Higher Risk Of Acute Kidney Injury Research Articles

Urinary [TIMP-2]·[IGFBP7]-guided randomized controlled intervention trial to prevent acute kidney injury in the emergency department.

Early detection and prevention of acute kidney injury (AKI) is important to reduce morbidity and mortality. Discovery of early-detection biomarkers has enabled early preventive approaches. There are no data on early biomarker-guided intervention with nephrological consultation in emergency departments (EDs). In this prospective randomized controlled intervention trial, patients at high risk for AKI were screened with urinary [TIMP-2]·[IGFBP7] in the ED of Robert-Bosch-Hospital (Stuttgart, Germany). We screened 257 eligible patients of whom 100 met the inclusion criteria, with urinary [TIMP-2]·[IGFBP7] >0.3, and were included. The intervention group received immediate one-time nephrological consultation after randomization, implementing Kidney Disease: Improving Global Outcomes (KDIGO) 2012 recommendations on AKI. The primary outcome was the incidence of moderate to severe AKI within the first day after admission. Secondary outcomes were AKI occurrence within 3 days after admission, need for renal replacement therapy (RRT), length of hospital stay and death. The primary outcome did not differ significantly (P = 0.9) between the groups, neither within the first day nor within the first 3 days after admission. The intervention group had significantly (P < 0.05) lower serum creatinine (SCr) on Day 2 and lower maximum SCr and tended (P = 0.08) to have higher urine output (UOP) at Day 3 than the non-intervention group. No patient in the intervention group needed RRT (0 versus 3) during the hospital stay (P = 0.09). One-time routine nephrologist-guided application of the KDIGO bundle in ED patients with a risk for AKI cannot currently be recommended. However, due to the uniform trend of study endpoints in favour of intervention, further trials to investigate larger cohorts of more severely ill patients are warranted. www.ClinicalTrials.gov, study number NCT02730637.

Cardiac and Vascular Surgery-Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group.

Acute kidney injury (AKI) occurs in 7% to 18% of hospitalized patients and complicates the course of 50% to 60% of those admitted to the intensive care unit, carrying both significant mortality and morbidity.[1][1] Even though many cases of AKI are reversible within days to weeks of occurrence, data

Impact of total body weight on acute kidney injury in patients with gram-negative bacteremia

ABSTRACTBackground: The impact of total body weight (TBW) on the development of acute kidney injury (AKI) associated with gram-negative bacteremia has not been previously evaluated.Methods: The cohort included 323 patients >/ = 18 years old with gram-negative bacteremia (1/1/2008–8/31/2011) who received >/ = 48 hours of antibiotics. We compared the incidence of AKI in patients with a TBW </ = 80kg vs. >80kg with a multivariable stepwise logistic regression adjusting for age >/ = 70 years, baseline serum creatinine of > 2.0 mg/dl, and receipt of a vasopressor. AKI was defined as an increase of 0.5 mg/dL or a > 50% increase from baseline for at least two consecutive days.Results: The cohort was 62% TBW </ = 80kg and 38% TBW >80kg. TBW >80kg patients had higher risk of AKI (24% vs. 9%, p < 0.001), which was significant in the multivariable analysis (OR 3.41, 95% CI 1.73–6.73). A baseline serum creatinine of > 2.0 mg/dl and vasopressor use were also independently associated with AKI.Conclusions: TBW >80kg was associated with the development of AKI. However, the mechanism for this association is not clear.

Association between central venous pressure as assessed by echocardiography, left ventricular function and acute cardio-renal syndrome in patients with ST segment elevation myocardial infarction.

Recent reports have demonstrated the adverse effects of venous congestion on renal function in patients with heart failure. None of these trials, however, has evaluated the effect of acute myocardial ischemia on the occurrence of acute kidney injury (AKI). We conducted a retrospective study of 1336 ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) between June 2012 and June 2016. Comprehensive echocardiographic examination was performed within 72h of hospital admission. Non-invasive evaluation of central venous pressure (CVP) was estimated from measurements of inferior vena cava diameter and its collapsibility. Intermediate-high CVP was defined as ≥ 8mm/Hg. Patients were stratified according to left ventricular ejection fraction (LVEF) and CVP and assessed for AKI. Intermediate-high CVP was associated with AKI both in patients with LVEF greater than 45% and those with 45% or lower. Patients having LVEF ≤ 45% and intermediate-high CVP had a 10-fold increase in the incidence of AKI compared to patients with LVEF > 45% and normal CVP (39 vs. 4%). In a multivariable logistic regression model, intermediate-high CVP was independently associated with AKI (OR = 2.73, 95% CI 1.54-4.87; p = 0.001). Other variables associated with AKI included LVEF ≤ 45% (OR = 2.37, 95%CI 1.25-4.51; p = 0.008), time to reperfusion, mechanical ventilation and chronic kidney disease. Among STEMI patients undergoing PCI, the utilization of simple echocardiographic measurements (LVEF and CVP) may be useful for early identification of those at high risk for AKI.

