Post-Discharge Mortality and Rehospitalization among participants in a Comprehensive Acute Kidney Injury Rehabilitation Program

Background: Hospitalization-associated acute kidney injury (AKI) is common and associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with post-discharge outcomes. Methods: Adult patients hospitalized from 9/19/19-2/29/20 in a large health system in Pennsylvania with stage 2-3 AKI who were alive, and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1-3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching. Results: Among high-risk AKI patients evaluated, 77/183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared to 400 contemporary non-participant stage 2/3 AKI survivors. Crude post-discharge rates of rehospitalization or death were lower for participants vs. non-participants at 30 days (15.4% vs 34.2%; p=0.01) and at 90 days (30.8% vs 50.5%; p=0.01). After multivariable adjustment AKI rehabilitation program participation was associated with lower risk of rehospitalization or mortality at 30 days (OR 0.41, 95% CI: 0.16-0.93) with similar findings at 90-days (OR 0.52, 95% CI: 0.25-1.05). Due to small sample size, propensity-matched analyses were limited. The participants' rehospitalization or mortality were numerically lower but not statistically significant at 30 days (17.8% vs. 31.1%; p=0.22) or at 90 days (46.7% vs. 57.8%; p=0.4). Conclusions: The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.

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Abstract 13623: Predicting Acute Kidney Injury Using Biomarkers of Renal Injury Following Cardiac Arrest

Circulation ◽

10.1161/circ.144.suppl_2.13623 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Rahul D Pawar ◽

Lara L Roessler ◽

Mahmoud S Issa ◽

Anne V Grossestreuer ◽

Mathias Johan J Holmberg ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Arrest ◽

Serum Creatinine ◽

Cystatin C ◽

Small Sample Size ◽

Kidney Injury ◽

Primary Outcome Measure ◽

Small Sample ◽

Stage Iii ◽

Baseline Serum

Aim: Acute kidney injury (AKI) after cardiac arrest (CA) is common and associated with worse outcomes. We aimed to evaluate the performance of kidney specific biomarkers including kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin-C in predicting AKI post-CA as compared to serum creatinine. Methods: Patients with kidney specific biomarkers collected as part of randomized trials conducted in adult post-CA populations (NCT02260258, NCT01319110) were included. Patients with Kidney Disease Improving Global Outcome (KDIGO) stage III AKI immediately after enrollment and patients not enrolled at the coordinating center were excluded. Creatinine, KIM-1, NGAL and cystatin-C were measured immediately before enrollment. The primary outcome measure was KDIGO stage III AKI in the first 7-days after enrollment. We determined the association and discrimination of renal biomarkers with relation to KDIGO stage III AKI. Results: Of 63 patients included, 12 (19.1%) developed stage III AKI and 40 (63.5%) died prior to hospital discharge. As compared to patients who did not develop stage III AKI, those who developed stage III AKI had higher baseline serum creatinine (1.75 [IQR:1.3, 2.75] vs 1.3 [1.1, 1.7], p=0.04), higher NGAL (879 [IQR: 442,1194] vs 234 [IQR: 163, 482], p<0.001) and higher cystatin-C (2567 [IQR: 1222,3835] vs 1248 [IQR: 808,1691], p=0.01). There was no difference in KIM-1 (-1.70 [IQR: -2.79, -0.40] vs -1.87 [IQR: -2.70, -1.27], p=0.57). Of the various biomarkers, NGAL measured early after return of spontaneous circulation had the highest discrimination for the future development of stage III AKI [AUROC 0.81 (95%CI:0.69-0.93)] as compared to creatinine [AUROC 0.69 (95%CI: 0.51-0.87)], and cystatin-C [AUROC 0.74 (95%CI:0.57-0.90)] though the difference in AUROC was not significant (p>0.05 for all comparisons). KIM-1 had lowest discrimination [AUROC 0.55 (95%CI:0.34-0.76)]. Conclusion: In post-CA patients enrolled in the two clinical trials, NGAL measured early after CA had the highest discrimination for the development of stage III AKI though the discrimination was not significant compared to creatinine possibly due to small sample size.

