Epidemiology Of Acute Kidney Injury Research Articles

Trends of Acute Kidney Injury Requiring Dialysis Among Hospitalized Patients Undergoing Invasive Electrophysiology Procedures.

Electrophysiology (EP) procedures carry the risk of kidney injury due to contrast/hemodynamic fluctuations. We aim to evaluate the national epidemiology of acute kidney injury requiring dialysis (AKI-D) in patients undergoing EP procedures. Using the National Inpatient Sample, we included 2,747,605 adult hospitalizations undergoing invasive diagnostic EP procedures, ablation and implantable device placement from 2006 to 2014. We examined the temporal trend of AKI-D and outcomes associated with AKI-D. The rate of AKI-D increased significantly in both diagnostic/ablation group (8-21/10,000 hospitalizations from 2006 to 2014, P = 0.02) and implanted device group (19-44/10,000 hospitalizations from 2006 to 2014, P < 0.01), but it was explained by temporal changes in demographics and comorbidities. Cardiac resynchronization therapy and pacemaker placement had higher risk of AKI-D compared to implantable cardioverter-defibrillator placement (23 vs. 31 vs. 14/10,000 hospitalizations in cardiac resynchronization therapy, pacemaker placement, and implantable cardioverter-defibrillator group, respectively). Development of AKI-D was associated with significant increase in in-hospital mortality (adjusted odds ratio, 9.6 in diagnostic/ablation group, P < 0.01; adjusted odds ratio, 5.1 in device implantation group, P < 0.01) and with longer length of stay (22.5 vs. 4.5 days in diagnostic/ablation group, 21.1 vs. 5.7 days in implanted device group) and higher cost (282,775 vs. 94,076 USD in diagnostic/ablation group, 295,660 vs. 102,007 USD in implanted device group). The incidence of AKI-D after EP procedures increased over time but largely explained by the change of demographics and comorbidities. This increasing trend, however, was associated with significant increase in resource utilization and in-hospital mortality in these patients.

P0595CHANGING EPIDEMIOLOGY AND OUTCOME OF AKI PATIENTS IN TEACHING HOSPITAL FROM A DEVELOPING COUNTRY: A POPULATION-BASED COHORT STUDY

Abstract Background and Aims While considerable information is available on acute kidney injury (AKI) in North America and Europe, large comprehensive epidemiologic studies of AKI from Latin America and Asia are still lacking. The present study aimed to evaluate the epidemiology and outcome of AKI in patients evaluated by nephrologists in a teaching Brazilian hospital. Method We performed a large retrospective observational study that looked into epidemiology for AKI and its effect on patient outcome across time periods. For comparison purposes, patients were divided into two groups according to the year of follow up: 2011-2014 and 2015-2018. Results We enrolled 7,976 AKI patients and after excluding patients with Chronic Kidney Disease stages 3 to 5, kidney transplanted and those with incomplete data, 5,428 AKI patients were included (68%). The maximum AKI stage was 3 (50.6%) and mortality rate occurred in 1865 patients (34.3%). Dialysis treatment was indicated in 928 patients (17.1%). Patient survival improved along study periods: patients treated at 2015-2018 had a relative risk death reduction of 0.89 (95% CI 0.81–0.98, p=0.02). The independent risk factors for mortality were sepsis, older &amp;gt;65 anos, admission to ICU, AKI-KDIGO 3, recurrent AKI, no metabolic and fluid demand to capacity imbalance as dialysis indication and the period of treatment. Conclusion We observed an improvement in AKI patient survival along the years even after correction for several confounders and using a competing risk approach. Identification of risk factors for mortality can help in decision making for timely intervention, leading to better clinical outcomes.

Acute kidney injury in critically ill cancer patients is associated with mortality: A retrospective analysis.

In critically ill patients, acute kidney injury (AKI) is common and associated with short- and long-term complications. Our objectives were to describe the epidemiology and impact of AKI in cancer patients admitted to the Intensive Care Unit (ICU). We identified all patients with a haematological malignancy (HM) or solid tumour (ST) who had an emergency admission to the ICU in a tertiary care centre between January 2004 and July 2012. AKI was defined according to the KDIGO criteria. 429 patients were included of whom 259 (60%) had AKI. Among HM patients, 73 (78%) had AKI (70% AKI on admission to ICU; 7% during ICU stay); among ST patients, 186 (56%) had AKI (45% on admission to ICU, 11% during ICU stay). ICU and 28-day mortality rates were 33% and 48%, respectively in HM patients, and 22% and 31%, respectively in ST patients. Multivariable analysis showed that AKI was an independent risk factor for both ICU and 28-day mortality. New AKI after 24 hours in ICU was associated with higher mortality than AKI on admission. AKI is common in critically ill cancer patients and independently associated with ICU and 28-day mortality.

