AKIN Criteria Research Articles

Impairment of Renal Function in Perinatal Asphyxia with Hypoxic Ischemic Encephalopathy in Term Neonates

Background: Perinatal asphyxia is a major cause of neonatal morbidity and mortality worldwide including in Bangladesh. It causes damage to almost every tissue and organ of the body. In kidneys, renal insufficiency may occur promptly even within 24 hours of asphyxia. So, renal function assessment is essential for accurate management of metabolic derangement in neonates as prolonged hypoxic ischemic episode can lead to irreversible cortical necrosis with onset of acute renal failure.Objectives: To find out renal impairment and to measure serum creatinine, serum electrolyte and eGFR, Also to compare biochemical parameters level and determine the frequency of AKI among the asphyxiated neonates with HIE.Materials and Methods: This cross-sectional study was conducted in the neonatal care unit of Sir Salimullah Medical College Mitford Hospital, Dhaka. A total of 70 term neonates suffered from perinatal asphyxia with different stages of Hypoxic ischaemic encephalopathy. A ‘p’ value <0.05 was considered as statistically significant.Results: Among 70 term neonates having HIE, it was observed that 62.9% neonates had moderate birth asphyxia followed by mild (28.6%) and severe (8.6%). Newborns with SGA (71.4%) had more renal impairment than AGA. Among biochemical variables Blood urea and serum creatinine were high and eGFR was low in stage Π. Among electrolytes, hyponatremia was present in 24.3% of cases and more in stage Π, and hyperkalemia was present in 21.4% of cases and more in stage Ш. AKI was found in 18.6% of cases, Risk (stage 1) was 77%, Injury (stage Π) was 15.3% and Failure (stage 3) was 7.7 %.Conclusion: Renal impairment was found in 18.5% of term asphyxiated neonates with HIE according to pRIFLE and AKIN criteria and Biochemical parameters showed no significant changes between different stages of HIE. KYAMC Journal Volume: 14, No: 04, January 2024: 198-205.

#1900 Should we prescind of KDIGO Stage 2 in AKI severity classification?

Abstract Background and Aims The most worldwide used classification system for staging AKI is KDIGO-2012, it was based on a combination of the RIFLE and AKIN criteria. KDIGO severity stages are defined: Stage 1 ↑ in SCr by >0.3 mg/dl or increase in SCr to >1.5x baseline. Stage 2 ↑ in SCr ≥2.0–2.9x baseline. Stage 3 ↑ in SCr ≥3.0x baseline, ↑ in SCr to >4.0 mg/dl, or initiation of RRT. Some authors advocate for the elimination of the Stage 2 level and its incorporation in the severer stage; the justification is that this stage has a smaller number of individuals, and they show poorer clinical outcomes. We tested this hypothesis in a real-world setting. Method We retrospectively included all patients admitted to nephrology ward and nephrology consultations with AKI diagnosis by KDIGO-2012 classification, during a 3-y period. We compared clinical outcomes between KDIGO-AKI Stage 2 and 3. We excluded need for HD (because it is a criterion for Stage 3) and HD dependence at discharge (a consequence of initiating HD). In addition, we calculated the proportion of patients classified in Stage 2 by the rate of SCr increment, that were re-classified into Stage 3 by KDIGO criteria. Results 1130 individuals met inclusion criteria. 458 (41%) Stage-1, 148 (13%) Stage-2, 524 (46%) in Stage-3. We found no statistically significant differences in age, Charlson's Index, HTN and DM prevalence, hospitalization in medical wards, and hospital acquired AKI between groups. We found significant differences in sex distribution (61% Stage-2, 70% Stage-3) (see Table A: Features). Hospital stay was significantly shorter in Stage1-15d (±12) but not significantly different between Stage-2 19d (±16) and Stage-3 20d (±17). Median of time to nephrology consultation was 6-7d in all groups. Rate of in-hospital mortality incremented gradually in every severity stage: 9% Stage-1, 18% Stage-2 and 31% Stage-3 (see Table B: Results). When using only the rate of SCr increment as the classification criterion, 265 (24%) of patients would have been catalogued in the moderate AKI stratum. Of the 117 patients that were reclassified as AKI Stage-3, 36 needed HD, and 81 reached a SCr >4.0 mg/dl. Conclusion The proportion of subjects classified in KDIGO AKI Stage-2 is small but not negligible. We found that Stage-2 individuals show longer hospital stay and increased mortality than Stage-1, and slightly better outcomes than Stage-3; therefore, we consider that an increase in SCr ≥2.0–2.9x from baseline still leads to deleterious consequences. We also observed that possibly KDIGO AKI Stage 3 criteria lead to a skew to classification in the severer stage, (almost half of individuals are reclassified). With these findings, should we prescind of KDIGO Stage-2 in AKI severity classification?

