scholarly journals Evaluation of the Biomarkers HMGB1 and IL-6 as Predictors of Mortality in Cirrhotic Patients with Acute Kidney Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Célio Geraldo de Oliveira Gomes ◽  
Marcus Vinicius Melo de Andrade ◽  
Ludmila Resende Guedes ◽  
Henrique Carvalho Rocha ◽  
Roberto Gardone Guimarães ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Mortality Rate ◽  
Prospective Observational Study ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Cirrhotic Patients ◽  
The Mean ◽  
The One

Background. Acute kidney injury (AKI) affects from 20% to 50% of cirrhotic patients, and the one-month mortality rate is 60%. The main cause of AKI is bacterial infection, which worsens circulatory dysfunction through the release of HMGB1 and IL-6. Objectives. To evaluate HMGB1 and IL-6 as biomarkers of morbidity/mortality. Methods. Prospective, observational study of 25 hospitalised cirrhotic patients with AKI. Clinical and laboratory data were collected at the time of diagnosis of AKI, including serum HMGB1 and IL-6. Results. The mean age was 55 years; 70% were male. Infections accounted for 13 cases. The 30-day and three-month mortality rates were 17.4% and 30.4%, respectively. HMGB1 levels were lower in survivors than in nonsurvivors at 30 days (1174.2 pg/mL versus 3338.5 pg/mL, p=0.035), but not at three months (1540 pg/mL versus 2352 pg/mL, p=0.243). Serum IL-6 levels were 43.3 pg/mL versus 153.3 pg/mL (p=0.061) at 30 days and 35.8 pg/mL versus 87.9 pg/mL (p=0.071) at three months, respectively. The area under the ROC curve for HMGB1 was 0.842 and 0.657, and that for IL-6 was 0.803 and 0.743 for discriminating nonsurvivors at 30 days and three months, respectively. In multivariate analysis, no biomarker was independently associated with mortality. Conclusion. HMGB1 levels were associated with decreased survival in cirrhotics. Larger studies are needed to confirm our results.

scholarly journals Hepatorenal Syndrome

2021 ◽  
Author(s):  
Arshpal Gill ◽  
Ra’ed Nassar ◽  
Ruby Sangha ◽  
Mohammed Abureesh ◽  
Dhineshreddy Gurala ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Blood Flow ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Type I ◽  
Tubular Necrosis ◽  
Cirrhotic Patients

Hepatorenal Syndrome (HRS) is an important condition for clinicians to be aware of in the presence of cirrhosis. In simple terms, HRS is defined as a relative rise in creatinine and relative drop in serum glomerular filtration rate (GFR) alongside renal plasma flow (RPF) in the absence of other competing etiologies of acute kidney injury (AKI) in patients with hepatic cirrhosis. It represents the end stage complication of decompensated cirrhosis in the presence of severe portal hypertension, in the absence of prerenal azotemia, acute tubular necrosis or others. It is a diagnosis of exclusion. The recognition of HRS is of paramount importance for clinicians as it carries a high mortality rate and is an indication for transplantation. Recent advances in understanding the pathophysiology of the disease improved treatment approaches, but the overall prognosis remains poor, with Type I HRS having an average survival under 2 weeks. Generally speaking, AKI and renal failure in cirrhotic patients carry a very high mortality rate, with up to 60% mortality rate for patients with renal failure and cirrhosis and 86.6% of overall mortality rates of patients admitted to the intensive care unit. Of the various etiologies of renal failure in cirrhosis, HRS carries a poor prognosis among cirrhotic patients with acute kidney injury. HRS continues to pose a diagnostic challenge. AKI can be either pre-renal, intrarenal or postrenal. Prerenal causes include hypovolemia, infection, use of vasodilators and functional due to decreased blood flow to the kidney, intra-renal such as glomerulopathy, acute tubular necrosis and post-renal such as obstruction. Patients with cirrhosis are susceptible to developing renal impairment. HRS may be classified as Type 1 or rapidly progressive disease, and Type 2 or slowly progressive disease. There are other types of HRS, but this chapter will focus on Type 1 HRS and Type 2 HRS. HRS is considered a functional etiology of acute kidney injury as there is an apparent lack of nephrological parenchymal damage. It is one several possibilities for acute kidney injury in patients with both acute and chronic liver disease. Acute kidney injury (AKI) is one of the most severe complications that could occur with cirrhosis. Up to 50% of hospitalized patients with cirrhosis can suffer from acute kidney injury, and as mentioned earlier an AKI in the presence of cirrhosis in a hospitalized patient has been associated with nearly a 3.5-fold increase in mortality. The definition of HRS will be discussed in this chapter, but it is characterized specifically as a form of acute kidney injury that occurs in patients with advanced liver cirrhosis which results in a reduction in renal blood flow, unresponsive to fluids this occurs in the setting of portal hypertension and splanchnic vasodilation. This chapter will discuss the incidence of HRS, recognizing HRS, focusing mainly on HRS Type I and Type II, recognizing competing etiologies of renal impairment in cirrhotic patients, and the management HRS.

