Comparison of the Kidney Injury Risk Tool to the Clinical Assessment of Contrast Induced Nephropathy Risk

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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Validation of the STARZ neonatal acute kidney injury risk stratification score

Pediatric Nephrology ◽

10.1007/s00467-021-05369-1 ◽

2022 ◽

Author(s):

Sidharth Kumar Sethi ◽

Rupesh Raina ◽

Abhyuday Rana ◽

Gopal Agrawal ◽

Abhishek Tibrewal ◽

...

Keyword(s):

Acute Kidney Injury ◽

Risk Stratification ◽

Injury Risk ◽

Kidney Injury ◽

Risk Stratification Score

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Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

World Journal of Emergency Medicine ◽

10.5847/wjem.j.issn.1920-8642.2012.04.007 ◽

2012 ◽

Vol 3 (4) ◽

pp. 278 ◽

Cited By ~ 4

Author(s):

Xue-zhong Xing ◽

Hai-jun Wang ◽

Chu-lin Huang ◽

Quan-hui Yang ◽

Shi-ning Qu ◽

...

Keyword(s):

Acute Kidney Injury ◽

Cardiac Surgery ◽

Cancer Patients ◽

Critically Ill ◽

Injury Risk ◽

Kidney Injury ◽

Risk Scores

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Correction to: National Cardiovascular Data Registry-Acute Kidney Injury (NCDR) vs. Mehran risk models for prediction of contrast-induced nephropathy and need for dialysis after coronary angiography in a German patient cohort

Journal of Nephrology ◽

10.1007/s40620-021-01154-3 ◽

2021 ◽

Author(s):

Claudio Parco ◽

Maximilian Brockmeyer ◽

Lucin Kosejian ◽

Julia Quade ◽

Jennifer Tröstler ◽

...

Keyword(s):

Acute Kidney Injury ◽

Coronary Angiography ◽

Kidney Injury ◽

Risk Models ◽

Contrast Induced Nephropathy ◽

Patient Cohort ◽

German Patient ◽

Data Registry ◽

National Cardiovascular

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Abstract 12873: Blood Transfusion and the Risk of Contrast-Induced Nephropathy Among Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Circulation ◽

10.1161/circ.132.suppl_3.12873 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Wassef Karrowni ◽

Amit N Vora ◽

Dadi Dai ◽

Daniel Wojdyla ◽

Habib Dakik ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Blood Transfusion ◽

Primary Outcome ◽

Kidney Injury ◽

Coronary Intervention ◽

Contrast Induced Nephropathy ◽

Coronary Syndrome ◽

Post Procedure ◽

Lower Baseline ◽

Percutaneous Coronary

Introduction: Emerging scientific and clinical evidence suggests that blood transfusion might be risk factor for acute kidney injury. Hypothesis: Blood transfusion is independently associated with contrast-induced nephropathy (CIN) in acute coronary syndrome (ACS) patients undergoing PCI. Methods: Retrospective cohort study from the NCDR CathPCI Registry (2009-2014) (n=1,756,864). Primary outcome was CIN defined as rise in serum creatinine peak post-procedure ≥ 0.5 mg/dl or ≥ 25% above baseline. Results: CIN developed in 9.0% of the cohort; these patients were older (66.0 vs. 64.0 years; P<0.01), more often female (43.2% vs. 31.9%; P<0.01), and had more baseline comorbidities including DM (46.1%), hypertension (85.1%), and lower baseline GFR. Blood transfusion was utilized in 38,626 (2.2%) of patients. The adjusted OR for the risk of CIN with transfusion in the overall sample, patients with major bleeding, and patients with no bleeding were 4.87 (4.71-5.04), 2.21 (2.12-2.31), and 4.80 (4.40 - 5.24) respectively (Table). Association of CIN with transfusion was significantly increased across all pre-procedure hemoglobin (Hgb) levels and in stepwise fashion with increasing Hgb levels and regardless of post-procedure bleeding (Hgb &lt=10: adjusted OR (95%CI) 2.90 (2.75-3.05); Hgb &gt10 to &lt=13: 5.26 (5.06-5.48); Hgb &gt13 to &lt=15: 6.37 (5.99-6.78); Hgb &gt15 g/dl: 7.03 (6.43-7.67); Ptrend <0.01). Conclusions: Blood transfusion is strongly associated with CIN in ACS patients undergoing PCI. Whether a restrictive blood transfusion strategy lowers the risk of contrast nephropathy should be investigated.

