scholarly journals Development and Performance of Electronic Acute Kidney Injury Triggers to Identify Pediatric Patients at Risk for Nephrotoxic Medication-associated Harm

2014 ◽  
Vol 05 (02) ◽  
pp. 313-333 ◽  
Author(s):  
W.L. Spires ◽  
T.A. Mottes ◽  
J.K. Schaffzin ◽  
C. Barclay ◽  
S.L. Goldstein ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Data Entry ◽  
Kidney Injury ◽  
Clinical Work ◽  
Web Based ◽  
Predictive Values ◽  
Patients At Risk ◽  
And Performance

Summary Background: Nephrotoxic medication-associated acute kidney injury (NTMx-AKI) is a costly clinical phenomenon and more common than previously recognized. Prior efforts to use technology to identify AKI have focused on detection after renal injury has occurred. Objectives: Describe an approach and provide a technical framework for the creation of risk-stratifying AKI triggers and the development of an application to manage the AKI trigger data. Report the performance characteristics of those triggers and the refinement process and on the challenges of implementation. Methods: Initial manual trigger screening guided design of an automated electronic trigger report. A web-based application was designed to alleviate inefficiency and serve as a user interface and central workspace for the project. Performance of the NTMx exposure trigger reports from September 2011 to September 2013 were evaluated using sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV). Results: Automated reports were created to replace manual screening for NTMx-AKI. The initial performance of the NTMx exposure triggers for SN, SP, PPV, and NPV all were 0.78, and increased over the study, with all four measures reaching 0.95 consistently. A web-based application was implemented that simplifies data entry and couriering from the reports, expedites results viewing, and interfaces with an automated data visualization tool. Sociotechnical challenges were logged and reported. Conclusion: We have built a risk-stratifying system based on electronic triggers that detects patients at-risk for NTMx-AKI before injury occurs. The performance of the NTMx-exposed reports has neared 100% through iterative optimization. The complexity of the trigger logic and clinical work-flows surrounding NTMx-AKI led to a challenging implementation, but one that has been successful from technical, clinical, and quality improvement standpoints. This report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system. Citation: Kirkendall ES, Spires WL, Mottes TA, Schaffzin JK, Barclay C, Goldstein SL. Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm. Appl Clin Inf 2014; 5: 313–333 http://dx.doi.org/10.4338/ACI-2013-12-RA-0102

scholarly journals Stratifying risk of acute kidney injury in pre and post cardiac surgery patients using a novel biomarker-based algorithm and clinical risk score

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
William T. McBride ◽  
Mary Jo Kurth ◽  
Gavin McLean ◽  
Anna Domanska ◽  
John V. Lamont ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Score ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Patients At Risk ◽  
Post Cardiac Surgery

AbstractAcute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.

Renal involvement in pediatric patients with COVID-19: an up-to-date

2021 ◽  
Vol 17 ◽  
Author(s):  
Yuri Márcio Campos ◽  
André Luís Vieira Drumond ◽  
Mariane de Matos Gamonal ◽  
Milena Pereira Parreira ◽  
Ana Cristina Simões e Silva
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Renal Involvement ◽  
Kidney Injury ◽  
Renal Diseases ◽  
Glomerular Diseases ◽  
Report Data

Background: In pediatric patients, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has been mostly associated with mild symptoms. However, as in adults, renal involvement has been reported in children and adolescents with Coronavirus Disease 2019 (COVID-19). Objective: This review aimed to report data about renal involvement in pediatric COVID-9. The focuses were on the pathophysiology of acute kidney injury in Pediatric Inflammatory Multisystem Syndrome Temporally Associated (PIMS-TS) with SARS-CoV-2 and the possible impact of SARS-CoV-2 infection upon kidney function, as well as data concerning patients with previous kidney diseases, including Nephrotic Syndrome and Chronic Renal Disease. The implications for COVID-19 outcome in pediatric patients were also discussed. Methods: This integrative review searched for articles on renal involvement in pediatric COVID-19 patients. The databases evaluated were PubMed and Scopus. Results: The emergence of PIMS-TS with SARS-CoV-2 has shown that pediatric patients are at risk of severe COVID-19, with multi-organ involvement and dysfunction. In addition to intense inflammation, several systems are affected in this syndrome, collectively creating a combination of factors that results in acute kidney injury. Several studies have proposed that kidney cells, including the podocytes, might be at risk of direct infection by SARS-CoV-2, as high levels of ACE2, the virus receptor, are expressed on the membrane of such cells. Some cases of glomerular diseases triggered by SARS-CoV-2 infection and relapses of previous renal diseases have been reported. Conclusion: Further studies are necessary to establish risk factors for renal involvement in pediatric COVID-19 and to predict disease outcome.

scholarly journals Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

2020 ◽  
Author(s):  
Heyman Luckraz ◽  
Ramesh Giri ◽  
Benjamin Wrigley ◽  
Kumaresan Nagarajan ◽  
Eshan Senanayake ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Kidney Injury ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Number Needed To Treat ◽  
Forced Diuresis ◽  
Patients At Risk

Abstract OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits. Clinical trial registration number: NCT02974946

Management of patients at risk of acute kidney injury

The Lancet ◽  
2017 ◽  
Vol 389 (10084) ◽  
pp. 2139-2151 ◽  
Author(s):  
Jill Vanmassenhove ◽  
Jan Kielstein ◽  
Achim Jörres ◽  
Wim Van Biesen
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Patients At Risk

Accuracy of urine dipstick in the detection of patients at risk for crush-induced rhabdomyolysis and acute kidney injury

2012 ◽  
Vol 19 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Mostafa Alavi-Moghaddam ◽  
Saeed Safari ◽  
Iraj Najafi ◽  
Mostafa Hosseini
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Urine Dipstick ◽  
Patients At Risk
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