Diagnosis Of AKI Research Articles

Fractional Excretion of Urea for the Differential Diagnosis of AKI: A Systematic Review and Meta-Analysis with Comparison to Fractional Excretion of Sodium

Fractional Excretion of Urea for the Differential Diagnosis of AKI: A Systematic Review and Meta-Analysis with Comparison to Fractional Excretion of Sodium

Predicting acute kidney injury with an artificial intelligence-driven model in a pediatric cardiac intensive care unit

BackgroundAcute kidney injury (AKI) is among the most common complications following cardiac surgery in adult and pediatric patients, significantly affecting morbidity and mortality. Artificial Intelligence (AI) with Machine Learning (ML) can be used to predict outcomes. AKI diagnosis anticipation may be an ideal target of these methods. The scope of the study is building a Machine Learning (ML) train model with Random Forest (RF) algorithm, based on electronic health record (EHR) data, able to forecast AKI continuously after 48 h in post-cardiac surgery children, and to test its performance.Four hundred nineteen consecutive patients out of 1115 hospital admissions were enrolled in a single-center retrospective study. Patients were younger than 18 years and admitted from August 2018 to February 2020 in a pediatric cardiac intensive care unit (PCICU) undergoing cardiac surgery, invasive procedure (hemodynamic studies), and medical conditions with complete EHR records and discharged after 48 h or more.ResultsThirty-six variables were selected to build the algorithm according to commonly described cardiac surgery-associated AKI clinical predictors. We evaluated different models for different outcomes: binary AKI (no AKI vs. AKI), severe AKI (no-mild vs severe AKI), and multiclass classification (maximum AKI and the most frequent level of AKI, mode AKI). The algorithm performance was assessed with the area under the curve receiver operating characteristics (AUC ROC) for binary classification, with accuracy and K for multiclass classification. AUC ROC for binary AKI was 0.93 (95% CI 0.92–0.94), and for severe AKI was 0.99 (95% CI 0.98–1). Mode AKI accuracy was 0.95, and K was 0.80 (95% CI 0.94–0.96); maximum AKI accuracy was 0.92, and K was 0.71 (95% CI 0.91–0.93). The importance matrix plot demonstrated creatinine, basal creatinine, platelets count, adrenaline support, and lactate dehydrogenase for binary AKI with the addition of cardiopulmonary bypass duration for severe AKI as the most relevant variables of the model.ConclusionsWe validated a ML model to detect AKI occurring after 48 h in a retrospective observational study that could help clinicians in individuating patients at risk of AKI, in which a preventive strategy can be determinant to improve the occurrence of renal dysfunction.

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.

Acute kidney injury in children: incidence, awareness and outcome—a retrospective cohort study

The primary objective was to determine the epidemiologic influence of AKI awareness among physicians in a mixt paediatric population, including neonates. This single-centre, multiyear, observational retrospective study included all admitted patients between first of July 2014 and 31 December 2021. AKI was identified in 2194 patients out of the 128,036 hospital admissions with 129,936 serum creatinine measurements. Matching comparisons were used between AKI aware and AKI non-aware patients. The overall incidence of AKI was 1.65%. Stage 1 was identified in 24.24% of the AKI cases, stage 2 in 31.03% and stage 3 in 44.71%. The most prevalent cause of AKI was represented by prerenal AKI in 85.64% of the cases, followed by 12.16% renal causes respectively 2.18% postrenal causes. Exposure to sepsis, critical illness, hypovolemic shock and mechanical ventilation increased mortality by 2.09, 4.69, 4.64- and 4.93-times (p = 0.001). Cancer and heart failure increased mortality by 4.22 (p < 0.001) respectively 2.17 times (p = 0.001). The presence of AKI increased mortality by 79.11 times while only half of the AKI associated deaths were recognized by physicians. AKI increased hospitalization more than 4 times the average stay. AKI awareness was dependent of lower age and severity. Also, awareness increased mortality and prolonged hospitalization. 1 in 3 neonates and 1 in 4 children were AKI aware. The physician’s awareness of AKI diagnosis is in general low due to lack of appliance of current guidelines in exploring exposures and susceptibilities for AKI screening.

Use of furosemide in preterm neonates with acute kidney injury is associated with increased mortality: results from the TINKER registry.

