Acute Kidney Injury Guidelines Research Articles

Chinese clinical practice guideline for acute kidney injury

Acute kidney injury (AKI), a common and severe disease, is associated with a high risk of developing chronic kidney disease (CKD) and end-stage renal disease (ESRD), which is a global health burden with high morbidity and mortality. Although many foreign clinical practice guidelines have standardized the management and treatment of AKI, there is a lack of overall guidance for AKI which is suitable for our national conditions. Thus, an expert group in related fields were organized by the National Clinical Research Center for Kidney Diseases and Chinese Nephrologist Association to collaborate to complete the Chinese Clinical Practice Guideline for Acute Kidney Injury based on the latest existing evidence-based medical evidence both domestically and internationally. The guideline systematically introduces the definition and epidemiological feature, diagnosis and monitoring of AKI, pharmacological approaches to prevent or treat AKI, and management of renal replacement therapy, management of AKI on special populations, and the outcome and prognosis of AKI, aiming to provide reasonable recommendations for all level clinicians in China.

Association between carotid intima-media thickness and acute kidney injury following isolated coronary artery bypass surgery.

The association between pre-operative carotid intima-media thickness (CIMT) and early postoperative acute kidney injury (AKI) following isolated coronary artery bypass grafting (CABG) was investigated. Data were sought retrospectively of 237 patients (166 male, 71 female; mean age 61.4 ± 8.1 years; range: 32-74), operated on for isolated CABG with cardiopulmonary bypass (CPB) in a single centre between June 2014 and December 2020, with a serum creatinine level < 1.5 mg/dl and normal carotid arteries on Doppler ultrasonography. AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline. Patients were grouped as group 1 with AKI in the early postoperative period (n = 63) and group 2 without AKI ( n = 174). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was done to determine independent predictors of AKI. AKI occurred in 63 (26.6%) patients. Pre-operative CIMT was significantly higher in the AKI group (p = 0.0001). Multivariate logistic regression analysis revealed that elevated pre-operative CIMT ( p = 0.005), C-reactive protein ( p = 0.001), erythrocyte sedimentation rate ( p = 0.005), neutrophil-lymphocyte ratio ( p = 0.0001) and platelet-lymphocyte ratio ( p = 0.0001) increased on the postoperative seventh day. C-reactive protein ( p = 0.04), postoperative first day platelet- lymphocyte ratio ( p = 0.0001), postoperative seventh day erythrocyte sedimentation rate ( p = 0.02) and intubation time ( p = 0.02) were independent predictors of early postoperative AKI following isolated CABG. Pre-operative CIMT was found to be an independent predictor of AKI in the early postoperative period of isolated CABG.

Sex as a biological variable in acute kidney injury.

The purpose of this review is to provide an overview of the preclinical and clinical studies investigating sex as a biological variable, as well as the impact of gender, on the development of and progression of acute kidney injury (AKI). Despite a matched degree of ischemia-reperfusion AKI based on measured glomerular filtration rates, male and female mice demonstrated important sex biases in cardiorenal outcomes (1). Although the 2012 Kidney Disease Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI reported that female sex is associated with increased rates of hospital acquired AKI, subsequent meta-analyses do not show increased risk of AKI in women. Recent large scale, multicenter epidemiologic studies suggest males have higher rates of hospital acquired AKI. However, women have been consistently shown to have worse renal outcomes after AKI. There may be also be gender-based differences in presentation to care and management. Sex is an important biological variable in animal models of acute kidney injury. The impact of sex on AKI likely varies based on the etiology of AKI. Preclinical studies demonstrate the nuances of sex chromosomes, sex hormones and epigenetic factors on AKI, however these have not been well studied in humans. Gender may also impact processes of care, treatment and clinical outcomes related to AKI. The scientific rigor and reproducibility of translational studies benefit from the consideration of sex and gender.

Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies.

Background Postoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. Methodology A total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts. Results The incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. Conclusions Patients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.

Survival outcomes in older patients with different stages of acute kidney injury defined by the addition of urine output criteria.

