Factors For Acute Renal Failure Research Articles

Explainable Boosting Machine approach identifies risk factors for acute renal failure

BackgroundRisk stratification and outcome prediction are crucial for intensive care resource planning. In addressing the large data sets of intensive care unit (ICU) patients, we employed the Explainable Boosting Machine (EBM), a novel machine learning model, to identify determinants of acute kidney injury (AKI) in these patients. AKI significantly impacts outcomes in the critically ill.MethodsAn analysis of 3572 ICU patients was conducted. Variables such as average central venous pressure (CVP), mean arterial pressure (MAP), age, gender, and comorbidities were examined. This analysis combined traditional statistical methods with the EBM to gain a detailed understanding of AKI risk factors.ResultsOur analysis revealed chronic kidney disease, heart failure, arrhythmias, liver disease, and anemia as significant comorbidities influencing AKI risk, with liver disease and anemia being particularly impactful. Surgical factors were also key; lower GI surgery heightened AKI risk, while neurosurgery was associated with a reduced risk. EBM identified four crucial variables affecting AKI prediction: anemia, liver disease, and average CVP increased AKI risk, whereas neurosurgery decreased it. Age was a progressive risk factor, with risk escalating after the age of 50 years. Hemodynamic instability, marked by a MAP below 65 mmHg, was strongly linked to AKI, showcasing a threshold effect at 60 mmHg. Intriguingly, average CVP was a significant predictor, with a critical threshold at 10.7 mmHg.ConclusionUsing an Explainable Boosting Machine enhance the precision in AKI risk factors in ICU patients, providing a more nuanced understanding of known AKI risks. This approach allows for refined predictive modeling of AKI, effectively overcoming the limitations of traditional statistical models.

The Year in Cardiothoracic Transplant Anesthesia: Selected Highlights From 2022 Part I: Lung Transplantation

These highlights focus on the research in lung transplantation (LTX) that has been published in the year 2022 and includes the assessment and optimization of candidates for LTX, donor optimization, the use of organs from donation after circulatory death (DCD), and outcomes when using marginal or novel donors, recipient factors affecting LTX, including age, disease, the use of extracorporeal life support (ECLS), and special situations, such as COVID-19, pediatric LTX, and retransplantation. The remainder of the article focuses on the perioperative management of LTX, including the perioperative risk factors for acute renal failure (AKI), and the incidence and management of phrenic nerve injury, delirium, and pain and the postoperative management of hyperammonemia, early postoperative infections, and the use of donor-derived cell-free deoxynucleic acid (DNA) to detect rejection.

The causal relationship between immune cells and different kidney diseases: A Mendelian randomization study.