Association between influenza vaccination and the reduced risk of acute kidney injury among older people: A nested case-control study

ObjectiveThe objective of this study is to determine whether vaccination against influenza is associated with a reduced risk of acute kidney injury (AKI) in a nationwide cohort of adults aged ≥65 years. MethodsWe investigated a total of 13,270 patients aged ≥65 years who were hospitalized for AKI between 2000 and 2013 from Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, monthly income, urbanization level, and baseline comorbidities. Odds ratios (ORs) for AKI associated with exposure to the influenza vaccine in the previous year were calculated in a nested case-control analysis. ResultsInfluenza vaccination in the previous year was associated with a lower risk of AKI (adjusted OR 0.67, 95% confidence interval [CI] 0.63–0.72). Compared with a reference group of unvaccinated individuals with no influenza infection, vaccination with no influenza infection was associated with a lower risk of AKI (adjusted OR 0.68, 95% CI 0.64–0.73). Lack of vaccination and presence of influenza infection was associated with a higher risk of AKI (adjusted OR 1.78, 95% CI 1.57–2.01), whereas the risk of AKI was insignificant in vaccinated patients who developed influenza (adjusted OR 1.01, 95% CI 0.69–1.18). ConclusionsThe risk of AKI was 37% lower among older people who received vaccination against influenza in a real-world setting. Further work is required to clarify causality.

Nephrotoxicity of piperacillin/tazobactam combined with vancomycin: should it be a concern?

The combination of piperacillin/tazobactam (TZP) and vancomycin (VAN) provides a wide spectrum of activity against many pathogens acquired in healthcare settings. However, there have been reports of increased potential for nephrotoxicity with this combination. The aim of this study was to evaluate the nephrotoxic effect of TZP+VAN and to compare it with that of TZP and VAN monotherapies as well as VAN + meropenem (MEM), another broad-spectrum combination. A total of 402 patients receiving any of the antimicrobial regimens for >48 h were evaluated retrospectively over a 2-year period (2012-2013). Patients admitted to the intensive care unit, those with a baseline serum creatinine >2.0 mg/dL, patients on haemodialysis or peritoneal dialysis, pregnant women and those in septic shock were excluded. The presence and severity of acute kidney injury (AKI) was assessed according to the AKIN criteria. The incidence of AKI was significantly higher in the TZP+VAN group (41.3%) compared with the TZP (16.0%), VAN (15.7%) and VAN+MEM (10.1%) groups (P < 0.001). In the multivariate analysis, the risk of AKI increased 3.5-fold in patients treated with TZP+VAN and 1.7-fold in those who were receiving a potentially nephrotoxic drug when the antibiotic regimen was started compared with patients treated with VAN alone. Combined use of TZP+VAN carries a much higher risk of AKI than either antibiotic monotherapy regimen. Therefore, this broad-spectrum combination should be used cautiously in patients with a high likelihood of developing kidney injury.

Preventing EVAR Associated Acute Kidney Injury: The Optimal Strategy Remains Elusive

Preventing EVAR Associated Acute Kidney Injury: The Optimal Strategy Remains Elusive

Endovascular interventions decrease length of hospitalization and are cost-effective in acute mesenteric ischemia

ObjectiveAcute mesenteric ischemia (AMI) continues to be one of the most devastating diagnoses requiring emergent vascular intervention. There is a national trend toward increased use of endovascular procedures, with improved survival for the treatment of these patients. Our aim was to evaluate whether this trend has changed the treatment of AMI and the subsequent impact on length of hospitalization and hospitalization costs. MethodsWe identified all patients admitted for AMI from the National Inpatient Sample from 2004 to 2014 who received open surgical revascularization (OPEN) or an endovascular intervention (ENDO). Primary end points included length of hospital stay and cost of hospitalization. Our secondary end points included acute kidney injury (AKI), in-hospital mortality, and routine discharge. ResultsAmong 10,381 discharges identified in the data set, 3833 (37%; 97.5% confidence interval [CI], 35%-39%) were male patients with a mean age of 69 years (range, 18-98 years); 4543 (44%; 97.5% CI, 41%-47%) patients were treated ENDO, and 5839 (56%; 97.5% CI, 53%-59%) patients were treated OPEN. Although a higher proportion of patients in the ENDO group (28%; 97.5% CI, 24%-31%) vs the OPEN group (14%; 97.5% CI, 11%-16%) had a moderate to severe Charlson Comorbidity Index (P < .0001), ENDO was associated with a lower mortality rate (12.3% [97.5% CI, 9.8%-14.8%] vs 33.1% [97.5% CI, 29.9%-36.2%]; P < .0001) and a lower mean hospitalization cost ($41,615 [97.5% CI, $38,663-$44,567] vs $60,286 [97.5% CI, $56,736-$63,836]; P < .0001). After propensity-adjusted logistic regression analysis, OPEN retained a significant association with higher mortality than ENDO (odds ratio, 3.0; 97.5% CI, 2.2-4.1) and with higher costs (mean, $9196; 97.5% CI, $3797-$14,595). Patients in the OPEN group had higher risk for AKI (P < .0001) and discharge to a skilled nursing facility (P < .0001) rather than home. ConclusionsAlthough the rate of ENDO continues to rise nationally, it still has not surpassed OPEN revascularization in the face of AMI. Patients treated endovascularly demonstrated one-third the rate of in-hospital mortality (odds ratio, 3.0; 97.5% CI, 2.2-4.1), an increased hazard ratio for discharge alive (hazard ratio, 2.27; 97.5% CI, 2.00-2.58), and a cost saving of $9196 (97.5% CI, $3797-$14,595) per hospitalization. Furthermore, they were less likely to develop AKI and to be discharged home after hospitalization.

