Factors Of Acute Kidney Injury Research Articles

REST contributes to AKI-to-CKD transition through inducing ferroptosis in renal tubular epithelial cells.

Ischemic-reperfusion injury (IRI) is a major pathogenic factor in acute kidney injury (AKI), which directly leads to the hypoxic injury of renal tubular epithelial cells (RTECs). Although emerging studies suggest repressor element 1-silencing transcription factor (REST) as a master regulator of gene repression under hypoxia, its role in AKI remains elusive. Here, we found that REST was upregulated in AKI patients, mice, and RTECs, which was positively associated with the degree of kidney injury, while renal tubule-specific knockout of Rest significantly alleviated AKI and its progression to chronic kidney disease (CKD). Subsequent mechanistic studies indicated that suppression of ferroptosis was responsible for REST-knockdown-induced amelioration of hypoxia-reoxygenation injury, during which process Cre-expressing adenovirus-mediated REST downregulation attenuated ferroptosis through upregulating glutamate-cysteine ligase modifier subunit (GCLM) in primary RTECs. Further, REST transcriptionally repressed GCLM expression via directly binding to its promoter region. In conclusion, our findings revealed the involvement of REST, a hypoxia regulatory factor, in AKI-to-CKD transition and identified the ferroptosis-inducing effect of REST, which may serve as a promising therapeutic target for ameliorating AKI and its progression to CKD.

Renal perfusion pressure and capillary leaks index as risk factors for acute kidney injury after major abdominal surgery

Background & Objective: Many factors can contribute to the development of acute kidney injury (AKI) following major abdominal surgery, including the effect of fluid extravasation into interstitial space due to capillary leakage. Microalbuminuria is also brought on by capillary leakage. Increased central venous pressure (CVP) or intra-abdominal pressure (IAP) will decrease renal filtration according to the degree of pressure transmission to the glomeruli. The objective of this study was to know the correlation of capillary leakage index (CLI), microalbuminuria [urine albumin to creatinine ratio (ACR)] and renal perfusion pressure (RPP) with the incidence of AKI. Methodology: A prospective longitudinal cohort design with consecutive sampling was used in this study. The parameters capillary leakage index (CLI), microalbuminuria (ACR) and renal perfusion pressure (RPP) were examined preoperatively, and at 12 h and 36 h postoperatively, and the incidence of AKI was observed till the fourth postoperative day. CLI was defined as C-reactive protein (CRP mg/dL) over albumin (g/L) multiplied by 100. RPP as glomerular pressure was obtained from mean arterial pressure (MAP), IAP, and renal venous pressure estimated by CVP, by the formula RPP = MAP-(IAP+CVP). Results: Following major abdominal surgery, 19 (25.68%) of the 74 subjects developed AKI. There was no significant difference in CLI and ACR between patients with and without AKI. Renal perfusion measurements examined at 0, 12, and 36 h showed significantly lower values in AKI patients. The relative risk (RR) of RPP was 9.125 with a 95 % CI of 1.141293−72.95725 (P = 0.037) after data analysis with Cox Regression to establish the correlation between CLI, ACR, and RPP, as well as covariate variables on the occurrence of AKI at 0 h. Compared to participants without AKI, those with AKI had a mortality risk of 2.384 times higher (P = 0.0351, 95 % CI = 1.133−5.018). Conclusion: Renal perfusion pressure showed a significant correlation with acute kidney injury. Additionally, there is a strong connection between acute kidney injury and mortality. Abbreviations: ACR- albumin to creatinine ratio; AKI- acute kidney injury; CLI- capillary leakage index; CVP- central venous pressure; IAP- intra-abdominal pressure; MAP- mean arterial pressure; RPP- renal perfusion pressure Key word: AKI; Capillary Leaks Index; Microalbuminuria; Renal perfusion pressure; Major abdominal surgery; Systemic capillary leak syndrome Citation: Suria Mariati NMA, Aditianingsih D, Marsaban AHM. Renal perfusion pressure and capillary leaks index as risk factors for acute kidney injury after major abdominal surgery. Anaesth. pain intensive care 2023;27(3):294−300. DOI: 10.35975/apic.v27i3.1925 Received: July 03, 2022; Reviewed: July 17, 2023; Accepted: April 22, 2023