Studies have suggested that the progress of most kidney diseases from occurrence to course and subsequent related complications are closely related to inflammatory reaction. Increased common leukocytes count in the family (neutrophils, eosinophils, basophils, lymphocytes, etc.) are also involved in the tissue damage of kidney diseases. However, these studies are only traditional observational studies, which cannot prove whether there is a causal relationship between these four kinds of leukocytes count and kidney diseases. We aim to explore the causal relationship between these four kinds of leukocytes count and kidney diseases by Mendelian randomization (MR). Large sample size of the genome-wide association database of four cell traits (neutrophil, basophil, lymphocyte, and eosinophil cell counts) in the leukocyte family were used as exposure variables. The outcome variables were various renal diseases (including chronic renal failure, acute renal failure, hypertensive heart or/and kidney disease, hypertensive renal disease, disorders resulting from impaired renal tubular function, and type 1 diabetes with renal complications). The covariates used in multivariable MR are also four cell traits related to blood cells (neutrophil, basophil, lymphocyte, and eosinophil cell counts). Instrumental variables and single nucleotide polymorphic loci were identified (P < 5 × 10-8. Linkage disequilibrium R2 < 0.001). The causal relationships were studied by inverse variance weighted (IVW), weighted median, and MR-Egger regression. Sensitivity analysis was also performed. In our study, IVW analysis results showed that increased neutrophil cell count was a risk factor for chronic renal failure (OR = 2.0245861, 95% CI = 1.1231207-3.649606, P = 0.01896524), increased basophil cell count was a risk factor for chronic renal failure (OR = 3.975935, 95% CI = 1.4871198-10.62998, P = 0.005942755). Basophil cell count was not a risk factor for acute renal failure (OR = 1.160434, 95% CI = 0.9455132-1.424207, P = 0.15448828). Increased basophil cell count was a protective factor for hypertensive heart and/or renal disease (OR = 0.7716065, 95% CI = 0.6484979-0.9180856, P = 0.003458707). Increased basophil cell count was a risk factor for disorders resulting from impaired renal tubular function (OR = 1.648131, 95% CI = 1.010116-2.689133, P = 0.04546835). Increased lymphocyte cell count was a risk factor for hypertensive renal disease (OR = 1.372961, 95% CI = 1.0189772-1.849915, P = 0.03719874). Increased eosinophil cell count was a risk factor for type 1 diabetes with renal complications (OR = 1.516454, 95% CI = 1.1826453-1.944482, P = 0.001028964). Macrophage inflammatory protein 1b levels was a protective factor for renal failure (OR = 0.9381862, 95% CI = 0.8860402-0.9934013, P = 0.02874872). After multivariable MR was used to correct covariates (neutrophil, basophil, and lymphocyte cell counts), the correlation effect between increased eosinophil cell counts and type 1 diabetes with renal complications was still statistically significant (P = 0.02201152). After adjusting covariates (neutrophil, basophil, and eosinophil cell counts) with multivariable MR, the correlation effect between increased lymphocyte cell counts and hypertensive renal disease was still statistically significant (P = 0.02050226). This study shows that increased basophils can increase the relative risk of chronic renal failure and renal tubular dysfunction, and reduce the risk of hypertensive heart disease and/or hypertensive nephropathy, while increased basophil cell count will not increase the relative risk of acute renal failure, increased neutrophil cell count can increase the risk of chronic renal failure, increased lymphocyte cell count can increase the relative risk of hypertensive nephropathy, and increased eosinophil cell count can increase the relative risk of type 1 diabetes with renal complications. Macrophage inflammatory protein 1b levels was a protective factor for renal failure.

Postoperative nomogram and risk calculator of acute renal failure for Stanford type A aortic dissection surgery.

This study aimed to explore the risk factors of acute renal failure (ARF) after Stanford type A aortic dissection (AAD) surgery, establish a nomogram prediction model and calculate the risk of ARF. 241 AAD patients who received aortic surgery in the department of cardiovascular surgery, Zhongnan Hospital of Wuhan University were enrolled in this study. All enrolled patients were divided into the ARF group and non-ARF group. The clinical data of the two groups were collected and compared. The independent risk factors of ARF after aortic surgery were analyzed by univariate and multivariate logistic regression analyses. Moreover, a nomogram prediction model was generated. The calibration curve, ROC curve and independent external validation were performed to evaluate the nomogram prediction model. 67 patients were diagnosed with ARF within 48h after the operation. Univariate and multivariate logistic regression analyses showed that hypertension, preoperative renal artery involvement, CPB time extension and postoperative decreased platelet lymphocyte ratio were the independent risk factors of ARF after AAD surgery. The nomogram model could predict the risk of ARF with a sensitivity of 81.3% and a specificity of 78.6%. The calibration curve displayed good agreement of the predicted probability with the actual observed probability. AUC of the ROC curve was 0.839. External data validation was performed with a sensitivity of 79.2% and a specificity of 79.8%. Hypertension, preoperative renal artery involvement, CPB time extension and postoperative decreased platelet lymphocyte ratio could predict the risk of ARF after AAD surgery.

Risk factors of acute renal failure in patients with protective ileostomy after rectal cancer surgery