Acute Kidney Injury in the Context of COVID-19: An Analysis in Hospitalized Mexican Patients.

During the COVID-19 pandemic, a considerable proportion of patients developed a severe condition that included respiratory failure, shock, or multiple organ dysfunction. Acute Kidney Injury (AKI) has been recognized as a possible cause of severe COVID-19 development. Given this, this study investigates the occurrence and consequences of AKI in Mexican patients to contribute to better knowledge and management of this problem. Methods: Using a retrospective observational cohort methodology, we investigated 313 cases from a cohort of 1019 patients diagnosed with COVID-19 at the IMSS Zacatecas General Hospital of Zone No. 1 in 2020. The prevalence of AKI was determined using the AKIN criteria based on serum creatinine levels and a detailed review of demographic characteristics, medical history, comorbidities, and clinical development. Results: The data showed a 25.30% prevalence of AKI among patients infected with severe COVID-19. Remarkably, these patients with AKI exhibited an advanced age (>65 years), arterial hypertension, a higher number of white blood cells during admission and the hospital stay, and elevated levels of C-reactive protein, serum creatinine, and blood urea nitrogen (BUN). Clinically, patients with AKI had signs of prostration, pneumonia, and the requirement for ventilatory assistance when compared to those without AKI. Finally, those diagnosed with AKI and COVID-19 had a 74% death rate. Relative risk analyses indicated that age (>65 years), arterial hypertension, high creatinine levels, endotracheal intubation, and pneumonia are associated with the development of AKI. On the other hand, among the protective factors against AKI, high hemoglobin levels and the consumption of statins during COVID-19 were found. Conclusions: The findings of this study underscore the significance of promptly identifying and effectively managing AKI to potentially alleviate the negative consequences of this complication within the Mexican population during COVID-19.

Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study.

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine-postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87-0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.

SOD1 is a novel prognostic biomarker of acute kidney injury following cardiothoracic surgery

BackgroundAcute kidney injury (AKI) is a major burden among hospitalized and critical care patients. Among hospitalized patients that progress to severe AKI there is increased risk for morbidity, mortality, and the need for renal replacement therapy (RRT). As there are no specific treatments for AKI, the discovery of novel biomarkers that predict the progression of AKI may aid in timely implementation of supportive care to improve outcomes.MethodsWe collected urine from 204 patients that developed Stage 1 AKI by AKIN criteria within 72 h following cardiothoracic surgery. Urine samples were collected at the time of the initial diagnosis of AKI and stored at −80° C. Among the 204 patients, 25 progressed to a composite primary outcome of Stage 3 AKI, requirement of RRT, or 30-day mortality. The remaining 179 patients did not progress beyond Stage 2 AKI and were considered controls. Urinary concentrations of SOD1 and SOD1 activity were measured following collection of all samples. Samples were thawed and urinary superoxide dismutase 1 (SOD1) concentrations were measured by sandwich ELISA and urinary SOD1 activity was measured through a commercially available colorimetric assay.ResultsUrinary concentrations of SOD1 were significantly elevated (67.0 ± 10.1 VS 880.3 ± 228.8 ng/ml, p < 0.0001) in patients that progressed to severe AKI and were able to predict the progression to severe AKI (AUC – 0.85, p < 0.0001). Furthermore, total SOD activity also increased in the urine of patients that required RRT (77.6% VS 49.81% median inhibition, p < 0.01) and was able to predict the need for RRT (AUC: 0.83, p < 0.01).ConclusionThese findings show that urinary SOD1 concentrations and SOD activity are novel prognostic biomarkers for severe AKI following cardiothoracic surgery.