scholarly journals Using Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) in Neonates with Acute Kidney Injury

2019 ◽  
Vol 7 (21) ◽  
pp. 3559-3563
Author(s):  
Silvana Naunova-Timovska ◽  
Olivera Jordanova ◽  
Zoja Babinkostova
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Mortality Rate ◽  
Newborn Infants ◽  
Kidney Injury ◽  
Control Group ◽  
Lethal Outcome ◽  
Pathological Conditions ◽  
The Mean

BACKGROUND: Acute kidney injury is a severe clinical condition. It is common in neonates in intensive care unit. It is defined as a sudden deterioration in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. The score for neonatal acute physiology perinatal extension in critically sick neonates with kidney injury is a useful tool for assessing the severity of the disease. AIM: This study aimed to determine the incidence of AKI and the role of SNAPPE 2 score in predicting mortality and morbidity of kidney injury in neonates. METHODS: The study was designed as a prospective clinical investigation performed in the period of three years, which included 100 neonates (50 with AKI and 50 without AKI) hospitalised in intensive care unit of University Clinic of Children Diseases in Skopje. The severity of the illness of hospitalised newborn infants was estimated with SNAPPE 2 score realised in the first 12 hours of admission to NICU. Medical data records of admitted neonates with AKI were analysed. The material was statistically processed using methods of descriptive statistics. RESULTS: During the study period, 770 new born's were hospitalised in the intensive care unit due to various pathological conditions and 50 new born's were selected with AKI. The control group consisted of 50 neonates with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study in both groups (AKI and non-AKI) were born at term (64% and 54%) with a predominance of male neonates (68% and 60%). The mortality rate was significantly higher in newborns with AKI than in the control group (36% vs 24%) (p < 0.01). The mean SNAPPE 2 score value in neonates with AKI was higher than in the control group (58.72 vs 40.0), and the difference was significant (p = 0.00001). Difficult score level predominated in half (50%) of newborn infants with AKI, while median score level predominated in control group (42%). There was a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs 40.2 ± 16.6) (p < 0.0001). CONCLUSION: Acute kidney injury is a life-threatening condition with still high mortality rate. The severity of the illness of hospitalised neonates in an intensive care unit is estimated by SNAPPE 2 score. Also, the risk of mortality is estimated too, taking into consideration the fact that higher values of the score are associated with higher mortality. Appropriate treatment of neonates with severe kidney injury improves the outcome and reduces the mortality of the disease.

scholarly journals Timing of Renal Replacement Therapy Initiation in Patients with Septic Acute Kidney Injury; A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Hyung Jung Oh ◽  
In Kyung Min ◽  
Yun Ho Roh ◽  
Jung ho Kim ◽  
Jin Young Ahn ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Mortality Rate ◽  
Replacement Therapy ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Treated Group ◽  
Optimal Timing ◽  
Late Group

Abstract Background; Acute kidney injury (AKI) is the most frequent complication seen in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy (RRT) is standard care for patients with severe septic AKI, the optimal timing of RRT initiation remains controversial.Methods; The PubMed, Cochrane, and Embase databases were searched from their inception to June 2021 to identify the ideal timing of RRT initiation in patients with septic AKI by comparing 28- and 90-day mortality rates.Results; Among a total of six studies including 1,058 patients, the 28-day mortality rate was significantly lower in the early RRT-treated group compared to the late group [RR=0.69; 95% CI (0.51-0.94); P=0.018]. Moreover, among the five studies including 938 patients, the 90-day mortality rate was also significantly lower in the early RRT-treated group than the late group [RR=0.61; 95% CI (0.47-0.80); P=0.01]. In a subgroup analysis for continuous RRT (CRRT), we also found significantly lower 28- and 90-day mortality rates in the early CRRT-treated group compared to the late group.Conclusion; This study showed that early initiation of RRT might reduce 28- and 90-day mortality compared with late initiation in septic AKI patients.