Diuretics are commonly used in neonatal AKI with the rationale to decrease positive fluid balance in critically sick neonates. The patterns of furosemide use vary among hospitals, which necessitates the need for a well-designed study. The TINKER (The Indian Iconic Neonatal Kidney Educational Registry) study provides a database, spanning 14 centres across India since August 2018. Admitted neonates (≤ 28days) receiving intravenous fluids for at least 48h were included. Neonatal KDIGO criteria were used for the AKI diagnosis. Detailed clinical and laboratory parameters were collected, including the indications of furosemide use, detailed dosing, and the duration of furosemide use (in days). A total of 600 neonates with AKI were included. Furosemide was used in 8.8% of the neonates (53/600). Common indications of furosemide use were significant cardiac disease, fluid overload, oliguria, BPD, RDS, hypertension, and hyperkalemia. The odds of mortality was higher in neonates < 37 weeks gestational agewith AKIwho received furosemide compared to those who did not receive furosemide 3.78 [(1.60-8.94); p = 0.003; univariate analysis] and [3.30 (1.11-9.82); p = 0.03]; multivariate logistic regression]. In preterm neonates with AKI, mortality was independently associated with furosemide treatment. The furosemide usage rates were higher in neonates with associated co-morbidities, i.e. significant cardiac diseases or surgical interventions. Sicker babies needed more resuscitation at birth, and died early, and hence needed shorter furosemide courses. Thus, survival probability was higher in neonates treated with long furosemide courses vs. short courses.

Design, validation and implementation of an automated e-alert for acute kidney injury: 6-month pilot study shows increased awareness

BackgroundAcute kidney injury (AKI) is defined as a sudden episode of kidney failure but is known to be under-recognized by healthcare professionals. The Kidney Disease Improving Global Outcome (KDIGO) guidelines have formulated criteria to facilitate AKI diagnosis by comparing changes in plasma creatinine measurements (PCr). To improve AKI awareness, we implemented these criteria as an electronic alert (e-alert), in our electronic health record (EHR) system.MethodsFor every new PCr measurement measured in the University Medical Center Utrecht that triggered the e-alert, we provided the physician with actionable insights in the form of a memo, to improve or stabilize kidney function. Since e-alerts qualify for software as a medical device (SaMD), we designed, implemented and validated the e-alert according to the European Union In Vitro Diagnostic Regulation (IVDR).ResultsWe evaluated the impact of the e-alert using pilot data six months before and after implementation. 2,053 e-alerts of 866 patients were triggered in the before implementation, and 1,970 e-alerts of 853 patients were triggered after implementation. We found improvements in AKI awareness as measured by (1) 2 days PCr follow up (56.6–65.8%, p-value: 0.003), and (2) stop of nephrotoxic medication within 7 days of the e-alert (59.2–63.2%, p-value: 0.002).ConclusionHere, we describe the design and implementation of the e-alert in line with the IVDR, leveraging a multi-disciplinary team consisting of physicians, clinical chemists, data managers and data scientists, and share our firsts results that indicate an improved awareness among treating physicians.

Reduction in NGAL at 48h predicts the progression to CKD in patients with septic associated AKI: a single-center clinical study.

In this study, our objective was to investigate the predictive value of serum and urine fluctuations of neutrophil gelatinase-associated lipid transporters (NGAL) in relation to the progression of chronic kidney disease (CKD) among patients with septic associated AKI (SA-AKI). A total of 425 SA-AKI patients were enrolled in this study and divided into the recovery group (n = 320) and the AKI-to-CKD group (n = 105) based on 3-month follow-up data. The serum and urine NGAL levels on the day of AKI diagnosis (T0) and 48h after anti-AKI treatment (T1) were recorded and calculated. The levels of NGAL in serum and urine were found to be higher in the AKI-to-CKD group compared to the recovery group at T1 point (P < 0.05). The reductions of NGAL at 48h in serum and urine were lower in the AKI-to-CKD group than those observed in the recovery group (P < 0.05). In comparison to T0, a significant decrease was noted for both serum and urine NGAL levels on T1 among patients who recovered from AKI (P < 0.05), whereas no such trend was observed among those with AKI-to-CKD transition (P > 0.05). After adjusting age, sex, and BMI through partial correlation analysis, the reduction of serum NGAL was found to be most strongly associated with the transition from AKI to CKD. ROC analysis showed an AUC of 0.832 for serum NGAL reduction, with a cut-off value of -111.24ng/ml and sensitivity and rates of 76.2% and 81.2%, respectively. Logistic regression analysis indicated that a reduction of serum NGAL ≥ -111.24ng/ml was the early warning indicator for the progression of CKD in SA-AKI patients. The reduction of serum NGAL following 48h of anti-AKI therapy represents a distinct hazard factor for the advancement of CKD in patients with SA-AKI, independent of other variables.

