Psoriasis and Its Impact on In-Hospital Outcome in Patients Hospitalized with Acute Kidney Injury

Background: Psoriasis is a chronic inflammatory disease which affects the body far beyond the skin. Whereas there is solid evidence that chronic skin inflammation in psoriasis drives cardiovascular disease, the impact on renal impairment and acute kidney injury (AKI) is still unclear. We aimed to analyze the impact of psoriasis on the in-hospital outcome of patients hospitalized with AKI. Methods: In this retrospective database study, we investigated data on characteristics, comorbidities, and in-hospital outcomes for all hospitalized patients with AKI stratified for concomitant psoriasis, which were collected by the Federal Office of Statistics in Germany between 2005 and 2016. Results: Among the 3,162,449 patients treated for AKI in German hospitals between 2005 and 2016, 11,985 patients (0.4%) additionally suffered from psoriasis. While the annual number of AKI patients with psoriasis increased significantly from 485 cases (4.0%) in 2005 to 1902 (15.9%) in 2016 (p < 0.001), the in-hospital mortality decreased substantially (from 24.9% in 2005 to 17.4% in 2016; p < 0.001). AKI patients with concomitant psoriasis were younger (70 (IQR; 60–78) vs. 76 (67–83) years; p < 0.001) and were more often treated with dialysis (16.3% vs. 13.6%, p < 0.001). Presence of psoriasis in AKI patients was associated with reduced prevalence of myocardial infarction (OR 0.62; p < 0.001), stroke (OR 0.85; p = 0.013), and in-hospital mortality (OR 0.75; p < 0.001). Conclusions: AKI patients with psoriasis were hospitalized in median 6 years earlier than those without. Despite younger age, we detected higher use of kidney replacement therapy in patients with psoriasis, indicating a more severe course of AKI. Our findings might improve management of these patients and contribute evidence for extracutaneous, systemic manifestations of psoriasis.

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The Impact of Post-contrast Acute Kidney Injury on In-hospital Mortality After Endovascular Thrombectomy in Patients With Acute Ischemic Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.665614 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mona Laible ◽

Ekkehart Jenetzky ◽

Markus Alfred Möhlenbruch ◽

Martin Bendszus ◽

Peter Arthur Ringleb ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Stroke Severity ◽

Post Contrast ◽

Endovascular Thrombectomy ◽

Symptomatic Intracerebral Hemorrhage ◽

The Impact

Background and Purpose: Clinical outcome and mortality after endovascular thrombectomy (EVT) in patients with ischemic stroke are commonly assessed after 3 months. In patients with acute kidney injury (AKI), unfavorable results for 3-month mortality have been reported. However, data on the in-hospital mortality after EVT in this population are sparse. In the present study, we assessed whether AKI impacts in-hospital and 3-month mortality in patients undergoing EVT.Materials and Methods: From a prospectively recruiting database, consecutive acute ischemic stroke patients receiving EVT between 2010 and 2018 due to acute large vessel occlusion were included. Post-contrast AKI (PC-AKI) was defined as an increase of baseline creatinine of ≥0.5 mg/dL or >25% within 48 h after the first measurement at admission. Adjusting for potential confounders, associations between PC-AKI and mortality after stroke were tested in univariate and multivariate logistic regression models.Results: One thousand one hundred sixty-nine patients were included; 166 of them (14.2%) died during the acute hospital stay. Criteria for PC-AKI were met by 29 patients (2.5%). Presence of PC-AKI was associated with a significantly higher risk of in-hospital mortality in multivariate analysis [odds ratio (OR) = 2.87, 95% confidence interval (CI) = 1.16–7.13, p = 0.023]. Furthermore, factors associated with in-hospital mortality encompassed higher age (OR = 1.03, 95% CI = 1.01–1.04, p = 0.002), stroke severity (OR = 1.05, 95% CI = 1.03–1.08, p < 0.001), symptomatic intracerebral hemorrhage (OR = 3.20, 95% CI = 1.69–6.04, p < 0.001), posterior circulation stroke (OR = 2.85, 95% CI = 1.72–4.71, p < 0.001), and failed recanalization (OR = 2.00, 95% CI = 1.35–3.00, p = 0.001).Conclusion: PC-AKI is rare after EVT but represents an important risk factor for in-hospital mortality and for mortality within 3 months after hospital discharge. Preventing PC-AKI after EVT may represent an important and potentially lifesaving effort in future daily clinical practice.