scholarly journals Diagnosis dan Tatalaksana Sindrom Hepatorenal

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jovanca G. Timbul ◽  
Cerelia E. C. Sugeng ◽  
Bradley J. Waleleng
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Literature Review ◽  
Poor Prognosis ◽  
Hepatorenal Syndrome ◽  
Kidney Injury ◽  
Google Scholar ◽  
Definitive Therapy ◽  
The Mean

Abstract: Hepatorenal syndrome (HRS) is known as a complication of cirrhosis. Currently, there are no specific laboratory tests to diagnose HRS while liver transplantation, as the definitive therapy, is still problematic due to the poor prognosis and long waiting lists. HRS is typically associated with poor prognosis, with a mortality rate of more than 95%. Without liver transplantation or appropriate vasoconstrictor therapy, the life expectancy was less than 2 weeks. This study was aimed to describe the diagnosis and management of the hepatorenal syndrome. The study design was literature review. Published literature was obtained from three databases: PubMed, ScienceDirect, and Google Scholar. All articles that met the inclusion and exclusion criteria were included in this study. According to five studies regarding the diagnosis, both the incidence and mortality rate of HRS was relatively high (38.1% of all acute kidney injury cases and 64.5%, respectively), even with in-hospital therapy. Five other studies analyzed the management of HRS. It was reported that the mean age of the youngest SHR patients was 53.3 years and the mean oldest age was 65 years. The male gender predominated in all studies (50-79%). In conclusion, the latest revision classified HRS into three groups: HRS-AKI, HRS-AKD, and HRS-CKD. Pharmacological therapies for HRS including terlipressin, octreotide, midodrine, albumin, pentoxifylline, and various combinations of these therapies.                    Keywords: Hepatorenal Syndrome, Diagnosis of HRS, Management of HRSAbstrak: Komplikasi dari sirosis hati antara lain sindrom hepatorenal (HRS). Sampai saat ini pemeriksaan laboratorium secara spesifik untuk mendiagnosis HRS belum ada. Transplantasi hati secara teori merupakan terapi yang tepat namun masih merupakan masalah utama karena prognosisnya buruk dan daftar tunggu yang lama di pusat transplantasi. Prognosis HRS umumnya buruk dengan angka mortalitas lebih dari 95%, jika tidak melalui transplantasi hati atau terapi vasokonstriktor yang tepat maka rerata angka harapan hidup pasien kurang dari 2 minggu. Penelitian ini bertujuan untuk mengetahui diagnosis dan tatalaksana HRS. Jenis penelitian ialah literature review dengan menggunakan tiga database yaitu PubMed, Science Direct, dan Google Scholar sesuai dengan kriteria inklusi dan eksklusi yang ada. Berdasarkan lima literatur penegakan diagnosis HRS, diketahui insidensi dan angka kematian HRS relatif tinggi (38,1% dari seluruh kasus acute kidney injury (AKI) dan angka kematian 64,5%), meskipun telah mendapatkan terapi di rumah sakit. Lima literatur lainnya tentang tatalaksana SHR, diketahui rerata (mean) usia termuda pasien HRS 53,3 tahun dan rerata (mean) usia tertua 65 tahun, dan yang mendominasi sampel penelitian ialah jenis kelamin laki-laki (50-79%). Simpulan penelitian ini ialah revisi terbaru menunjukkan HRS diklasifikasikan menjadi tiga kelompok: HRS-AKI, HRS-AKD, dan HRS-CKD. Terapi medikamentosa untuk HRS di antaranya terlipressin, oktreotida, midodrine, albumin, pentoxifylline, serta berbagai kombinasi dari terapi tersebut.                                                    Kata kunci:  sindrom hepatorenal, diagnosis HRS, tatalaksana HRS 

scholarly journals Adsorption therapy in critically ill with septic shock and acute kidney injury: a retrospective and prospective cohort study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Gregor A. Schittek ◽  
Philipp Zoidl ◽  
Michael Eichinger ◽  
Simon Orlob ◽  
Holger Simonis ◽  
...  
Keyword(s):  
Septic Shock ◽  
Acute Kidney Injury ◽  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Intervention Group ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Control Group ◽  
Link Type

