scholarly journals Acute kidney disease in hospitalized acute kidney injury patients

PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11400
Author(s):  
Ping Yan ◽  
Xiang-Jie Duan ◽  
Yu Liu ◽  
Xi Wu ◽  
Ning-Ya Zhang ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Critically Ill ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Additional Information ◽  
Acute Kidney Disease ◽  
Tertiary Hospitals ◽  
One Year ◽  
Stage 1

Background Acute kidney injury (AKI) and chronic kidney disease (CKD) have become worldwide public health problems, but little information is known about the epidemiology of acute kidney disease (AKD)—a state in between AKI and CKD. We aimed to explore the incidence and outcomes of hospitalized patients with AKD after AKI, and investigate the prognostic value of AKD in predicting 30-day and one-year adverse outcomes. Methods A total of 2,556 hospitalized AKI patients were identified from three tertiary hospitals in China in 2015 and followed up for one year.AKD and AKD stage were defined according to the consensus report of the Acute Disease Quality Initiative 16 workgroup. Multivariable regression analyses adjusted for confounding variables were used to examine the association of AKD with adverse outcomes. Results AKD occurred in 45.4% (1161/2556) of all AKI patients, 14.5% (141/971) of AKI stage 1 patients, 44.6% (308/691) of AKI stage 2 patients and 79.6% (712/894) of AKI stage 3 patients. AKD stage 1 conferred a greater risk of Major Adverse Kidney Events within 30 days (MAKE30) (odds ratio [OR], 2.36; 95% confidence interval 95% CI [1.66–3.36]) than AKD stage 0 but the association only maintained in AKI stage 3 when patients were stratified by AKI stage. However, compared with AKD stage 0, AKD stage 2–3 was associated with higher risks of both MAKE30 and one-year chronic dialysis and mortality independent of the effects of AKI stage with OR being 31.35 (95% CI [23.42–41.98]) and 2.68 (95% CI [2.07–3.48]) respectively. The association between AKD stage and adverse outcomes in 30 days and one year was not significantly changed in critically ill and non-critically ill AKI patients. The results indicated that AKD is common among hospitalized AKI patients. AKD stage 2–3 provides additional information in predicting 30-day and one-year adverse outcomes over AKI stage. Enhanced follow-up of renal function of these patients may be warranted.

Renal Outcomes of Dialysis-Dependent Acute Kidney Injury in Noncritically Ill Patients: A Retrospective Study

2021 ◽  
pp. 1-7
Author(s):  
Pasquale Esposito ◽  
Alessandro Avella ◽  
Fiorenza Ferrari ◽  
Giancarlo Bruno ◽  
Carmelo Libetta ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Significant Risk ◽  
Kidney Injury ◽  
Renal Recovery ◽  
Renal Outcomes ◽  
Acute Kidney Disease ◽  
Stage 1 ◽  
Clinical Conditions

<b><i>Introduction:</i></b> Acute kidney injury (AKI) is a common complication among hospitalized patients, potentially affecting short- and long-term clinical outcomes. In this retrospective study, we evaluated renal outcomes in noncritically ill patients who required acute hemodialysis (HD) because of an AKI episode occurring during hospitalization. <b><i>Methods:</i></b> Sixty-three hemodynamically stable patients with AKI undergoing acute intermittent HD were included. Kidney function was evaluated at baseline control (pre-AKI), at AKI diagnosis and during the follow-up. According to serum creatinine and the estimated glomerular filtration rate (eGFR), we defined three clinical conditions: renal recovery, different stages of acute kidney disease (AKD), and chronic kidney disease (CKD). <b><i>Results:</i></b> Among the 63 patients evaluated, 34 patients (54%) had a history of CKD. Six patients (10%) presented early full renal recovery. HD treatment was stopped in 38 patients (60%), while 25 patients (40%) required maintenance HD. Dialysis-independent patients presented lower comorbidity and higher baseline eGFR and delta creatinine, compared to dialysis-dependent patients. Baseline CKD, previous AKI episodes, and parenchymal causes of AKI were associated with a significant risk of dialysis dependence. At 1-month control, 15 patients (39%) presented AKD stage 0, 6 patients (16%) AKD stage 1, and 17 patients (44%) AKD stage 2–3. At 3-month control, 29 out of 38 patients recovering from AKI (76%) presented CKD. AKD stage was significantly correlated with the risk of CKD development, which, resulted higher in patients with lower baseline eGFR. <b><i>Conclusions:</i></b> AKI might represent a risk factor for the development of chronic kidney damage, even in noncritically ill patients.