CARC4: Incidence, Outcomes, and Risk Factors of Acute Kidney Injury in Patients on Percutaneous Mechanical Circulatory Support with Impella 5.0 and 5.5 for Cardiogenic Shock

Purpose: Use of temporary mechanical circulatory devices (tMCS) such as the transaxial flow pump (ImpellaTM. Abiomed, Danvers, MA) for CS-HF is growing. Despite advances in tMCS investigations have found AKI is highly prevalent and strongly associated with mortality in CS patients supported with MCS. We identified pre and post implant risk factors of AKI in CS-HF patients supported with Impella 5.0 and 5.5. Methods: Single center retrospective analysis of 144 Impella 5.0/5.5 devices from 01/2012 to 07/2022 for CS-HF. Patients with non heart failure etiology (n=5) and pre-implant renal replacement therapy (RRT. n=44) were excluded. Demographics and pre-implant chacteristics of patients) as well as post-implant outcomes including mortality, heart replacement therapy (HRT) with ventricular assist device (VAD) or heart transplant (HTX), and native heart survival at discharge were compared between patients with and without acute kidney injury (AKI). AKI was defined as rise in Creatinine 1.5 x baseline or new need for RRT. Logistic regression was used to find independent predictors of post-implant AKI and spearmann correlation was used to find associations with 90-day kidney function defined as fold change in creatine from baseline to peak 90 day values). Results: The final cohort consisted of 96 patients with mean duration of Impella support of 10±12 days.. Of the remaining 96 devices 57 (59.4%) developed AKI with 9 requiring RRT (9.4%). Patients with AKI had higher mortality (42.1% vs 17.9%, p=0.04), lower HRT (43.9% vs 56.4%, p=0.04) and less native heart survival (discharged without HRT) (14.0% vs 25.6%, p=0.04) than those without AKI. Demographics and pre-implant characteristics are shown in in Table 1. Pre-implant creatinine, lactate dehydrogenase (LDH), total bilirubin, Model for End Stage Liver Disease (MELD), and mean right atrial pressure to pulmonary capillary wedge pressure (mRAP/PCWP) as well as post-implant hemolysis (rise in plasma free hemoglobin > 20 or LDH 2.5 x upper limit of normal) were higher in patients with AKI. On logistic regression with backwards selection independent predictors of AKI included pre-implant mRAP/PCWP (OR 33.5 95%CI 1.6-708.8, p=0.02) and post-implant hemolysis (OR 5.6 95%CI 2.1-31.5, p=0.045) (Table 2). On spearman correlation (Table 3) only pre-implant mRAP/PCWP and post-implant LDH:Upper limit of normal LDH were associated with worse long term kidney function defined as fold change of 90-day peak creatinine from baseline. Conclusions: AKI is associated with higher mortality after Impella 5.0 and 5.5 insertion. The etiology of AKI in patients with cardiogenic shock supported by Impella 5.0 and 5.5 is multifactorial but clearly related to venous congestion and hemolysis. Optimization of patient’s fluid status when the device is inserted and avoidance of hemolysis during device support play key roles in reducing AKI in this group of high risk patients.

High dose methotrexate (MTX) treatment: Value of post treatment MTX level monitoring and risk factors for acute kidney injury.