BackgroundDespite the potential benefits of protective ileostomy in rectal surgery, diverting loop ileostomy construction is not free of specific medical consequences implying unplanned hospital readmissions. The most common reason for readmission in these patients is a dehydration with a prevalence of acute renal failure (ARF) of 20%. The objective of this study was to establish the predictive factors of ARF in patients with protective ileostomy after surgery for rectal cancer from a bicentric study.Methodswe conducted a bicentric retrospective cohort study to identify the risk factor of ARF. This study was carried out on 277 patients operated for rectal cancer with necessity of a protective ileostomy during the study period. ARF was measured at any endpoint between ileostomy creation and reversal. Multiple logistic regressions were performed to identify independent risk factors.ResultsA total of 277 patients were included, and 18% (n = 50) were readmitted for ARF. In multivariate logistic regression, increased age (OR 1.02, p = 0.01), Psychiatric diseases (OR 4.33, p = 0.014), Angiotensin II receptor blockers (OR 5.15, p < 0.001) and the ASA score ≥ 3 (OR 9.5, p < 0.001) were significantly associated with ARF.ConclusionAcute renal failure is a prevalent and significant event in the postoperative course of ileostomy patients. Patients at risk should be risk stratified before discharge and targeted for intensive preventive measures.

Post-operative complications of total knee arthroplasty in patients with hypertension.

Hypertension is one of the most common comorbidities among patients undergoing surgery. However, few studies have focused on patients undergoing knee arthroplasty, and most of them had small sample sizes. This study aimed to analyze post-operative complications associated with hypertension in patients who underwent knee replacement surgery. Data from the 2019 National Inpatient Sample (NIS) database were used. Patients who underwent primary total knee arthroplasty (pTKA) and those who underwent aseptic revision total knee arthroplasty (rTKA) were analyzed separately. Propensity score matching was performed to reduce the effects of demographic factors and comorbidities other than hypertension on post-operative complications. A multinomial logistic regression that included all significantly different demographics and comorbidities was performed to verify the results and evaluate the odds ratios. A total of 107,981 patients who underwent pTKA and 6571 who underwent rTKA owing to mechanical complications were identified in the 2019 NIS database. Compared with the non-hypertension group, patients with hypertension had a higher risk of developing acute renal failure and electrolyte disorders after TKA. Further analysis revealed that hyponatraemia and hypokalaemia were associated with hypertension. Hypertension was associated with the incidence of acute renal failure after TKA. It is important to identify patients with risk factors for acute renal failure (in addition to hypertension) and take careful measures to prevent acute renal failure in them.

The outcomes of ultrafiltration in on-pump versus off-pump coronary artery bypass grafting in patients with renal impairment

ObjectiveIn chronic kidney disease (CKD), using cardiopulmonary bypass (CPB) may contribute to renal dysfunction. Off-pump coronary artery bypass grafting (OPCAB) is one technique that preserved renal function, but the procedure may not be possible in certain situations. The ultrafiltration (UF) can remove excess fluid and inflammatory mediators that result from exposure to the CPB. Coronary artery bypass grafting (CABG) with UF could be an alternative way to preserve renal function.MethodA retrospective study of CKD patients who underwent CABG. The renal outcomes were compared between the patients who underwent CABG with UF and OPCAB. A repeated measure adjusted by propensity score was used for comparing the renal outcome. Univariable and multivariable logistic regression was used to identify the risk factors for acute renal failure (AKI) and adverse outcomes.ResultsFrom January 2009 and June 2020, there were 220 CKD patients, 109 (49.55%) patients underwent CABG with UF, and 111 (50.45%) patients underwent OPCAB. There were statistically significant differences in the change of the average level of creatinine between CABG with UF (increased + 0.09 mg/dl) and OPCAB (decreased − 0.05 mg/dl) (p = 0.043). Also, patients who underwent CABG with UF had a significantly increased risk for AKI (OR 5.38, 95%CI 1.09, 26.5).ConclusionThe UF adjunct technique in CABG with CPB tends to provide a lower protective effect for renal function and had a significantly higher incidence of post-cardiac surgery AKI when compared to OPCAB. If technically feasible, OPCAB would be a preferable choice for CKD patients.Study registration number: SUR-2562-06607/Research ID: 6607.

Outcomes of Upper Gastrointestinal Bleeding in Hospitalized Patients With Generalized Anxiety Disorder.