Epidemiology and outcome of acute kidney injury in hospitalized children: experience from a tertiary care hospital in Eastern India

Background: The aim of the study was to assess the etiology, clinical profile and short-term outcome of acute kidney injury in hospitalized children. Methods: A single centre prospective observational study conducted at a tertiary care hospital in eastern India. Consecutive hospitalized children aged between one month to twelve years who developed AKI according to AKIN criteria were included in the study. Relevant clinical and laboratory parameters as guide by clinical condition along with outcome of patients were recorded at the time of discharge and at one month and three months after discharge. Results: 116 hospitalized children who developed AKI were included in the study; 63 (54.3%) participants are above 5 years of age with male to female ratio of the study population was 1.07:1. Infections (46.5%), acute glomerulonephritis (19.8%), snake bite (11.2%) and post-surgery (8.6%) were the common causes of AKI. 43.1% of them had AKIN stage 3. 66.4% had oliguria, 33.6% had shock. 72.4% required admission at Pediatric Intensive Care Unit support, 32.4% required ionotrop support, 44.8% required mechaicanical ventilator support. Around 65% requrired dialysis support; of which 75% recieved hemodialysis and 25% requied peritoneal hemodialysis. Mortality rate was 44%. At discharge, 41.6% (n=27) of the patients had complete renal recovery from AKI. Percentage of partial renal recovery at the time of discharge, 1 month and 3 months after discharge were respectively 53.8%; 47.7% and 10%. 3 patients at the time of discharge and 2 patients after 3 months required persistent dialysis support. Number of factors are associated with poor outcome especially higher acute kidney injury state, critically ill patients and low serum albumin at admission. Conclusions: Infection is the leading cause of acute kidney injury in hospitalized children in this part of world. Mortality in critically ill children with acute kidney injury is high. Various clinical parameters at presentation are associated with poor short term renal outcome.

ESTIMATION OF ACUTE KIDNEY INJURY AND DYSELECTROLYTEMIA IN ASPHYXIATED NEWBORNS - A SINGLE CENTRE STUDY

Background: In babies with perinatal asphyxia, hypoxia and ischemia can cause damage to almost every tissue and organ of the body and kidneys are one of the most commonly affected organs. Renal insufciency may occur within 24 hours of a hypoxic ischemic episode leading to variable degree of kidney injury. Serum electrolyte levels are also found to be signicantly affected in perinatal asphyxia.Aims &amp; Objective: Estimation of acute kidney injury and its correlation with severity of perinatal asphyxia and assess electrolyte imbalance in term neonates with perinatal asphyxia. Materials and Methods: It is a prospective observational study conducted at a tertiary care centre during the study period. Renal parameters and serum electrolytes of asphyxiated newborns were evaluated and kidney injury was classied on the basis of AKIN criteria. Results: Among 175 newborns with perinatal asphyxia, 29.7% had HIE1, 14.3% of them developed HIE 3 while maximum of them (56%) had HIE stage 2. It was observed that 38.3% of the enrolled babies developed acute kidney injury. 14.9 % of cases had stage 1 AKI, stage 2 acute kidney injury was found in 16.6 % of cases and stage 3 acute kidney injury developed in 6.8 % of cases. Among total babies, 77.1% of the babies had hyponatremia while 9.7% of the babies had hyperkalemia. Out of 160 babies who were followed till outcome, 90% discharged while 10% of them died. Conclusion: Perinatal asphyxia is an important cause of renal dysfunction which plays an important role in mortality and morbidity of the asphyxiated newborn. Early diagnosis and management of AKI in babies with perinatal asphyxia can improve their outcome. Electrolyte disturbance in the form of hyponatremia and hyperkalemia is also an important derangement in babies with birth asphyxia which needs accurate and careful management for better outcome.

Incidence and Associations of Acute Kidney Injury after General Thoracic Surgery: A System Review and Meta-Analysis.

(1) Background: Acute kidney injury (AKI) is related to adverse outcomes in critical illness and cardiovascular surgery. In this study, a systematic literature review and meta-analysis was carried out to evaluate the incidence and associations of AKI as a postoperative complication of thoracic (including lung resection and esophageal) surgical procedures. (2) Methods: Adopting a systematic strategy, the electronic reference databases (PubMed, EMBASE, and Cochrane Library) were searched for articles researching postoperative renal outcomes that were diagnosed using RIFLE, AKIN or KDIGO consensus criteria in the context of a thoracic operation. A random-effects model was applied to estimate the incidence of AKI and, where reported, the pooled relative risk of mortality and non-renal complications after AKI. The meta-analysis is registered in PROSPERO under the number CRD42021274166. (3) Results: In total, 20 studies with information gathered from 34,826 patients after thoracic surgery were covered. Comprehensively, the incidence of AKI was estimated to be 8.8% (95% CI: 6.7−10.8%). A significant difference was found in the mortality of patients with and without AKI (RR = 2.93, 95% CI: 1.79−4.79, p < 0.001). Additionally, in patients experiencing AKI, cardiovascular and respiratory complications were more common (p = 0.01 and p < 0.001, respectively). (4) Conclusions: AKI is a common complication associated with adverse outcomes following general thoracic surgery. An important issue in perioperative care, AKI should be considered as a highly significant prognostic indicator and an attractive target for potential therapeutic interventions, especially in high-risk populations.