e19539 Background: High-dose methotrexate therapy is an effective treatment for primary central nervous system (CNS) lymphoma and other tumors. Methotrexate (MTX) is an antimetabolite which penetrates blood brain barrier when administered intravenously at high doses. Defective or delayed clearance of MTX may lead to toxicities, especially acute kidney injury (AKI) in 2-13% of patients. We developed a protocol to mitigate side effects by checking MTX levels every 24 hours, administering leucovorin or glucarpidase rescue, and hydration with urine alkalization. This study examines the risk factors for developing AKI after high dose MTX administration. Methods: Patients who began treatment with high dose methotrexate in 2020 and 2021 were eligible. We collected data on demographics, diagnosis, methotrexate levels, laboratory levels at baseline and after treatment, toxicities, interventions and outcomes. Results: 26 patients were included, who received 112 cycles of treatments (median 3.5, range 1-10). Median age was 62 years (range 25-83) and 57% were male. 20 patients experienced elevated MTX levels. Among the 112 cycles, MTX levels were elevated at 24h, 48h and 72h in 22 (19.6%), 16 (14.3%), and 45 (40.2%) of the cycles respectively, which trigged an increase in the rescue leucovorin dose and hydration dose in 26 (23.2%) and 16 (14.3%) cycles, respectively. AKI was recorded in 20 cycles (17.9%), with 17 (85%) being grade 1 (ULN – 1.5 x ULN), and 3 (2.7%) being grade 2 (1.5-3x ULN). In 20 cycles with AKI, 9 (45%) had grade 1 elevated creatinine level pretreatment; 8 (88.9%) of them remained grade1 without increase > 0.2. The development of AKI occurred in all MTX dose levels, without a difference in frequency. 57% of cycles with elevated 24h MTX level, and 13% of cycles with delayed clearance > 4 days, were associated with AKI. 75% of cycles with AKI had delayed clearance (avg 7 days). Two patients required glucarpidase rescue treatment, based on elevated 24-36 h MTX level and grade 1-2 AKI; one of these patients permanently discontinued MTX. Conclusions: Among 26 patients who received a total of 112 cycles of high dose MTX treatment, 11 developed AKI in 20 cycles, mostly grade 1 with spontaneous recovery. MTX level elevation at 24 hours predicted the development of AKI. Elevated baseline creatinine or MTX dose range is not a risk factor for AKI.

FRI-341 - Outcomes, clinical trajectories and risk factors of acute kidney injury (AKI) in critically-ill patients with liver cirrhosis

FRI-341 - Outcomes, clinical trajectories and risk factors of acute kidney injury (AKI) in critically-ill patients with liver cirrhosis

THU-489 - Increased left ventricular dimensions are the new risk factor for acute kidney injury after living donor liver transplantation (cardio-renal interaction)

THU-489 - Increased left ventricular dimensions are the new risk factor for acute kidney injury after living donor liver transplantation (cardio-renal interaction)

Postoperative Acute Kidney Injury in Geriatric Gynecologic Oncology Patients After Major Open Abdominal Surgery: A Retrospective Cohort Study

Introduction: This investigation’s purpose was to determine the incidence of acute kidney injury, the associated risk factors, and the 90-day outcomes and kidney function of geriatric patients who underwent major open abdominal gynecologic oncologic surgery. Materials and Method: This retrospective cohort study involved patients aged ≥ 65 years who underwent major open abdominal gynecologic oncologic surgery. Results: The postoperative incidence of acute kidney injury in gynecologic oncologic surgical procedures was 22.1%, with a transient nature observed in 72% of patients. The in-hospital mortality rate was 4 %. Kidney function on the 90th day after acute kidney injury development revealed that estimated glomerular filtration rate regressed by over 25% in 6 patients (24%). Acute kidney injury development was associated with surgical time, intraoperative bleeding volume, bowel procedures, the presence of ascites, intraoperative hypotension, vasopressor use, postoperative diuretic use, postoperative hypoalbuminemia, prolonged post-anesthesia care unit, and hospital stay (p < 0.05). A logistic regression analysis of the risk factors for acute kidney injury revealed that surgery duration was a significant one (p < 0.05). Conclusion: Postoperative acute kidney injury is an important postoperative complication associated with the development or progression of chronic kidney disease. This leads to a prolonged stay in the post-anesthesia care unit and in the hospital. Although acute kidney injury is frequently transient in geriatric patients following major open abdominal gynecologic oncologic surgery, developing preventive measures, encouraging team collaboration, and monitoring serum creatinine concentration in the early postoperative period are critical in complex surgical procedures. Keywords: Postoperative Complications; Acute Kidney Injury; Geriatrics.

A Retrospective Case Study Identifying Risk Factors of Acute Kidney Injury in Excessively Obese Patients Post Cardiac Surgery

Cardiac patients with excessive BMI≥35 kg/m2 are independently associated with an increased risk of acute kidney injury (AKI) after cardiac surgery. This retrospective case study investigated the association of obesity with identifying the risk of acute kidney injury development after cardiac surgery in the intensive care unit.