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The impact of diabetes on outcomes, length of stay and costs in acute kidney injury patients: a cross-sectional multicenter study in China

10.21203/rs.3.rs-16071/v1 ◽

2020 ◽

Author(s):

Lishan Tan ◽

Li Chen ◽

Lingyan Li ◽

Jinwei Wang ◽

Xiaoyan Huang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Length Of Stay ◽

Hospital Mortality ◽

Hospital Stay ◽

Kidney Injury ◽

Renal Recovery ◽

Cross Sectional ◽

Patients With Diabetes ◽

The Impact ◽

Physician Diagnosis

Abstract Background : With the increasing worldwide prevalence and disease burden of diabetic mellitus, data on the impact of diabetes on acute kidney injury (AKI) patients in China are limited.Methods: A nationwide cross-sectional and retrospective study was conducted in China, which included 2,223,230 hospitalized adult patients and covered 82% of the country’s population. Diabetes was identified according to blood glucose, hemoglobin A1c levels, physician diagnosis and drug use. In total, 7604 AKI patients were identified, and 1404 and 6200 cases were defined as diabetic and non-diabetic respectively. Clinical characteristics, outcome, in-hospital stay, and costs of AKI patients with and without diabetes were compared. Multivariable logistic and linear regression analyses were conducted to evaluate the association of diabetes with mortality and renal recovery in the admitted AKI patients.Results: In this survey, AKI patients with diabetes were older, male-dominated (61.9%), with more comorbidities, and higher serum creatinine levels. Compared to patients without diabetes, a significant upswing in all-cause in-hospital mortality, hospital stay, and costs were found in those with diabetes ( p <0.05). After adjusted for relevant covariables, diabetes was independently associated with failed renal recovery (OR=1.13, p =0.04), rather than all-cause in-hospital mortality (OR=1.09, p =0.39). Also, diabetic status was positively associated with length of stay ( β =0.04, p =0.04) and costs ( β =0.09, p <0.01) in hospital after adjusted for possible confounders. Conclusions: Failed renal recovery, rather than all-cause in-hospital mortality, is independently associated with diabetes in hospitalized AKI patients. Moreover, diabetes is significantly correlated with in-hospital stay and expenditures in AKI.

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The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients

Brazilian Journal of Nephrology ◽

10.1590/2175-8239-jbn-2021-0123 ◽

2021 ◽

Author(s):

João Bernardo ◽

Joana Gonçalves ◽

Joana Gameiro ◽

João Oliveira ◽

Filipe Marques ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hospital Mortality ◽

Hospital Admission ◽

Kidney Injury ◽

Baseline Serum ◽

Negative Prognostic Factor ◽

Long Term Follow Up ◽

Vasopressor Use ◽

The Impact

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

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Incidence and Impact of Acute Kidney Injury in Patients Receiving Extracorporeal Membrane Oxygenation: A Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm8070981 ◽

2019 ◽

Vol 8 (7) ◽

pp. 981 ◽

Cited By ~ 13

Author(s):

Charat Thongprayoon ◽

Wisit Cheungpasitporn ◽

Ploypin Lertjitbanjong ◽

Narothama Reddy Aeddula ◽

Tarun Bathini ◽

...

Keyword(s):

Systematic Review ◽

Acute Kidney Injury ◽

Extracorporeal Membrane Oxygenation ◽

Hospital Mortality ◽

Meta Analysis ◽

Kidney Injury ◽

Incidence Rates ◽

Adult Patients ◽

Membrane Oxygenation ◽

The Impact

Background: Although acute kidney injury (AKI) is a frequent complication in patients receiving extracorporeal membrane oxygenation (ECMO), the incidence and impact of AKI on mortality among patients on ECMO remain unclear. We conducted this systematic review to summarize the incidence and impact of AKI on mortality risk among adult patients on ECMO. Methods: A literature search was performed using EMBASE, Ovid MEDLINE, and Cochrane Databases from inception until March 2019 to identify studies assessing the incidence of AKI (using a standard AKI definition), severe AKI requiring renal replacement therapy (RRT), and the impact of AKI among adult patients on ECMO. Effect estimates from the individual studies were obtained and combined utilizing random-effects, generic inverse variance method of DerSimonian-Laird. The protocol for this systematic review is registered with PROSPERO (no. CRD42018103527). Results: 41 cohort studies with a total of 10,282 adult patients receiving ECMO were enrolled. Overall, the pooled estimated incidence of AKI and severe AKI requiring RRT were 62.8% (95%CI: 52.1%–72.4%) and 44.9% (95%CI: 40.8%–49.0%), respectively. Meta-regression showed that the year of study did not significantly affect the incidence of AKI (p = 0.67) or AKI requiring RRT (p = 0.83). The pooled odds ratio (OR) of hospital mortality among patients receiving ECMO with AKI on RRT was 3.73 (95% CI, 2.87–4.85). When the analysis was limited to studies with confounder-adjusted analysis, increased hospital mortality remained significant among patients receiving ECMO with AKI requiring RRT with pooled OR of 3.32 (95% CI, 2.21–4.99). There was no publication bias as evaluated by the funnel plot and Egger’s regression asymmetry test with p = 0.62 and p = 0.17 for the incidence of AKI and severe AKI requiring RRT, respectively. Conclusion: Among patients receiving ECMO, the incidence rates of AKI and severe AKI requiring RRT are high, which has not changed over time. Patients who develop AKI requiring RRT while on ECMO carry 3.7-fold higher hospital mortality.