Survival outcomes in older patients with different stages of acute kidney injury defined by the addition of urine output criteria.

ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy.

Mishra RC, Sodhi K, Prakash KC, Tyagi N, Chanchalani G, Annigeri RA, et al. ISCCM Guidelines on Acute Kidney Injury and Renal Replacement Therapy. Indian J Crit Care Med 2022;26(S2):S13-S42.

ACUTE KIDNEY INJURY AS A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19

ACUTE KIDNEY INJURY AS A PREDICTOR OF MORTALITY IN PATIENTS WITH COVID-19

The predictors of mortality in patients with methyl alcohol intoxication

Aim: Methanol intoxication is a worldwide public health problem. Mortality rates are quite high unless there is early intervention and diagnosis. The aim of this study was to investigate the predictors of mortality in patients with methyl alcohol intoxication. Material and Method: The study included 18 patients admitted to emergency department of our hospital in 2019-2020, who were diagnosed with methanol intoxication. Laboratory parameters and basic features of the patients were recorded. According to the criteria of 2012 Clinical Practice Guideline for Acute Kidney Injury (AKI), patients were diagnosed with AKI. Results: The mean age of the patients was 45.7±15.21 years and 72.2% of those were male. The mortality and AKI rate were 38.9% and 44.4%, respectively. In regression analyses, delay in admission to hospital, low Glasgow coma scale score, AKI development and high lactate level were independent predictors of mortality. According to ROC analyses when lactate level was more than 5.75 mmol/L, mortality rate increased more rapidly. Conclusion: Mortality rate is very high in methanol intoxication. Patients with AKI and high lactate levels should be intervened faster.

Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study

Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients. A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60mg/dL) and hypermagnesemia (> 2.40mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28days during ICU stay. A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08-1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89-1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32-2.06 and 1.52; 95% CI 1.01-2.29). Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.

FC 127: Acute Kidney Injury and Exposure to Nephrotoxic Drugs in Critically Ill Patients: A Report From the Multicenter Rescue Project in the Netherlands

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) is a common problem in patients admitted to the intensive care unit (ICU). Nephrotoxic drugs play a causal role in 14–28% of the ICU AKI cases and are one of the few preventable AKI causes. The Dutch multicenter project ‘Towards a leaRning mEdication Safety system in a national network of Intensive Care Units—timely detection of adverse drug Events’ (RESCUE) aims to improve medication safety in ICU patients with respect to drug-induced AKI. This requires knowledge on which drugs may cause AKI and the strength of their effects. Obtaining such knowledge is challenging due to confounding. Especially in the ICU, where patients often have multiple comorbidities, AKI risk factors may also be indications or contraindications for drugs. We aimed to estimate the independent associations between nephrotoxic drug groups and AKI in ICU patients by adjusting for drug group-specific confounders. METHOD We used a detailed electronic health record database of ICU patients admitted to 13 different ICUs between 2010 and 2019 in the Netherlands. The database contains admission characteristics, (chronic) comorbidities, physiology measurements, Acute Physiology and Chronic Health Evaluation IV admission diagnoses and predicted mortality probabilities, serum creatinine (SCr), drug administrations, arterial blood pressure and renal replacement therapy (RRT) treatments. We included admissions with at least two SCr values and excluded admissions with one or more missing AKI risk factor values. Using the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury, we diagnosed and staged AKI according to the SCr and RRT criteria. We recorded exposure to eight drug groups widely regarded as acutely nephrotoxic [1] until AKI onset, discharge or death. Multilevel logistic regression models were applied to estimate the independent association between each drug group and AKI. The estimates were adjusted for drug group-specific confounders: we registered which AKI risk factors were indications or contraindications for each drug group. RESULTS We included 98 391 ICU admissions, of which 14 074 (14%) were diagnosed with AKI, ranging between 6 and 21% across the ICUs. Of all admissions with AKI, 8962 (64%), 1283 (9%) and 3829 (27%) developed AKI stage 1, stage 2 or stage 3, respectively (Figure 1). The percentage of admissions exposed to nephrotoxic drug groups was 7% for aminoglycosides, 6% for nonsteroidal anti-inflammatory drugs (NSAIDs), 6% for penicillin combinations, 5% for glycopeptide antibiotics, 2% for sulfonamides, 2% for antivirals for herpes infections, 1% for immunosuppressants and 1% for antimycotic antibiotics. All drug groups were associated with a higher odds of AKI except NSAIDs and penicillin combinations (Table 1). While penicillin combinations were not associated with AKI, NSAIDs were associated with a lower odds of AKI. The drug groups with the highest odds of AKI were immunosuppressants [odds ratio (OR) 2.26, 95% confidence interval (95% CI) 1.97–2.60; P &amp;lt; 0.001), sulfonamides (OR 1.84, 95% CI 1.65–2.04; P &amp;lt; 0.001) and aminoglycosides (OR 1.70, 95% CI 1.59–1.81; P &amp;lt; 0.001). The NSAID group was the only group that showed a higher OR after adjustment. CONCLUSION We estimated the independent associations between nephrotoxic drug groups and AKI by adjusting for drug-group specific confounders. Our results provide new estimates of the strengths of the associations. Surprisingly, NSAIDs were associated with a lower odds of AKI. This association might be biased due to residual confounding by contraindication. Future studies may investigate strategies to avoid drug-induced AKI.

