scholarly journals COVID-19 in ESRD and Acute Kidney Injury

2020 ◽  
pp. 1-11
Author(s):  
Jeroen P. Kooman ◽  
Frank M. van der Sande
Keyword(s):  
Acute Kidney Injury ◽  
General Population ◽  
Kidney Injury ◽  
Severe Infection ◽  
Clinical Situation ◽  
System A ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
The Face ◽  
Severe Comorbidity

The COVID-19 pandemic has greatly affected nephrology. Firstly, dialysis patients appear to be at increased risk for infection due to viral transmission next to an enhanced risk for mortality as compared to the general population, even in the face of an often apparently mild clinical presentation. Derangements in the innate and adaptive immune systems may be responsible for a reduced antiviral response, whereas chronic activation of the innate immune system and endothelial dysfunction provide a background for a more severe course. The presence of severe comorbidity, older age, and a reduction of organ reserve may lead to a rapid deterioration of the clinical situation of the patients in case of severe infection. Secondly, patients with COVID-19 are at increased risk of acute kidney injury (AKI), which is related to the severity of the clinical disease. The presence of AKI, and especially the need for renal replacement therapy (RRT), is associated with an increased risk of mortality. AKI in COVID-19 has a multifactorial origin, in which direct viral invasion of kidney cells, activation of the renin-angiotensin aldosterone system, a hyperinflammatory response, hypercoagulability, and nonspecific factors such as hypotension and hypoxemia may be involved. Apart from logistic challenges and the need for strict hygiene within units, treatment of patients with ESRD and COVID-19 is not different from that of the general population. Extracorporeal treatment of patients with AKI with RRT can be complicated by frequent filter clotting due to the hypercoagulable state, for which regional citrate coagulation provides a reasonable solution. Also, acute peritoneal dialysis may be a reasonable option in these patients. Whether adjuncts to extracorporeal therapies, such as hemoadsorption, provide additional benefits in the case of severely ill COVID-19 patients needs to be addressed in controlled studies.

scholarly journals Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies

2021 ◽  
Vol 10 (10) ◽  
pp. 2151
Author(s):  
Rita Pavasini ◽  
Matteo Tebaldi ◽  
Giulia Bugani ◽  
Elisabetta Tonet ◽  
Roberta Campana ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Coronary Intervention ◽  
Pooled Analysis ◽  
Coronary Syndrome ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Short Term Mortality

Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality.

Incidence, Predictors, and Prognosis of Acute Kidney Injury Among Cardiac Arrest Survivors

2020 ◽  
pp. 088506662091135
Author(s):  
Abhishek Dutta ◽  
Krupal J. Hari ◽  
John Azizian ◽  
Youssef Masmoudi ◽  
Fatima Khalid ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Arrest ◽  
Kidney Disease ◽  
Chronic Kidney Disease Stage ◽  
Kidney Injury ◽  
Disease Stage ◽  
Neurological Outcomes ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Acute Kidney Injury Stage

Background: Acute kidney injury (AKI) is common among cardiac arrest survivors. However, the outcomes and predictors are not well studied. Methods: This is a cohort study of cardiac arrest patients enrolled from January 2012 to December 2016 who were able to survive for 24 hours post-cardiopulmonary resuscitation. Patients with anuria, chronic kidney disease (stage 5), and end-stage renal disease were excluded. Acute kidney injury (stage 1) or higher was defined using Kidney Disease: Improving Global Outcomes classification. Multivariable adjusted regression models were used to compute hazard ratio (HR) for association of AKI with risk of mortality and odds ratio (OR) with risk of poor neurological outcomes after adjusting for demographics, comorbidities, and medical therapy. Multivariable logistic regression model was used to compute OR for association of various predictors with AKI. Results: Of 842 cardiac arrest survivors, 588 (69.8%) developed AKI. Among AKI patients, 69.4% died compared with 52.0% among non-AKI patients. In multivariable adjusted Cox proportional hazard model, development of AKI post-cardiac arrest was significantly associated with mortality (HR: 1.35; 95% confidence interval [CI]: 1.07-1.71, P = .01) and poor neurological outcomes defined as cerebral performance category >2 (OR: 2.27; 95% CI: 1.45-3.57, P < .001) and modified Rankin scale >3 (OR: 2.22; 95% CI: 1.43-3.45, P < .001). Postdischarge dialysis was also associated with increased risk of mortality (HR: 2.57; 95% CI: 1.57-4.23, P < .001). Use of vasopressors was strongly associated with development of AKI and continued need for postdischarge dialysis. Conclusions: Acute kidney injury was associated with increased risk of mortality and poor neurological outcomes. There is need for further studies to prevent AKI in cardiac arrest survivors.

scholarly journals Developing better mouse models to study cisplatin-induced kidney injury