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PP162 Use Of The RenalGuard® System To Prevent Contrast-Induced Nephropathy

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462321001239 ◽

2021 ◽

Vol 37 (S1) ◽

pp. 23-23

Author(s):

Perizat Bektassova ◽

Valeriy Benberin ◽

Andrey Avdeyev ◽

Nasrulla Shanazarov ◽

Ruslan Akhmedullin ◽

...

Keyword(s):

Contrast Media ◽

Hospital Setting ◽

Kidney Injury ◽

Contrast Induced Nephropathy ◽

Management Guidelines ◽

Forced Diuresis ◽

Risk Patients ◽

Intravenous Hydration ◽

Clinical Advantage ◽

Meta Analyses

IntroductionContrast-induced nephropathy (CIN) is a common cause of hospital-acquired acute kidney injury (AKI) following the administration of contrast media for coronary interventions or procedures such as diagnostic coronary angiography. The optimal way of preventing CIN remains uncertain. However, preliminary intravenous hydration, minimizing the volume of contrast media, and avoiding the use of nephrotoxic drugs are recommended in current management guidelines. The aim of this analysis was to compare the RenalGuard® system with standard care.MethodsA comprehensive literature search was conducted in PubMed and Google Scholar to identify evidence on the clinical and economic effectiveness of forced diuresis with matched hydration using the RenalGuard system for preventing CIN. Multiple criteria decision analysis (MCDA) was used to assess the performance of the method in hospital settings, compared with alternative options.ResultsSeveral systematic reviews with meta-analyses demonstrated that forced diuresis with matched hydration using the RenalGuard system was associated with a significantly lower relative risk of CIN among high-risk patients with chronic kidney disease. However, the evidence supporting the advantage of the proposed method over current forced diuresis techniques with manual calculation of the volumes for matched hydration in the hospital setting was limited.ConclusionsAlthough the effectiveness of the RenalGuard system has been demonstrated in meta-analyses, its clinical advantage over forced diuresis with manual hydration calculation is uncertain. It is also worth noting the lack of evidence to date on this technology, the fact that it is still at the research stage in some countries, and that it is not included in CIN management guidelines.

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Clinical Assessment of Drop-Jump Landing for Determination of Risk for Knee Injury

International Journal of Athletic Therapy & Training ◽

10.1123/ijatt.18.3.10 ◽

2013 ◽

Vol 18 (3) ◽

pp. 10-13 ◽

Cited By ~ 5

Author(s):

Nelson Cortes ◽

James Onate

Keyword(s):

Clinical Assessment ◽

Injury Risk ◽

Knee Injury ◽

Collegiate Athletes ◽

Assessment Tools ◽

Ligament Injury ◽

Drop Jump ◽

Jump Landing ◽

Level Of Agreement

Context:Clinical assessment tools are needed to identify individual athletes who possess elevated risk for anterior cruciate ligament injury. Existing methods require expensive equipment and the investment of a large amount of time for data processing, which makes them unfeasible for preparticipation screening of a large number of athletes.Objective:To assess the extent of agreement between LESS and the iLESS classifications of jump landing performance and the level of agreement between ratings assigned by a novice evaluator and an expert evaluator.Methods:Ratings of drop-jump landings from 20 video recordings of NCAA Division I collegiate athletes, which were randomly selected from a large database.Results:The dichotomous iLESS score corresponded to the dichotomous classification of LESS score for 15 of 20 cases rated by the expert evaluator and 17 of 20 cases rated by the novice evaluator. For the iLESS, only 2 scores out of 20 differed between the evaluators.Conclusions:A high level of agreement was observed between the LESS and iLESS methods for classification of jump- landing performance. Because the iLESS method is inexpensive and efficient, it may prove to be valuable for preparticipation assessment of knee injury risk.

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