Incidence, mortality, and risk factors of acute kidney injury after immune checkpoint inhibitors: Systematic review and meta-analysis of real-world evidence

BackgroundTo precisely quantify the incidence, mortality, and risk factors for acute kidney injury (AKI) following immune checkpoint inhibitor (ICI) treatment for cancer in real-world scenarios. MethodsComprehensive searches were performed on PubMed, EMBASE and the Cochrane library. Real-world observational studies reporting incidence, mortality and/or factors for AKI in ICI-treated patients were eligible. Odds ratio (OR) with 95% CI for potential predictors and hazard ratio (HR) with 95% CI for mortality risk associated with AKI were calculated using the random-effect model. ResultsEighteen articles comprising 12,111 patients receiving ICI were finally eligible. The pooled incidence was 16.0% (95% CI 11.2%-20.8%; n = 15) for AKI following ICI therapies overall and 3.5% (95% CI 2.1%-4.9%; n = 8) for ICI-induced AKI. Patients who developed AKI during ICI therapies had 51% increased risk of death compared with those without (HR 1.51, 95% CI 1.07–2.14). Regarding risk factors, statistically increased risk for AKI during ICI therapies was observed with preexisting chronic kidney diseases (OR 1.86, 1.25–2.78), diabetes (OR 1.26, 1.04–1.53), and concomitant extrarenal immune-related adverse events (OR 2.53, 1.79–3.56). Ipilimumab (OR 2.18, 1.43–3.32), combined ICI therapies (OR 1.80, 1.14–2.83) and concomitant use of proton pump inhibitors (OR 1.97, 1.56–2.49), renin‐angiotensin system inhibitors (OR 1.50, 1.05–2.14), diuretics (OR 1.69, 1.27–2.26) also significantly predicted the incident AKI. ConclusionsAKI episode is frequently observed during ICI exposure for cancer treatment, but ICI induced nephrotoxicity is only occasionally. Higher risk of AKI during ICI therapies was significantly associated with specific comorbidities, concomitant of certain drugs, ipilimumab and ICI combination therapies.

Incidence and risk factors of acute kidney injury in cancer patients treated with immune checkpoint inhibitors: a systematic review and meta-analysis.

The incidence and risk factors of acute kidney injury (AKI) in patients with malignancies receiving immune checkpoint inhibitors (ICIs) are being extensively reported with their widespread application. This study aimed to quantify the incidence and identify risk factors of AKI in cancer patients treated with ICIs. We searched the electronic databases of PubMed/Medline, Web of Science, Cochrane and Embase before 1 February 2023 on the incidence and risk factors of AKI in patients receiving ICIs and registered the protocol in PROSPERO (CRD42023391939). A random-effect meta-analysis was performed to quantify the pooled incidence estimate of AKI, identify risk factors with pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) and investigate the median latency period of ICI-AKI in patients treated with ICIs. Assessment of study quality, meta-regression, and sensitivity and publication bias analyses were conducted. In total, 27 studies consisting of 24048 participants were included in this systematic review and meta-analysis. The overall pooled incidence of AKI secondary to ICIs was 5.7% (95% CI: 3.7%-8.2%). Significant risk factors were older age (OR: 1.01, 95% CI: 1.00-1.03), preexisting chronic kidney disease (CKD) (OR: 2.90, 95% CI: 1.65-5.11), ipilimumab (OR: 2.66, 95% CI: 1.42-4.98), combination of ICIs (OR: 2.45, 95% CI: 1.40-4.31), extrarenal immune-related adverse events (irAEs) (OR: 2.34, 95% CI: 1.53-3.59), and proton pump inhibitor (PPI) (OR: 2.23, 95% CI: 1.88-2.64), nonsteroidal anti-inflammatory drug (NSAID) (OR: 2.61, 95% CI: 1.90-3.57), fluindione (OR: 6.48, 95% CI: 2.72-15.46), diuretic (OR: 1.78, 95% CI: 1.32-2.40) and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) (pooled OR: 1.76, 95% CI: 1.15-2.68) use. Median time from ICIs initiation to AKI was 108.07 days. Sensitivity and publication bias analyses indicated robust results for this study. The occurrence of AKI following ICIs was not uncommon, with an incidence of 5.7% and a median time interval of 108.07 days after ICIs initiation. Older age, preexisting chronic kidney disease (CKD), ipilimumab, combined use of ICIs, extrarenal irAEs, and PPI, NSAID, fluindione, diuretics and ACEI/ARB use are risk factors for AKI in patients receiving ICIs. https://www.crd.york.ac.uk/prospero/, identifier CRD42023391939.