BackgroundUpper gastrointestinal bleeding (UGIB) has a high morbidity and mortality. Social deprivation is a risk factor for UGIB and is associated with anxiety. The primary pharmaceutical therapeutic agents for anxiety are selective serotonin reuptake inhibitors. Anxiety is prevalent in the general population and generalized anxiety disorder (GAD) is a common form of anxiety. This study explores the impact of GAD on the outcomes of adult patients hospitalized with UGIB.MethodsAdult UGIB patients were selected utilizing the National (Nationwide) Inpatient Sample database from year 2014 and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The outcomes of UGIB patients with and without GAD were investigated. The outcomes explored include inpatient mortality, hypotension/shock, acute renal failure, acute hepatic failure, acute respiratory failure and acute myocardial infarction. A multivariate logistic regression analysis was used to determine if GAD is an independent predictor of the outcomes.ResultsAmong 19,850 UGIB patients studied, 2357 had comorbid GAD. GAD was identified as a risk factor for acute renal failure (adjusted odds ratio [aOR] 1.37, 95% confidence interval [CI] 1.30-1.57, p < 0.05) and inpatient mortality (aOR 1.50, 95% CI 1.01-2.06, p < 0.05). The aORs of hypotension/shock, acute hepatic failure, acute respiratory failure and acute myocardial infarction were not statistically significant.ConclusionUGIB patients with comorbid GAD are at elevated risk of inpatient mortality and acute renal failure. These results may gain increasing relevance as GAD prevalence has increased since the start of the coronavirus disease 2019 (COVID-19) pandemic.

Outcome of Acute Renal Failure in Neonates and Its Associating Factors

Objective:To identify various predisposing causes and immediate consequences in new-borns presenting with acute renal failure. Study design: The study design was case series. Place &amp; duration:In the Pediatric department of Shifa International Hospital, Islamabad for one-year duration from September 2020 to August 2021. Material and Methods:A total of 1300 cases were assessed for acute renal failure (ARF)and 98 established cases of ARF being included in the research. The neonates (0-28 days old) who met the criteria for ARF, i.e., anuria/oliguria plus a serum creatinine level more than 1.5 mg/dl, were included in this research. The patient's relevant medical history, physical examination, and laboratory tests were recorded on a separate proforma after given informed permission for the procedure. Each patient's outcome was precisely documented. The statistical software for social sciences was used to examine the data (SPSS20.0). A p-value of less than &lt; 0.05 was considered significant. Results:A total of 98 cases (7.5 percent) were studied, with 68 (69.4 percent) males and 30 (30.6 percent) females. The ratio of males to females was 1.6:1. According to the study results, the mean age was 9.85± 7.20 days and the mean weight was 2.54± 0.65 kg. The majority of the infants were delivered at a hospital (73.5 percent). The most prevalent ARF symptoms in our neonates were birth asphyxia (30.6%), sepsis (24.5%), respiratory distress syndrome (RDS) (11.2%), and dehydration (9.2%), bleeding in (4.1 percent) and meconium aspiration in 3(3.1 percent). CCF and neurogenic bladder were both present in two patients. In 4 individuals, obstructive uropathy was found, including 2 cases of urethral valve (PUV) blockage and 2 cases of pelvic ureteric junction obstruction (PUJO). Neonates with ARF had a 28.5 percent overall death rate (28 cases). Conclusion:When it comes to neonates in critical care, acute renal failure is a frequent concern to observe. More than one predisposing factor for acute renal failure was present in the majority of the patients. Preventing acute renal failure in infants may be accomplished by early identification of risk factors and prompt treatment of underlying diseases. Keywords:Renal failure, Sepsis, Birth asphyxia, Neonates

Investigating a Potential Limit to Access to Care: Preoperative Cutoff Values for Body Mass Index for Shoulder Arthroplasty.

The primary purpose of this study was to determine the number of patients who would be denied a complication-free total shoulder arthroplasty (TSA) based on implementation of body mass index (BMI) eligibility cutoffs. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent primary TSA. Patient demographics and 30-day postoperative complications were compared according to BMI stratification using the Pearson chi-square test and binary logistic regression analysis adjusted for age and modified Charlson comorbidity index. A BMI eligibility criterion of ≥40 kg/m2 was used to calculate the positive predictive value (PPV) to assess the number of complication-free TSAs that would be denied to avoid a complication in a single patient. A total of 23,284 patients who underwent TSA met inclusion criteria. The overall complication rate was 7.2%. Using a BMI cutoff of ≥40 kg/m2 would yield a PPV of 7% for all Major Complications. This means that 14 complication-free procedures would be denied to avoid a Major Complication. In addition, BMI ≥40 kg/m2 served as an independent risk factor for acute renal failure, pulmonary embolism, ventilator use >48 hours, and readmission. The PPV for these clinically significant complications using BMI ≥40 kg/m2 as a cutoff was 4.9%. This translates into 20 patients being denied a complication-free procedure to avoid a single clinically significant medical complication. If this policy was enforced on the 2,426 patients who exceeded BMI ≥40 kg/m2 in this study, nearly 2,307 patients would be denied the potential benefit of surgery to prevent 119 complications. The use of eligibility criteria for primary TSA or RSA based solely on BMI threshold values presents a potential limitation in access to care to these patients who otherwise would have a complication-free procedure. Level III, prognostic, retrospective cohort study.