779: FACTOR XA INHIBITORS IN PATIENTS WITH ACUTE KIDNEY INJURY

Introduction: Data is lacking regarding the safety and efficacy of factor Xa inhibitors in patients with acute kidney injury (AKI). The goal of this study is to compare bleeding and thromboembolic events in patients receiving therapeutic doses of apixaban or rivaroxaban versus unfractionated heparin (UFH) in patients with AKI. Methods: This retrospective, observational study evaluated hospitalized adult patients who received therapeutic doses of either apixaban, rivaroxaban, or UFH for at least 24 hours in the setting of AKI as defined by AKIN criteria. Patients were excluded if they met any of the following criteria: non-FDA approved factor-Xa inhibitor indication; COVID admission; major bleeding or clinically relevant non-major bleeding (CRNMB) on admission, embolic event within 30 days of admission; coagulopathy; receipt of a contraindicated medication, or ESRD. Bleeding events were evaluated in accordance with International Society on Thrombosis and Hemostasis criteria. The primary outcome was defined as composite major and clinically relevant non-major bleeding events. Secondary outcomes included comparison of the individual components of the composite bleeding endpoint and thromboembolic events. Results: A total of 500 patients met inclusion criteria, with 250 patients included in the UFH group and factor Xa inhibitor group. AKIN Stage I was most prevalent in the overall study population; patients with AKIN stage III were more likely to be transitioned to UFH (p< 0.01). Surgical patients were more likely to be transitioned to UFH (p< 0.01). Patients transitioned to IV heparin were more likely to undergo a procedure (p< 0.01). After adjusting for confounding factors, patients who received a factor Xa inhibitor experienced a lower risk of composite major bleeding and CRNMB events as compared to UFH (OR: 0.57, 95% CI: 0.34-0.94; p = 0.03). This was driven by a decreased risk of CRNMB in the factor Xa inhibitor group (OR: 0.55, 95% CI: 0.33-0.91, p = 0.02). No significant differences in major bleeding or VTE were noted. Conclusions: Continuation of factor Xa inhibitor therapy in the setting of AKI was associated with a reduced incidence of bleeding events compared to patients transitioned to UFH in accordance with package insert recommendations.

629. Vancomycin AUC:MIC-Based Dosing is Associated with Significantly Less Acute Kidney Injury in Patients Admitted to a Burn Intensive Care Unit

Abstract Background Vancomycin is often used for empiric coverage of methicillin-resistant Staphylococcus aureus (MRSA). Vancomycin is well known to cause acute kidney injury (AKI), which can be detrimental to patients in the intensive care unit (ICU) setting. In 2020, the American Society of Health-systems Pharmacists updated their vancomycin dosing guidelines to target an area under the plasma concentration-time curve to minimum inhibitory concentration ratio (AUC:MIC) of 400-600 mg*h/L, a change from targeting a trough concentration of 10-20 mg/L. This suggests that vancomycin toxicity is likely minimized using the AUC:MIC ratio. Methods This retrospective cohort study compares the incidence of AKI in patients admitted to the burn ICU dosed to achieve a target to those dosed to achieve an AUC:MIC goal. Incidence of AKI, per the AKIN criteria, was recorded. Known risk factors such as history of hypertension, concomitant furosemide use, pre-existing renal insufficiency, and other concomitant nephrotoxins were considered. All data collected were previously obtained as a part of usual practice. Results Two hundred thirty-six subjects who received 317 courses of vancomycin were included. One hundred twenty courses were dosed to achieve an AUC goal, and 197 courses were dosed to achieve a trough goal. In the AUC group, 49 (57.7%) subjects were admitted for burns, 21 (24.7%) were admitted for necrotizing soft tissue infection (NSTI), and 15 (17.7%) were admitted for other reasons. In the trough group, 97 (64.7%) were admitted for burns, 22 (18.7%) for NSTI, and 25 (16.7%) for other reasons. Demographics were similar between the two groups. The incidence of AKI was 10.3% in the AUC group, as compared to 20.3% in the trough group (p=0.0171). Patients in the AUC group received significantly less vancomycin than in the trough group (3524 ± 1551 vs 3145 ± 1491, p=0.0315). Risk factors for AKI were similar between the two groups (55.6% vs 52.8%, p=0.6347), and concomitant nephrotoxin exposure was similar (52.6% vs 42.7%, p=0.0924). Conclusion Using AUC:MIC-based dosing was associated with a decreased incidence of AKI than trough-based dosing in patients admitted to the burn ICU. Disclosures All Authors: No reported disclosures.