POS-054 PERSISTENT MARKERS OF RENAL INJURY IN CHILDREN WHO DEVELOPED ACUTE KIDNEY INJURY AFTER PEDIATRIC CARDIAC SURGERY: A PROSPECTIVE COHORT STUDY

Acute kidney injury (AKI) in the immediate postoperative period is common, occurring in 30-60% of children undergoing pediatric cardiac surgery for congenital heart disease (CHD). Longer-term outcomes and the incidence of chronic kidney disease (CKD) after AKI are not well known. This is an important issue, as CKD occurs in 30-50% of the growing ACHD population, being responsible for an excess burden in healthcare utilization. Currently, AKI guidelines in children offer no recommendations on structured renal follow-up. Therefore, this prospective cohort study investigated the long-term renal consequences of AKI after pediatric cardiac surgery, based on a formal assessment visit conducted at 5 years of follow-up and blood samples collected during the latest available visit at >10 years after the index AKI episode. All eligible children (<16 years) who had developed AKI following cardiac surgery at our tertiary referral hospital between December 2004 and December 2008 were prospectively invited for a formal renal assessment 5 years after AKI, including measurements of estimated glomerular filtration rate (eGFR), proteinuria, alpha-1-microglobulin, renal ultrasound, and blood pressure. Longer follow-up data on renal function (>10 years after AKI) were collected at latest available visit. Of 640 cardiac operations performed in 571 patients between December 2004-2008. AKI occurred in 113 patients (19.7%) following 122 procedures (19.1%). Fifteen of these patients (13.3%) died at a median of 31 days (interquartile range, IQR 9-57) after surgery. A total of 66 patients participated in the renal assessment at a median of 4.8 years (IQR 3.9-5.7) after the index AKI episode. Reduced renal function (eGFR <90mL/min/1.73m²; CKD stages 2-5) was present in 9 patients (13.6%), proteinuria in 27 (40.9%), alpha-1-microglobinuria in 5 (7.6%), hypertension in 13 (19.7%), abnormalities on renal ultrasound in 9 (13.6%), and CKD stages 1-5 (eGFR <90mL/min/1.73m² or eGFR 90-100mL/min/1.73m² with echocardiographic or laboratory abnormalities) in 18 (27.3%). No differences were observed between AKIN stages. Patients with CKD were more likely to have an associated syndrome (55.6% versus 20.8%, p=0.015) and had a lower lower height percentile (10, IQR 1.88-34.2 versus 50, IQR 10-53.2, p=0.005), despite similar weight percentile (17.5, IQR 3-35.2 versus 25, IQR 5.25-50, p=0.181), when compared to those without CKD. At 13.1 years (IQR 11.2-14.0) of follow-up, eGFR had declined further (from 114±25 mL/min/1.73m² to 99±23 mL/min/1.73m², p=0.001) and reduced renal function was present in 18/49 patients (36.7%). Children who developed AKI after pediatric cardiac surgery show persistent markers of renal injury. Detection and treatment of CKD, proteinuria, and hypertension in children is critical because these are risk factors for cardiovascular diseases and progressive renal damage in adults. Patients with CHD are especially high-risk for long-term cardiac events, and the superposition of comorbidities such as coronary artery disease, diabetes, smoking, and hypertension in adulthood leads to an excess of healthcare utilization in ACHD. We therefore suggest a structured renal follow-up in this vulnerable population and recommend that prevention of renal disease should start in childhood to ensure optimal outcomes in the growing population of ACHD.