The incidence, risk factors and outcomes of chemotherapy related acute kidney injury in China.

e24161 Background: Nephrotoxicity of chemotherapeutic agents remains a significant complication limiting the efficacy of the treatment. However, comprehensive data on the epidemiology and outcomes of chemotherapy related acute kidney Injury in China is lacking. Methods: We conducted a nationwide cohort study of hospitalized patients from 25 general and children’s hospitals in China during 2013-2015. Patient-level data were obtained from the electronic hospitalization information system, prescription database and laboratory databases of all cancer patients who received chemotherapy and had at least two serum creatinine tests within any 7-day window during the hospitalization. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria. The incidence of AKI in patients with various type of cancer and chemotherapeutic agents was examined. The outcomes of AKI, including in-hospital mortality, death after discharge, kidney recovery, and length of stay, were also assessed. Results: A total of 23,232 cancer patients, including 3,120 children ( &lt; 18 years old), 16,310 adult (19-65 years old) and 3,802 elderly patients ( &gt; 65 years old), were analyzed. Platinum compounds and pyrimidine analogues were the most common used chemotherapy agents for cancer patients. The overall incidence of AKI was 4.9%. Patients with urinary system malignancy (12.3%), hematological malignancy (10.2%) and nerve motor system malignancy (4.1%) have the highest incidence of HA-AKI. The top three types of chemotherapy drugs with the highest incidence of AKI were Purine analogues (30.1%), folic acid analogues (15.3%) and combinations of antineoplastic agents (14.1%). The nephrotoxicity of chemotherapy drugs was different among age groups. AKI is associated with a higher risk of in-hospital mortality and death after discharge. Conclusions: The risk of AKI in cancer patients varied in different age group, type of cancer and chemotherapeutic agents.

Changing epidemiology and outcomes of acute kidney injury in hospitalized patients with cirrhosis – a US population-based study

Acute kidney injury (AKI) is a significant clinical event in cirrhosis yet contemporary population-based studies on the impact of AKI on hospitalized cirrhotics are lacking. We aimed to characterize longitudinal trends in incidence, healthcare burden and outcomes of hospitalized cirrhotics with and without AKI using a nationally representative dataset. Using the 2004-2016 National Inpatient Sample (NIS), admissions for cirrhosis with and without AKI were identified using ICD-9 and ICD-10 codes. Regression analysis was used to analyze the trends in hospitalizations, costs, length of stay and inpatient mortality. Descriptive statistics, simple and multivariable logistic regression were used to assess associations between individual characteristics, comorbidities, and cirrhosis complications with AKI and death. In over 3.6 million admissions for cirrhosis, 22% had AKI. AKI admissions were more costly (median $13,127 [IQR $7,367-$24,891] vs. $8,079 [IQR $4,956-$13,693]) and longer (median 6 [IQR 3-11] days vs. 4 [IQR 2-7] days). Over time, AKI prevalence doubled from 15% in 2004 to 30% in 2016. CKD was independently and strongly associated with AKI (adjusted odds ratio 3.75; 95% CI 3.72-3.77). Importantly, AKI admissions were 3.75 times more likely to result in death (adjusted odds ratio 3.75; 95% CI 3.71-3.79) and presence of AKI increased risk of mortality in key subgroups of cirrhosis, such as those with infections and portal hypertension-related complications. The prevalence of AKI is significantly increased among hospitalized cirrhotics. AKI substantially increases the healthcare burden associated with cirrhosis. Despite advances in cirrhosis care, a significant gap remains in outcomes between cirrhotics with and without AKI, suggesting that AKI continues to represent a major clinical challenge. Sudden damage to the kidneys is becoming more common in people who are hospitalized and have cirrhosis. Despite advances in cirrhosis care, those with damage to the kidneys remain at higher risk of dying.

