Renal insufficiency following contrast media administration trial III: Urine flow rate‐guided versus left‐ventricular end‐diastolic pressure‐guided hydration in high‐risk patients for contrast‐induced acute kidney injury. Rationale and design

2019 ◽  
Vol 95 (5) ◽  
pp. 895-903 ◽  
Author(s):  
Carlo Briguori ◽  
Carmen D'Amore ◽  
Francesca De Micco ◽  
Nicola Signore ◽  
Giovanni Esposito ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Renal Insufficiency ◽  
Contrast Media ◽  
Diastolic Pressure ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Urine Flow ◽  
Risk Patients ◽  
Contrast Media Administration

scholarly journals Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate–Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury

2020 ◽  
Vol 13 (17) ◽  
pp. 2065-2074 ◽  
Author(s):  
Carlo Briguori ◽  
Carmen D’Amore ◽  
Francesca De Micco ◽  
Nicola Signore ◽  
Giovanni Esposito ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Flow Rate ◽  
Diastolic Pressure ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Urine Flow ◽  
Urine Flow Rate

scholarly journals Preventing acute kidney injury in high-risk patients by temporarily discontinuing medication – an observational study in general practice

2019 ◽  
Author(s):  
Suzanne J Faber ◽  
Nynke Scherpbier ◽  
Hans Peters ◽  
Annemarie Uijen
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Kidney Injury ◽  
Cross Sectional Study ◽  
Fluid Loss ◽  
Cross Sectional ◽  
High Risk Patients ◽  
Risk Patients ◽  
Raas Inhibitors

Abstract Background Elderly, patients with chronic kidney disease (CKD) and patients with heart failure who continue using renin-angiotensin-aldosterone-system (RAAS) inhibitors, diuretics, or non-steroidal-anti-inflammatory drugs (NSAIDs) during times of fluid loss have a high risk of developing complications like acute kidney injury (AKI). The aim of this study was to assess how often advice to discontinue high-risk medication was offered to high-risk patients consulting the general practitioner (GP) with increased fluid loss. Furthermore, we assessed the number and nature of the complications that occurred after GP consultation. Methods We performed a cross-sectional study with patients from seven Dutch general practices participating in the Family Medicine Network between 1-6-2013 and 1-7-2018. We included patients who used RAAS-inhibitors, diuretics, or NSAIDs, and had at least one of the following risk factors: age ≥70 years, CKD, or heart failure. From this population, we selected patients with a ‘dehydration-risk’ episode (vomiting, diarrhoea, fever, chills, or gastrointestinal infection). We manually checked their electronic patient files and assessed the percentage of episodes in which advice to discontinue the high-risk medication was offered and whether a complication occurred in three months after the ‘dehydration-risk’ episode. Results We included 3607 high-risk patients from a total of 44.675 patients (8.1%). We found that patients were advised to discontinue the high-risk medication in 38 (4.6%) of 816 ‘dehydration-risk’ episodes. In 59 of 816 episodes (7.1%) complications (mainly AKI) occurred. Conclusions Dutch GPs do not frequently advise high-risk patients to discontinue high-risk medication during ‘dehydration-risk’ episodes. Complications occur frequently. Timely discontinuation of high-risk medication needs attention.

scholarly journals What nephrologist should know about COVID-19 outbreak?

2020 ◽  
Author(s):  
Omar maoujoud
Keyword(s):  
Acute Kidney Injury ◽  
High Risk ◽  
Renal Impairment ◽  
High Mortality ◽  
Medical Management ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Prognostic Indicator ◽  
High Risk Patients ◽  
Risk Patients

Acute Kidney injury is relatively uncommon in COVID-19 patients yet carries a high mortality. It occurs in patients complicated with ARDS or multiorgan failure, but further investigation about inflammatory and apopotic mechanisms during renal impairment are needed. Since the development of AKI is an important negative prognostic indicator for survival with CoV as reported in previous SAR-CoV and MERS-CoV outbreaks, adequate medical management of high risk patients with AKI may improve the results of previous outbreaks related to CoV.