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Comprehensive Geriatric Care to Improve Mobility after Hip Fracture: An RCT

Gerontology ◽

10.1159/000510903 ◽

2020 ◽

Vol 66 (6) ◽

pp. 542-548

Author(s):

Wendy L. Cook ◽

Penelope M.A. Brasher ◽

Pierre Guy ◽

Stirling Bryan ◽

Meghan G. Donaldson ◽

...

Keyword(s):

Hip Fracture ◽

Small Sample Size ◽

Controlled Trial ◽

Geriatric Care ◽

Small Sample ◽

Community Dwelling ◽

Post Discharge ◽

Mobility Performance ◽

Discharge Care ◽

Comprehensive Geriatric Care

Background: Comprehensive geriatric care (CGC) for older adults during hospitalization for hip fracture can improve mobility, but it is unclear whether CGC delivered after a return to community living improves mobility compared with usual post-discharge care. Objective: To determine if an outpatient clinic-based CGC regime in the first year after hip fracture improved mobility performance at 12 months. Methods: A two-arm, 1:1 parallel group, pragmatic, single-blind, single-center, randomized controlled trial at 3 hospitals in Vancouver, BC, Canada. Participants were community-dwelling adults, aged ≥65 years, with a hip fracture in the previous 3–12 months, who had no dementia and walked ≥10 m before the fracture occurred. Target enrollment was 130 participants. Clinic-based CGC was delivered by a geriatrician, physiotherapist, and occupational therapist. Primary outcome was the Short Physical Performance Battery (SPPB; 0–12) at 12 months. Results: We randomized 53/313 eligible participants with a mean (SD) age of 79.7 (7.9) years to intervention (n = 26) and usual care (UC, n = 27), and 49/53 (92%) completed the study. Mean 12-month (SD) SPPB scores in the intervention and UC groups were 9.08 (3.03) and 8.24 (2.44). The between-group difference was 0.9 (95% CI –0.3 to 2.0, p = 0.13). Adverse events were similar in the 2 groups. Conclusion: The small sample size of less than half our recruitment target precludes definitive conclusions about the effect of our intervention. However, our results are consistent with similar studies on this population and intervention.

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Fifteen-minute consultation: how to identify and treat children with acute kidney injury

Archives of Disease in Childhood - Education and Practice ◽

10.1136/archdischild-2020-319928 ◽

2021 ◽

pp. edpract-2020-319928

Author(s):

Maura Scott ◽

Grace McCall

Keyword(s):

Acute Kidney Injury ◽

Fluid Management ◽

Kidney Injury ◽

Case Presentation ◽

Mortality And Morbidity ◽

Fluid Status ◽

Close Observation ◽

Long Term Follow Up

Acute kidney injury (AKI) is under-recognised in children and neonates. It is associated with increased mortality and morbidity along with an increased incidence of chronic kidney disease in adulthood. It is important that paediatricians are able to recognise AKI quickly, enabling prompt treatment of reversible causes. In this article, we demonstrate an approach to recognising paediatric AKI, cessation of nephrotoxic medication, appropriate investigations and the importance of accurately assessing fluid status. The mainstay of treatment is attempting to mimic the kidneys ability to provide electrolyte and fluid homeostasis; this requires close observation and careful fluid management. We discuss referral to paediatric nephrology and the importance of long-term follow-up. We present an approach to AKI through case-presentation.

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Nutritional Support in Acute Kidney Injury

10.2310/tywc.12040 ◽

2018 ◽

Author(s):

Alice Sabatino ◽

Giuseppe Regolisti ◽

Filippo Fani ◽

Enrico Fiaccadori

Keyword(s):