Acute kidney injury in hospitalized patients with nonexacerbated chronic obstructive pulmonary disease

BackgroundThe epidemiology of acute kidney injury (AKI) in nonexacerbated chronic obstructive pulmonary disease (NECOPD) patients is unknown. This study investigated the factors associated with AKI and the association between AKI and in-hospital mortality in the hospitalized NECOPD population.MethodsThe electronic medical records of 2897 patients hospitalized with NECOPD were analyzed retrospectively. Demographic information, medicine used before AKI, diagnosis records and laboratory data were collected. AKI was classified as community-acquired (CA-) or hospital-acquired (HA-) AKI according to the serum creatinine criteria. Risk factors for HA-AKI and in-hospital mortality were analyzed by logistic regression analyses. To avoid an interaction between cor pulmonale and AKI, the association between AKI and in-hospital morality was further analyzed with cor pulmonale stratification.ResultsThe incidence rates of CA- and HA-AKI were 7.1 and 12.0%, respectively. Increased age, female sex, cor pulmonale comorbidity, chronic kidney disease stage, diuretic and glycopeptide use before AKI and iodine-containing contrast medium exposure were independently associated with HA-AKI. A total of 5.7% of the patients died. After adjustment for age, sex, cor pulmonale, chronic kidney disease, Charlson comorbidity index score (without renal disease) and hemoglobin level, HA-AKI was an independent risk factor for in-hospital mortality [OR 13.909 (95% CI 8.699–22.238) in non-cor pulmonale subgroup; OR 26.604 (95% CI 12.166–58.176) in cor pulmonale subgroup], whereas CA-AKI was not.ConclusionsAKI is common in the NECOPD population. Diuretics and contrast media are associated with HA-AKI in this population. The patients with HA-AKI have a higher mortality risk than the patients without AKI.

Acute Kidney Injury

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies. This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references. Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis

Acute Kidney Injury

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies. This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references. Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis

Acute Kidney Injury

Acute renal failure definitions have changed dramatically over the last 5 to 10 years as a result of criteria established through the following consensus statements/organizations: RIFLE (Risk, Injury, Failure, Loss of function, End stage renal disease), AKIN (Acute Kidney Injury Network), and KDIGO (Kidney Disease: Improving Global Outcomes). In 2002, the Acute Dialysis Quality Initiative was tasked with the goal of establishing a consensus statement for acute kidney injury (AKI). The first order of business was to provide a standard definition of AKI. Up to this point, literature comparison was challenging as studies lacked uniformity in renal injury definitions. Implementing results into evidence-based clinical practice was difficult. The panel coined the term “acute kidney injury,” encompassing previous terms, such as renal failure and acute tubular necrosis. This new terminology represented a broad range of renal insults, from dehydration to those requiring renal replacement therapy (RRT). This review provides an algorithmic approach to the epidemiology, pathophysiology, diagnosis, prevention, and management of AKI. Also discussed are special circumstances, including rhabdomyolysis, contrast-induced nephropathy, and hepatorenal syndrome. Tables outline the AKIN criteria, most current KDIGO consensus guidelines for definition of AKI, differential diagnosis of AKI, agents capable of causing AKI, treatment for specific complications associated with AKI, and options for continuous RRT. Figures show the RIFLE classification scheme and KDIGO staging with prevention strategies. This review contains 1 management algorithm, 2 figures, 6 tables, and 85 references. Keywords: Kidney, renal, KDIGO, azotemia, critical, urine, oliguria, creatinine, dialysis

Incidence and epidemiology of acute kidney injury in a pediatric Malawian trauma cohort: a prospective observational study

BackgroundAcute kidney injury (AKI) is highly associated with mortality risk in children worldwide. Trauma can lead to AKI and is a leading cause of pediatric death in Africa. However, there is no information regarding the epidemiology of pediatric, trauma-associated AKI in Africa.MethodsProspective cohort study of pediatric trauma patients admitted to a tertiary referral hospital in Malawi. Participants enrolled at admission were followed prospectively throughout their hospitalization. AKI was defined by creatinine-only Kidney Disease Improving Global Outcomes criteria. We calculated descriptive statistics and univariate relative risks (RR) for hypothesis-generation of potential risk factors associated with AKI.ResultsWe analyzed data from 114 participants. Depending on baseline creatinine definition, AKI incidence ranged from 4 to 10%. The new Schwartz equation estimated baseline creatinine values best and yielded an AKI incidence of 9.7%. Almost one in ten children died during hospitalization, but those with AKI (n = 4) were at significantly higher risk of death compared to those without AKI (40.0% vs 6.2%; RR 6.5, 95% CI 2.2–19.1). Burn injuries were most commonly associated with AKI (63.6%). Other potential AKI risk factors included multiple injuries, trunk or facial injuries, and recent consumption of herbal remedies.ConclusionsAKI occurs in up to 10% of admitted pediatric trauma patients in Malawi and increases the risk of death 7-fold compared to those without AKI. This large unrecognized burden in trauma requires further investment by researchers, clinicians and policymakers to develop evidenced-based triage, recognition, and management approaches to prevent the associated sequelae and potential mortality from AKI.

