Burden Of Acute Kidney Injury Research Articles

Incidence, risk factors, and outcomes of acute kidney injury among hiv positive medical admissions at the Bamenda Regional Hospital

Background: There is a paucity of data on the burden of acute kidney injury (AKI) in hospitalized HIV-infected patients in Sub-Saharan Africa in the “test and treat” era. Objectives: To study the incidence, risk factors, and outcomes of AKI among HIV-positive medical admissions in a secondary hospital. Materials and methods: We prospectively screened adult HIV-positive patients who gave their informed consent and were admitted to the Bamenda Regional Hospital for AKI from February to June 2020. We excluded participants with Chronic Kidney Disease (CKD) Stage 5 and those with confounders of serum creatinine. On admission and after 2-7 days, we extracted a venous blood sample from each participant to evaluate serum creatinine and diagnose AKI. The participants were then followed up on until they were discharged or died. We measured the need for dialysis, access to dialysis, and renal recovery at three months for patients with AKI. The amended KDIGO 2012 criteria were used to define and classify AKI. The University of Bamenda’s institutional review board provided ethical approval. Results: A total of 206 participants (39.8% men) were enrolled, with a mean (SD) age of 45.71(13.13) years. On enrolment, 89.8% (n = 185) of the participants were on combination antiretroviral therapy (c-ART), with 81.6% (n = 151) on tenofovir-containing regimens. The WHO HIV clinical stages 3 and 4 were present in 81.5% (n = 168) of the individuals. The most common reason for hospitalization was opportunistic infections (69.8%; n = 142). AKI was found in 30.6% (n = 63) of the patients, with 58.7% (n = 37) of them being classified as KDIGO stage 3. A total of 12 (42.9%) participants out of the 28 in need, were dialyzed. AKI was independently associated with use of traditional medicines (aOR = 2.9; 95% CI 1.4-6.3; p = 0.006), WHO HIV stages 3 and 4 (aOR = 4.1; 95% CI 1.1-15.7; p = 0.038), hypotension (aOR = 3.3; 95% CI 1.4-7.8; p = 0.008) and low haemoglobin level ≤ 8.0 g/dl (aOR = 3.5; 95% CI 1.7-7.4; p = 0.001). The AKI group used to have a significantly higher mortality rate (42.9% vs. 16.1%; p < 0.001). Renal recovery was complete in 66.7% of the 30 survivors at three months, partial in 13.3%, and no recovery in 20% of the survivors. Conclusion: Despite the growing use of combination antiretroviral medication, significant immunosuppression is still common in hospitalized HIV-positive patients, increasing the risk of AKI and worsening prognosis. In this high-risk population, early detection of AKI with renal function monitoring may improve results.

Acute Kidney Injury in Acute Stroke.

Madam, Acute kidney injury (AKI) in acute stroke setting has recently gained importance as a relatively common complication and its associated adverse clinical outcomes in this population. Early diagnosis of AKI in its potentially reversible stages is of utmost importance, especially in a resource-limited setting like ours, and may improve outcomes in these patients. The lack of data on the burden of AKI and its risk factors in patients with acute stroke in Pakistan represents an important knowledge gap. We aimed to fill this gap by studying the frequency of AKI in patients with acute stroke and delineating associated risk factors. We performed a cross-sectional study of 215 acute stroke patients admitted to the stroke unit at our institution between December 2019 and June 2020. The mean age was 60 ± 14 years. One hundred and thirty-one patients (60.9%) were males. Hypertension and diabetes were found in 164 (76.3%) and 92 (42.8%) patients, respectively. Acute ischemic stroke (AIS) was seen in 130 patients (60.5%), while 85 (39.5%) had intracranial hemorrhage (ICH). Acute kidney injury was found in 73 patients (34%) of which 26 % (n=56) seen in patients <50 years age group vs 39.5% (n=85) and 34.4% (n=74) in 50-65 years and >65 years, respectively. Males were more likely to experience AKI than females (72.6% vs 27.4%); odds ratio (OR) = 2.174 (95% CI: 1.18 – 4.007) p=0.012. Increasing severity of stroke was associated with an increased risk of AKI (p<0.001). However, no significant factors affecting the severity of AKI were found on subgroup analysis by age, gender, comorbidities, type and severity of stroke or admission blood pressure. Patients with ICH were more likely to suffer from AKI than to those with AIS (OR 1.429; 95% CI: 1.033 – 1.977; p=0.035). In our study, the frequency of A|KI in acute stroke was much higher than previously reported from other parts of the world (1–3). This high burden of AKI has major implications in a resource-limited setting, given the demand for integrated long-term care required by stroke patients with renal dysfunction. Moreover, we observed male gender susceptibility to AKI, a finding reported by other studies from South Asia (3,4) but not from the western world. This might reflect gender biased access to health care in the subcontinent but multivariable analysis with larger database is needed to verify the independent link between gender and risk for AKI, if any. ---Continue

