scholarly journals Diagnostics, Risk Factors, Treatment and Outcomes of Acute Kidney Injury in a New Paradigm

2020 ◽  
Vol 9 (4) ◽  
pp. 1104 ◽  
Author(s):  
Charat Thongprayoon ◽  
Panupong Hansrivijit ◽  
Karthik Kovvuru ◽  
Swetha R. Kanduri ◽  
Aldo Torres-Ortiz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
New Paradigm ◽  
Short Term ◽  
Clinical Environments ◽  
Personalized Approach ◽  
The Impact ◽  
Long Term Mortality

Acute kidney injury (AKI) is a common clinical condition among patients admitted in the hospitals. The condition is associated with both increased short-term and long-term mortality. With the development of a standardized definition for AKI and the acknowledgment of the impact of AKI on patient outcomes, there has been increased recognition of AKI. Two advances from past decades, the usage of computer decision support and the discovery of AKI biomarkers, have the ability to advance the diagnostic method to and further management of AKI. The increasingly widespread use of electronic health records across hospitals has substantially increased the amount of data available to investigators and has shown promise in advancing AKI research. In addition, progress in the finding and validation of different forms of biomarkers of AKI within diversified clinical environments and has provided information and insight on testing, etiology and further prognosis of AKI, leading to future of precision and personalized approach to AKI management. In this this article, we discussed the changing paradigms in AKI: From mechanisms to diagnostics, risk factors, and management of AKI.

scholarly journals ACUTE KIDNEY INJURY AFTER LUNG TRANSPLANTATION: PERIOPERATIVE RISK FACTORS AND OUTCOME

2019 ◽  
Author(s):  
Enora Atchade ◽  
Samira Barour ◽  
Alexy Tran-Dinh ◽  
Sylvain Jean-Baptiste ◽  
Sébastien Tanaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Lung Transplantation ◽  
Kidney Injury ◽  
Short Term ◽  
Factors Associated ◽  
Icu Stay ◽  
Long Term Mortality

Abstract BACKGROUND Acute kidney injury (AKI) is associated with increased short-term and long-term mortality and morbidity after lung transplantation (LT). The primary objective of this study was to analyze the perioperative factors associated with AKI according to KDIGO criteria during hospitalization in an intensive care unit (ICU) after LT. METHODS This was a single-center observational, prospective study. AKI was defined according to KDIGO criteria. Results are expressed as median, interquartile range, absolute numbers and percentages. Statistical analyses were performed using Chi-square test, Fisher’s exact test and Mann-Witney U test (p<0.05 was considered to be significant). Multivariate analysis was performed to identify independent risk factors. RESULTS Between January 2016 and April 2018, 94 patients (pts) underwent LT (70% bilateral LT). AKI occurred during ICU stay in 46 pts (49%). KDIGO 1 AKI was observed in 16 pts (17%), KDIGO 2 in 14 pts (15%), and KDIGO 3 in 16 pts (17%) including 12 pts (75%) who required renal replacement therapy (RRT). AKI occurred before the fifth day after surgery for 38 patients (82% of the AKI patients). On multivariate analysis, independent factors associated with AKI were bilateral LT and mechanical ventilation (MV) > 3 days (OR 4.26 95%CI [1.49; 13.63] p=0.010 and OR 5.56 [1.25; 11.47] p=0.018, respectively). AKI and the need for RRT were significantly associated with ICU mortality, 28-day mortality and one-year mortality. CONCLUSION AKI is common during ICU stay after LT, especially after bilateral LT and is associated with prolonged MV, and increased short-term and long-term mortality.

scholarly journals Risk Factors for Long-Term Mortality and Progressive Chronic Kidney Disease Associated With Acute Kidney Injury After Cardiac Surgery