Does Your Program Know Its AKI and CRRT Epidemiology? The Case for a Dashboard.

Current acute kidney injury (AKI) literature focuses on diagnosis, treatment, and outcomes. While little literature exists studying the quality of care delivered to patients with AKI. However, improving outcomes for patients is dependent on the specifics of the delivered care (i.e., the who, what, when, and how). Therefore, it is necessary to direct attention to process measures to assess the relationship between care and outcomes. The application of quality improvement science to the care of AKI, uses a series of metrics encompassing both processes and outcomes to better understand, evaluate, and ensure the delivery high quality care.

SUN-007 CAUSES AND OUTCOMES OF ACUTE KIDNEY INJURY IN CHILDREN REPORTING TO THE CHILD HEALTH DEPARTMENT, KBTH, ACCRA, GHANA

Acute kidney injury (AKI) has increasing prevalence in both well-resourced and emerging countries. It is associated with severe morbidity and mortality especially in children. The development of acute kidney injury is an independent risk factor for death in children. AKI is now known to have potential long-term implications for the development of chronic kidney disease in those who survive AKI. The epidemiology of AKI has evolved over the years and reflects the patient population under study. In emerging countries the most common causes of AKI continue to be volume depletion, infections and primary renal disease. In high well resourced countries, volume depletion and primary renal disease are common causes in previously healthy children but in hospitalised children particularly in tertiary centres, there has been a shift in aetiology of AKI from primary to secondary causes that are often multifactorial, a complication of another disease or its treatment. AKI requiring renal replacement therapy may occur in 5-6% of ICU patients. We set out to determine the causes and outcomes of children reporting to our emergency room with AKI. A retrospective review of all the admissions to the emergency unit of the paediatric department of the Korle Bu Teaching Hospital (KBTH), Accra Ghana, was carried out. All cases diagnosed with AKI using the pRIFLE criteria and the various causes were recorded. Further data obtained included the gender, age distribution, number that required peritoneal dialysis (PD), duration on PD and the outcomes of AKI. Out of the total of 9123 admissions to the emergency room, 38 had AKI from various causes forming 4.1 per 1000 admissions. The leading cause of AKI intravascular haemolysis secondary to varied causes, constituting 18 of the 38 cases (47.3%). Eleven of these children had severe malaria, making malaria the single most common cause of AKI. Other causes of intravascular haemolysis were herbal medication, G6PD deficiency, septicaemia and snake envenomation. Thirteen representing 34.2% had peritoneal dialysis with the following outcomes: 8(61%) recovered renal function, 1(7.6%) progressed to chronic kidney disease and 4(30%) mortalities occurred. The modal duration on peritoneal dialysis was 7-14 days. Gastroenteritis with severe dehydration which is the leading cause in some developing countries was the second leading cause of AKI. Other causes included acute glomerulonephritis and septic shock. Acute kidney injury in children in our centre is associated with significant morbidity, malaria with intravascular haemolysis was a major cause. and a significant proportion required renal replacement therapy (peritoneal dialysis). Malaria prevention and adequate management will therefore lead to a reduction in the incidence of AKI in our setting.

SUN-022 Use of Ibuprofen and the Risk of Hospital-acquired Acute Kidney Injury in Children