Mortality, disease progression, and disease burden of acute kidney injury in alcohol use disorder subpopulation

BackgroundThe aim of the study was to quantify the relationship between acute kidney injury (AKI) and alcohol use disorder (AUD). MethodsWe used a large academic medical center and the MIMIC-III databases to quantify AKI disease and mortality burden as well as AKI disease progression in the AUD and non-AUD subpopulations. We used the MIMIC-III dataset to compare two different methods of encoding AKI: ICD-9 codes, and the Kidney Disease: Improving Global Outcomes scheme (KDIGO) definition. In addition to the AUD subpopulation, we also present analyses for the hepatorenal syndrome (HRS) and alcohol-related cirrhosis subpopulations identified via ICD-9/ICD-10 coding. ResultsIn both the ICD-9 and KDIGO encodings of AKI, the AUD subpopulation had a higher incidence of AKI (ICD-9: 43.3% vs. 37.92% AKI in the non-AUD subpopulations; KDIGO: 48.65% vs. 40.53%) in the MIMIC-III dataset. In the academic dataset, the AUD subpopulation also had a higher incidence of AKI than the non-AUD subpopulation (ICD-9/ICD-10: 12.76% vs. 10.71%). The mortality rate of the subpopulation with both AKI and AUD, HRS, or alcohol-related cirrhosis was consistently higher than that of the subpopulation with only AKI in both datasets, including after adjusting for disease severity using two methods of severity estimation in the MIMIC-III dataset. Disease progression rates were similar for AUD and non-AUD subpopulations. ConclusionsOur work shows that the AUD patient subpopulation had a higher number of AKI patients than the non-AUD subpopulation, and that patients with both AKI and AUD, HRS, or alcohol-related cirrhosis had higher rates of mortality than the non-AUD subpopulation with AKI.

Frequency of Acute Kidney Injury (AKI) among patients presenting with Organophosphate Poisoning at National Poison Control Centre, Karachi: A prospective cross-sectional survey.

Background and Objective:Organophosphates poisoning is among the most prevalent forms of intentional and unintentional poisoning in Pakistan. However, the actual burden of AKI secondary to organophosphate poisoning in Pakistani population is still not known. This study aimed to determine the actual burden of AKI among patients admitted at National Poison Control Centre, Karachi.Methods:A cross-sectional survey was conducted at National Poison Control Centre, Karachi November, 2013 to April, 2014. A sample of 300 patients of age 18 years and above, presenting with organophosphate poisoning within 24 of exposure or ingestion were included in the study. Frequency of acute kidney injury was calculated using the diagnostic criteria of serum creatinine level of >1.4 mg/dL. Data was analyzed using SPSS version 19.Results:The frequency of AKI which was defined as creatinine level >1.4 mg/dL was 22.3% (n=67). However, there was no statistically significant difference was found in frequency of AKI on the basis of age, sex, amount of organophosphates ingested and BMI. This study found statistically significant differences in the AKI frequency on the basis of lag time. Those who presented earlier after poisoning had relatively low frequency of AKI.Conclusion:This study concludes that AKI is a common complication among patients presenting with organophosphate poisoning at National Poison Control Center, Karachi. Lag time is a key determinant of AKI among patients with organophosphate poisoning. Timely treatment can prevent this critical complication among patients with organophosphate poisoning.

Incidence and Burden of Acute Kidney Injury among Traumatic Brain-Injury Patients.