Mediators of the effects of canagliflozin on kidney protection in patients with type 2 diabetes

Canagliflozin reduced kidney disease progression in participants with type 2 diabetes in the CANagliflozin cardioVascular Assessment Study (CANVAS) Program. This analysis explored potential mediators of the effects of canagliflozin on kidney outcomes. The percent mediating effect of 18 biomarkers indicative of disease was determined by comparing the hazard ratios for the effect of randomized treatment from an unadjusted model and from a model adjusting for the average post-randomization level of each biomarker. Multivariable analyses assessed the joint effects of biomarkers that mediated most strongly in univariable analyses. The kidney outcome was defined as a composite of 40% estimated glomerular filtration rate decline, end-stage kidney disease, or death due to kidney disease. Nine biomarkers (systolic blood pressure [8.9% of effect explained], urinary albumin:creatinine ratio [UACR; 23.9%], gamma glutamyltransferase [4.1%], hematocrit [51.1%], hemoglobin [41.3%], serum albumin [19.5%], erythrocytes [56.7%], serum urate [35.4%], and urine pH [7.5%]) individually mediated the effect of canagliflozin on the kidney outcome. In a parsimonious multivariable model, erythrocyte concentration, serum urate, and systolic blood pressure maximized cumulative mediation (115%). Mediating effects of UACR, but not other mediators, were highly dependent upon the baseline level of UACR: UACR mediated 42% and 7% of the effect in those with baseline UACR 30 mg/g or more and under 30 mg/g, respectively. The identified mediators support existing hypothesized mechanisms for the prevention of kidney outcomes with sodium glucose co-transporter 2 inhibitors. Thus, the disparity in mediating effects across baseline UACR subgroups suggests that the mechanism for kidney protection with canagliflozin may vary across patient subgroups.

Risk Factors for Acute Renal Failure after Cardiac Catheterization Most Cited in the Literature: An Integrative Review.

Acute renal failure (ARF) represents 17% of the complications of cardiac catheterization (CC), with a high death rate and longer hospitalization time. The objective of this review is to describe the most cited risk factors for acute kidney failure in the literature. It is a descriptive and exploratory Integrative Literature Review (ILR) with a qualitative approach, using articles published in the Latin American and Caribbean Health Sciences Literature (LILACS) and PubMed databases between the years of 2009 and 2019 in English, Portuguese, and Spanish, including original articles, reviews, and case studies. The search was made using the following descriptors: cardiac catheterism, kidney diseases, risk factors, coronary catheterization, acute kidney injury, acute renal failure, and nephropathies. The organization and analysis of the data was through the application of a questionnaire that was structured by the authors, and the results are presented in a table. For the final sample, 10 articles were sought. The highlighted factors were being elderly, hypertensive, and diabetic; having previous kidney disease, hypotension, heart failure, higher contrast volumes, and types; the use of non-steroidal anti-inflammatory drugs associated to other risk factors; and atrial fibrillation. Atrial fibrillation was the main finding, which has recently been documented. The identification of risk factors provides health professionals with information to plan measures to prevent ARF, minimizing complications, length of stay, and mortality.