The platelet-lymphocyte ratio is a promising predictor of early postoperative acute kidney injury following cardiac surgery: a case-control study.

BackgroundAcute kidney injury (AKI) is a common complication following cardiac surgery. This study explored the correlation between hematological biomarkers and the occurrence of postoperative AKI following cardiac surgery.MethodsThis was a retrospective case-control, single-center study. This study enrolled 91 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) support in Guangdong Provincial People’s Hospital Zhuhai Hospital between March 2019 and July 2021. The baseline serum creatinine levels of the patients was <132.6 µmol/L. The patients’ electronic medical records were retrospectively reviewed. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Acute Kidney Injury Guideline criteria. Patients who sustained AKI in the 48 hours following cardiac surgery were categorized as Group A (n=48), while patients with normal serum creatinine levels postoperatively were categorized as Group B (n=43). The baseline demographic and clinical characteristics of the two groups were compared. Univariate analysis was performed to evaluate the correlation between biomarkers and postoperative AKI. Multivariate logistic regression was performed to identify the predictors of AKI following cardiac surgery.ResultsForty-eight patients were diagnosed with AKI during the first 48 hours after cardiac surgery, while 43 patients were found to have normal creatinine levels postoperatively. Multivariate logistic regression analysis revealed advanced age (P=0.007), preoperative increased creatinine (P=0.023), duration of intraoperative hypotension (P=0.027), and the platelet-lymphocyte ratio (P/LR; P=0.042) as predictors of AKI following cardiac surgery with CPB. This study was performed in a single center, which might not be generalized to whole population. Ongoing review and modification of the surgical protocols may contribute to bias of the study.ConclusionsThe P/LR can be obtained from a routine blood test, and may potentially be utilized as an independent indicator of AKI following cardiac surgery.

Electronic alerts for acute kidney injury across primary and secondary care

ProblemIn 2009 the National Confidential Enquiry into Patient Outcome and Death suggested only 50% of patients with acute kidney injury (AKI) receive good standards of care. In response National Health...

Anticoagulation strategies in continuous renal replacement therapy

The most common anticoagulant options for continuous renal replacement therapy (CRRT) include unfractionated heparin (UFH), regional citrate anticoagulation (RCA), and no anticoagulation. Less common anticoagulation options include UFH with protamine reversal, low-molecular weight heparin (LMWH), thrombin antagonists, and platelet inhibiting agents. The choice of anticoagulant for CRRT should be determined by patient characteristics, local expertise, and ease of monitoring. The Kidney Disease Improving Global Outcomes (KDIGO) acute kidney injury guidelines recommend using RCA rather than UFH in patients who do not have contraindications to citrate and are with or without increased risk of bleeding. Monitoring should include evaluation of the anticoagulant effect, circuit life, filter efficacy, and complications.

Mean platelet volume and cardiac-surgery-associated acute kidney injury: a retrospective study.