Medicine ◽  
2015 ◽  
Vol 94 (45) ◽  
pp. e2025 ◽  
Author(s):  
Jia-Rui Xu ◽  
Jia-Ming Zhu ◽  
Jun Jiang ◽  
Xiao-Qiang Ding ◽  
Yi Fang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Long Term Mortality

scholarly journals The Impact of New-onset Atrial Fibrillation on Short-term and Long-term Mortality of Critically ill Patients with Candidemia

2021 ◽  
Author(s):  
zengli xiao ◽  
Qi Wang ◽  
Xuebin Li ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Short Term ◽  
The Impact ◽  
Onset Atrial Fibrillation ◽  
Long Term Mortality ◽  
New Onset

Abstract Background Both new-onset atrial fibrillation (NOAF) and candidemia occurred frequently in critically ill patients, which are associated with poor outcomes. But, the association between NOAF and critically ill patients with candidemia is still uncertain. This study is try to identify the impact of NOAF on short-term and long-term mortality of critically ill patients with candidemia. Methods We retrospectively identified NOAF in all patients with candidemia admitted to a non-cardiac intensive care unit (ICU) from January 2011 to March 2018 in a teaching hospital. We categorized these patients into 3 groups (NOAF, Prior AF, No AF) and compared clinical information between groups. Risk factors for these patients’ short-term and long-term mortality were also analyzed. Results Ninety-two patients with candidemia were identified from 2011 to 2018. Among these patients, 26 (28.3%) developed NOAF during their hospital stay. The multivariable logistic regression analysis indicated that stroke, anemia, Sequential Organ Failure Assessment (SOFA) score and NOAF were independent risk factors for in-hospital mortality and NOAF was also the independent risk factor for 1 year mortality. Conclusions There was a high incidence of NOAF in critically ill patients with candidemia, which was associated with in-hospital mortality and 1 year mortality after hospital discharge. Further multicenter studies should be conducted to help confirm this relationship and to find effective interventions that reduce short-term and long-term mortality.

scholarly journals The Prevalence, Risk Factors and Prognosis of Acute Kidney Injury after Lung Transplantation: A Single-center Cohort Study in China

2020 ◽  
Author(s):  
Ling Sang ◽  
Sibei Chen ◽  
Lingbo Nong ◽  
Yonghao Xu ◽  
Haichong Zheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Survival Rate ◽  
Lung Transplantation ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Single Center ◽  
Short Term ◽  
Stage 1

Abstract Background To evaluate the incidence, risk factors, and prognosis of acute kidney injury (AKI) after lung transplantation (LTx). Methods Records of patients who underwent LTx in a single center were retrospectively reviewed. The prevalence of post-transplant AKI, the use of continuous renal replacement therapy (CRRT), and the risk factors for AKI were investigated. The impact of AKI and CRRT on short-term outcomes and long-term survival was measured. Results 148 patients were included with 67 cases developed post-operative AKI. 31 patients underwent CRRT; the percentage of CRRT was 6.2%, 0%, 10% and 86.2% in no-AKI, and stage 1, 2 and 3 AKI, respectively. Patients with AKI had significantly higher ICU mortality and in-hospital mortality. The 1-year post-LTx survival rate of patients with AKI was 47.8%, significantly lower than those without (74.1%). There was no difference in the 1-year survival rate of those with stage 1 and stage 2 AKI, but patients with stage 3 AKI showed the worst survival. Patients who underwent CRRT had an inferior survival outcome (9.7% vs. 76.1%, P < 0.05). We found that higher APACHE II score (OR 1.082, P = 0.009), and higher intraoperative fluid balance (OR 1.001, P = 0.012) were independent risk factors, and female (OR 2.539) and pulmonary hypertension (OR 2.869) were potential risk factors for post-LTx AKI. A prediction model integration of the above factors showed a good concordance with actual risks and had a C-index of 0.76 (95% CI, 0.66–0.87). Conclusion Severe AKI which needed CRRT had a negative impact on the short-term and long-term outcomes.

scholarly journals Risk factors for acute kidney injury after initial acute aortic dissection and their effect on long-term mortality