Contrast induced acute kidney injury prevention during angiographic procedure with early renal replacement therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Gritti ◽  
S Pierini ◽  
M Ornaghi ◽  
A Paggi ◽  
I Baragetti ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Contrast Media ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Shock Onset ◽  
Ventricular Ejection Fraction

Abstract Background and purpose Post-angiography renal replacement therapy (RRT) has shown protective effects from Ci-AKI (contrast induced acute kidney injury) in patients with pre-existing advanced renal disfunction. We analysed a series of 1095 continuative patients who undergone coronary or peripheral angiography in our center. In non-haemodialyzed patients with eGFR <20ml/min/1.73m2 or with poor renal reserve we performed an “early” RRT, starting during angiography procedure and applied for at least 6 h after procedure, thus diverging from previous literature data based only on post-procedure hours delayed RRT application. The RRT modality chosen was CVVHDF (continous veno-venous hemodiafiltration). Methods We considered following subjects variability: age, sex, weight, presence of hypertension, dyslipidaemia, diabetes, smoking habitude, left ventricular ejection fraction, amount of contrast media given and shock or infection occurrence during hospital stay. We evaluate statistic significative of serum creatine (SCr) variation in patients receiving RRT from pre-procedure time (T0), at 24h (T1), 48h (T2), 72h (T3) after procedure and at 3–8 weeks follow-up (T4). Quantitative data were compared with Student T test, qualitative data with Chi Square test, considering statistically significant p value <0.05 with two tails. Ci-AKI was defined as serum creatinine rise ≥0.3 mg/dL at 48h from contrast media administration, following KDIGO (kidney disease improving global outcomes) guidelines definition. Results 26 patients received RRT. Medium SCr at T0 was 3.37 mg/dl and showed a significative reduction (see figure) at T1 (−0.88mg/dl = −20.6%, p=0.003) and T2 (−0.96mg/dl = −18.33%, p=0.029) and a trend towards reduction at T3 (−0.78mg/dl, p=0.174) and at T4 (−0.28mg/dl, p=0.568). Between 26 pts, 6 pts (23%) developed Ci-AKI. Only contrast media amount significatively diverge between two groups (183 ml in the group with Ci-AKI vs 162 ml in pts with no Ci-AKI, p=0.03), showing also a trend towards significance for infection occurrence (83.3% pts Ci-AKI vs 40% pts no Ci-AKI, p=0.06) and shock onset (33.3%pts Ci-AKI vs 5% pts no Ci-AKI, p=0.06). Average SCr diverge at T2 (3.18mg/dl Ci-AKI vs 2.04mg/dl no Ci-AKI, p=0.01) and at T3 (3.33mg/dl CI-AKI vs 2.31mg/dl no CI-AKI, p=0.06); we also found a trend towards progressive increase of SCr for Ci-AKI pts (T0-T1: +0.17mg/dl, p=ns; T0-T2: +0.41mg/dl, p=ns; T0-T3: +0.57mg/dl, p=ns; T0-T4: +1.35mg/dl, p=ns) and a significative reduction in SCr for no Ci-AKI pts (T0-T1: −1.23mg/dl = −29.32% p=0.001; T0-T2: −1.46mg/dl = −30.78%, p=0.01; T0-T4: −0.41mg/dl = −15.5%, p=0.05). Conclusions Early RRT with CVVHDF modality results effective in 77% of patients in avoiding Ci-AKI, with a significative SCr reduction at 24 and 48h. An increased amount of contrast media is significatively related to Ci-AKI incidence. Ci-AKI development could also possibly be related to shock and infection occurrence. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals A prospective study of acute kidney injury in the intensive care unit: development and validation of a risk prediction model

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Qi Wang ◽  
Yi Tang ◽  
Jiaojiao Zhou ◽  
Wei Qin
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
High Risk ◽  
Prediction Model ◽  
Risk Prediction ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Risk Prediction Model ◽  
Risk Patients

Abstract Background Acute kidney injury (AKI) has high morbidity and mortality in intensive care units (ICU). It can also lead to chronic kidney disease (CKD), more costs and longer hospital stay. Early identification of AKI is important. Methods We conducted this monocenter prospective observational study at West China Hospital, Sichuan University, China. We recorded information of each patient in the ICU within 24 h after admission and updated every two days. Patients who reached the primary outcome were accepted into the AKI group. Of all patients, we randomly drew 70% as the development cohort and the remaining 30% as the validation cohort. Using binary logistic regression we got a risk prediction model of the development cohort. In the validation cohort, we validated its discrimination by the area under the receiver operator curve (AUROC) and calibration by a calibration curve. Results There were 656 patients in the development cohorts and 280 in the validation cohort. Independent predictors of AKI in the risk prediction model including hypertension, chronic kidney disease, acute pancreatitis, cardiac failure, shock, pH ≤ 7.30, CK > 1000 U/L, hypoproteinemia, nephrotoxin exposure, and male. In the validation cohort, the AUROC is 0.783 (95% CI 0.730–0.836) and the calibration curve shows good calibration of this prediction model. The optimal cut-off value to distinguish high-risk and low-risk patients is 4.5 points (sensitivity is 78.4%, specificity is 73.2% and Youden’s index is 0.516). Conclusions This risk prediction model can help to identify high-risk patients of AKI in ICU to prevent the development of AKI and treat it at the early stages. Trial registration TCTR, TCTR20170531001. Registered 30 May 2017, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=2573

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