Acute Kidney Injury ◽

Oxidation Rate ◽

Nutritional Support ◽

Rapid Change ◽

Kidney Injury ◽

Resting Energy Expenditure ◽

Protein Energy Wasting ◽

Mortality And Morbidity ◽

Protein Energy ◽

Increased Risk

Protein-energy wasting (PEW) is particularly common in patients with acute kidney injury (AKI). It is correlated, at least in part, with specific factors of the reduction of renal function and is associated with significant increase in mortality and morbidity. In this clinical condition, the optimal nutritional support remains an open question due to its qualitative composition in terms of macro- and micronutrients. In fact, data on critically ill patients have confirmed that nutritional support targeting the real protein and energy needs is associated with improvement of clinical outcome. However, data available in AKI patients are still scarce. AKI is characterized by increased risk of both under- and overfeeding because of the coexistence of many factors that can influence the evaluation of nutrient needs, such as a rapid change in body weight due to alterations in fluid balance, loss of nutrients during renal replacement therapy (RRT), and the presence of hidden calories in the RRT (ie, calories derived from anticoagulants and/or from solutions used in the different dialysis methods). As AKI comprises a highly heterogeneous group of patients, with oscillatory nutrient needs during patients’ clinical course, nutritional requirements should be frequently reassessed, individualized, and carefully integrated with RRT. Nutrient needs in patients with AKI can be difficult to estimate and should be directly measured, especially in the intensive care unit setting. This review contains 4 figures, 3 tables and 104 references Keywords: Malnutrition In ICU Patients, Acute Kidney Injury, Nutritional Support, Indirect Calorimetry, Resting Energy Expenditure, Lipid Oxidation Rate, Glucose Oxidation Rate, Micronutrients

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The Cottage: providing medical respite care in a home-like environment for people experiencing homelessness

Housing Care and Support ◽

10.1108/hcs-08-2018-0020 ◽

2018 ◽

Vol 22 (1) ◽

pp. 54-64

Author(s):

Angela Gazey ◽

Shannen Vallesi ◽

Karen Martin ◽

Craig Cumming ◽

Lisa Wood

Keyword(s):

Case Studies ◽

Small Sample Size ◽

Treatment Compliance ◽

Small Sample ◽

Health Conditions ◽

Hospital Inpatient ◽

City Hospital ◽

Post Discharge ◽

Content Type ◽

The Usa

Purpose Co-existing health conditions and frequent hospital usage are pervasive in homeless populations. Without a home to be discharged to, appropriate discharge care and treatment compliance are difficult. The Medical Respite Centre (MRC) model has gained traction in the USA, but other international examples are scant. The purpose of this paper is to address this void, presenting findings from an evaluation of The Cottage, a small short-stay respite facility for people experiencing homelessness attached to an inner-city hospital in Melbourne, Australia. Design/methodology/approach This mixed methods study uses case studies, qualitative interview data and hospital administrative data for clients admitted to The Cottage in 2015. Hospital inpatient admissions and emergency department presentations were compared for the 12-month period pre- and post-The Cottage. Findings Clients had multiple health conditions, often compounded by social isolation and homelessness or precarious housing. Qualitative data and case studies illustrate how The Cottage couples medical care and support in a home-like environment. The average stay was 8.8 days. There was a 7 per cent reduction in the number of unplanned inpatient days in the 12-months post support. Research limitations/implications The paper has some limitations including small sample size, data from one hospital only and lack of information on other services accessed by clients (e.g. housing support) limit attribution of causality. Social implications MRCs provide a safe environment for individuals to recuperate at a much lower cost than inpatient admissions. Originality/value There is limited evidence on the MRC model of care outside of the USA, and the findings demonstrate the benefits of even shorter-term respite post-discharge for people who are homeless.

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Mechanisms of LPS-Induced Acute Kidney Injury in Neonatal and Adult Rats

Antioxidants ◽

10.3390/antiox7080105 ◽

2018 ◽

Vol 7 (8) ◽

pp. 105 ◽

Cited By ~ 8

Author(s):

Egor Plotnikov ◽

Anna Brezgunova ◽

Irina Pevzner ◽

Ljubava Zorova ◽

Vasily Manskikh ◽

...