995. Acute Kidney Injury Rates Before and After Implementation of Integrated Bayesian Software for Vancomycin Dosing

Abstract Background Therapeutic drug monitoring of vancomycin with Bayesian models is recommended to maximize efficacy and minimize nephrotoxicity by targeting a 24-hour area under the curve (AUC24) of 400-600mg*h/L. Minimal real-world evidence exists on the impact of this strategy. In 2020, we integrated Bayesian software from DoseMeRx into Epic OneChart and converted from trough-based vancomycin to AUC-guided dosing. We assessed the incidence of acute kidney injury (AKI) in patients receiving vancomycin before and after this change and sought to establish an efficient method of assessment. Methods This was a retrospective, single-center quasi-experimental study. Patients were divided into pre-Bayesian software (trough guided dosing, Jan-Jun 2018) and post- (Jan-Jun 2021). Preliminary data showed 10% &amp; 6% AKI rates, respectively. Therefore, a sample of 1442 patients was needed to detect a difference. Adults were included with a baseline Scr ≤2 mg/L, who received ≥3 vancomycin doses and had ≥1 vancomycin level measured. The primary outcome was AKI incidence assessed using AKIN criteria. Patients were reviewed in each period until 500 met inclusion criteria. This sample was used to determine the feasibility and accuracy of using EHR-generated reports. Results Of the 1,000 patients reviewed, baseline characteristics were similar; however, indications varied as pneumonia was more common in the pre-group and skin and soft tissue infection was more common in the post-group (Table 1). Initial daily dose and duration of vancomycin treatment were not different between groups. Incidence of AKI was decreased in the post-integration group, although this was not significant by bivariate analysis (15.4% vs. 12.6%, p=0.20). Fewer trough concentrations were drawn in the post-group (2 vs. 1.8, p=0.005), with overall lower vancomycin levels (13.2 vs. 12.1 mg/L, p=0.04). Conclusion The rate of AKI was numerically lower in patients monitored and dosed with Bayesian AUC-guided dosing software for vancomycin. Trough levels were lower, and vancomycin levels were needed less often. AKI incidence was higher than in our pilot but similar to what is reported in other studies. Further investigation is required to establish statistical significance and whether the assessment process can be automated. Disclosures Bryan T. Alexander, PharmD, BCIDP, AAHIVP, Astellas Pharma: Advisor/Consultant Trevor C. Van Schooneveld, MD, bioMerieux: Advisor/Consultant|bioMerieux: Grant/Research Support|Insmed: Grant/Research Support|Merck: Grant/Research Support|Thermo-Fischer: Advisor/Consultant Scott J. Bergman, PharmD, BCIDP, FCCP, FIDSA, Merck &amp; Co., Inc: Advisor/Consultant|Merck &amp; Co., Inc: Grant/Research Support|Merck &amp; Co., Inc: Honoraria|Pfizer: Advisor/Consultant|Pfizer: Honoraria.