MO348CLINICAL TRAJECTORIES AND IMPACT OF ACUTE KIDNEY DISEASE AFTER ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT: A 5-YEAR SINGLE-CENTER COHORT STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Arthur Orieux ◽  
Mathilde Prezelin-Reydit ◽  
Christian Combe ◽  
Renaud Prevel ◽  
Alexandre Boyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Proportional Hazard ◽  
Acute Kidney Disease ◽  
Incidence Of Ckd ◽  
Stage 1

Abstract Background and Aims Acute kidney injury (AKI) is observed in more than 50% of patients admitted in intensive care units (ICU) and more than 10% of them require renal replacement therapy (RRT) Acute kidney disease (AKD) has been recently proposed to describe a highly vulnerable period with pathophysiological process following AKI during which the patient could experience a decline in glomerular filtration and finally developed CKD. Patients suffering from AKI in ICU could have various renal trajectories and outcomes (early, late, or absence of recovery; early or late relapse; acute kidney disease (AKD); or chronic kidney disease (CKD)) after discharge. No cohort study described them accurately. Aims were to assess the various clinical trajectories after AKI in ICU and to determine risk factors for developing CKD taking into account the new concept of AKD and to assess the long-term incidence of CKD. Method We conducted a prospective five-year follow-up study in a medical ICU in Bordeaux University Hospital (France). The patients who received invasive mechanical ventilation, catecholamine infusion or both and developed an AKI (defined by KDIGO criteria) from September 2013 to May 2015 were included. We excluded the patients with a previous estimated glomerular filtration rate (eGFR) of &lt;90mL/min/1.73m2. AKD was defined as a condition wherein the criteria for AKI stage 1 or greater persists ≥7 days after exposure. CKD was defined by an eGFR of &lt;60ml/min/1.73m2 at least 90 days after the AKI. Renal recovery was defined by serum creatinine ≤125% of serum basal creatinine. Using the Aalen-Johansen estimator to account for competing risks, we estimated the cumulative incidence of CKD. To estimate adjusted hazard ratios (HRs) we used standard Cox proportional hazard models adjusted for age, sex, hypertension, diabetes, cardiovascular history, SOFA and AKI stage. Proportional hazard assumptions were checked using Schoenfeld residuals. Violation of proportional hazard assumption for AKD was handled by using appropriate interaction terms with time, resulting in time-dependent HR. Results 232 patients were enrolled. The age was 62 ± 16 years, 142/232 (61%) were male. AKI stage 1 was present in 62/232 (27%) patients, AKI stage 2 in 50/232 (21%), and AKI stage 3 in 120/232 (52%). Among patients with AKI, 65/232 (28%) recovered before day 7. At day 7, 106/232 (46%) had been progressing to AKD. AKD also developed secondary in 3/65 because of a second episode of AKI without recovery. Among the AKD patients, 21/109 (19%) recovered before day 90, 41/109 (38%) dead and 47/109 (43%) progressed to CKD (figure). The cumulative incidence of CKD was 17 [12-21]% at 1-year follow-up and 30 [24-36] % at 5-years follow-up. This incidence was higher in AKD-patients (44 [35-54]%, and 48 [39-58]%) than in non-AKD patients (9 [1-16]% and 22 [10-34]%) after 1 and 5 years of follow-up, respectively (p=6.10-5). The risk of developing CKD in AKD-patients was increased up to six months compared to those without AKD (HR 27.1 [7.9-93.5]; p&lt;0.0001). Six months after AKI, the risk of progression to CKD was not statistically different between AKD patients and non-AKD patients (HR 2.45 [0.68 – 8.85]; p = 0.17). In this model only gender (male sex: HR 0.5 [0.3-0.9]; p= 0.02) was also significantly associated with CKD. Conclusion There were many clinical trajectories after AKI in ICU. Risk for developing CKD remained during the 5 years of follow-up. AKD was the main risk factors for developing CKD only in the first 6 months. After, the risk was similar in AKD or non-AKD patients. Female gender was associated with CKD during all the follow-up. These patients need a specific follow-up after ICU discharge.

Renal C3 Production Drives Acute Kidney Injury and Acute Kidney Disease in Diabetics with Sepsis

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1737-P
Author(s):  
LYNN M. FRYDRYCH ◽  
GUOWU BIAN ◽  
PETER A. WARD ◽  
MARKUS BITZER ◽  
MATTHEW DELANO
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Acute Kidney Disease

scholarly journals Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative

2021 ◽  
Author(s):  
John R. Prowle ◽  
Lui G. Forni ◽  
Max Bell ◽  
Michelle S. Chew ◽  
Mark Edwards ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Baseline Risk ◽  
Major Surgery ◽  
Increased Risk