BackgroundAcute kidney injury (AKI) has been occurs commonly in the clinical management of traumatic brain injury (TBI) patients and is correlated with outcomes in these patients. We designed this study to investigate the incidence, duration, stage, and burden of AKI among these patients.MethodsA total of 419 TBI inpatients at our hospital were included in the study. We calculated the AKI burden, reflecting both stage and duration, and then analyzed associations among AKI occurrence, highest AKI stage, AKI duration, AKI burden, and outcomes with logistic regression analysis.ResultsIncidence of AKI among TBI patients was 19.8%. These patients’ AKIs occurred mainly on the first day from admission (10.74%), and mostly developed stage 1 AKI (9.79%). Modes of AKI duration and burden in those with AKI were both 1. Multivariate logistic regression showed AKI occurrence (OR 3.792, p=0.004) and the highest AKI stage (OR 3.122, p<0.001) was significantly associated with mortality. Neither AKI duration (OR 1.083, p=0.206) nor AKI burden (OR 1.062, p=0.171) were associated with mortality. Incorporating AKI occurrence or highest AKI stage did not improve the predictive value of the constructed prognostic model.ConclusionThe high-incidence period of AKI in TBI patients was the first 3 days after admission. AKI occurrence and highest AKI stage were associated with mortality, while AKI duration and AKI burden were not associated with mortality.

Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study

Acute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17–28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37–36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05–0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12–11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.

FC 047COMPARISON OF THE CHARACTERISTICS AND MORTALITY OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 AND OTHER RESPIRATORY INFECTIONS: A PROSPECTIVE COHORT STUDY

Background and AimsPrevious studies have indicated a coherency between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI), indicating poor outcomes. However, most studies only included patients with COVID-19 and lacked a control group. Therefore, the aim of this study was to investigate the prevalence and prognostic impact of AKI in patients with COVID-19 in comparison with other respiratory tract infections.MethodThe prospective single-center observational case-control COronaVIrus surviVAl (COVIVA, clinicaltrials.gov NCT04366765) study performed at the University Hospital Basel Switzerland consecutively enrolled patients presenting to the emergency department with symptoms suggestive of COVID-19 between March 23 and May 31, 2020. The final diagnosis that led to the inclusion in the study was adjudicated by physicians after reviewing all available medical data including laboratory test results 30 days after discharge. For this analysis, we compared patients tested positive for SARS-CoV-2 with patients tested negative but with an adjudicated diagnosis of upper or lower respiratory tract infection including pneumonia. Primary outcome measure was death at 30 days, secondary outcomes were AKI incidence, renal recovery and need for renal replacement therapy. AKI was defined according to the serum creatinine criteria of the 2012 KDIGO clinical practice guideline.ResultsOf the 1086 patients included, 507 had a final adjudicated diagnosis of respiratory tract infection and were eligible for this analysis. Of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. Baseline characteristics were comparable between patients with and without COVID-19.AKI occurred in 95 patients (19%) with a higher incidence (30%, 95%CI 24-37 versus 12%, 95%CI 9-17, p<0.001) and a higher severity (KDIGO stage 3, 22% versus 10%, p=0.003) in patients with COVID-19 as compared to controls, respectively. Need for intensive care (22% versus 6%, p<0.001) and requirement for RRT were higher in patients with COVID-19 (8 patients (4.4%) versus 2 patients (0.62%); p=0.01). Renal recovery at discharge in survivors was similar in patients with (64%) and without COVID-19 (48%, p=0.175). Survival analysis identified AKI as a predictor of 30-day mortality independent of COVID-19 status (adjusted hazard ratio (aHR) 3.44, 95% confidence interval (CI) 1.55-7.63, p=0.002), but COVID-19 patients with AKI carried the highest risk (aHR 4.24, 95%CI 1,82-9.88, p<0.001). (Figure 1)ConclusionAKI occurs more frequently and more severely in patients with COVID-19 compared to other respiratory tract infections. It is associated with an increased risk for death, with the highest risk observed in COVID-19 patients. This underlines the augmented burden of AKI during the COVID-19 pandemic.