Risk Factors for Acute Renal Failure after Thoracoabdominal Aortic Aneurysm Surgery

Objective To investigate the risk factors associated with acute renal failure (ARF) after thoracoabdominal aortic aneurysm (TAAA) surgery. Methods A total of 156 patients underwent TAAA repair between January 2009 and December 2017. Renal failure was defined based on the Kidney Disease Improving Global Outcomes criteria. The patients were divided into ARF group and non-ARF group based on the presence/absence of postoperative ARF. The risk factors of ARF were analyzed by univariate analysis and multivariate logistic analysis. Results The subjects included 111 males and 45 females aged (40.4±10.9) years (range:19-65 years). The surgical reasons included aortic dissection (n=130,83.3%),aneurysm (n=22,14.1%),and pseudoaneurysm (n=4,2.6%). The degrees of repair included Crawford extent I in 6 patients (3.8%),extent Ⅱ in 128 patients (82.1%),extent Ⅲ in 20 patients (12.8%),and extent Ⅳ in 2 patients(1.3%). There were 3 patients presented with aortic rupture and 6 patients received emergent operations. Nine patients (5.8%) died within 30 days after surgery,and 8 patients (5.1%) suffered from permanent paraplegia. Thirty-six patients (23.1%) had ARF after surgery,and 18 of them needed dialysis. Multivariate logistic analysis showed that smoking (OR =2.637,95%CI=1.113-6.250,P=0.028),packed red blood cell usage in operation (≥6 U) (OR =5.508,95%CI=2.144-11.930,P=0.000),reoperation for bleeding (OR=3.529,95%CI=1.298-9.590,P=0.013) were independent risk factors for ARF after TAAA repair. Conclusion Smoking,packed red blood cell usage in operation (≥6 U),reoperation for bleeding are the independent risk factors of ARF after TAAA surgery.

MON-281 CARDIORENAL SYNDROME-AN UNDERDIAGNOSED ENTITY IN CHILDREN

To determine the etiology, incidence and outcome of cardiorenal syndrome(CRS). Its often a underdiagnosed in children Prospective descriptive study of children < 18 years of age who were admitted to our hospital between June 2017 and August 2018 with 1)primary renal dysfunction (CKD KDIGO stage 3-5D and AKI stage II and III as per pRIFLE criteria) and developed secondary cardiac dysfunction (abnormal echocardiogram including low left ventricular ejection fraction, regional wall motion abnormalities, cardiogenic shock) or 2) primary cardiac disease (congenital or acquiredheart disease) and developed secondary renal dysfunction(AKI stages I-III with or without proteinuria).Baseline characteristics including age, sex, etiology, blood pressure, number of hospitalization were taken. Patients were classified into 5 types of CRS using the 7th acute dialysis quality initiative (ADQI) workgroup classification Total of78 children were included for analysis. who met the inclusion criteria, among those 9%,1%,33%,42% and 15% had CRS type 1,2,3,4 and 5, respectively. Cardiac disease leading to CRS were myocarditis(42%), dilated cardiomyopathy(42%) followed by rheumatic heart disease(14%); renal disease associated with CRS were chronic kidney disease(66%) followed by acute kidney injury(44%) and systemic disorder leading to CRS were severe sepsis(41%), MODS(25%), severe dengue(25%) and CMV infection(8%). The incidence of CRS is quite high in children with cardiac, renal and systemic diseases; risk factors of acute renal failure are multiple. Children presenting with these illnesses should be monitored for the occurrence of CRS so that early intervention may reduce mortality and morbidity.

The impact of chronic kidney disease on postoperative complications in patients undergoing revision total knee arthroplasty: A propensity matched analysis