AbstractPostoperative acute kidney injury (PO-AKI) is a common complication of major surgery that is strongly associated with short-term surgical complications and long-term adverse outcomes, including increased risk of chronic kidney disease, cardiovascular events and death. Risk factors for PO-AKI include older age and comorbid diseases such as chronic kidney disease and diabetes mellitus. PO-AKI is best defined as AKI occurring within 7 days of an operative intervention using the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI; however, additional prognostic information may be gained from detailed clinical assessment and other diagnostic investigations in the form of a focused kidney health assessment (KHA). Prevention of PO-AKI is largely based on identification of high baseline risk, monitoring and reduction of nephrotoxic insults, whereas treatment involves the application of a bundle of interventions to avoid secondary kidney injury and mitigate the severity of AKI. As PO-AKI is strongly associated with long-term adverse outcomes, some form of follow-up KHA is essential; however, the form and location of this will be dictated by the nature and severity of the AKI. In this Consensus Statement, we provide graded recommendations for AKI after non-cardiac surgery and highlight priorities for future research.

Elevated Levels of Urinary Biomarkers TIMP-2 and IGFBP-7 Predict Acute Kidney Injury in Neonates after Congenital Heart Surgery

2021 ◽  
Author(s):  
Michelle Ramírez ◽  
Sujata Chakravarti ◽  
Jaclyn McKinstry ◽  
Yasir Al-qaqaa ◽  
Raj Sahulee ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Congenital Heart ◽  
Heart Surgery ◽  
Kidney Injury ◽  
Acute Kidney Injury Network ◽  
Congenital Heart Surgery ◽  
Adverse Outcomes ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Stress Injury ◽  
Stage 1

Abstract Objectives: This article investigated the utility of urine biomarkers tissue inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein-7 (IGFBP-7) in identifying acute kidney injury (AKI) in neonates after congenital heart surgery (CHS). TIMP-2 and IGFBP-7 are cell cycle arrest proteins detected in urine during periods of kidney stress/injury. Methods: We conducted a single-center, prospective study between September 2017 and May 2019 with neonates undergoing CHS requiring cardiopulmonary bypass (CPB). Urine samples were analyzed using NephroCheck prior to surgery and 6, 12, 24, and 96 hours post-CPB. All patients were evaluated using the Acute Kidney Injury Network (AKIN) criteria. Wilcoxon rank sum tests were used to compare the medians of the [TIMP-2*IGFBP-7] values in the AKIN negative and positive groups at each time point. Receiver operating characteristic curves were used to measure how well the [TIMP-2*IGFBP-7] values predict AKIN status. Results: Thirty-six patients were included. No patients met the AKIN criteria for AKI preoperatively. Postoperatively, 19 patients (53%) met the AKIN criteria for AKI diagnosis: 13 (36%) stage 1, 5 (14%) stage 2, and 1 (3%) stage 3. None required renal replacement therapy. At the 24-hour time points, patients who met the AKIN criteria for AKI had a statistically significantly higher [TIMP-2*IGFBP7] values than the patients without AKI (1.1 vs. 0.27 [ng/mL]2/1,000) at 24 hours (adj-p = 0.0019). Conclusion: AKI is a serious complication associated with adverse outcomes in patients undergoing cardiac surgery. [TIMP-2*IGFBP-7] urinary level 24 hours after CPB is a good predictor of AKI in this population.

Urinary biomarkers predict progression and adverse outcomes ofacute kidney injury in critical illness

2021 ◽  
Author(s):  
Stephen Duff ◽  
Ruairi Irwin ◽  
Jean Maxime Cote ◽  
Lynn Redahan ◽  
Blaithin A McMahon ◽  
...  
Keyword(s):  
Critically Ill ◽  
Cystatin C ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Urinary Biomarkers ◽  
High Morbidity ◽  
Diagnostic Analysis ◽  
Prognostic Analysis ◽  
Stage 1

Abstract Background Acute Kidney Injury (AKI) is common in hospitalized patients and is associated with high morbidity and mortality. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective cohort study of critically ill patients (n = 717). We hypothesised that novel urinary biomarkers would predict progression of AKI and associated outcomes. Methods The primary (diagnostic) analysis assessed the ability of biomarkers levels at the time of early Stage 1 or2 AKI to predict progression to higher AKI Stage, RRT or Death within 7 days of ICU admission. In the secondary (prognostic) analysis, we investigated the association between biomarker levels and RRT or Death within 30 days. Results In total, 186 patients had an AKI within 7 days of admission. In the primary (diagnostic) analysis, eight of the 14 biomarkers were independently associated with progression. The best predictors were Cystatin C (aOR 5.2; 95% CI, 1.3-23.6), IL-18 (aOR 5.1; 95% CI, 1.8-15.7), Albumin (aOR 4.9; 95% CI, 1.5-18.3) and NGAL (aOR 4.6; 95% CI, 1.4-17.9). ROC and Net Reclassification Index analyses similarly demonstrated improved prediction by these biomarkers. In the secondary (prognostic) analysis of Stage 1-3 AKI cases, IL-18, NGAL, Albumin, and MCP-1 were also independently associated with RRT or Death within 30 days. Conclusions Among 14 novel urinary biomarkers assessed, Cystatin C, IL-18, Albumin and NGAL were the best predictors of Stage 1-2 AKI progression. These biomarkers, after further validation, may have utility to inform diagnostic and prognostic assessment and guide management of AKI in critically ill patients.