1085: HYPERCHLOREMIA AND ACUTE KIDNEY INJURY IN PATIENTS WITH NONTRAUMATIC INTRACRANIAL HEMORRHAGE

Introduction: Hypertonic saline (HTS) is commonly used in patients with non-traumatic intracranial hemorrhage (ICH) as a prophylactic and therapeutic option for intracranial hypertension and/or cerebral edema. Hyperchloremia is often resulted an adverse event due to the accompanying chloride load. Among patients with subarachnoid hemorrhage, traumatic brain injury, and acute ischemic stroke, previous literature has demonstrated an association between hyperchloremia and acute kidney injury (AKI) incidence, length of stay (LOS), and even mortality. We sought to investigate this relationship in patients with non-traumatic ICH. Methods: This was a single-center, retrospective, cohort study comparing patients with and without hyperchloremia in the first 7 days of hospitalization. This was defined as a serum chloride level above 115 mEq/L. Primary outcome was incidence of AKI in the first 10 days of hospitalization, defined by having met any of either AKIN or RIFLE criteria. Secondary outcomes included ICU and hospital LOS, disposition status, and in-hospital mortality. All adult patients with non-traumatic ICH were included. Those who had CKD stage 3 or higher, baseline SCr > 2 mg/dL or chloride > 115 mEq/L, mannitol administration, and LOS < 72 hours were excluded. Results: A total of 133 patients were analyzed, 54 of which were in the hyperchloremia group. Baseline characteristics were similar between groups, except for chloride, Modified Early Warning score (MEWS), and ICH score. Incidence of AKI was found in 32.9% and 35.2% of the non-hyperchloremia and hyperchloremia groups, respectively (p=0.785). Patients with hyperchloremia had longer ICU LOS (7 vs. 5 days, p=0.006), lower rate of independent disposition (18.5% vs. 44.3%, p=0.001), and higher rate of mortality (38.9% vs. 15.2%, p=0.002). A logistic regression analysis was run to predict mortality risk using AKI, hyperchloremia, ICH score, and MEWS. ICH score was the only significant predictor of mortality (OR 2.25 (95% CI 1.40 -3.64), p=0.01). Conclusions: In non-traumatic ICH patients, we found no significant difference with AKI development between non-hyperchloremia and hyperchloremia groups. Baseline ICH score was predictive of mortality risk. Study limitations were its observational nature and lack of propensity score matching.

Acute Kidney Injury (AKI) at Admission Predicts Mortality in Patients With Severe Alcoholic Hepatitis (SAH)

Severe alcoholic hepatitis (SAH) is a grave condition, and the presence of acute kidney injury (AKI) further jeopardizes patient survival. However, the impact of AKI on survival in SAH has not been assessed from this region of Asia. This study was conducted on consecutive alcohol-associated liver disease (ALD) patients hospitalized in Gastroenterology Department, SCB Medical College, Cuttack, India, between October 2016 and December 2018. On diagnosis of SAH (mDF score ≥32), demographic, clinical, and laboratory parameters were recorded, and survival was compared between patients with and without AKI (AKIN criteria). In addition, survival was compared among SAH patients defined by other criteria and prognostic models in the presence and absence of AKI. 309 (70.71%) of ALD patients had SAH, and 201 (65%) of them had AKI. SAH patients with AKI had higher total leucocyte count, total bilirubin, serum creatinine, serum urea, INR, MELD (UNOS), MELD (Na+), CTP score, mDF score, Glasgow score, ABIC score, and increased prevalence of acute on chronic liver failure (ACLF) as per EASL-CLIF Consortium criteria (P < 0.001). Further, they had prolonged hospital stay, and increased death during hospitalization, at 28 days as well as 90 days (P < 0.001). Significant differences in survival were also seen in SAH (as per MELD, ABIC, and GAHS criteria) patients above the marked cut offs in respect to AKI. Over two-thirds of ALD patients had SAH, and about two-thirds had AKI. Patients with SAH and AKI had an increased prevalence of ACLF, longer hospital stay, and increased mortality during hospitalizationat 28 days and 90 days. SAHis a critical condition, and the presence of AKInegatively affects their survival. Hence, early identification of SAH and AKI, as well as early initiation of treatment, is crucial for better survival. Our study from the coastal part of eastern India is the first to demonstrate the prevalence of SAH among patients with ALD along with the prevalence of AKI among SAH patients in this region. This knowledge will be helpful in managing these patients from this region of world.

Sepsis associated acute kidney injury in pediatric intensive care unit.

