12 g/dL). Conclusion The occurrence of acute kidney injury is common in the surgical ICU. It is associated with a higher risk for hospital and one-year mortality. These results, in particular the identified haemoglobin thresholds, are relevant for stratifying a patient’s acute kidney injury risk.

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