Keyword(s):

Oxidative Stress ◽

Acute Kidney Injury ◽

Smooth Muscle Actin ◽

Accelerated Aging ◽

Kidney Injury ◽

Nuclear Antigen ◽

Kidney Cells ◽

Adult Rats ◽

Mortality And Morbidity ◽

Causes Of Mortality

Neonatal sepsis is one of the major causes of mortality and morbidity in newborns, greatly associated with severe acute kidney injury (AKI) and failure. Handling of newborns with kidney damage can be significantly different compared to adults, and it is necessary to consider the individuality of an organism’s response to systemic inflammation. In this study, we used lipopolysaccharide (LPS)-mediated acute kidney injury model to study mechanisms of kidney cells damage in neonatal and adult rats. We found LPS-associated oxidative stress was more severe in adults compared to neonates, as judged by levels of carbonylated proteins and products of lipids peroxidation. In both models, LPS-mediated septic simulation caused apoptosis of kidney cells, albeit to a different degree. Elevated levels of proliferating cell nuclear antigen (PCNA) in the kidney dropped after LPS administration in neonates but increased in adults. Renal fibrosis, as estimated by smooth muscle actin levels, was significantly higher in adult kidneys, whereas these changes were less profound in LPS-treated neonatal kidneys. We concluded that in LPS-mediated AKI model, renal cells of neonatal rats were more tolerant to oxidative stress and suffered less from long-term pathological consequences, such as fibrosis. In addition, we assume that by some features LPS administration simulates the conditions of accelerated aging.

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The impact of minimal invasive extracorporeal circulation on postoperative kidney function

Perfusion ◽

10.1177/0267659120954601 ◽

2020 ◽

pp. 026765912095460

Author(s):

Ara Shwan Media ◽

Peter Juhl-Olsen ◽

Nils Erik Magnusson ◽

Ivy Susanne Modrau

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Kidney Function ◽

Extracorporeal Circulation ◽

Artery Bypass ◽

Bypass Graft ◽

Kidney Injury ◽

Minimal Invasive ◽

Mortality And Morbidity ◽

The Impact

Introduction: Acute kidney injury following cardiac surgery is a frequent complication associated with increased mortality and morbidity. Minimal invasive extracorporeal circulation is suggested to preserve postoperative renal function. The aim of this study was to assess the impact of minimal invasive versus conventional extracorporeal circulation on early postoperative kidney function. Methods: Randomized controlled trail including 60 patients undergoing elective stand-alone coronary artery bypass graft surgery and allocated in a 1:1 ratio to either minimal invasive (n = 30) or conventional extracorporeal circulation (n = 30). Postoperative kidney injury was assessed by elevation of plasma neutrophil gelatinase-associated lipocalin (NGAL), a sensitive tubular injury biomarker. In addition, we assessed changes in estimated glomerular filtration rate (eGFR), and the incidence of acute kidney injury according to the Acute Kidney Injury Network (AKIN) classification. Results: We observed no differences between groups regarding increase of plasma NGAL (p = 0.31) or decline of eGFR (p = 0.82). In both groups, 6/30 patients developed acute kidney injury according to the AKIN classification, all regaining preoperative renal function within 30 days. Conclusion: Our findings challenge the superiority of minimal invasive compared to conventional extracorporeal circulation in terms of preservation of renal function following low-risk coronary surgery.

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Paucity of renal follow-up by school age after neonatal cardiac surgery

Cardiology in the Young ◽

10.1017/s1047951120001067 ◽

2020 ◽

Vol 30 (6) ◽

pp. 822-828

Author(s):

Sara Rodriguez-Lopez ◽

Louis Huynh ◽

Kelly Benisty ◽

Adrian Dancea ◽

Daniel Garros ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Glomerular Filtration Rate ◽