ObjectivesThough the role of chronic kidney disease (CKD) has been studied previously in primary arthroplasty procedures of the hips and knees, there is a paucity of literature analyzing CKD's impact on surgical outcomes in revision total knee arthroplasty (rTKA) patients. As the number of patients with CKD requiring revision surgery increases, more vigilant pre-operative and post-operative measures can be taken to ensure successful outcomes. This retrospective study sought to 1) determine differences in demographics and preoperative comorbidities of patients with normal or mild CKD and those with moderate/severe CKD and 2) establish moderate/severe CKD as an independent risk factor for complications in the 30-day postoperative period in patients undergoing rTKA. MethodsThe ACS-NSQIP database was queried for patients who had undergone rTKA from 2005 to 2016. Patient were assigned to one of five CKD severity classes after eGFR calculation and were further stratified into two cohorts: stages 1/2 vs. stages 3/4/5. After propensity matching to generate a matched normal/mild CKD cohort of rTKA patients, univariate and multivariate analyses were used to assess differences and the impact of severe CKD on the risk for complications. ResultsThere were significant differences in several demographic features, comorbidities, and complications between the two cohorts upon univariate analyses. Upon multivariate analyses, CKD of moderate/severe/failure status was found to be a significant independent risk factor for acute renal failure (OR 18.097, 95% CI 4.970–65.902, p < 0.001), blood transfusions (OR 1.697, 95% CI 1.500–1.919, p < 0.001), return to the operating room (OR 1.257, 95% CI 1.009–1.566, p = 0.041), extended length of stay (OR 1.707, 95% CI 1.292–2.255, p < 0.001), and mortality (OR 2.165, 95% CI 1.116–4.200, p = 0.022) in the 30-day postoperative period. ConclusionThis current study found moderate/severe CKD to be an independent risk factor for several complications and should guide healthcare professionals for better patient-optimization. Orthopaedic surgeons should factor in CKD severity in the management of patients undergoing rTKA to effectively mitigate the effects of adverse events.

The Yield and Safety of Screening Colonoscopy in Patients Evaluated for Liver Transplantation.

Colorectal cancer (CRC) screening with colonoscopy is commonly used in patients who are candidates for liver transplantation. We initiated this study to define the risk‐benefit ratio of performing screening colonoscopy in this population. A retrospective observational study of all consecutive patients undergoing colonoscopy during pre–liver transplantation screening between 2004 and 2017 was conducted. Endoscopic and pathological findings and clinical events potentially related to the colonoscopy in the 30 days after the procedure were registered and compared with a 30‐day inpatient control time frame. A total of 858 colonoscopies were performed in 808 patients (65% male; median age, 55 years [interquartile range (IQR), 47‐62]; median model for end‐stage liver disease (MELD) score, 15 [IQR, 11‐18]). CRC was found in 2 patients (0.2%), and advanced adenomas were found in 44 patients (5.4%). The only independent risk factor for an advanced neoplasm was age (odds ratio, 1.072 per year; 95% confidence interval, 1.031‐1.115; P < 0.001). During the 30‐day postprocedure period, 178 clinical events occurred in 128 patients compared with 101 clinical events in 72 patients in the control time frames (P < 0.001). After colonoscopy, there was a significantly increased risk for renal failure (P = 0.001) and gastrointestinal (GI) bleeding (P = 0.023). Presence of ascites and MELD score were identified as independent risk factors for acute renal failure and GI bleeding. During the study observation period, 53.5% of the screened population actually underwent liver transplantation. Conclusion: CRC screening in pre–liver transplantation patients is associated with a relatively low prevalence of CRC and an increased risk of postcolonoscopy complications such as acute renal failure and GI bleeding, especially in patients with advanced liver disease. Because the risk‐benefit ratio of standard performance of a screening colonoscopy in this population appears questionable, alternative screening strategies should be considered.

Correlation of cardiopulmonary bypass duration with acute renal failure after cardiac surgery

ObjectivesProlonged cardiopulmonary bypass (CPB) is recognized as a risk factor for acute renal failure (ARF), but the dose effect of time on bypass is unknown. We therefore examined the risk of ARF associated with increasing CPB time stratified by preoperative renal function. MethodsA retrospective analysis was performed on 3889 patients undergoing cardiac surgery on CPB without circulatory arrest between 2011 and 2017 excluding those with a diagnosis of dialysis-dependent renal failure and those who had an intra-aortic balloon pump. Postoperative ARF was defined as a 3-fold increase in creatinine level, creatinine level > 4 mg/dL, or requirement for dialysis. A logistic regression model was built to identify predictors of ARF and to determine the probability of ARF. ResultsPostoperative ARF occurred in 72 patients (2%) overall. Of 100 patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2, 22% developed ARF, of which 16 required dialysis. Thirty-day mortality was 31% for those with ARF compared with <1% for those without ARF (P < .01). Risk factors for ARF included obesity (odds ratio, 3.03; P < .01), increasing preoperative creatinine level (odds ratio, 4.21; P < .01), CPB time scaled by a factor of 10 minutes (odds ratio, 1.06; P = .04), and postoperative transfusion (odds ratio, 11.94; P < .01). The adjusted probability of ARF as a function of CPB time was determined and stratified by preoperative glomerular filtration rate. ConclusionsIncreasing CPB duration is associated with postoperative ARF, particularly among those with preoperative renal impairment. For patients with an estimated glomerular filtration rate <30 mL/min/1.73 m2 the risk increases exponentially with time.