Increased mean platelet volume (MPV) may indicate platelet activation, platelet aggregation, and a resulting prothrombotic state. Such changes in the postoperative period have been associated with organ injury and adverse outcomes. We hypothesized that changes in MPV after cardiac surgery are associated with both a higher risk of acute kidney injury (AKI) and mortality. In this retrospective study, we evaluated consecutive patients undergoing adult cardiac surgery patients between 12 December 2011 and 5 June 2018. The change in MPV was derived by calculating the difference between the baseline MPV before surgery and the average postoperative MPV just prior to the occurrence of AKI. We defined postoperative AKI according to Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for Acute Kidney Injury as either a ≥ 50% increase in serum creatinine in the first ten postoperative days, or an increase of ≥ 0.3 mg·dL-1 during any 48-hr window across the ten-day postoperative period. Multivariable logistic regression analysis was used to examine the association between MPV change and postoperative AKI and mortality. Of the 4,204 patients studied, 1,373 (32.7%) developed postoperative AKI, including 83 (2.0%) and 38 (0.9%) who developed stages II and III AKI, respectively. Compared with patients who had an increase in median postoperative MPV of 0.2 femtolitre (fL), those with an increase of 0.8 fL had an 80% increase in the odds of developing AKI (adjusted odds ratio [aOR], 1.80; 95% confidence interval [CI],1.36 to 2.38; P < 0.001) and were almost twice as likely to progress to a higher severity AKI (aOR, 1.66; 95% CI, 1.28 to 2.16; P < 0.001). Change in MPV was not associated with mortality (aOR,1.32; 95% CI, 0.92 to 1.89; P = 0.14). Increased MPV change in the postoperative period was associated with both increased risk and severity of AKI, but not mortality.

Urine neutrophil gelatinase‐associated lipocalin to diagnose and characterize acute kidney injury in dogs

BackgroundUrine neutrophil gelatinase‐associated lipocalin (NGAL) is a promising biomarker of acute kidney injury (AKI) in dogs.ObjectivesTo evaluate the utility of urinary NGAL for characterizing AKI according to volume responsiveness, presence of inflammation and sepsis, and prognosis.AnimalsDogs with AKI (n = 76) and healthy controls (n = 10).MethodsProspective study. Clinical and clinicopathologic data including absolute urine NGAL concentration (uNGAL) and NGAL normalized to urine creatinine concentration (uNGALC) were measured upon admission. Dogs were graded according to International Renal Interest Society (IRIS) AKI guidelines and compared based on AKI features: volume‐responsive (VR‐) AKI vs. intrinsic (I‐) AKI based on IRIS criteria; VR‐AKI and I‐AKI based on urine chemistry; inflammatory versus noninflammatory; septic versus nonseptic; and survivors versus nonsurvivors. Nonparametric statistics were calculated, and significance set at P < .05.ResultsUrinary NGAL was significantly higher in dogs with AKI compared to controls, regardless of AKI grade. Urinary NGAL did not differ between dogs with VR‐AKI and I‐AKI based on IRIS criteria, whereas higher uNGALC was recorded in dogs with I‐AKI based on urine chemistry. Urinary NGAL was significantly higher in dogs with inflammatory AKI, whereas no difference with respect to sepsis or outcome was identified.Conclusions and Clinical ImportanceUrinary NGAL is a sensitive marker for AKI in dogs, but its specificity is affected by systemic inflammation. Increased urinary NGAL in both I‐AKI and VR‐AKI also suggests the presence of tubular damage in transient AKI. Combining urine chemistry data with IRIS criteria could facilitate AKI characterization in dogs.

Risk factors for acute kidney injury among patients with chikungunya: a multi-center experience from the 2017 chikungunya outbreak in Dhaka, Bangladesh