Ibuprofen is widely used in children worldwide, especially in children with cancer, fever or trauma. However, large and high-quality studies on the association between ibuprofen and acute kidney injury (AKI) in children have been lacking. We aim to estimate the effect of ibuprofen on the risk of hospital-acquired AKI (HA-AKI) in a large cohort of hospitalized children in China. The Epidemiology of AKI in Chinese Hospitalized patients (EACH2 study) is a multicenter, retrospective study of 3,044,024 patients admitted from 2013 to 2015 at 25 academic medical centers in China. Patient-level data were obtained from the electronic hospitalization information system. We included 50,420 hospitalized children aged between 1 month to 18 years who had at least one SCr test during the first 3 days and any interval between two continuous SCr testing <14 days during the first 30 days of hospitalization, excluding those with end-stage renal disease, community-acquired AKI, insufficient SCr testing and without prescription. AKI was defined as an increase in SCr by 26.5 μmol/L within 48 hours or a 50% increase in SCr from the baseline. We estimated the effect of exposure to ibuprofen on the risk of HA-AKI using a COX proportional hazard model with adjustment for age, sex, standardized baseline creatinine, comorbidities, clinical procedures, other nephrotoxic drugs use and stratification by hospital and division. In the model, exposure to ibuprofen and other nephrotoxic drugs as well as operations were coded as time-varying variables. We also compared the effect sizes of ibuprofen among subgroups stratified by age, gender, chronic kidney disease, need for intensive care and exposure to other nephrotoxic drugs. Among 50,420 children who met the inclusion and exclusion criteria, 5,526 (11.0%) were ibuprofen users, and 3,476 (6.9%) had HA-AKI during hospitalization. Characteristics of hospitalized children were showed in Table 1. Ibuprofen use was associated with significantly increased risk of HA-AKI (hazard ratios,1.23; 95% CI, 1.14-1.34) after adjusting for confounders (Table 2). The greater nephrotoxicity of ibuprofen was observed in children who had chronic kidney disease, required intensive care, or were of elder age (Table 3). Abbreviation: IQR, Inter quartile range; SCr, serum creatinine; PPIs, proton pump inhibitors; ACEI, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blocker. a: Adjusted age, sex, standardized baseline creatinine, comorbidities, clinical procedures, other nephrotoxic drugs use and stratified by hospital and division. a: Adjusted age, sex, standardized baseline creatinine, comorbidities, clinical procedures, other nephrotoxic drugs use and stratified by hospital and division. Ibuprofen was widely used and associated with an increased risk of HA-AKI in hospitalized children in China.

AWAKEN-Ing a New Frontier in Neonatal Nephrology

In 2013, literature about the epidemiology of neonatal acute kidney injury (AKI) was limited to primarily retrospective, single center studies that suggested that AKI was common and that those with AKI had higher rates of mortality. We developed a 24-center retrospective cohort of neonates admitted to the NICU between January 1 and March 31, 2014. Analysis of the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) cohort, has allowed us to describe the prevalence, risk factors and impact of neonatal AKI for different gestational age cohorts. The ample sample size allows us to provide convincing data to show that those with AKI have an increase independent higher odds of death and prolonged hospitalization time (1). This data mirrors similar studies in pediatric (2) and adult (3) critically ill populations which collectively suggest that patients do not just die with AKI, but instead, AKI is directly linked to hard clinical outcomes. This study has allowed us to answer multiple other questions in the field which has expanded our understanding of the risk factors, complications, impact of fluid overload, the definition of neonatal AKI and suggests interventions for improving outcomes. Furthermore, this project brought together neonatologist and nephrologist within and across centers. Finally, the AWAKEN project has enabled us to build relationships and infrastructure that has launched the Neonatal Kidney Collaborative http://babykidney.org/ on its way to accomplish its stated mission to improve the health of newborns with or at risk for kidney disease through multidisciplinary collaborative research, advocacy, and education.

Acute kidney injury in paediatric patients with sickle cell disease is associated with increased morbidity and resource utilization

Renal disease is a common complication experienced by patients with sickle cell disease (SCD), though the epidemiology of acute kidney injury (AKI) in paediatric patients and its impact on long-term renal outcomes is unclear. We utilized the Pediatric Health Information System (PHIS) to identify inpatient encounters of paediatric patients with SCD admitted for vaso-occlusive pain crisis (VOC). Overall, 1·4% of patients experienced at least one episode of AKI and 2·5% of admissions were complicated by AKI. Patients with at least one episode of AKI were more likely to be adolescents or young adults at the time of their initial admission, had increased rates of admission to the ICU, longer lengths of stay, increased costs of hospitalization, increased risk of readmission and increased rates of SCD-related comorbidities. Generalized estimating equation modelling demonstrated that increasing age, history of hypertension, history of haematuria and history of chronic kidney disease were associated with increased odds of developing AKI, though hydroxycarbamide use (OR 0·64, 95% CI 0·44-0·94) was protective. Episodes of AKI during hospitalization in children with SCD are associated with increased morbidity and utilization of hospital resources. Increasing the use of hydroxycarbamide may decrease the likelihood of this complication.

Predictors of Acute Kidney Injury and Mortality in Intensive Care Unit at a Teaching Tertiary Hospital_ID.