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MO417NEPHROLOGIST INTERVENTION TO AVOID KIDNEY REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab083.009 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Jonathan Chávez ◽

Pablo Maggiani-Aguilera ◽

Andres De la Torre-Quiroga ◽

Alejandro Martínez-Gallardo Gonzalez ◽

Ramón Medina-González ◽

...

Keyword(s):

Acute Kidney Injury ◽

Replacement Therapy ◽

Prospective Cohort ◽

Kidney Injury ◽

Primary Objective ◽

Early Interventions ◽

Kidney Replacement Therapy ◽

The Impact ◽

First Time ◽

Antibiotic Dose

Abstract Background and Aims Based on the pathophysiology of acute kidney injury (AKI) it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression and death. Method In a prospective cohort at Hospital Civil of Guadalajara, we followed-up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment and removal of hyperchloremic solutions) after propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3 and death (secondary objectives). Results From 2017 to 2020 we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (OR 0.58, 95% CI 0.48-0.70, p = <0.001) and AKI progression to stage 3 (OR 0.59, 95% CI 0.49-0.71, p = <0.001). Receiving vasopressors and KRT were associated with mortality, but neither of these interventions reduced these risks. Conclusion In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment was associated with a reduction in the risk of starting KRT and progression to AKI stage 3.

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Impact of acute kidney injury on in-hospital outcomes among patients hospitalized with acute heart failure: a propensity score matched analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1247 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Shetty ◽

H Malik ◽

A Abbas ◽

Y Ying ◽

W Aronow ◽

...

Keyword(s):

Heart Failure ◽

Acute Kidney Injury ◽

Propensity Score ◽

Hospital Mortality ◽

Acute Heart Failure ◽

Kidney Injury ◽

Matched Cohort ◽

Hospital Outcomes ◽

Increased Risk ◽

The Impact

Abstract Background Acute kidney injury (AKI) is frequently present in patients admitted for acute heart failure (AHF). Several studies have evaluated the mortality risk and have concluded poor prognosis in any patient with AKI admitted for AHF. For the most part, the additional morbidity and mortality burden in AHF patients with AKI has been attributed to the concomitant comorbidities, and/or interventions. Purpose We sought to determine the impact of acute kidney injury (AKI) on in-hospital outcomes in patients presenting with acute heart failure (AHF). We identified isolated AKI patients after excluding other concomitant diagnoses and procedures, which may contribute to an increased risk of mortality and morbidity. Methods Data from the National Inpatient Sample (2012- 14) were used to identify patients with the principal diagnosis of AHF and the concomitant secondary diagnosis of AKI. Propensity score matching was performed on 30 baseline variables to identify a matched cohort. The outcome of interest was in-hospital mortality. We further evaluated in-hospital procedures and complications. Results Of 1,470,450 patients admitted with AHF, 24.3% had AKI. After propensity matching a matched cohort of 356,940 patients was identified. In this matched group, the AKI group had significantly higher in-hospital mortality (3.8% vs 1.7%, p<0.001). Complications such as sepsis and cardiac arrest were higher in the AKI group. Similarly, in-hospital procedures including CABG, mechanical ventilation and IABP were performed more in the AKI group. AHF patients with AKI had longer in-hospital stay of ∼1.7 days. Conclusions In a propensity score-matched cohort of AHF with and without AKI, the risk of in-hospital mortality was >2-fold in the AKI group. Healthcare utilization and burden of complications were higher in the AKI group. Funding Acknowledgement Type of funding source: None

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Clinical impact of diabetes mellitus in patients hospitalized for myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.1506 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V.H Schmitt ◽