What's New in Musculoskeletal Infection.

What's New in Musculoskeletal Infection.

702 Hydroxycobalamin is An Independent Risk Factor for Acute Kidney Injury.

Abstract Introduction Previous studies have reported a correlation between the use of hydroxocobalamin and acute kidney injury (AKI), but this is often attributed to the severity of their burn injury. In this study, we use a matched control group to correct for severity of injury and assess the relationship between hydroxycobalamin and AKI. Methods All patients receiving hydroxycobalamin over a three year period were identified. The patients were matched 1:1 based on TBSA and age to create a control group. Creatinine and change in creatinine every 24 hours for the first 72 hours were recorded and compared, with an increase in creatinine >1.5 being considered an AKI. A retrospective matched cohort study was performed using the student’s T-test for continuous data and a chi squared test for categorical data. Results A total of 50 patients receiving hydroxycobalamin were identified and matched with 50 patients who did not receive hydroxycobalamin. The groups were no signficant differences between groups in terms of age, TBSA or baseline creatinine. Patient receiving hydroxycobalamin had a mean increase of creatinine of 0.13, 0.13 and 0.07 at 24, 48, 72 hours respectively versus 0.0, 0.04 and 0.0 in the control group (p = .09, .06, .49). Qualitatively, 15/50 patients receiving hydroxycobalamin developed AKI vs 2/50 in the control group (p < .001 ), with 6/33 minor burns developing AKI with hydroxycobalamin vs 1/33 in the control group (p=.058). Five patients receiving hydroxycobalamin developed AKI lasting greater than 72 hours, two of which had only minor burns. Conclusions Hydroxycobalamin is an independent risk factor for the development of acute kidney injury, even in the setting of minor burns and should only be used in patients with high risk for cyanide poisoning. Empiric and protocolized use may result in harm to patients and should be discouraged. Applicability of Research to Practice This study demonstrates the risk of AKI with the use of hydroxycobalamin in both major and minor burns, which burn centers should consider when creating protocols regarding potential cyanide poisoning.

Cardiometabolic disease and obesity patterns differentially predict acute kidney injury after total joint replacement: a retrospective analysis

BackgroundAcute kidney injury (AKI) is a frequent yet understudied postoperative total joint arthroplasty complication. This study aimed to describe cardiometabolic disease co-occurrence using latent class analysis, and associated postoperative AKI risk. MethodsThis retrospective analysis examined patients ≥18 years old undergoing primary total knee or hip arthroplasties within the US Multicenter Perioperative Outcomes Group of hospitals from 2008 to 2019. AKI was defined using modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Latent classes were constructed from eight cardiometabolic diseases including hypertension, diabetes, and coronary artery disease, excluding obesity. A mixed-effects logistic regression model was constructed for the outcome of any AKI and the exposure of interaction between latent class and obesity status adjusting for preoperative and intraoperative covariates. ResultsOf 81 639 cases, 4007 (4.9%) developed AKI. Patients with AKI were more commonly older and non-Hispanic Black, with more significant comorbidity. A latent class model selected three groups of cardiometabolic patterning, labelled ‘hypertension only’ (n=37 223), ‘metabolic syndrome (MetS)’ (n=36 503), and ‘MetS+cardiovascular disease (CVD)’ (n=7913). After adjustment, latent class/obesity interaction groups had differential risk of AKI compared with those in ‘hypertension only’/non-obese. Those ‘hypertension only’/obese had 1.7-fold increased odds of AKI (95% confidence interval [CI]: 1.5–2.0). Compared with ‘hypertension only’/non-obese, those ‘MetS+CVD’/obese had the highest odds of AKI (odds ratio 3.1, 95% CI: 2.6–3.7), whereas ‘MetS+CVD’/non-obese had 2.2 times the odds of AKI (95% CI: 1.8–2.7; model area under the curve 0.76). ConclusionsThe risk of postoperative AKI varies widely between patients. The current study suggests that the co-occurrence of metabolic conditions (diabetes mellitus, hypertension), with or without obesity, is a more important risk factor for acute kidney injury than individual comorbid diseases.