2017 ◽  
Vol 313 (4) ◽  
pp. F835-F841 ◽  
Author(s):  
Cierra N. Sharp ◽  
Leah J. Siskind
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Therapeutic Interventions ◽  
Low Doses ◽  
Dosing Regimen ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Novel Therapeutic

Cisplatin is a potent chemotherapeutic used for the treatment of many types of cancer. However, its dose-limiting side effect is nephrotoxicity leading to acute kidney injury (AKI). Patients who develop AKI have an increased risk of mortality and are more likely to develop chronic kidney disease (CKD). Unfortunately, there are no therapeutic interventions for the treatment of AKI. It has been suggested that the lack of therapies is due in part to the fact that the established mouse model used to study cisplatin-induced AKI does not recapitulate the cisplatin dosing regimen patients receive. In recent years, work has been done to develop more clinically relevant models of cisplatin-induced kidney injury, with much work focusing on incorporation of multiple low doses of cisplatin administered over a period of weeks. These models can be used to recapitulate the development of CKD after AKI and, by doing so, increase the likelihood of identifying novel therapeutic targets for the treatment of cisplatin-induced kidney injury.

scholarly journals Prognostic value of hematocrit levels among critically ill patients with acute kidney injury

2019 ◽  
Vol 17 ◽  
pp. 205873921984682
Author(s):  
Ying Zhou ◽  
Ming-Hua Zheng ◽  
Chao-Sheng Chen ◽  
Dan-Qin Sun ◽  
Xin-Xin Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Prognostic Value ◽  
Univariate Analysis ◽  
Kidney Injury ◽  
Inverse Association ◽  
Risk Of Mortality ◽  
Increased Risk

The aim of this study was to investigate the value of hematocrit (HCT) level in predicting the outcomes of critically ill patients with acute kidney injury (AKI). A retrospective study of a total of 14,350 intensive care unit (ICU) patients, who were selected from Beth Israel Deaconess Medical Center (Boston, MA, USA) and met the inclusion criteria, was carried out. And the patient data were extracted from the Multiparameter Intelligent Monitoring in Intensive Care Database III version 1.3 (MIMIC-III v1.3). In our study, HCT quintiles were used to categorize the subjects into groups. The clinical outcomes were 30- and 90-day mortality in the ICU. Cox proportional-hazards models were used to evaluate the association between the HCT and survival. A total of 2827 30-day deaths and 3828 90-day deaths occurred. In univariate analysis, low HCT was significantly associated with increased 30- and 90-day mortality among females, which, however, was not observed in multivariate analysis adjusted for age, ethnicity, dialysate, continuous renal replacement therapy (CRRT), use of insulin, use of ventilator, AKI stages, and report of obesity. In subgroup analysis, an inverse association between HCT levels and risk of mortality for 90-day outcome was observed for female patients by exclusion of dialysate use, receiving CRRT, and obesity reports. Therefore, these findings suggest that lower HCT was associated with an increased risk of mortality in critically ill patients with AKI, and the effect appears to be stronger among women than men. The prognostic value of HCT seems dependent on other factors, for example, dialysate use, CRRT, and obesity. Further multicenter study is in demand to confirm the validity of the results presented in this article.

scholarly journals Increased risk of mortality after lower extremity bypass in individuals with acute kidney injury in the Vascular Quality Initiative

2017 ◽  
Vol 65 (4) ◽  
pp. 1055-1061 ◽  
Author(s):  
Erica Flores ◽  
Juan Pablo Lewinger ◽  
Vincent L. Rowe ◽  
Karen Woo ◽  
Fred A. Weaver ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Lower Extremity ◽  
Kidney Injury ◽  
Risk Of Mortality ◽  
Increased Risk

scholarly journals The therapeutic features of acute kidney injury in the elderly

2021 ◽  
Vol 2 (3) ◽  
pp. 67-72
Author(s):  
Nicoleta Mirela Blebea ◽  
Alina Stăniguț ◽  
Gabriela Mitea
Keyword(s):  
Acute Kidney Injury ◽  
Supportive Therapy ◽  
Kidney Injury ◽  
The Elderly ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Adequate Hydration ◽  
Treatment Measures ◽  
Stage Renal Disease ◽  
End Stage

The incidence of acute kidney injury (AKI) is increasing in people of all ages, but patients over the age of 65 are more likely to develop AKI due to structural and functional renal failure associated with aging, comorbidities, and reduced ability to recover. For this reason, the functionality of many organs tends to decrease. Older patients with AKI have an increased risk of mortality in both the short and long term, and survivors are patients with chronic kidney disease (CKD) who eventually progress to end-stage renal disease (ESRD). This paper aims at the therapeutic management of the elderly suffering from AKI. Maintaining adequate hydration and avoiding nephrotoxic agents are helpful in preventing AKI in the elderly. There are no proven treatment measures for AKI in the elderly, except for supportive therapy.

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