We aimed to compare the acute kidney injury (AKI) incidence in pediatric septic shock patients according to the three different classifications. We analyzed retrospectively 52 patients with severe sepsis between January 2019 and December 2019. While 21 patients have been diagnosed with SA-AKI according to the pRIFLE criteria, 20 children have been diagnosed according to the AKIN criteria, and 21 children have been diagnosed according to the KDIGO criteria. Older age, lower platelet count were determined as independently risk factor for SA-AKI. Older age and higher PRISM score were associated with mortality. According to Canonical correlation coefficients, pRIFLE is the most successful classification to distinguish AKI state. The canonical correlation coefficients for pRIFLE, KDIGO, and AKIN were 0.817, 0.648, and 0.615, respectively. Although AKI incidence was similar between the three classifications, pRIFLE was the most successful classification to distinguish AKI state.

Acute kidney injury after major orthopedic surgery: A retrospective study of frequency and related risk factors.

This study aimed to analyze the frequency of postoperative kidney injury, the related factors, and its effect on outcomes in major orthopedic surgery cases treated in the postanesthesia intensive care unit (PACU). Major orthopedic surgery cases treated in the PACU were included in this study retrospectively. Demographic, operation, and anesthesia characteristics, CCI, ASA risk classes, preoperative biochemistry, and hemogram results of the patients were recorded. Postoperative serum creatinine level, urine output, renal replacement therapy requirement, and hemoglobin levels were recorded. The kidney damage of the patients was evaluated with RIFLE and AKIN criteria. Postoperative complications were recorded. The frequency of kidney injury in the early postoperative period was 7.1%. When only arthroplasty cases were taken, the frequency was 11%. It was determined that there was a correlation between preoperative ASA, CCI, BMI, K levels, lactate levels, and postoperative kidney damage (P <0.05). It was determined that the frequency and duration of inotropic use, the frequency and duration of noninvasive mechanical ventilation, and the duration of hospitalization increased in patients with postoperative kidney damage, and the frequency of pneumonia, wound infection, atelectasis, sepsis, arrhythmia, atrial fibrillation and mortality increased in the postoperative period (P <0.05). There is a need for further studies on the relationship between ASA, CCI, BMI, K, and lactate values and postoperative kidney damage. Postoperative kidney injury is associated with prolonged hospitalization and increased morbidity and mortality. Level IV, Therapeutic Study.

Renal Biomarker combinations predict early CRRT need in a mixed ICU population

Background: Acute kidney injury (AKI) is associated with markedly increased morbidity and mortality in critically ill patients and often necessitates the use of continuous renal replacement therapy (CRRT). The aim of the present study was to compare the predictive performance of urine neutrophil gelatinase (uNGAL), plasma cystatin C (pCysC), serum creatinine (sCr), and their combinations for CRRT requirement within the first 7 days post-admission in a general ICU.Method and material: A total of 81 consecutive ICU patients were included in the analysis. AKI was defined according to AKIN criteria. Biomarkers’ predictive abilities were evaluated by the area under the receiver operating characteristics (AUC-ROC) curves.Results and Conclusions: AKI occurred in 21% of patients and 14% of them needed CRRT 7 days post-admission. The two novel biomarkers, as well as sCr had moderate predictive abilities for CRRT requirement. The most efficient combinations (sCr+ uNGAL) and (sCr+uNGAL+pCysC) had better AUC-ROCs (0.845 and 0.84, respectively) than that of any individual biomarker (sCr, pCysC, uNGAL, with AUC-ROCs 0.81, 0.74 and 0.80, respectively). Renal biomarker combinations had better predictive characteristics for CRRT need within one week post admission as compared to each biomarker alone.

ГОСТРА НИРКОВА НЕДОСТАТНІСТЬ УНАСЛІДОК ВИКОРИСТАННЯМ ВНУТРІШНЬОВЕННИХ КОНТРАСТНИХ РЕЧОВИН ДЛЯ МЕДИЧНИХ РАДІОЛОГІЧНИХ ВТРУЧАНЬ: ПОШИРЕНІСТЬ ТА ВИЗНАЧЕННЯ ФАКТОРІВ ВПЛИВУ