Early fluid and norepinephrine resuscitation in septic acute kidney injury diminishes pro-inflammatory cytokine levels and kidney hypoperfusion in newborn pigs

Background and Objective: Sepsis is the most frequent risk factor for acute kidney injury (AKI) in critically ill infants. Whereas sepsis-induced AKI has been studied in several animal models, alterations in renal microcirculation are unclear. The objective of this study was to use the translational swine model to evaluate the changes in renal hemodynamics during the early phase of sepsis in the first week of life. We also examined the impact of early fluid and norepinephrine (NE) resuscitation on renal hemodynamics in newborn septic AKI. Methodology: Newborn pigs (3-7 days old) were randomly allocated to three groups; 1) Sham, 2) Sepsis (cecal ligation and puncture; CLP) without subsequent resuscitation, and 3) CLP-induced sepsis with fluid and vasopressor NE resuscitation. All animals underwent standard anesthesia induction, mechanical ventilation, and intravenous fluid. Cardiac output (COP) and GFR were measured non-invasively using electrical velocimetry and a transdermal system. The pigs were instrumented to measure the mean arterial pressure (MAP), total renal blood flow (tRBF), cortical perfusion (coPf), and medullary perfusion (mePf). Also, a fiber-optic probe was placed in the medulla to measure medullary tissue oxygen tension (tPO2). Baseline values were recorded for the above indices in all groups. In resuscitated animals, fluid bolus and NE infusion were started at the 4-h to maintain MAP within 15 mmHg from baseline. The pigs were euthanized after twelve hours. Results: Compared to baseline values, MAP and COP decreased by more than two-thirds in non-resuscitated sepsis, with a proportional increase in RVR and reduction in tRBF, coPf, mePf, and tPO2 in contrast to sham. CLP also decreased GFR and increased serum creatinine, BUN, and NGAL. A few tubular coagulative necroses were observed in the septic pigs. Changes in all these parameters, except tPO2, were ameliorated in resuscitated pigs. Resuscitation also attenuated sepsis-induced increase in the levels of serum C-reactive protein, inflammatory cytokines (IL-6, IL-8, IL-12, and IL-18), liver enzymes (aspartate aminotransferase and alanine aminotransferase), and renal NLRP3 inflammasome. Conclusions: Early implementation of resuscitation to maintain MAP, COP, and kidney perfusion lessens the degree of inflammation, AKI, and liver injury in newborn pigs. The discrepancy between medullary perfusion and oxygenation indicates that optimizing perfusion and blood flow does not always correlate with improved medullary oxygen delivery in newborns, especially in cases of increased metabolic demand, as in sepsis. Sepsis is a dynamic illness with phases of hypodynamic and hyperdynamic renal perfusion; therefore, management strategies would differ based on hemodynamic status. NIH R01DK120595 and R01DK127625 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Incidence of acute kidney injury in dogs with systemic mycotic infections treated with amphotericin B (1996-2020).

Amphotericin-B (AmB) is an essential medication for the treatment of life-threatening systemic mycoses but the incidence and risk factors for acute kidney injury (AKI) after its administration are not known in dogs. Determine the incidence of and risk factors for AKI in dogs receiving AmB. Fifty-one client owned dogs receiving AmB for the treatment of systemic mycoses. Retrospective study. Signalment, potential risk factors, AKI development (creatinine ≥0.3 mg/dL from baseline), drug formulation (deoxycholate [AmB-D] or lipid complex [ABLC]), dose, and treatment duration were recorded. The probability of an AKI diagnosis was evaluated using a log-rank test. The incidence of AKI and odds ratios were calculated for potential risk factors. Incidence of AKI was 5/12 (42%) for dogs receiving AmB-D and 14/39 (36%) for dogs receiving ABLC. Of the 19 dogs that developed AKI, 16 (84%) continued treatment after a pause in the planned dosing protocol. Fifty percent of dogs received a cumulative dose of 6.9 mg/kg for AmB-D and 22.5 mg/kg for ABLC (P < .01) at time of AKI diagnosis. ICU hospitalization (odds ratio [OR] 0.21, 95% confidence interval [CI]: 0.58-0.87) and inpatient status (OR 0.25, 95% CI: 0.07-0.86) were associated with decreased odds of AKI. Incidence of AKI with AmB is common but does not always preclude continued treatment. The incidence of AKI is similar between AmB-D and ABLC, but dogs receiving ABLC tolerated a higher cumulative total dose before AKI diagnosis.