#6104 CLINICAL IMPACT OF UNDIAGNOSED HOSPITAL ACUTE KIDNEY INJURY

Abstract Background and Aims Hospital Acute kidney injury (H-AKI) is associated with an increased risk of complications and mortality. Despite attempts to uniform the diagnosis of AKI and point attention to this condition, in clinical practice, the recognition of AKI is often limited. In this study, we tried to evaluate the impact of underdiagnosed AKI in hospitalized patients. Method We collected data of patients hospitalized at IRCSS Policlinico San Martino, Genoa, Italy, between 1/1/2106 and 31/12/2019. We considered clinical data, serum creatinine (sCr), length of hospital stay, death, comorbidities, and primary diagnoses as codified in the hospital discharge form-HDF. Patients with CKD stage 4-5 were excluded. In the selected patients, we defined and graded AKI according to the KDIGO criteria, by comparing the peak sCr to the lowest sCr during hospitalization under the assumption that the lowest sCr would represent baseline kidney function. Then, we divided this cohort into 3 groups: 1) patients with no AKI at all, 2) AKI calculated by sCR changes and formally codified in HDF (diagnosed AKI), 3) AKI calculated by sCR changes but not codified in HDF (i.e., undiagnosed AKI). Finally, we compared the clinical characteristics and outcomes of these groups. Results We included 56,820 pts. The incidence of AKI was 24.5% (n = 13,920), evaluating the distribution among the 3 groups, we noticed that a small percentage of AKI was reported in HDF (Fig. 1). Only in 27% of cases in medical wards, 13% in surgical wards, and 19% in Intensive care Units AKI was formally reported in HDF, while in the emergency department, AKI was diagnosed in 78% of cases. Compared with No AKI patients, those with AKI (both diagnosed and undiagnosed) had a higher prevalence of comorbidities (diabetes mellitus, heart failure, atrial fibrillation) and incidence of myocardial ischemia and sepsis (Table 1). Moreover, patients with AKI had a significantly longer hospitalization and major mortality risk, at cox regression (HR 2.6, IC 2.4-2.8, p0.000) and Kaplan Meier (Fig. 2). The mortality risk augmented in all patients with AKI analyzed by both logistic regression univariate (OR 7.1, IC 6.7-7.6, p&amp;lt;0.001) and multivariate analysis corrected by age, gender, and comorbidities (OR 4,5, IC 4,2-4,9, p&amp;lt;0.001). Interestingly, these findings were confirmed also considering only the group of patients with undiagnosed AKI (univariate: OR 5.9, IC 4.2-4.9, p&amp;lt;0.001; multivariate: OR 4.6, IC 4.2-4.9, p&amp;lt;0.001). Conclusion Undiagnosed AKI is still very common in hospitalized patients, even if it identifies a category of patients with a high risk of complications and mortality. Proper recognition of H-AKI remains a problem to face.

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? CON.

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? CON.

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? PRO.

Do Novel Biomarkers Have Utility in the Diagnosis and Prognosis of AKI? PRO.

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.

Analysis of urinary C–C motif chemokine ligand 14 (CCL14) and first-generation urinary biomarkers for predicting renal recovery from acute kidney injury: a prospective exploratory study

BackgroundAcute kidney injury (AKI) is a frequent syndrome in the intensive care unit (ICU). AKI patients with kidney function recovery have better short-term and long-term prognoses compared with those with non-recovery. Numerous studies focus on biomarkers to distinguish them. To better understand the predictive performance of urinary biomarkers of renal recovery in patients with AKI, we evaluated C–C motif chemokine ligand 14 (CCL14) and two first-generation biomarkers (cell cycle arrest biomarkers and neutrophil gelatinase-associated lipocalin) in two ICU settings.MethodsWe performed a prospective study to analyze urinary biomarkers for predicting renal recovery from AKI. Patients who developed AKI after ICU admission were enrolled and urinary biomarkers including tissue inhibitor of metalloproteinase-2 (TIMP-2), insulin-like growth factor-binding protein 7 (IGFBP7), CCL14, and neutrophil gelatinase-associated lipocalin (NGAL) were detected on the day of AKI diagnosis. The primary endpoint was non-recovery from AKI within 7 days. The individual discriminative ability of CCL14, [TIMP-2] × [IGFBP7] and NGAL to predict renal non-recovery were evaluated by the area under receiver operating characteristics curve (AUC).ResultsOf 164 AKI patients, 64 (39.0%) failed to recover from AKI onset. CCL14 showed a fair prediction ability for renal non-recovery with an AUC of 0.71 (95% CI 0.63–0.77, p < 0.001). [TIMP-2] × [IGFBP7] showed the best prediction for renal non-recovery with an AUC of 0.78 (95% CI 0.71–0.84, p < 0.001). However, NGAL had no use in predicting non-recovery with an AUC of 0.53 (95% CI 0.45–0.60, p = 0.562). A two-parameter model (non-renal SOFA score and AKI stage) predicted renal non-recovery with an AUC of 0.77 (95% CI 0.77–0.83, p = 0.004). When [TIMP-2] × [IGFBP7] was combined with the clinical factors, the AUC was significantly improved to 0.82 (95% CI 0.74–0.87, p = 0.049).ConclusionsUrinary CCL14 and [TIMP-2] × [IGFBP7] were fair predictors of renal non-recovery from AKI. Combing urinary [TIMP-2] × [IGFBP7] with a clinical model consisting of non-renal SOFA score and AKI stage enhanced the predictive power for renal non-recovery. Urinary CCL14 showed no significant advantage in predicting renal non-recovery compared to [TIMP-2] × [IGFBP7].

