Faculty Opinions recommendation of A genetic variant of hypoxia-inducible factor-1alpha is associated with adverse outcomes in acute kidney injury.

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

Download Full-text

Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery

Journal of Pediatric Intensive Care ◽

10.1055/s-0041-1740359 ◽

2021 ◽

Author(s):

Michelle Ramírez ◽

Sujata Chakravarti ◽

Jaclyn McKinstry ◽

Yasir Al-qaqaa ◽

Raj Sahulee ◽

...

Keyword(s):

Acute Kidney Injury ◽

Congenital Heart ◽

Heart Surgery ◽

Kidney Injury ◽

Acute Kidney Injury Network ◽

Congenital Heart Surgery ◽

Adverse Outcomes ◽

Tissue Inhibitor Of Metalloproteinase ◽

Stress Injury ◽

Stage 1

Abstract Objectives: This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods: We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results: Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019). Conclusion: AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.

Download Full-text

528 EVALUATING THE PRESCRIPTION OF OPIATES IN PATIENTS WITH NECK OF FEMUR FRACTURES IN OUT OF HOSPITAL AND EMERGENCY CARE SETTING

Age and Ageing ◽

10.1093/ageing/afab116.16 ◽

2021 ◽

Vol 50 (Supplement_2) ◽

pp. ii8-ii13

Author(s):

S Kanabar ◽

D Mistry ◽

H Naeem ◽

R Smith ◽

F Zahir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hip Fracture ◽

Respiratory Depression ◽

Local Governance ◽

Statistical Tests ◽

Kidney Injury ◽

Adverse Outcomes ◽

Respiratory Compromise ◽

Femur Fractures ◽

Fracture Management

Abstract Introduction Opiate based analgesia forms a key component of Hip Fracture management. If prescribed inappropriately, opiate based analgesia can lead to respiratory depression, nephrotoxicity, and delayed recovery. The aim of this project was to evaluate opiate prescription in NOF patients in both out of hospital (OOH) and Emergency Department (ED). Methods 100 consecutive patients were identified from National Hip Fracture Database between January and August 2019. Medical records were reviewed in both care settings, reviewing dose of morphine in comparison to body weight and renal function. Outcomes measured include constipation, acute kidney injury, respiratory compromise, and mortality. Statistical tests (t-test and chi square) were used to discern significance. Following the first cycle of results, results were disseminated to paramedics and at local governance meetings. Teaching was undertaken to increase awareness of harms associated with inappropriate opiate prescribing. A second cycle evaluated 30 consecutive NOFs from July 2020. Results In our study population, 74% were female and the average age was 84. The range of morphine doses given OOH ranged from 2-40 mg, in comparison to 2.5-20 mg in ED. 18% of patient suffered from Respiratory depression with 48 hours of their admission with a further 7% suffering from an acute kidney injury. After intervention, OOH morphine doses ranged between 5-10 mg, a reduction of 75% on maximum dose, with increased use of adjuvants as guided by the WHO pain ladder. No adverse outcomes were noted within 48 hours of admission. Conclusion Patient safety should be high on the agenda whilst caring for frail patients with Hip Fractures and opiate prescription is one of the most critical in the patient’s journey. Reducing harm by prescribing the optimal opiates helps to reduce mortality, morbidity, improve rehabilitation and patient flow within the NHS pathways. A guideline has been published to aid opiate prescription in elderly patients.

Download Full-text

CYBA Gene Polymorphisms and Adverse Outcomes in Acute Kidney Injury: A Prospective Cohort Study

Nephron Extra ◽

10.1159/000333017 ◽

2011 ◽

Vol 1 (1) ◽

pp. 112-123 ◽

Cited By ~ 4

Author(s):

Mary C. Perianayagam ◽

Hocine Tighiouart ◽

Caroline M. Nievergelt ◽

Daniel T. O’Connor ◽

Orfeas Liangos ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Gene Polymorphisms ◽

Kidney Injury ◽

Adverse Outcomes ◽

I Gene

Download Full-text

Treatment with a Novel Hypoxia-Inducible Factor Hydroxylase Inhibitor (TRC160334) Ameliorates Ischemic Acute Kidney Injury

American Journal of Nephrology ◽

10.1159/000341870 ◽

2012 ◽

Vol 36 (3) ◽

pp. 208-218 ◽

Cited By ~ 17

Author(s):

Prashant Jamadarkhana ◽

Anita Chaudhary ◽

Laxmikant Chhipa ◽

Amita Dubey ◽

Anookh Mohanan ◽

...

Keyword(s):

Acute Kidney Injury ◽

Hypoxia Inducible Factor ◽

Kidney Injury ◽

Ischemic Acute Kidney Injury

Download Full-text

Editor’s Choice- What do small serum creatinine changes tell us about outcomes after acute myocardial infarction?

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872617728721 ◽

2017 ◽

Vol 7 (8) ◽

pp. 739-742 ◽

Cited By ~ 3

Author(s):

Johann Auer ◽

Frederik H Verbrugge ◽

Gudrun Lamm

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Acute Kidney Injury ◽

Percutaneous Coronary Intervention ◽

Serum Creatinine ◽

Kidney Injury ◽

Coronary Intervention ◽

Adverse Outcomes ◽

Hospital Length Of Stay ◽

Percutaneous Coronary

Acute kidney injury (AKI), mostly defined as a rise in serum creatinine concentration of more than 0.5 mg/dl, is a common, serious, and potentially preventable complication of percutaneous coronary intervention and is associated with adverse outcomes including an increased risk of inhospital mortality. Recent data from the National Cardiovascular Data Registry/Cath-PCI registry including 985,737 consecutive patients undergoing percutaneous coronary intervention suggest that approximately 7% experienced AKI with a reported incidence of 3–19%. In patients undergoing primary percutaneous coronary intervention for acute myocardial infarction (AMI), AKI occurs more frequently with rates up to 20% depending on patient and procedural characteristics. However, varying definitions of AKI limit comparisons of AKI rates across different studies. Recently, most studies have adopted the Acute Kidney Injury Network (AKIN) criteria for definition and classification of AKI. Beyond the AKIN criteria for AKI, other classifications such as the risk, injury, failure, loss and end-stage kidney disease (RIFLE) and kidney disease: improving global outcomes (KDIGO) criteria are used to define AKI. Notably, even small increases in serum creatinine beyond AKI may be associated with adverse outcomes including increased hospital length of stay and excess. Acute kidney injury (AKI) is a serious and potentially preventable complication of percutaneous coronary intervention (PCI). Worsening renal function is associated with adverse outcomes including a higher rate of in-hospital mortality. In patients undergoing primary PCI for acute myocardial infarction (AMI), AKI occurs up to 20% of such individuals. Varying definitions of AKI limit comparisons of AKI rates across different studies. Additionally, even small increases in serum creatinine beyond lavels meeting AKI definitions may be associated with adverse outcomes including increased hospital length of stay.

Download Full-text