Medical radiological diagnostic or therapeutic interventions are widely used as routine medical procedures in patients of all ages. At the same time, radiographic contrast agent exposure has been increasingly blamed for acute kidney injury (AKI) which reduces patients’ quality of life. This study aimed to explore the diff erences in incidence and infl uencing factors for AKI and its subtypes among patients after radiological diagnostic or therapeutic interventions with intravenous contrast agents, including computed tomography (CT), angiography, and magnetic resonance imaging (MRI). This observational study included 8060 patients (from the large nephrological clinic in Berlin, Germany) and AKI was diagnosed according to AKIN criteria ranging. The pooled prevalence of AKI was 9 %. Patients with AKI aged 60–79 years (51%) and 80–100 years (37%), respectively, were predominant. AKI was signifi cantly associated with using iodinated radiographic contrast agents (94 %) after CT and angiography and 92 % of patients had AKIN 1. The prevalence of AKIN 2 and AKIN 3 was higher among patients after MRI with non-iodinated radiographic contrast agents. To sum up obtained results, the incidence of AKI among patients after intravenous contrast agents for medical radiological interventions is low. Diff erences in the prevalence of AKI were found to be related to age and the type of contrast agents used

The Role of RIFLE, AKIN and KDIGO Criteria in Determining the Relationship Between Acute Kidney Injury and Mortality in Intensive Care Patients

The Role of RIFLE, AKIN and KDIGO Criteria in Determining the Relationship Between Acute Kidney Injury and Mortality in Intensive Care Patients

POS-007 ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION II (APACHE II) SCORING IS A PREDICTOR FOR ACUTE KIDNEY INJURY IN POLYTRAUMA PATIENTS

Trauma patients are at risk of acute kidney injury (AKI), which may be explained by renal hypoperfusion, rhabdomyolysis, direct renal injury, or the nephrotoxic effects of therapies in these patients, who survive their initial injuries and are associated with poor outcomes and higher mortality rates. The current study aimed to identify the predictors of AKI in polytrauma patients to prevent its occurrence and to improve the management of those critical patients. This is a prospective observational and analytical study. It was conducted on 300 polytrauma patients in Mansoura University Emergency Hospital (MUEH), Egypt, with the exclusion of diabetic and chronic kidney disease patients. APACHE II, Glasgow Coma Score (GCS), and Injury Severity Score (ISS) were evaluated with other routine laboratory data for every patient. Serum creatinine was repeated every 24 hours to assess the presence of AKI and determine the stage according to AKIN criteria. The frequency of AKI development among the polytrauma patients was (23.7%); including 50.7% with stage 1 AKI; 32.4% with stage 2 AKI and 16.9% with stage 3 AKI. Univariate analysis showed that low GCS, high ISS, high APACHE II score, high initial lactate, and high initial serum creatinine were risk factors for AKI in trauma patients. While multivariate analysis revealed only APACH II risk stratification scoring and the initial serum creatinine at admission were independent predictors for AKI development in polytrauma patients. Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring and initial serum creatinine are predictors for acute kidney injury in polytrauma patients.

Acute Kidney Injury Following Coronary Artery Bypass Grafting with Cardiopulmonary Bypass at Dr. Soetomo General Academic Hospital Surabaya: A Preliminary Study

Introduction: Acute Kidney Injury (AKI) is a significant cause of morbidity and mortality following common cardiac surgery. The most common cardiac surgery performed at Dr Soetomo General Academic Hospital Surabaya is coronary artery bypass grafting (CABG). Along with the increasing number of these procedures performed on subjects, Cardiopulmonary Bypass (CPB) has also grown in popularity, which is frequently associated with postoperative AKI. Objective: To investigate the incidence of postoperative AKI in subjects who had undergone a CABG procedure using the CPB technique. Materials and Methods: A retrospective study was conducted at Dr. Soetomo General Academic Hospital in Surabaya. All subjects who had CABG with CPB in 2019 were included in the study. The incidence of AKI was determined by comparing the creatinine serum level before and after surgery on days 0, 1, 2, 3, and &gt;3 according to the AKIN criteria. Results and Discussion: The 68 subjects who underwent the CABG with CPB procedure were made up of 53 males (77.9%) and 15 females (22.1%). The average age of the subjects was 58.209.07. This study included 63 subjects (five subjects could not be evaluated due to incomplete data), and AKI was diagnosed in 44 of them using the AKIN criteria (69.8%). Postoperative AKI was reported in 14 subjects (22.2%) on day 0, 18 subjects (28.6%) on day 1 post-operation, and the same number of 6 subjects (9.5%) on day 2 and day 3 post-operation. None of them had AKI after the third post-operative day. Conclusion: More than 50 % of cases of post-CABG Acute Kidney Injury (AKI) occur at Dr. Soetomo General Academic Hospital, with the majority occurring on the first day after surgery.