Global Perspectives in Acute Kidney Injury: Spain.

Global Perspectives in Acute Kidney Injury: Spain.

Effect of fluid overload on survival in patients with sepsis-induced acute kidney injury receiving continuous renal replacement therapy

The association between fluid overload and survival has not been well elucidated in critically ill patients with sepsis-induced acute kidney injury (SIAKI) receiving continuous renal replacement therapy (CRRT). We investigated the optimal cutoff value of fluid overload for predicting mortality and whether minimizing fluid overload through CRRT is associated with a survival benefit in these patients. We examined 543 patients with SIAKI who received CRRT in our intensive care unit. The degree of cumulative fluid overload in relation to body weight was expressed as the percentage fluid overload (%FO). %FO was further subdivided into %FO from AKI diagnosis to CRRT initiation (%FOpreCRRT) and total fluid overload (%FOtotal). The best cutoff value of fluid overload for predicting the 28-day mortality was %FOpreCRRT > 4.6% and %FOtotal > 9.6%. Multivariable analysis demonstrated that patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% were 1.9 times and 3.37 times more likely to die than those with %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6%. The 28-day mortality was the highest in patients with %FOpreCRRT > 4.6% and %FOtotal > 9.6% (84.7%), followed by those with %FOpreCRRT ≤ 4.6% and %FOtotal > 9.6% (65.0%), %FOpreCRRT > 4.6% and %FOtotal ≤ 9.6% (43.6%), and %FOpreCRRT ≤ 4.6% and %FOtotal ≤ 9.6% (22%). This study demonstrated that fluid overload was independently associated with the 28-day mortality in critically ill patients with SIAKI. Future prospective studies are needed to determine whether minimizing fluid overload using CRRT improves the survival of these patients.

ILEOSTOMY AND RISK OF ACUTE KIDNEY INJURY IN PATIENTS WITH CROHN'S DISEASE

Abstract BACKGROUND Chron's disease is an inflammatory disorder that can involve any part of GI tract but most commonly involves the small intestine. Many of the patients with Cohn’s disease end up requiring surgery, and the 10-year risk of requiring surgery is estimated to be around 50%. The most common type of surgery in patients with Crohn’s disease is ileocecal resection. More than 40,000 ileostomies are formed annually in the United States. Up to 15% of patients who receive ileostomy experience a de novo or community-onset AKI within 90 days. Oral rehydration with iso-osmolar fluids is the mainstay of outpatient management. Both hypotonic fluids, and hypertonic fluids can cause a net flow of fluid into the bowel lumen increasing the ostomy output. We aimed to study the risk of AKI within 30 days in CD patients after an ileostomy procedure. METHODS We collected data from the Healthcare Cost and Utilization Project- (HCUP) Nationwide Readmission Database- 2016- 2018. CD patients were identified and those who received an ileostomy procedure were identified using ICD-10 and PCS-10 codes respectively. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and the Chi-Square test for Categorical variables. RESULTS We identified 214,622 index hospitalizations with CD, 3,789 of whom received an ileostomy procedure. Of those who received ileostomy, 2.1% were readmitted within 30 days for a primary diagnosis of AKI while 2.9% had 30-day readmission with a secondary diagnosis of AKI. CD patients admitted for AKI after ileostomy had a median length of stay of 14 days (IQR: 8-24). CD patients who received ileostomy had a higher rate of 30-day admission for AKI (2.1% vs. 0.3%, P &amp;lt;0.001) and a higher rate of 30-day readmission with a secondary diagnosis of AKI (2.9% vs. 1.5%, P &amp;lt;0.001) compared to CD patients who didn’t receive ileostomy during the index hospitalization. CD patients who received an ileostomy procedure and were readmitted for AKI within 30 days had an average cost of hospitalization of $140,544 (IQR: $85,072 - $242,059). CD patients admitted for AKI within 30 days after an ileostomy were older (59, IQR: 48-69 vs. 47, IQR: 33-61, P &amp;lt;0.001) compared to those who didn’t have a 30day readmission for AKI respectively. CONCLUSION In a nationwide cohort of patients hospitalized with Crohn’s disease, patients who received ileostomy had a significant risk of AKI within 30-days. The development of AKI was associated with significant morbidity, hospital readmission, and elevated costs of hospitalization. Further studies are needed to investigate novel measures to decrease the risk of AKI in this patient population.