Glomerular Filtration ◽

Filtration Rate ◽

Kidney Injury ◽

Post Discharge ◽

Heart Repair ◽

Neonatal Cardiac Surgery

AbstractIntroduction:There are little data about renal follow-up of neonates after cardiovascular surgery and no guidelines for long-term renal follow-up. Our objectives were to assess renal function follow-up practice after neonatal cardiac surgery, evaluate factors that predict follow-up serum creatinine measurements including acute kidney injury following surgery, and evaluate the estimated glomerular filtration rate during follow-up using routinely collected laboratory values.Methods:Two-centre retrospective cohort study of children 5–7 years of age with a history of neonatal cardiac surgery. Univariable and multivariable analyses were performed to determine factors associated with post-discharge creatinine measurements. Glomerular filtration rate was estimated for each creatinine using a height-independent equation.Results:Seventeen of 55 children (30%) did not have any creatinine measured following discharge after surgery until the end of study follow-up, which occurred at a median time of 6 years after discharge. Of the 38 children who had the kidney function checked, 15 (40%) had all of their creatinine drawn only in the context of a hospitalisation or emergency department visit. Acute kidney injury following surgery did not predict the presence of follow-up creatinine measurements.Conclusions:A large proportion of neonates undergoing congenital heart repair did not have a follow-up creatinine measured in the first years following surgery. In those that did have a creatinine measured, there did not appear to be any identified pattern of follow-up. A follow-up system for children who are discharged from cardiac surgery is needed to identify children with or at risk of chronic kidney disease.

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Renal Failure

10.1093/med/9780199755691.003.0473 ◽

2012 ◽

Author(s):

Kianoush B. Kashani ◽

Amy W. Williams

Keyword(s):

Chronic Kidney Disease ◽

Acute Kidney Injury ◽

Renal Failure ◽

Kidney Disease ◽

Kidney Injury ◽

Diabetic Patients ◽

Clinical Approach ◽

Mortality And Morbidity ◽

Electrolyte Disturbances ◽

Metabolic Bone

Renal failure is caused by acute kidney injury or chronic kidney disease. Acute kidney injury (AKI) is a common, devastating complication that increases mortality and morbidity among patients with various medical and surgical illnesses. Also known as acute renal failure, AKI is a rapid deterioration of kidney function that results in the accumulation of nitrogenous metabolites and medications and in electrolyte and acid-base imbalances. This chapter discusses the definition, epidemiology, pathophysiology, and etiology of AKI; the clinical approach to patients with AKI; and the management of AKI. Chronic kidney disease (CKD) has been categorized into 5 stages. When renal function decreases to stage 3, the complications of CKD become evident. These complications include hypertension, cardiovascular disease, lipid abnormalities, anemia, metabolic bone disease, and electrolyte disturbances. To prevent the progression of CKD, therapy must be directed toward preventing these complications and achieving adequate glucose control in diabetic patients with CKD.

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Incidence, Risk Factors, and Outcome of Acute Kidney Injury in the Intensive Care Unit: A Single-Center Study from Jordan

Critical Care Research and Practice ◽

10.1155/2020/8753764 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ashraf O. Oweis ◽

Sameeha A. Alshelleh ◽

Suleiman M. Momany ◽

Shaher M. Samrah ◽

Basheer Y. Khassawneh ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Acute Kidney Injury ◽

Intensive Care ◽

Kidney Injury ◽

Tertiary Hospital ◽

Acute Kidney Injury Network ◽

Apache Ii Score ◽

Mortality And Morbidity ◽

Incidence Risk

Background. Acute kidney injury (AKI) is a common serious problem affecting critically ill patients in intensive care unit (ICU). It increases their morbidity, mortality, length of ICU stay, and long-term risk of chronic kidney disease (CKD). Methods. A retrospective study was carried out in a tertiary hospital in Jordan. Medical records of patients admitted to the medical ICU between 2013 and 2015 were reviewed. We aimed to identify the incidence, risk factors, and outcomes of AKI. Acute kidney injury network (AKIN) classification was used to define and stage AKI. Results. 2530 patients were admitted to medical ICU, and the incidence of AKI was 31.6%, mainly in stage 1 (59.4%). In multivariate analysis, increasing age (odds ratio (OR) = 1.2 (95% CI 1.1–1.3), P = 0.0001) and higher APACHE II score (OR = 1.5 (95% CI 1.2–1.7), P = 0.001) were predictors of AKI, with 20.4% of patients started on hemodialysis. At the time of discharge, 58% of patients with AKI died compared to 51.3% of patients without AKI (P = 0.05). 88% of patients with AKIN 3 died by the time of discharge compared to patients with AKIN 2 and 1 (75.3% and 61.2% respectively, P = 0.001). Conclusion. AKI is common in ICU patients, and it increases mortality and morbidity. Close attention for earlier detection and addressing risk factors for AKI is needed to decrease incidence, complications, and mortality.

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