Abstract Background Haemoadsorption has been described as an effective way to control increased pro- and anti-inflammatory mediators (“cytokine storm”) in septic shock patients. No prospective or randomised clinical study has yet confirmed these results. However, no study has yet prospectively specifically investigated patients in severe septic shock with sepsis-associated acute kidney injury (SA-AKI). Therefore, we aimed to examine whether haemoadsorption could influence intensive care unit (ICU) and hospital mortality in these patients. Furthermore, we examined the influence of haemoadsorption on length of stay in the ICU and therapeutic support. Methods Retrospective control group and prospective intervention group design in a tertiary hospital in central Europe (Germany). Intervention was the implementation of haemoadsorption for patients in septic shock with SA-AKI. 76 patients were included in this analysis. Results Severity of illness as depicted by APACHE II was higher in patients treated with haemoadsorption. Risk-adjusted ICU mortality rates (O/E ratios) did not differ significantly between the groups (0.80 vs. 0.83). We observed in patients treated with haemoadsorption a shorter LOS and shorter therapeutic support such as catecholamine dependency and duration of RRT. However, in multivariate analysis (logistic regression for mortality, competing risk for LOS), we found no significant differences between the two groups. Conclusions The implementation of haemoadsorption for patients in septic shock with acute renal failure did not lead to a reduction in ICU or hospital mortality rates. Despite univariate analysis delivering some evidence for a shorter duration of ICU-related treatments in the haemoadsorption group, these results did not remain significant in multivariate analysis. Trial registration CytoSorb® registry https://clinicaltrials.gov/ct2/show/NCT02312024. December 9, 2014. Database: https://www.cytosorb-registry.org/ (registration for content acquisition is necessary)

scholarly journals Incidence of acute kidney injury in bone marrow transplant patients; investigation of consequences within one to three years

2020 ◽  
Vol 10 (2) ◽  
pp. e10-e10
Author(s):  
Asieh Aref ◽  
Mohsen Maleknia ◽  
Alireza Nasrollahi ◽  
Abbas Hajifathali ◽  
Mahshid Mehdizadeh ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Acute Kidney Injury ◽  
Mortality Rate ◽  
Kidney Injury ◽  
Allogeneic Transplant ◽  
Transplant Patients ◽  
Significant Difference ◽  
History Of ◽  
One Year ◽  
The One

Introduction: Previous studies have demonstrated that acute kidney injury (AKI) is a serious complication following hematopoietic stem cell transplantation (HSCT). The incidence of AKI in association with HSCT varies considerably because of several definitions for AKI. Objectives: In this study, we determined the rate of AKI after bone marrow transplantation (BMT) and its effects on patients’ outcomes according to modern definitions of AKI to conclude whether all these criteria can be useful for predicting AKI occurrence after BMT or not. Patients and Methods: We conducted a retrospective study of 271 patients undergoing HSCT, and after obtaining written informed consent from all patients, the required information was reviewed. AKI was defined according to RIFLE, KDIGO, and AKIN criteria. Renal function was assessed by calculating creatinine clearance, urine output, and estimated glomerular filtration rate (eGFR), determined through the MDRD equation. Results: Allogeneic and autologous transplantations were performed on 38 (14.02%) and 233 (85.97%) patients, respectively. According to the RIFLE criteria, 96 patients (35.42%) suffered from AKI, and based on AKIN, and KDIGO criteria, 101 patients (37.26%) were afflicted with it after BMT. The one-year mortality rate in allogeneic transplant patients with a history of AKI was 30.43% and 53.33% in patients without a history of AKI. The three-year mortality rate in allogeneic transplant patients with and without a history of AKI was 52.17% and 73.33% respectively, which showed no statistically significant difference. The three-year mortality rate in autologous transplant patients with and without a history of AKI was 60.27% and 22.5%, respectively. Conclusion: The one-year and three-year mortality rates, survival of patients, and AKI’s diagnosis were similar in all three criteria. Therefore, all these criteria can be useful for the prediction of AKI occurrence after BMT.

scholarly journals Utility of neutrophil gelatinase-associated lipocalin in the management of acute kidney injury: A prospective, observational study

2018 ◽  
Vol 27 (1) ◽  
pp. 8-14
Author(s):  
Ali Işıkkent ◽  
Serkan Yılmaz ◽  
İbrahim Ulaş Özturan ◽  
Nurettin Özgür Doğan ◽  
Elif Yaka ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Kidney Injury ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Rifle Classification ◽  
Neutrophil Gelatinase ◽  
The Relationship