Role of Renal Angina Index (RAI) to predict development of Acute Kidney Injury (AKI) in children after 72hrs of admission in PICU

Background : Acute Kidney injury (AKI) is a leading cause of increased morbidity and an independent variable for increased risk of mortality in the PICU. AKI lacks physical signs and symptoms to trigger an alert for detection in its early stage. Therefore, there is a need for a predictive scoring system that can predict the development of AKI significantly early. Recently, the empiric concept of renal angina had been transformed into measurable factors and a renal angina index (RAI) had been calculated by some researchers as an emerging predictor to identify children at risk for AKI. A RAI score of ≥8 was observed to be associated with subsequent development of AKI. Methods : This was a prospective observational study (June 2016 to August 2017), conducted in a tertiary care intensive care unit. Children aged between one month and 18 years who were admitted to PICU for various diseases were included. Children who had died or discharged within 24hrs of PICU admission were excluded. On the day of admission, the following data were collected to calculate RAI:1) Risk (depends on presence/ or absence of ventilation and inotropes and /or stem cell transplantation) 2) Estimated Creatinine Clearance (eCCl) and 3) % of Fluid Overload. On Day 3 of PICU stay, children were categorised in two groups: 1) AKI and 2) non-AKI as per KDIGO criteria. Children were followed up to recovery or mortality. The primary outcome variable was presence of AKI 72hrs after PICU admission and the secondary variables were age, gender, height, weight, length of PICU stay, duration of mechanical ventilation, number and duration of inotropes, serum lactate, serum creatinine, requirement and duration of renal replacement therapy (RRT) and RAI. These variables were compared between the two groups. Results : A total of 81 children were included in the study of who 37 subsequently developed AKI. The mean RAI of the AKI group was 10.22±3.09 and the mean RAI of the non-AKI group was 8.14±3.15. This difference was found to be statistically significant (p=0.004). Day 0 RAI ≥8 predicted Day 3 AKI rates with a sensitivity of 78%, positive predictive value of 58%, negative predictive value of 74% and an AUC of 0.77 (95% confidence interval CI= 0.58-0.80). Conclusion : Renal Angina Index can be a useful predictor for development of AKI after 72hrs of PICU admission. Applying the RAI scores, children can be stratified as high risk for AKI and those with RAI ≥8, can be further evaluated with renal biomarkers.

Differential Signature of Obesity in the Relationship with Acute Kidney Injury and Mortality after Coronary Artery Bypass Grafting.

BackgroundObesity is related to several comorbidities and mortality, but its relationship with acute kidney injury (AKI) and long-term mortality remain undetermined in patients undergoing coronary artery bypass grafting.MethodsData from 3,018 patients (age ≥ 18 years) who underwent coronary artery bypass graft surgery from two tertiary referral centers were retrospectively reviewed between 2004 and 2015. Obesity was defined using the body mass index, according to the World Health Organization's recommendation. The odds and hazard ratios in post-surgical, AKI, and all-cause mortality were calculated after adjustment for multiple covariates. Patients were followed for 90 ± 40.9 months (maximum: 13 years).ResultsAmong the cohort, 37.4%, 2.4%, 21.1%, 35.1%, and 4.0% of patients were classified as normal weight, underweight, overweight-at-risk, obese I, and obese II, respectively. Post-surgical AKI developed in 799 patients (26.5%). Patients in the obese groups (overweight-at-risk to obese II) had a higher risk of AKI than did those in the normal-weight group. During the follow-up period, 787 patients (26.1%) died. Underweight patients had a higher risk of mortality than did normal-weight patients, whereas overweight-at-risk, obese I, and obese II patients showed better survival rates.ConclusionAfter coronary artery bypass graft surgery, obese patients encountered a high risk of AKI, and underweight patients exhibited a low chance of survival. Awareness of both obese and underweight statuses should be raised in these patients.