Acute Kidney Injury After Liver Transplantation: Incidence, Risk Factors, and Outcomes

Introduction: Although numerous risk factors for acute kidney injury (AKI) have been identified, their cumulative impact remains unclear. This study aimed to identify perioperative risk factors for early post-transplant AKI on patients and outcomes and to predict AKI using clinical variables.&#x0D; Material and Methods: A single-center, retrospective cohort study involving 34 pediatric patients and 31 adults who underwent LT between 2015 and 2017.&#x0D; Results: AKI occurred in 16 (47%) pediatric patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43.8, 50, and 6.3%, respectively. Renal replacement therapy (RRT) was initiated in 18.8% of pediatric LT patients. Preoperative liver enzymes and the etiology of liver failure are the most critical factors affecting AKI in pediatric LT patients. AKI occurred in 15 (48%) adult patients during the first-week post-LT with stage 1, stage 2, and stage 3 AKI frequencies of 43%, 21%, and 21%, respectively. The requirement for RRT was seen in 43% of adult LT patients. There were also statistical differences between the two groups regarding the number of patients with preoperative kidney dysfunction (20-80%, p=.047) and mortality rates (6-31 %, p=.047). In adult patients who developed post-LT AKI compared with those who did not develop post-LT AKI, they had significantly higher levels of serum creatinine (sCr) (1.9±1.9 mg/dL vs. 0.7±0.1 mg/dL, p=.013), were given lower amounts of crystalloids (73±32 mL/kg vs. 106±33 mL/kg, p=.018) and had lower urine output (UO) intraoperatively (11±9 mL/kg vs. 20±9 mL/kg, p=.047). There was a higher mortality rate in adult patients with post-LT AKI (89 vs. 11%, p=.003).&#x0D; Conclusion: The results of our study contribute to raising awareness of the potential risk factors associated with preoperative evaluation, intraoperative and postoperative close follow-up, careful anesthesia management, and early onset of post-LT AKI.

Screening of Influencing Factors for AKI Based on Lasso Regression

Background: Acute kidney injury (AKI) is one of the common critical diseases in hospitalized patients. There are many factors affecting acute kidney injury, difficult to obtain disease data, and short treatment time window. Early detection of AKI is critical to reducing mortality. Methods: MIMIC-IV data were used to establish the prediction model of AKI in critical patients after operation. 1585 intensive care unit (ICU) patients were randomly divided into a training set (n=1109) and a prediction set (n=476) on a 7:3 basis. LASSO regression analysis was performed on the data, area under the operating characteristic curve (AUROC) was used to evaluate the model, and Hosmer-Lemeshow (HL) was used to test the degree of fit. Results: Spinal injury, implantation of temporary cardiac pacemaker, esophageal disease, contrast media, diuretic, epinephrine, aminoglycoside antibiotics, tumor chemotherapy drugs, age, gender and red blood cells were determined to be independent risk factors for acute kidney injury. The AUROC of the model in the train set was 0.901 (95% confidence interval: 0.856~0.946). In the validation set, AUROC was 0.851 (95% confidence interval: 0.808~0.894). AUROC of the above two groups indicated that the model had a good degree of differentiation, which was greater than 70% in both groups. Hosmer-Lemeshow (HL) test showed P&gt;0.05, indicating a good fit of the model. Conclusion: This prediction model can be used for the identification of post-operative AKI patients and provide a basis for clinicians or inpatients to more quickly self-measure the risk.

Cohort study on immune checkpoint inhibitor-associated acute kidney injury: Incidence, risk factors, and management strategies.