POS-032 BARRIER TO AND CONSTRAINTS OF ACUTE PERITONEAL DIALYSIS IN ACUTE KIDNEY INJURY: A NATIONAL SURVEY

Amidst the ever-increasing global burden of acute kidney injury (AKI), the ability to perform acute peritoneal dialysis (PD) is essential for many medical facilities. We, therefore, conducted a national survey to assess barriers and obstacles to acute PD usage in AKI to further promote the utility of PD in treating AKI cases. The national survey of practice patterns and obstacles in acute PD was performed by distributing an online questionnaire to all medical directors of public dialysis units registered with the Nephrology Society of Thailand during September-November, 2019. The barriers and constraints to performing acute PD were assessed using a 5-point Likert scale. Excluding duplicate responses, 113 adult facilities responded to the survey. Acute PD was performed in 66 centers (58%). In facilities where acute PD practice was available, the utilization rate was relatively low (<10 cases/year) and limited to specific conditions, including HIV seropositive patients, continuous kidney replacement therapy unavailability, and difficult vascular access creation. Only 9% of facilities performed acute PD routinely, but interestingly, all of such units permitted bedside catheter insertion by the nephrologists or internists. The major constraints placed on acute PD practice were PD catheter insertion competency, timely catheter insertion support, and knowledge/competency deficits of the medical supporting team. Clinical practice and patterns of acute PD in AKI were highly variable and deviated at times from the International Society for Peritoneal Dialysis (ISPD) guideline recommendations. Acute PD for AKI is underutilized in Thailand and limited by the inability to undertake timely PD catheter insertion and knowledge and competency deficits. Future research should focus on optimizing the safety and efficacy of improvized PD using readily available medical equipment in austere settings.

Laboratory Indicators of AKI in the Setting of HELLP Syndrome in Resource-constrained Backgrounds

Background: Acute Kidney Injury (AKI) in the setting of HELLPs (HELLP syndrome) brings in a high rate of maternal and perinatal morbidity/mortality. Its diagnosis depends on proper evaluation of relevant laboratory indices; a factor that is very limited in resource-constrained environs. Hence, the current study evaluated some routine laboratory indices of AKI in the setting of HELLPs in resource-constrained backgrounds. Methods: The study was conducted retrospectively at a tertiary hospital in Nigeria among 198 pregnant women diagnosed/managed for HELLPs from 2011-2020. Relevant variables and data were extracted from laboratory and other medical files using a well-designed research pro forma and analyzed using standard guidelines. Results: Among those evaluated, 57.1% (n=115) developed AKI. The AKI cohorts had higher mean plasma creatinine (PCr) and plasma uric acid (PUA) levels but lower 24-hour urine volume (UV) compared to the non-AKI cohorts (p<0.05). PCr and PUA levels increased while 24-hour urine volume (UV) decreased with advancing AKI stages (p<0.05). The PCr, PUA, and 24-hour UV predicted AKI on univariate logistic regression analysis (LRA) (p<0.05). However, on multivariate LRA, PUA level and the 24-hour UV lost their statistical significance while that of PCr level was significantly amplified (OR: 9.440; 95%CI: 6.733-11.202). At a cut-off value of 106.7 µmol/L, PCr level maintained a robust predictive potential (AUC: 0.938; 95%CI: 0.859-1.000; p<0.001) for AKI. Conclusion: PCr had a robust predictive potential of AKI among the studied population. Hence, timely measurement of PCr level should be considered during the management of HELLPs to reduce the burden of AKI among this at-risk group, especially in resource-constrained settings.

Acute Kidney Injury and Associated Factors in Intensive Care Units at a Tertiary Hospital in Northern Tanzania.