Background: Chikungunya is an emerging viral infection in Bangladesh. This self-limiting febrile illness may have acute life-threating features including cardiomyopathy and encephalitis. Acute kidney injury (AKI) is less well described complication of chikungunya. This study was designed to evaluate risk factors for AKI among patients with chikungunya virus infection.&#x0D; Methods: This case-control study was done in 3 different centers in Dhaka, Bangladesh from July to October 2017. Adult patients (&gt;18 years) with confirmed diagnosis of chikungunya were included in this study. AKI was diagnosed as per Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury. Patients suffering from chikungunya complicated by AKI were cases and those without AKI were controls.&#x0D; Results: Total patients were 107 (male 61) with a mean age of 35.6 (range 19-84) years. Common comorbidities were diabetes mellitus (DM) (20.6%), hypertension (17.8%) and chronic kidney disease (CKD) (12.1%). Common presentations included fever (86.9%) or recent history of fever (13.1%), joint pain (88.8%), rash (23.4%), pruritus (15.9%), gastro-intestinal (GI) features like diarrhea and/or vomiting (28%), lymphadenopathy (12.1%), gum swelling/oral ulcer (4.1%) and oedema (8.4%). Fourteen (13.1%) patients required hospitalization. Eleven (10.3%) cases were complicated by AKI. Among the risk factors for AKI, comorbidities like DM (OR 28.73, 95% CI 5.57-148.10, p 0.0001) and CKD (OR 31.0, 95% CI 2.94-326.7, p &lt;0.0001), GI features (OR 16.07, 95% CI 3.22-80.14, p 0.0007), requirement of hospitalization (OR 23.10, 95% CI 2.37-226.31, p &lt;0.0001) and use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) (OR 6.65, 95% CI 1.77-24.98, p 0.005) were significant.&#x0D; Conclusions: One-tenth of adult patients suffering from chikungunya were complicated by AKI in this study. DM, CKD, diarrhea and/or vomiting, hospitalization and use of ACEIs/ARBs appeared as significant risk factors for AKI.&#x0D; Birdem Med J 2019; 9(3): 193-196

Epidemiology of Hospital-Acquired Acute Kidney Injury(HAAKI) in Medical Hospitalized Patients in Al-Diwanyia Teaching Hospital

Background: Minimum elevation of serum creatinine,even within normal reference range are associated with worse outcome of the patients.&#x0D; Objective: The application of the most recent definition of AKI proposed by the Acute Kidney Injury Network (AKIN),published in March 2012 to promote the earlier detection of HAAKI. &#x0D; Patients&amp;Method: Cross –sectional observational study conducted in the medical ward in Al-Diwanyia Teaching Hospital for a period 9 months from 1st of January to 30 of September 2013 . All adolescents &amp; adults patients who fulfill the criteria of the study included. Data about demographics ,co-morbidities of patients &amp; serial measurement of (S.Cr) were directly collected . The definition of AKI according to Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury -2012,based on AKIN criteria.&#x0D; &#x0D; Result:&#x0D; Out of 522 patients included in the study( the mean age of them 59 ± 23) ,HAAKI (stage1)were recorded in 79 (15.13%) patients , elderly patients aged ? 65 represent 50.63% of all cases of HAAKI(without significant gender variation). About 19 patients(24.05%) morbidities HAAKI due to intermingle co morbidities. The most 3 prevalent co morbidities were reported either independent or in association with other co morbidities in patients with HAAKI,1stone diabetes mellitus , 51 diabetic patients which represent 64.5% of total 79 patients with HAAKI &amp; 37.22% of total diabetic patients studied . The 2nd was sepsis which reported in about 37 patients (46.83%).About 36 patients (45.56%) had HAAKI due to nephrotoxic drugs which represent the 3rd more frequent co morbidities.&#x0D; Limitations: Single-medical ward study of limited period .Classification of the diseases according to conventional method.&#x0D; Conclusions: Our results suggest that HAAKI is a common complication . Our efforts should be focused to prevent or minimize the risk factors of HAAKI (particularly in advanced age).