Background: Utilization of renal biomarkers such as neutrophil gelatinase-associated lipocalin in the management of acute kidney injury may be useful as a diagnostic tool in the emergency department. Objective: The aim of this study is to determine the relationship between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury based on the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification, and to investigate the role of the serum neutrophil gelatinase-associated lipocalin level in differentiating the etiology and predicting the 30-day mortality rate and need for dialysis. Methods: This prospective, observational study was conducted from March 2015 to 2016. Adult patients with acute kidney injury in the emergency department were enrolled in the study. Demographic and clinical features such as hypovolemic state, nephrotoxic substance exposure, renal functions, and serum neutrophil gelatinase-associated lipocalin level were evaluated. After the etiology of the acute kidney injury was ascertained, the severity of the acute kidney injury was determined according to RIFLE criteria. Primary outcome was defined as the correlation between serum neutrophil gelatinase-associated lipocalin level and the severity of the acute kidney injury according to RIFLE classification. Secondary outcomes were defined as the relationship between the serum neutrophil gelatinase-associated lipocalin level and the etiology of the acute kidney injury; need for dialysis and 30-day mortality were defined as poor outcomes. Results: A total of 87 patients were included in the study. Mean serum neutrophil gelatinase-associated lipocalin levels were 380.14 ± 276.65 ng/mL in RIFLE-R, 425.80 ± 278.99 ng/mL in RIFLE-I, and 403.60 ± 293.15 ng/mL in RIFLE-F groups. There was no statistically significant relationship between the severity of acute kidney injuries and serum neutrophil gelatinase-associated lipocalin level. Initial serum neutrophil gelatinase-associated lipocalin levels in the emergency department did not indicate a statistically significant ability to predict the etiology of acute kidney injury, 30-day mortality rates, or need for dialysis. Conclusion: Initial serum neutrophil gelatinase-associated lipocalin level in the emergency department is not a determinant tool for predicting the severity, etiology, 30-day mortality rates, or need for dialysis in cases of acute kidney injuries.

scholarly journals The effect of recombinant human soluble thrombomodulin on renal function and mortality in septic disseminated intravascular coagulation patients with acute kidney injury: a retrospective study

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Masayuki Akatsuka ◽  
Yoshiki Masuda ◽  
Hiroomi Tatsumi ◽  
Tomoko Sonoda
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Disseminated Intravascular Coagulation ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Soluble Thrombomodulin ◽  
Icu Discharge ◽  
Recombinant Human Soluble Thrombomodulin

Abstract Background Clinical evidence showing the effectiveness of recombinant human soluble thrombomodulin (rhTM) for treating sepsis-induced disseminated intravascular coagulation (DIC) and organ dysfunction (particularly renal injury) is limited because of differences in the inclusion criteria and disease severity among patients. This study aimed to assess the association between rhTM and outcomes in septic DIC patients with acute kidney injury (AKI). Methods This retrospective observational study analyzed the data of patients who were admitted to the intensive care unit (ICU) of a single center between January 2012 and December 2018, and diagnosed with sepsis-induced DIC and AKI. Data were extracted as follows: patients’ characteristics; DIC score, as calculated by the Japanese Association for Acute Medicine and the International Society of Thrombosis and Hemostasis criteria; serum creatinine levels; and ICU and 28-day mortality rates. The primary outcome was the dependence on renal replacement therapy (RRT) at ICU discharge. The propensity score (PS) was calculated using the following variables: age, sex, septic shock at admission, DIC score, and KDIGO classification. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcome. Results In total, 97 patients were included in this study. Of these, 52 (53.6%) patients had received rhTM. The dependence on RRT at ICU discharge was significantly lower in the rhTM than in the non-rhTM group (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.19–0.97; P = 0.043). The serum creatinine levels at ICU discharge (OR, 0.31; 95% CI, 0.13–0.72; P = 0.007) and hospital discharge (OR, 0.25; 95% CI, 0.11–0.60; P = 0.002, respectively), and the 28-day mortality rate (OR, 0.40; 95% CI, 0.17–0.93; P = 0.033) were significantly lower in the rhTM than in the non-rhTM group. Moreover, the Kaplan–Meier survival curve revealed significantly lower mortality rates in the rhTM than in the non-rhTM group (P = 0.009). No significant differences in the DIC score and AKI severity were observed between the groups. Conclusions Among sepsis-induced DIC patients with AKI, rhTM administration was associated with lower dependence on RRT at ICU discharge, improvement in renal function, and lower 28-day mortality rate.