L Hobohm ◽

T Munzel ◽

P Wenzel ◽

T Gori ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Kidney Injury ◽

Cardiovascular Risk ◽

Hospital Mortality ◽

Kidney Injury ◽

Funding Source ◽

Federal States ◽

Artery Disease ◽

The Impact

Abstract Background Diabetes mellitus (DM) represents a major cardiovascular risk factor for coronary artery disease and myocardial infarction (MI). Purpose We aimed to assess in-hospital events and time trends in MI patients with and without DM between 2005 and 2016 in Germany. Methods The nationwide German inpatient sample 2005–2016 was used for statistical analysis (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2016, own calculations). Hospitalized MI patients were stratified for the presence of DM and the impact of DM on in-hospital events was investigated. Results A total of 3,307,703 patients with acute MI (37.6% females, 56.8% aged ≥70 years) were included in the present analysis. Of these, 1,007,326 (30.5%) patients were coded for additional DM. More MI patients with DM were female (41.2% vs. 36.0%, P<0.001) and aged 70 years or older (64.3% vs. 53.5%, P<0.001). Presence of most cardiovascular risk factors was increased in coprevalence with DM compared to non-diabetics (obesity: 14.1% vs. 7.2%, essential arterial hypertension: 60.9% vs. 52.4%, hyperlipidaemia 40.5% vs. 37.8%, P<0.001), only smoking was more frequent in people without DM (4.8% vs. 8.5%, P<0.001). Additionally, DM was associated with an elevated occurrence of comorbidities like peripheral artery disease (10.8% vs. 4.5%, P<0.001), atrial fibrillation/flutter (26.5% vs. 19.6%, P<0.001) and acute or chronic kidney disease (39.8% vs. 21.8%, P<0.001). Recurrent MI events during the first 4 weeks after previous MI were more common in MI patients with DM (0.8% vs. 0.6%, P<0.001). Pneumonia (14.9% vs. 10.2%, P<0.001), acute kidney injury (8.6% vs. 5.2%, P<0.001) and stroke (3.4% vs. 2.7%, P<0.001) were more prevalent in MI patients with DM. Mortality was significantly increased in patients with DM (13.2% vs. 12.1%, P<0.001). While the proportion of MI patients with DM increased slightly from 29.8% in 2005 to 30.7% in 2016 (β 7.04 [95% CI 4.13–9.94], P<0.001), the in-hospital mortality rate of MI patients with DM decreased substantially from 15.2% in 2005 to 11.5% in 2016 (β −0.36 [95% CI: −0.38 to −0.34], P<0.001). Confirming this results, the univariate logistic regression analyses demonstrated that DM was associated with a higher in-hospital mortality (OR 1.1 [95% CI: 1.1–1.1], P<0.001), higher risk for recurrent MI (OR 1.3 [95% CI: 1.3–1.4], P<0.001), and higher frequency of acute kidney injury (OR 1.7 [95% CI: 1.7–1.7], P<0.001). Conclusions While the proportion of MI patients with DM increased only slightly from 2005 to 2016, the in-hospital mortality decreased substantially in MI patients with DM. DM was associated with an aggravated cardiovascular risk profile, higher prevalence of comorbidities and increased in-hospital mortality during hospitalization. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503); institutional grant for the Center for Thrombosis and Hemostasis.

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The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis

PLoS ONE ◽

10.1371/journal.pone.0185589 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0185589 ◽

Cited By ~ 9

Author(s):

Florica Gadalean ◽

Mihaela Simu ◽

Florina Parv ◽

Ruxandra Vorovenci ◽

Raluca Tudor ◽

...

Keyword(s):

Acute Kidney Injury ◽

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Kidney Injury ◽

Intravenous Thrombolysis ◽

Stroke Patients ◽

The Impact

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Nephrologist Interventions to Avoid Kidney Replacement Therapy in Acute Kidney Injury

Kidney & Blood Pressure Research ◽

10.1159/000517615 ◽

2021 ◽

pp. 1-10

Author(s):

Jonathan S. Chávez-Íñiguez ◽

Pablo Maggiani-Aguilera ◽

Christian Pérez-Flores ◽

Rolando Claure-Del Granado ◽

Andrés E. De la Torre-Quiroga ◽

...

Keyword(s):

Acute Kidney Injury ◽

Replacement Therapy ◽

Prospective Cohort ◽

Kidney Injury ◽

Primary Objective ◽

Early Interventions ◽

Risk Of Death ◽

Kidney Replacement Therapy ◽

The Impact ◽

First Time

Background: Based on the pathophysiology of acute kidney injury (AKI), it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression, and death. Methods: In a prospective cohort at the Hospital Civil of Guadalajara, we followed up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment, and removal of hyperchloremic solutions) after the propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3, and death (secondary objectives). Results: From 2017 to 2020, we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (odds ratio [OR]: 0.58, 95% confidence interval [CI]: 0.48–0.70, and p ≤ 0.001) and AKI progression to stage 3 (OR: 0.59, 95% CI: 0.49–0.71, and p ≤ 0.001). Receiving vasopressors and KRT were associated with mortality. None of the interventions studied was associated with reducing the risk of death. Conclusions: In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment were associated with lower risk of starting KRT and progression to AKI stage 3.

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