scholarly journals A survey on acute kidney injury in severely and critically ill COVID-19 patients without chronic kidney disease

2021 ◽  
Vol 10 (13) ◽  
pp. 42-42
Author(s):  
Yue Yu ◽  
Huipeng Ge ◽  
Xiufen Wang ◽  
Zhonghua Huang ◽  
Lei Chen ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Critically Ill ◽  
Kidney Injury

scholarly journals Atrial Fibrillation and Chronic Kidney Disease—A Risky Combination for Post-Contrast Acute Kidney Injury

2021 ◽  
Vol 10 (18) ◽  
pp. 4140
Author(s):  
Łukasz Kuźma ◽  
Anna Tomaszuk-Kazberuk ◽  
Anna Kurasz ◽  
Małgorzata Zalewska-Adamiec ◽  
Hanna Bachórzewska-Gajewska ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Coronary Angiography ◽  
Kidney Injury ◽  
Post Contrast ◽  
Acute Kidney Disease ◽  
Patients At Risk ◽  
Kidney Impairment

Atrial fibrillation (AF) symptoms may mimic coronary artery disease (CAD) which reflects the difficulties in qualifying AF patients for invasive diagnostics. A substantial number of coronary angiographies may be unnecessary or even put patients at risk of post-contrast acute kidney injury (PC-AKI), especially patients with chronic kidney disease (CKD). We aimed to investigate the hypothesis indicating higher prevalence of PC-AKI in patients with AF scheduled for coronary angiography. The study population comprised of 8026 patients referred for elective coronarography including 1621 with AF. In the comparison of prevalence of PC-AKI in distinguished groups we can see that kidney impairment was twice more frequent in patients with AF in both groups with CKD (CKD (+)/AF (+) 6.24% vs. CKD (+)/AF (−) 3.04%) and without CKD (CKD (−)/AF (+) 2.32% vs. CKD (−)/AF (−) 1.22%). In our study, post-contrast acute kidney disease is twice more frequent in patients with AF, especially in subgroup with chronic kidney disease scheduled for coronary angiography. Additionally, having in mind results of previous studies stating that AF is associated with non-obstructive coronary lesions on angiography, patients with AF and CKD may be unnecessarily exposed to contrast agent and possible complications.

Postoperative Acute Kidney Injury: Focus on Renal Recovery Definitions, Kidney Disease Progression and Survival

2019 ◽  
Vol 49 (3) ◽  
pp. 175-185 ◽  
Author(s):  
Thorir E. Long ◽  
Solveig Helgadottir ◽  
Dadi Helgason ◽  
Gisli H. Sigurdsson ◽  
Tomas Gudbjartsson ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Propensity Score ◽  
Matched Control ◽  
Kidney Injury ◽  
Renal Recovery ◽  
University Hospital ◽  
Control Group ◽  
One Year ◽  
Definition Of

Background: The aim of this study was to examine different definitions of renal recovery following postoperative acute kidney injury (AKI) and how these definitions associate with survival and the development and progression of chronic kidney disease (CKD). Methods: This was a retrospective study of all patients who underwent abdominal, cardiothoracic, vascular, or orthopedic surgery at a single university hospital between 1998 and 2015. Recovery of renal function following postoperative AKI was assessed comparing 4 different definitions: serum creatinine (SCr) (i) < 1.1 × baseline, (ii) 1.1–1.25 × baseline, (iii) 1.25–1.5 × baseline, and (iv) > 1.5 × baseline. One-year survival and the development or progression of CKD within 5 years was compared with a propensity score-matched control groups. Results: In total, 2,520 AKI patients were evaluated for renal recovery. Risk of incident and progressive CKD within 5 years was significantly increased if patients did not achieve a reduction in SCr to < 1.5 × baseline (hazard ratio [HR] 1.50; 95% CI 1.29–1.75) and if renal recovery was limited to a fall in SCr to 1.25–1.5 × baseline (HR 1.32; 95% CI 1.12–1.57) within 30 days. The definition of renal recovery that best predicted survival was a reduction in SCr to < 1.5 × baseline within 30 days. One-year survival of patients whose SCr decreased to < 1.5 × baseline within 30 days was significantly better than that of a propensity score-matched control group that did not achieve renal recovery (85 vs. 71%, p < 0.001). Conclusions: These findings should be considered when a consensus definition of renal recovery after AKI is established.

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