Prognostic factors of acute renal failure following partial nephrectomy of solitary kidney

Background. Acute renal failure (ARF) in the postoperative period increases the risk of complications and death. Estimating the risk of ARF prior to surgery is particularly important, because it allows modifying the treatment in high-risk patients.Objective: to develop prognostic models for evaluating the risks of ARF in patients undergoing resection of a solitary kidney by measuring preoperative parameters.Materials and methods. The study included 136 patients with tumors in a solitary kidney that underwent surgical treatment in the N.N. Alexandrov National Cancer Center of Belarus in the last 16 years.Results. Biochemical blood tests demonstrated that 28 patients (20.6 %) had ARF in the early postoperative period. The multivariate model for assessing the risk of ARF included the following three covariates: tumor size, multifocality, and serum potassium level. We identified the cut-off points of tumor size (3.6 and 5.2 cm) and potassium level (4.4 and 4.8 mmol/L) that ensured maximum predictive accuracy. Using the multivariate model, we developed a nomogram that allows graphical calculation of the ARF probability in the postoperative period by measuring preoperative parameters.Conclusion. Our model enables preoperative assessment of the risk of developing ARF after resection of a solitary kidney with an accuracy (С-index) of 85.1 % (95 % confidence interval: 79.3–89.7 %).

Predictive Factors of Acute Renal Failure in the Neonates with Respiratory Distress Syndrome

Background: Preterm birth occurs in a large number of pregnancies, and its incidence has been reported to be on the rise. Acute kidney injury (AKI) is a common complication in the premature infants with respiratory distress syndrome (RDS). The present study aimed to determine the predictive factors, clinical courses, and outcomes of AKI in the neonates with the clinical and radiological manifestations of RDS. Methods: Medical records of 84 premature neonates with RDS were evaluated in two groups of case (with AKI) (n=34) and control (without AKI) (n=50). Diagnosis of AKI was based on the increased level of serum creatinine (>1.5 mg/dL) after the third day of birth or increasing serum creatinine level. In addition, blood pressure and laboratory findings, including complete blood count, serum electrolytes, and urine volume, were compared between the two groups. Results: Mean age of the infants with AKI was 5.41±3.29 days, and the majority of the patients had nonoliguric renal failure. Among the samples, 23.5% died, and 76.5% were discharged without renal impairment. Birth weight, systolic blood pressure, blood urea nitrogen, calcium, and pH on admission had significant correlations with the presence of AKI. Moreover, birth weight was observed to be a relatively accurate predictive factor for AKI (AUC=0.08; 95% CI=0.68-0.91), with 73.5% sensitivity and 80% specificity. Conclusion: According to the results, AKI was more common in the low-birth-weight infants with severe RDS compared to the other subjects

Predictive Factors for Acute Renal Failure in Neonates with Septicemia

Objectives: Septicemia is an important cause of acute kidney injury (AKI) in neonates admitted to neonatal intensive care units. The aim of this study was to identify the predictive factors for AKI in neonates with culture-proven septicemia. Methods: Medical records of 138 newborns with septicemia were evaluated in 2 groups with (n, 65) and without (n, 73) AKI. Results: The mean age at diagnosis of AKI was 11.31 ± 9.92 days. AKI was more common in neonates with lower gestational age, birth weight, age, blood pressure, platelet count, and serum pH at admission. Moreover, AKI was associated with an increased incidence of intubation at birth, inotrope treatment, shock, disseminated intravascular coagulation (DIC), mechanical ventilation, and morality. Gestational age, initial serum pH, and DIC were the only independent predictors of AKI in the multivariate analysis. In addition, serum pH at admission was the most accurate laboratory marker for the prediction of AKI with 83% sensitivity and 60% specificity. Conclusions: Monitoring of renal function is highly recommended in low-birth-weight infants with severe septicemia.