Background:Acute kidney injury (AKI) is a recognized complication in critically ill patients. The epidemiology of AKI varies worldwide, depending on the diagnostic criteria used and the setting. The International Society of Nephrology has called for a reduction in preventable deaths from AKI to zero by the year 2025. It is suspected that the majority of AKI cases are in limited-resource countries, but the true burden of AKI in these settings remains unknown.Objective:We aimed to determine, using standardized KDIGO (Kidney Disease Improving Global Outcomes) criteria, the prevalence of AKI, associated factors, and clinical characteristics of adult (≥18 years) patients admitted to intensive care units (ICUs) at a tertiary hospital in Tanzania.Design:Prospective observational study from November 2017 to May 2018.Methods:In all, 320 patients admitted to medical and surgical ICUs were consecutively enrolled. Baseline, clinical, and laboratory data were collected on admission and during their ICU stay. Serum creatinine and urine output were measured, and KDIGO criteria were used to determine AKI status.Results:More than half (55.3%) of ICU patients were diagnosed with AKI. Of these, 80% were diagnosed within 24 hours of admission. Acute kidney injury stage 3 accounted for 35% of patients with AKI. Patients with AKI were older, more likely to have cardiovascular comorbidities, and with higher baseline serum levels of creatinine, potassium, universal vital assessment admission scores, and total white cell count ≥12. Sepsis (odds ratio [OR] = 3.81; confidence interval [CI] = 1.21-11.99), diabetes (OR = 2.54; CI = 1.24-5.17), and use of vasopressors (OR = 3.78; CI = 1.36-10.54) were independently associated with AKI in multivariable logistic regression. Less than one-third of those who needed dialysis received it. There was 100% mortality in those who needed dialysis but did not receive (n = 19).Limitations:Being based at a referral center, the findings do not represent the true burden of AKI in the community.Conclusion:The prevalence of AKI was very high in ICUs in Northern Tanzania. The majority of patients presented with AKI and were severely ill, suggesting late presentation, underscoring the importance of prioritizing prevention and early intervention. Further studies should explore locally suitable AKI risk scores that could be used to identify high-risk patients in the community health centers from where patients are referred.

Tackling AKI: prevention, timing of dialysis and follow-up.

Timely diagnosis and dialytic treatment of acute kidney injury (AKI) came to the forefront at the height of the coronavirus disease 2019 pandemic as admissions surged in intensive care units. Research on early diagnosis, timing of initiation of kidney replacement therapy, and appropriate post-hospitalization patient care remains essential to tackling the burden of AKI.

The incidence and outcomes of patients with acute kidney injury in a multidisciplinary intensive care unit in Durban, South Africa.

Background Acute kidney injury (AKI) in critically ill and resource-limited settings is under investigated. Objectives To describe the incidence, outcomes and healthcare burden of AKI in a multidisciplinary intensive care unit (ICU) in Durban, South Africa (SA). Methods All adult patients admitted to the ICU at King Edward VIII Hospital from January 2016 to June 2016, who did not have end-stage renal disease and survived for more than 6 hours after admission were evaluated for AKI using the kidney disease improving global outcomes (KDIGO) creatinine criteria. Potential risk factors for AKI and an association between AKI and outcomes including ICU mortality and length of stay were analysed. Results We screened 204 patients for inclusion into the study and 26 patients were excluded. About half of the patients (50.5%; n=90/178) who were included in the study were diagnosed with AKI at the time of admission and 16.3% (n= 29/178 developed AKI in the ICU. Among the patients who had AKI on admission, 50% (n=45/90) were classified as KDIGO stage1, 21.1% (n=19/90) as stage 2 and 28.8% (n=26/90) as stage 3. Less than one-third (24.7%; n=44/178) of the patients who developed AKI in the ICU were classified as KDIGO stage 1, 14% (n=25/178) were stage 2, and 28% (n=50/178) were stage 3. The mortality rate for patients with AKI on admission was 40.0% (n=36/90) compared with 39.8% (n=35/88) for those without AKI on admission (p=0.975). The mortality rate for all patients with AKI was 46.2% (n=55/119) compared with 27.1% (n=16/59) in patients who did not develop AKI (p=0.014). Conclusion AKI is common in critically ill patients presenting to a tertiary ICU in Durban, SA. AKI is associated with increased mortality and length of stay in the ICU. Strategies to prevent the development or worsening of AKI must be emphasised. These include prevention or at least early treatment of sepsis, adequate fluid resuscitation, aggressive haemodynamic optimisation and avoidance of nephrotoxins. This is especially important in settings where there is limited access to renal replacement therapy (RRT). Contributions of the study This is one of the first studies to describe the incidence and outcomes of AKI in a general critical care population in a resource-limited setting. The study highlights that AKI is very common in critically ill patients in a resource-limited setting, and is associated with increased mortality and resource utilisation. It also highlights the importance of sepsis as a risk factor for AKI.

High burden of acute kidney injury in COVID-19 pandemic: systematic review and meta-analysis

AimsHospitalised patients with COVID-19 have a variable incidence of acute kidney injury (AKI) according to studies from different nationalities. The present systematic review and meta-analysis describes the incidence of AKI,...