Case studies and retrospective chart reviews of health system data have demonstrated an increased risk of nephrotoxicity in patients receiving immune checkpoint inhibitors compared to clinical trials. This study investigated the frequency, causes, and risk factors for acute kidney injury in a real-world, rural setting. This was a retrospective cohort study of patients who received at least one dose of a checkpoint inhibitor at a rural health system from May 2013 to February 2020 and who received at least one dose of a checkpoint inhibitor. Electronic and manual chart review helped to determine the incidence of, risk factors for, and renal outcomes and management strategies of checkpoint inhibitor-related acute kidney injury. Multivariable Fine and Gray subdistribution hazard models were used to assess the impact of patient characteristics on the incidence of sustained acute kidney injury and checkpoint inhibitor-induced acute kidney injury. After exclusion criteria, 906 patients who received at least one dose of a checkpoint inhibitor at Marshfield Clinic Health System during the study period were included. The incidence of acute kidney injury of any duration and due to any cause was 36.1%, while sustained acute kidney injury occurred in 28.7% of patients. Checkpoint inhibitor-related acute kidney injury was thought to have occurred in 2.7% of patients. Baseline estimated glomerular filtration rate < 60 was the sole predictor of checkpoint inhibitors-related acute kidney injury. Most patients with suspected checkpoint inhibitor-related acute kidney injury were managed with corticosteroids, and 62.5% experienced complete renal recovery. Ours is the first retrospective cohort study to test whether baseline Eastern Cooperative Oncology Group score and checkpoint inhibitor place in therapy were associated with checkpoint inhibitor-related acute kidney injury, and neither of these data points were found to be predictive. Even after expanding the parameters and methodologies of our study as compared to other retrospective cohort studies, we found only three baseline characteristics to be predictive of sustained acute kidney injury: Baseline eGFR, loop diuretic, and spironolactone use. For checkpoint inhibitor-related baseline, eGFR alone was predictive.

Risk factors for acute kidney injury in pediatric patients after hematopoietic stem cell transplantation: a systematic review and meta-analysis.

Risk factors for acute kidney injury (AKI) in pediatric patients after hematopoietic stem cell transplantation (HSCT) remain controversial. This study aimed to identify risk factors for AKI following HSCT in the pediatric population. PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases were searched from inception to February 8, 2023. Studies meeting the following criteria were included: (1) The study was a case-control, cohort study, or cross-sectional design, (2) the study was performed among pediatric and young patients aged 21 years or younger undergoing HSCT, (3) the study measured at least one related factor for AKI after pediatric HSCT, (4) the study included a sample of at least ten patients, and (5) original articles published in English in peer-reviewed scientific journals. Children who were undergoing pediatric HSCT. We assessed the quality of the included studies and analyzed them with a random-effect model. Fifteen studies with a total of 2,093 patients were included. All were cohort studies of high quality. The overall pooled incidence of AKI was 47.4% (95%CI 0.35, 0.60). We found significant associations between post-transplant AKI in pediatric patients and unrelated donor [odds ratio (OR) = 1.74, 95% confidence interval (CI) 1.09-2.79], cord blood stem cell transplantation (OR = 3.14, 95%CI 2.14-4.60), and veno-occlusive disease (VOD)/sinusoidal obstruction syndrome (SOS) (OR = 6.02, 95%CI 1.40-25.88). Other controversial factors such as myeloablative conditioning (MAC), acute graft vs. host disease (aGVHD), and the use of calcineurin inhibitors (CNI) were not found to be related to AKI after pediatric HSCT. Results were limited mainly by heterogeneity in the characteristics of patients and transplantation. Posttransplant AKI in children is a common complication. Unrelated donors, cord blood stem cell transplantation, and VOD/SOS might be risk factors for AKI after pediatric HSCT. Further large-scale studies are still needed to draw firm conclusions. CRD42022382361 A higher resolution version of the Graphical abstract is available as Supplementary information.

White paper on mitigating risk factors for acute kidney injury in TAVR: A protocol to decrease TAVR-associated AKI

Acute kidney injury (AKI) after transcatheter aortic valve replacement (TAVR) portends a poor prognosis. In the TVT registry, AKI after TAVR occurred in 10% of the patients. The etiology of AKI after TAVR is multifactorial but contrast volume remains one of the few modifiable risk factors. As patients referred for TAVR have multiple touch points within a siloed healthcare system, there remains an unmet clinical need of a well-defined clinical pathway to minimize the risk of AKI from the time of referral for TAVR to the completion of the procedure. This white paper aims to provide such a clinical pathway.