scholarly journals Clinical Aspects and Prognosis Evaluation of Cirrhotic Patients Hospitalized with Acute Kidney Injury

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Célio Geraldo de Oliveira Gomes ◽  
Marcus Vinicius Melo de Andrade ◽  
Ludmila Resende Guedes ◽  
Henrique Carvalho Rocha ◽  
Roberto Gardone Guimarães ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Volume Expansion ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Clinical Aspects ◽  
Advanced Cirrhosis ◽  
Acute Kidney Injury Stage ◽  
Tertiary Center ◽  
Cirrhotic Patients ◽  
Stage 1

Background. Acute kidney injury occurs in approximately 20% of hospitalized cirrhotic patients. Mortality is estimated at 60% within a month and 65% within a year. Aims. To evaluate survival in 30 days and in 3 months of cirrhotic patients hospitalized with acute kidney injury, identifying factors associated with mortality. Methods. 52 patients with cirrhosis admitted to an academic tertiary center who presented acute kidney injury according to the International Club of Ascites criteria were evaluated. Clinical and laboratory data was collected at diagnosis between 2011 and 2015. Results. Average age was 54.6 (±10.7) years and 69.2% were male. The average MELD, MELD-Na, and Child-Pugh scores were 21.9 (±7.0), 24.5 (±6.7), and 10.1 (±2.2), respectively. Thirty patients (57.7%) were in acute kidney injury stage 1, 16 (30.8%) in stage 2, and six (11.6%) in stage 3. Mortality was 28.6% in 30 days and 44.9% in three months. In multivariate analysis, variables that were associated independently to mortality were lack of response to expansion treatment and Child-Pugh score. Mortality was 93.3% in three months among nonresponders compared to 28.6% among those who responded to volume expansion (p<0.0001). Conclusion. Acute kidney injury in cirrhosis has dire prognosis, particularly in patients with advanced cirrhosis and in nonresponders to volume expansion.

Peritoneal Dialysis Treatment in Small Children with Acute Kidney Injury: Experience in Northwest China

2019 ◽  
Vol 48 (4) ◽  
pp. 315-320 ◽  
Author(s):  
Huixian Li ◽  
Shifeng Yang ◽  
Li Jin ◽  
Zhigang Wang ◽  
Liyi Xie ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Peritoneal Dialysis ◽  
English Literature ◽  
Laboratory Data ◽  
Kidney Injury ◽  
Northwest China ◽  
Albumin Level ◽  
Obstructive Nephropathy ◽  
Drug Induced ◽  
The Mean

Background: Peritoneal dialysis (PD) is a kind of renal replacement therapy (RRT), which can be employed to treat pediatric acute kidney injury (AKI) as it is safe, simple, and cost-effective. The studies of PD treatment in pediatric AKI in China have rarely been reported in English literature. Objective: To investigate the efficacy and the outcome of PD in pediatric patients with AKI. Methods: We performed a retrospective study of children who received PD as RRT for AKI in a teaching hospital in northwest China from 2003 to 2013. Demographic characteristics and laboratory data were collected, and the prognostic factors of renal recovery were identified. Results: There were 24 children (62.5% male) identified, with the mean age of 22.4 ± 18.7 months (3 months to 5 years old). The most common causes of AKI were drug induced (25.0%), glomerulonephritis (20.9%), and obstructive nephropathy (16.7%). The mean duration of PD was 11.3 ± 7.8 days (2–39 days). PD treatment was highly effective in attenuation of toxics, improvement of fluid overload, and correction of electrolyte disturbances (p < 0.001). One catheter outflow obstruction was noted, and no major complication was identified. In total, 18 children (75.0%) recovered and had the catheter successfully removed, 2 (8.3%) needed further PD treatment, and 4 (16.7%) died. The albumin level was significantly higher in patients who recovered with PD treatment (33.7 ± 6.2 vs. 21.5 ± 4.8 g/L, p = 0.002). Conclusions: PD can be performed safely and efficiently for the treatment of pediatric AKI. Low albumin level may be associated with poor prognosis of pediatric AKI.

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