The Workforce in Critical Care Nephrology: Challenges and Opportunities.

The substantial burden of acute kidney injury and end-stage kidney disease among patients with critical illness highlights the importance and need for a specialized nephrologist in the intensive care unit. The last decade has seen a growing interest in a career focused on critical care nephrology. However, the scope of practice and job satisfaction of those who completed dual training in nephrology and critical care are largely unknown. This article discusses the current practice landscape of critical care nephrology and describes the educational tracks available to pursue this pathway and considerations to enhance the future of this field.

Clinical features, risk factors, and clinical burden of acute kidney injury in older adults

Background: Few epidemiologic studies on acute kidney injury (AKI) have focused on the older adult population. This study investigated the clinical features, risk factors, and clinical burden in this population. Methods: A retrospective observational study was performed with the clinical data of inpatients at Guangdong Geriatrics Institute from 1 August 2012, to 31 December 2016. AKI was classified into community-acquired AKI (CA-AKI) and hospital-acquired AKI (HA-AKI), and the risk factors for AKI were ranked by weight. The relationships between AKI and adverse outcomes during hospitalization were analyzed using univariate and multivariate logistic regression. Results: In total, 6126 patients were enrolled, and 1704 patients developed AKI (27.8%): 6.3% had CA-AKI, and 21.5% had HA-AKI. In total, 1425 (23.3%), 202 (3.3%), and 77 (1.3%) patients had stage 1, 2 and 3 AKI, respectively. Age, dementia, moderate/severe renal disease, moderate/severe liver disease, metastatic solid tumor, female sex, congestive heart failure, chronic pulmonary disease, diabetes mellitus with chronic complications, non-metastatic tumor and lymphoma were independent risk factors for HA-AKI. The first five were also independent risk factors for CA-AKI. After multiple adjustment, AKI was associated with intensive care admission (CA-AKI: OR 5.688, 95% CI 3.122–10.361; HA-AKI: OR 4.704, 95% CI 3.023–7.298) and in-hospital mortality (CA-AKI: OR 5.073, 95% CI 2.447–10.517; HA-AKI: OR 13.198, 95% CI 8.133–21.419). Conclusion: AKI occurs in >25% of older adults in the geriatric ward. In addition to traditional risk factors, dementia and tumors were risk factors for AKI in older adults. AKI is closely related to a poor prognosis.

A narrative review of the impact of surgery and anaesthesia on acute kidney injury.

The epidemiology of peri-operative acute kidney injury varies depending on the definition, type of surgery and acute and chronic comorbidities. Haemodynamic instability, disturbance of the microcirculation, endothelial dysfunction, inflammation and tubular cell injury are the main factors contributing to the pathogenesis. There are no specific therapies. The most effective strategies to protect renal function during the peri-operative period are: the avoidance of nephrotoxic insults; optimisation of haemodynamics; prevention of hypotension; and meticulous fluid management, including avoidance of both hypovolaemia and hypervolaemia. Peri-operative acute kidney injury is associated with an increased risk of short- and long-term postoperative complications, including a longer stay in hospital, development of premature chronic kidney disease and increased mortality. Resource utilisation and healthcare costs are also higher. In future, the development of advanced clinical prediction scores, new imaging and monitoring techniques and the application of new biomarkers for acute kidney injury have the prospect of identifying acute kidney injury earlier and allowing a more personalised management approach with the aim of reducing the global burden of acute kidney injury.

Population-Based Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Children.