Acute Kidney Injury After Paediatric Cardiac Surgery with Extracorporeal Circulation: Incidence and Risk Factors? Prospective Observational Study in A Cardiac Centre In A Developing Country

Introduction: Acute kidney injury is a clinico-biological syndrome that ranges in severity from Kidney attack to failure. The aim of this study was to determine the incidence and risk factors of AKI after paediatric cardiac surgery with extracorporeal circulation. Methods: Prospective observational study, conducted over a period of 4 months at the cardiac centre of the CHU of Fann. The diagnosis of AKI was based on the modified RIFLE criteria for paediatrics. Results: Our work involved 40 patients with a male predominance (sex ratio 1.8) and an average age of 7.2 years. We noted 02 types of surgery: congenital surgery (80%), valvular surgery (20%). All patients underwent scheduled surgery with a mean preoperative GFR of 130.2 ml/Kg/1.73 m2. The mean duration of extracorporeal circulation was 107.7 min. Postoperatively, 82.5% were placed on sympathomimetics, 12.5% had severe left ventricular systolic dysfunction, 27.5% had severe right ventricular systolic dysfunction and one quarter of the patients received a postoperative transfusion. The incidence of AKI was 30% with: 20% at risk, 7.5% with damage and only one patient in failure. Right ventricular systolic dysfunction and postoperative transfusion were the main risk factors. Mortality in our series was 10% and the dependence on AKI was significant (p=0.038). Conclusion: The epidemiology of AKI after paediatric cardiac surgery depends on the definition used. The incidence is highly variable and depends on the epidemiological, intraoperative and postoperative characteristics of the patients.

Valacyclovir-associated acute kidney injury and encephalopathy in an elderly woman with normal kidney function: a case report

A 72-year-old Japanese woman was treated by 3000 mg/day of valacyclovir for the herpes zoster in her left back. She had been treated as hypertension with no renal insufficiency. In two days, she visited an emergency room of a regional stroke care center with dysarthria, dexterity disorder and gait disturbance. Neither head CT nor MRI found intracranial lesions, then, laboratory tests revealed that her serum creatinine level was 4.63 mg/dL. She was transferred and admitted to our hospital on the following day and received hemodialysis under the diagnosis of AKI due to acyclovir accompanied with encephalopathy. Afterward, her serum concentration of acyclovir revealed as 44 μg/mL, which is extremely high. Her neurological symptom disappeared in parallel with the decrease of serum concentration of acyclovir. She received 3 sessions of hemodialysis and discharged on the 8th day of admission with almost normal renal function and no neurological sequela.

THE EFFECTS OF EARLY-PHASE FUROSEMIDE USE ON THE PROGRESSION OF OLIGURIC ACUTE KIDNEY INJURY ACROSS DIFFERENT CENTRAL VENOUS PRESSURE: A RETROSPECTIVE ANALYSIS.