Drug-Induced Acute Kidney Injury in China: A Multicenter Cross-Sectional Survey

Background: Acute kidney injury (AKI) is a severe kidney disease. Drug-induced AKI (D-AKI) is one type of AKI, which is difficult to be diagnosed. The incidence of D-AKI in China has rarely been studied. This study aims to explore the disease burden, related drugs and diagnosis status of D-AKI. Methods: A nationwide cross-sectional survey was conducted in adult patients from 23 academic hospitals in 17 provinces in mainland China. Suspected AKI was screened based on serum creatinine changes according to the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Acute Kidney Injury and patients who met the diagnosis of hospital-acquired AKI in January and July of 2014 were defined. D-AKI was firstly evaluated by pharmacists using Naranjo Adverse Drug Reaction Probability Scale and further confirmed by nephrologists through carefully reviewing the medical records. Findings: Altogether 280,255 hospitalized patients were screened and 1960 cases were diagnosed as hospital-acquired AKI, among which 735 cases were defined as D-AKI (37.50%, 735/1960) with a hospital mortality rate of 13.88% and 54.34% of the survivors not achieving full renal recovery. 1642 drugs were related to AKI in these 735 D-AKI patients. Anti-infectives (34.35%, 564/1642), diuretics (21.80%, 358/1642) and proton pump inhibitors (PPIs) (10.48%, 172/1642) were the top 3 types of drugs relavent to D-AKI, accounting for 66.63% cumulatively. Besides age, AKI staging, severe disease, hypoalbuminemia, plasma substitutes and carbapenems related D-AKI were independent risk factors for in-hospital mortality of D-AKI patients. Interpretation: In China, D-AKI has caused a substantial medical burden. Chinese pharmacists and nephrologists should bear the major responsibility of leading the campaign of managing D-AKI. Funding Statement: This study is supported by Medical Policy and Administration Department, National Health and Family Planning Commission of China, 2015. The National Natural Science Foundation of China (No.91742205 and No.81625004), the Beijing Young Scientist Program (BJJWZYJH01201910001006), and Peking University Clinical Scientist Program by the Fundamental Research Funds for the Central Universities. Declaration of Interests: The authors declare that they have no conflicts of interest. Ethics Approval Statement: This study was approved by the Ethics Committee of Xuanwu Hospital of Capital Medical University.

Incidence and Prognosis of Acute Kidney Diseases and Disorders Using an Integrated Approach to Laboratory Measurements in a Universal Health Care System

Abnormal measurements of kidney function or structure may be identified that do not meet criteria for acute kidney injury (AKI) or chronic kidney disease (CKD) but nonetheless may require medical attention. The Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI proposed criteria for the definition of acute kidney diseases and disorders (AKD), which include AKI; however, the incidence and prognosis of AKD without AKI remain unknown. To characterize the incidence and outcomes of AKD without AKI, with or without CKD. Retrospective cohort study including all adult residents in a universal health care system in Alberta, Canada, without end-stage kidney disease (ESKD) and with at least 1 serum creatinine measurement between January 1 and December 31, 2008, in a community or hospital setting. Data analysis took place in 2018. The Kidney Disease: Improving Global Outcomes guideline definitions for CKD, AKI, and AKD based on serum creatinine, estimated glomerular filtration rate, and albuminuria criteria were applied to estimate the proportion of patients with CKD, AKI, and AKD without AKI, and combinations of the conditions. Patients were followed up for up to 8 years (study end date, June 31, 2016) to characterize their risks of mortality, development of new CKD, progression of preexisting CKD, and ESKD. Among 1 109 099 Alberta residents included in the cohort, the mean (SD) age was 52.3 (17.6) years, and 43.0% were male. Findings showed that AKD without AKI was common (3.8 individuals without preexisting CKD and 0.6 with preexisting CKD per 100 population tested). In Cox proportional hazards and competing risks models over a median (interquartile range) of 6.0 (5.7-6.3) years of follow-up, AKD without AKI (compared with no kidney disease) was associated with higher risks of developing new CKD (37.4% vs 7.4%%; adjusted sub-hazard ratio [sHR], 3.17; 95% CI, 3.10-3.23), progression of preexisting CKD (49.5% vs 34.6%; adjusted sHR, 1.38; 95% CI, 1.33-1.44), ESKD (0.6% vs 0.1%; adjusted sHR, 8.56; 95% CI, 7.32-10.01), and death (25.8% vs 7.3%; adjusted hazard ratio, 1.42; 95% CI, 1.39-1.45). Criteria for AKD identified many patients who did not meet the criteria for CKD or AKI but had overall modestly increased risks of incident and progressive CKD, ESKD, and death. The clinical importance of AKD remains to be determined.