ABSTRACTBackground and aimsDespite the increased rates of acute kidney injury (AKI) in intensive care units (ICU) and associated mortality, information on the epidemiology of AKI is sparse in sub-Saharan Africa (SSA). We investigated the rates and predictors of AKI and associated mortality in a tertiary ICU.Materials and methodsThis retrospective study analyzed 280 hospital records of patients admitted to the ICU at a tertiary teaching hospital who were aged ≥15 years from January 2017 to May 31, 2018. The outcome parameters of the study were rates of AKI in the ICU, associated risk factors, and mortalities. Acute kidney injury and ICU mortality were established by the multivariate logistic analysis.ResultsThe median age was 36 years (IQR 28, 52). The rate of AKI was 52.9%, and the presence of human immunodeficiency virus (HIV) and oliguria was 2.3-fold (0.004) and 4-fold (0.016) positive predictors of ICU-AKI, respectively. Male gender (0.003), diabetes mellitus (DM) (0.010), respiratory disease (0.001), inotropes (0.004), and ventilator support (0.017) were predictors for ICU mortality after controlling for confounders.ConclusionThe rate of AKI is significantly higher in a referral tertiary hospital in Zambia compared to developed countries and the presence of HIV and noncommunicable diseases such as DM impacts severely on outcomes.How to cite this articleBanda J, Chenga N, Nambaya S, Bulaya T, Siziya S. Predictors of Acute Kidney Injury and Mortality in Intensive Care Unit at a Teaching Tertiary Hospital_ID. Indian J Crit Care Med 2020;24(2):116–121.

A systematic review and meta-analysis of acute kidney injury in the intensive care units of developed and developing countries.

ObjectivesAlthough the majority of the global population lives in developing countries, most of the epidemiological data related to intensive care unit (ICU) acute kidney injury (AKI) comes from developed countries. This systematic review aims to ascertain the methodology of studies on ICU AKI patients in developing and developed countries, to determine whether epidemiological comparisons between these two settings are possible, and to present a summary estimate of AKI incidence.MethodsA systematic review of published studies reporting AKI in intensive care units (2005–2015) identified in PubMed, LILACS, and IBECs databases was conducted. We compared developed and developing countries by evaluating study methodology, AKI reference serum creatinine definitions, population characteristics, AKI incidence and mortality. AKI incidence was calculated with a random-effects model.ResultsNinety-two studies were included, one of which reported data from both country categories: 60 from developed countries (1,057,332 patients) and 33 from developing countries (34,539 patients). In 78% of the studies, AKI was defined by the RIFLE, AKIN or KDIGO criteria. Oliguria had 11 different definitions and reference creatinine 23 different values. For the meta-analysis, 38 studies from developed and 18 from developing countries were selected, with similar AKI incidence: 39.3% and 35.1%, respectively. The need for dialysis, length of ICU stay and mortality were higher in developing countries.ConclusionAlthough patient characteristics and AKI incidence were similar in developed and developing countries, main outcomes were worse in developing country studies. There are significant caveats when comparing AKI epidemiology in developed and developing countries, including lack of standardization of reference serum creatinine, oliguria and the timeframe for AKI assessment. Larger, prospective, multicenter studies from developing countries are urgently needed to capture AKI data from the overall population without ICU access.

Big Data and Pediatric Acute Kidney Injury: The Promise of Electronic Health Record Systems.

Over the last decade, our understanding of acute kidney injury (AKI) has evolved considerably. The development of a consensus definition standardized the approach to identifying and investigating AKI in children. As a result, pediatric AKI epidemiology has been refined and the consequences of renal injury are better established. Similarly, “big data” methodologies experienced a dramatic evolution and maturation, leading the critical care community to explore potential AKI/big data synergies. One such concept with tremendous potential is electronic health record (EHR) enabled informatics. Much of the promise surrounding these approaches is due to the unique position of the EHR which sits at the intersection of data accumulation and care delivery. EHR data is generated simply via the provision of routine clinical care and should be considered “big” from the standpoint of volume, variety, and velocity as a myriad of diverse elements accumulate rapidly in real time, spontaneously generating an immense dataset. This massive dataset interfaces directly with providers which creates tremendous opportunity. AKI can be diagnosed more accurately, AKI-related care can be optimized, and subsequent outcomes can be improved. Although applying big data concepts to the EHR has proven more challenging than originally thought, we have seen much success and continue to explore its potential. In this review article, we will discuss the EHR in the context of big data concepts, describe approaches applied to date, examine the challenges surrounding optimal application, and explore future directions.

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