Background: Furosemide is a commonly used loop diuretic in critical care. However, its effect on the progression of oliguric acute kidney injury across different central venous pressure (CVP) remains unknown. This study therefore aims to investigate the association between furosemide 6-12h (defined as the use of furosemide within 6 h after the diagnosis of AKI according to the urine output [UO] criteria set by the Kidney Disease: Improving Global Outcomes [KDIGO] guidelines) and the progression of AKI across different CVP 6-12h (defined as CVP within 6 h after the diagnosis of AKI by the KDIGO UO criteria) levels. Methods: Patients involved in this study were identified from the Medical Information Mart for Intensive Care IV database with the following criteria: (i) adults with UO <0.5 mL/kg per hour for the first 6 h upon admission to the intensive care unit (ICU) (meeting stage 1 AKI by UO) and (ii) CVP 6-12h ranging from 0 to 30 mm Hg. From there on, the target primary outcome would be progression to stage 3 AKI by UO among these chosen patients. The secondary outcome was 28-d mortality since ICU admission. The risks of severe-stage AKI progression and 28-d mortality were respectively examined against furosemide 6-12h (vs. without furosemide 6-12h ) within the full cohort and across different subgroups of CVP 6-12h , using multivariate adjusted logistic regression and inverse probability treatment weighting (IPTW). Sensitivity analyses were performed to assess the robustness of our findings. Results: One thousand one hundred eighty patients were ultimately selected for this study, of whom 643 (54.5%) progressed to stage 3 AKI from stage 1 based on the UO criteria by KDIGO. Multivariate analysis showed that furosemide 6-12h is significantly associated with this severe-stage progression within the full cohort (odds ratio [OR] was 0.62 at 95% confidence interval [CI] of 0.43-0.90, P = 0.011). After dividing the patients into CVP 6-12h subgroups according to their CVP during the early phases, lower risk of AKI progression was observed only in furosemide 6-12h application at CVP 6-12h of ≥12 mm Hg (adjusted OR was 0.40 at 95% CI of 0.25-0.65, P < 0.001), as confirmed by the IPTW analysis (OR was 0.47 at 95% CI of 0.29-0.76, P = 0.002). The robustness of these findings was confirmed by sensitivity analyses. In addition, for patients with CVP 6-12h ≥12 mm Hg, furosemide 6-12h is also significantly associated with lower risk of 28-d mortality (adjusted OR was 0.47 at 95% CI of 0.25-0.92, P = 0.026) in the multivariate logistic regression analysis, and there was a similar trend in the IPTW analysis (adjusted OR was 0.55 at 95% CI of 0.28-1.10, P = 0.092). Conclusions: Among the identified early-stage AKI patients in critical care, the use of furosemide was associated only with lower risk of oliguric AKI progression and 28-d mortality within the high CVP group. These findings suggest the potential of CVP as a guidance or reference point in the usage of furosemide among early-stage oliguric AKI patients in the ICU.

Prognostic value of serum levels of multiple adhesion factors in patients with sepsis-induced acute kidney injury

BackgroundAcute kidney injury (AKI) is common in patients with sepsis and septic shock. Urine output and serum creatinine (SCr) levels are the criteria for diagnosing AKI. However, the application of these levels in the diagnosis of AKI has limitations.ObjectiveTo detect the expression of various adhesion factors in different stages of AKI as defined by Kidney Disease: Improving Global Outcomes (KDIGO) and to analyse their relationship with the prognosis of patients with sepsis-induced AKI (S-AKI).MethodsAdult patients with sepsis who were admitted to the hospital between June 2019 and May 2020 were included. Of 90 adult patients with sepsis, 58 had S-AKI. Sixty-seven subjects without sepsis were used as controls. Enzyme-linked immunosorbent assay kits were used to measure E-selectin (CD62E), L-selectin (CD62L), P-selectin, intercellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), and their relationship with the prognosis of patients with S-AKI patients was analysed. Receiver operating characteristic curves were used to analyse the predictive value of different adhesion factors on renal resistance index and renal function recovery. Multivariate logistic regression analysis was used to identify factors associated with renal recovery.ResultsThe expression of CD62L was significantly higher in S-AKI patients than in non-AKI patients with sepsis. Compared with the non-AKI group, Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores were significantly higher in the AKI group than in the non-AKI group (P < 0.05). Mean blood pressure, SCr levels and procalcitonin levels were higher in the AKI group than in the non-AKI group (P < 0.05 for all). The CD62L levels decreased with increasing S-AKI stage. The CD62E levels were highest in S-AKI stage 2, and the VCAM-1 levels were highest in S-AKI stage 3. All patients with S-AKI were followed up with for 28 days. The results found that VCAM-1 was the best predictor of renal recovery in patients with S-AKI.ConclusionCD62L is an indicator of S-AKI stage1, and CD62E is an indicator of S-AKI stage 2. In addition, VCAM-I demonstrated satisfactory performance in predicting early recovery of renal function in patients with S-AKI.

Biomarkers for Early Diagnosis of AKI: Could It Backfire?

This is an Early Access article. Please select the PDF button, above, to view it.