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Akiko Kato ◽  
Eri Ito ◽  
Naoki Kamegai ◽  
Minami Mizutani ◽  
Hiroya Shimogushi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Kidney Injury ◽  
Long Term Mortality

scholarly journals Incidence and risk factors for acute kidney injury in head and neck cancer patients treated with concurrent chemoradiation with high-dose cisplatin

BMC Cancer ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Maurice J. D. L. van der Vorst ◽  
Elisabeth C. W. Neefjes ◽  
Elisa C. Toffoli ◽  
Jolanda E. W. Oosterling-Jansen ◽  
Marije R. Vergeer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Head And Neck ◽  
Treatment Outcomes ◽  
Kidney Injury ◽  
Concurrent Chemoradiation ◽  
High Dose ◽  
The Impact

Abstract Background Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Concurrent chemoradiation (CRT) with high-dose cisplatin is associated with significant acute and late toxicities, including acute kidney injury (AKI). The aims of this study were to investigate the incidence of AKI in patients with LA-SCCHN during and after treatment with high-dose cisplatin-based CRT, to identify risk factors for cisplatin-induced AKI, and to describe the impact of AKI on long-term renal function and treatment outcomes. Methods This is a retrospective cohort study with measurements of renal function before CRT, weekly during CRT, every 1 or 2 days during hospitalizations, and 3 and 12 months after CRT in patients with LA-SCCHN. AKI was defined as increase in serum creatinine (sCr) of ≥1.5 times baseline or by ≥0.3 mg/dL (≥26.5 μmol/L) using the Kidney Disease Improving Global Outcomes (KDIGO) classification. Logistic regression models were estimated to analyze renal function over time and to identify predictors for AKI. Results One hundred twenty-four patients completed all measurements. AKI was reported in 85 patients (69%) with 112 episodes of AKI. Sixty of 85 patients experienced 1 AKI episode; 20 patients experienced ≥2 AKI episodes. Ninety-three (83%) AKI episodes were stage 1, 13 (12%) were stage 2, and 6 (5%) AKI episodes were stage 3. Median follow-up time was 29 months (Interquartile Range, IQR 22–33). Hypertension (Odds Ratio, OR 2.7, 95% Confidence Interval, CI 1.1–6.6; p = 0.03), and chemotherapy-induced nausea and vomiting (CINV; OR 4.3, 95% CI 1.6–11.3; p = 0.003) were associated with AKI. In patients with AKI, renal function was significantly more impaired at 3 and 12 months post-treatment compared to patients without AKI. AKI did not have a negative impact on treatment outcomes. Conclusion AKI occurred in 69% of patients with LA-SCCHN undergoing CRT with high-dose cisplatin. Long-term renal function was significantly more impaired in patients with AKI. Hypertension and CINV are significant risk factors. Optimizing prevention strategies for CINV are urgently needed.

scholarly journals Acute Kidney Injury: From Diagnosis to Prevention and Treatment Strategies

2020 ◽  
Vol 9 (6) ◽  
pp. 1704 ◽  
Author(s):  
Joana Gameiro ◽  
José Agapito Fonseca ◽  
Cristina Outerelo ◽  
José António Lopes
Keyword(s):  
Acute Kidney Injury ◽  
Treatment Strategies ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Risk Patients ◽  
Therapy Strategies ◽  
The Impact ◽  
Care Costs ◽  
Long Term Mortality

Acute kidney injury (AKI) is characterized by an acute decrease in renal function that can be multifactorial in its origin and is associated with complex pathophysiological mechanisms. In the short term, AKI is associated with an increased length of hospital stay, health care costs, and in-hospital mortality, and its impact extends into the long term, with AKI being associated with increased risks of cardiovascular events, progression to chronic kidney disease (CKD), and long-term mortality. Given the impact of the prognosis of AKI, it is important to recognize at-risk patients and improve preventive, diagnostic, and therapy strategies. The authors provide a comprehensive review on available diagnostic, preventive, and treatment strategies for AKI.

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