We describe the epidemiology, characteristics, risk factors, and incremental risks associated with acute kidney injury in critically ill children at a population-level. Population-based retrospective cohort study. PICUs in Alberta, Canada. All children admitted to PICUs in Alberta, Canada between January 1, 2015, and December 31, 2015. None. A total of 1,017 patients were included. Acute kidney injury developed in 308 patients (30.3%; 95% CI, 28.1-33.8%) and severe acute kidney injury (Kidney Disease: Improving Global Outcomes stage 2 and 3) developed in 124 patients (12.2%; 95% CI, 10.3-14.4%). Incidence rates for critical illness-associated acute kidney injury and severe acute kidney injury were 34 (95% CI, 30.3-38.0) and 14 (95% CI, 11.38-16.38) per 100,000 children-year, respectively. Severe acute kidney injury incidence rates were greater in males (incidence rate ratio, 1.55; 95% CI, 1.08-2.33) and infants younger than 1 year old (incidence rate ratio, 14.77; 95% CI, 10.36-21.07). Thirty-two patients (3.1%) did not survive to PICU discharge. The acute kidney injury-associated PICU mortality rate was 2.3 (95% CI, 1.4-3.5) per 100,000 children-year. In multivariate analysis, severe acute kidney injury was associated with greater PICU mortality (odds ratio, 11.93; 95% CI, 4.68-30.42) and 1-year mortality (odds ratio, 5.50; 95% CI, 2.76-10.96). Severe acute kidney injury was further associated with greater duration of mechanical ventilation, duration of vasoactive support, and lengths of PICU and hospital stay. The population-level burden of acute kidney injury and its attributable risks are considerable among critically ill children. These findings emphasize the need for enhanced surveillance for acute kidney injury, identification of modifiable risks, and evaluation of interventional strategies.

COVID-19 Pandemic and the Burden of Acute Kidney Injury: The Known and the Unknown.

The present pandemic of severe acute respiratory syndrome is caused by the coronavirus (2019-nCoV), commonly called COVID-19. Starting from China, it has spread worldwide, causing major morbidity and mortality. It primarily involves the pulmonary system, but other organ systems are not spared. Treatment is still elusive and evolving. The exact pathogenesis of renal damage from COVID-19 virus and the magnitude of renal failure in this infection are not very clear. PubMed was searched to identify published literature from 2019 to present using the following keywords: COVID-19, acute kidney injury, creatinine, blood urea nitrogen, chronic kidney disease, renal replacement therapy, and dialysis. Cited references were also used to further identify relevant articles and literature elsewhere on the web. This review looks at the burden and influence of the COVID-19 pandemic on the kidneys and on the implications it will have on public health planning.

Epidemiology of acute kidney injury in Intensive Care Units in Aswan University Hospital

Background: Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU) and is associated with adverse outcomes including increased length of ICU and hospital stay, development of chronic kidney disease (CKD) and increased short- and long-term mortality risk. Objective: To screen critically ill patient admitted to ICU in Aswan University Hospital for acute kidney injury from September 2017 up to September 2018. Patients and methods: In this study 538 patients were admitted to the ICU in Aswan University Hospital in Egypt, from August 1st, 2017 to August 1st 2018. This study was a prospective, randomized; hospital based clinical study on critically ill patients in Intensive Care Unit. With inclusion criteria patients who were 18 years or older and admitted to the Intensive Care Unit (ICU). Results: Out of 583 patients admitted to ICU, there were 97 patients had AKI, 64.9% of them already had AKI on the admission while the rest of them (35.1%) developed AKI after admission. There is more than one third of mortality among ICU patients related to AKI (35.1%), while (64.9%) were related to other causes. Conclusion: AKI is associated with high mortality in our ICU setting. Further studies are needed to estimate the burden of AKI among patients before ICU admission

Epidemiology of acute kidney injury in Intensive Care Units in Aswan University Hospital

Background: Acute kidney injury (AKI) is a frequent complication in patients admitted to the intensive care unit (ICU) and is associated with adverse outcomes including increased length of ICU and hospital stay, development of chronic kidney disease (CKD) and increased short- and long-term mortality risk. Objective: To screen critically ill patient admitted to ICU in Aswan University Hospital for acute kidney injury from September 2017 up to September 2018. Patients and methods: In this study 538 patients were admitted to the ICU in Aswan University Hospital in Egypt, from August 1st, 2017 to August 1st 2018. This study was a prospective, randomized; hospital based clinical study on critically ill patients in Intensive Care Unit. With inclusion criteria patients who were 18 years or older and admitted to the Intensive Care Unit (ICU). Results: Out of 583 patients admitted to ICU, there were 97 patients had AKI, 64.9% of them already had AKI on the admission while the rest of them (35.1%) developed AKI after admission. There is more than one third of mortality among ICU patients related to AKI (35.1%), while (64.9%) were related to other causes. Conclusion: AKI is associated with high mortality in our ICU setting. Further studies are needed to estimate the burden of AKI among patients before ICU admission