USE OF FUROSEMIDE STRESS TEST FOR EDEMA CONTROL AND PREDICTING ACUTE KIDNEY INJURY IN CHILDREN WITH NEPHROTIC SYNDROME

Background: Furosemide stress test (FST) involves measurement of 2?h urine output after giving 1 mg/kg of furosemide in clinically&nbsp;euvolemic patients and has been shown to identify those with severe and progressive acute kidney injury (AKI). Objectives: To&nbsp;assess whether using FST could help in deciding whether to give diuretics only, or combination of diuretics with albumin infusion,&nbsp;in children with nephrotic syndrome with edema to prevent AKI. Materials and Methods: This prospective, pilot cohort study was&nbsp;conducted on the use of FST to manage edema in children with nephrotic syndrome. Consecutive patients 1–14 years were enrolledfrom October 2016 to April 2017 from the pediatric nephrology outpatient department of a tertiary care center. They were assessed for&nbsp;fluid overload using their present and baseline weight. Patients with fluid overload of ?10% were screened for AKI by measurement&nbsp;of serum urea and creatinine and monitoring of urine output in the next 24 h. Systemic infections were excluded using clinical and&nbsp;laboratory criteria. AKI was defined using the pediatric RIFLE score. Children with fluid overload of ?10% were given intravenous&nbsp;furosemide 1 mg/kg provided; they had no clinical signs of intravascular dehydration or shock. Urine output was measured over thenext 2 h. Children with urine output &lt;1 ml/kg/h after FST were presumed to be at risk for progressive AKI. Differences between&nbsp;the average heart rate, serum albumin, and urea/creatinine ratio were analyzed by independent t?test. Results: A total of 67 children&nbsp;with nephrotic syndrome were reviewed, and 34 with fluid overload of &gt;10% were analyzed for inclusion in the study. Of them,&nbsp;11 were excluded and 23 were finally analyzed. 19/23 had urine output &gt;1 mg/kg/h in next 2 h and none had serum creatinine&nbsp;increase &gt;0.3 mg/dl or &gt;150% of the baseline value. 4 had urine output &lt; 1 ml/kg/h. Significant difference was found in the post?FSTheart rate and urea/creatinine ratio between the children who had urine output &gt;1 ml/kg/h and which had &lt; 1 ml/kg/h after furosemide.&nbsp;These children were assumed to be at risk for severe and progressive AKI as per FST and were thereafter given furosemide with&nbsp;albumin to prevent further intravascular dehydration. Conclusion: FST may be used as a bedside test to help identify the children&nbsp;with nephrotic syndrome with intravascular dehydration who are at high risk for AKI and helps rational use of diuretics.&nbsp

Understanding the implementation of ‘sick day guidance’ to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation

ObjectivesThe study sought to examine the implementation of sick day guidance cards designed to prevent acute kidney injury (AKI), in primary care settings.DesignQualitative semistructured interviews were conducted and comparative analysis...

Association Between High Environmental Heat and Risk of Acute Kidney Injury Among Older Adults in a Northern Climate: A Matched Case-Control Study

An association between high heat and acute kidney injury (AKI) has been reported in warm climates. However, whether this association generalizes to a northern climate, with more variable temperatures, is unknown. Matched case-control study. Our study focused on older adults (mean age, 80 years) in the northern climate of Ontario, Canada. 52,913 case patients who had a hospital encounter with AKI in April through September 2005 to 2012 were matched with 174,222 controls for exact date, age, sex, rural residence, income, and history of chronic kidney disease. Heat periods were defined as 3 consecutive days exceeding the 95th percentile of area-specific maximum temperature. Hospital encounter (inpatient admission or emergency department visit) with a diagnosis of AKI. ORs (95% CIs) were used to assess the association between heat periods and AKI. To quantify the effect in absolute terms, we multiplied the population incidence rate of AKI in the absence of heat periods byour adjusted OR (an approximate of relative risk). Heat periods were significantly associated with higher risk for AKI (adjusted OR, 1.11; 95% CI, 1.00-1.23). Heat periods in absolute terms were associated with an additional 182 cases of AKI per 100,000 person-years during the warm season. We did not know how long persons were outside or if they had access to air conditioning. In a northern climate, periods of higher environmental heat were associated with a modestly higher risk for hospital encounter with AKI among older adults.

A new plasma biomarker enhance the clinical prediction of postoperative acute kidney injury in patients with hepatocellular carcinoma

BackgroundThe ratio of serum γ-glutamyl transferase (GGT) to alanine aminotransferase (ALT) (GGT/ALT) is a marker for evaluating effects to antivirotic treatment and a helpful predictive factor for the prognosis of Child-Pugh A hepatocellular carcinoma (HCC) patients after surgery. The relationship between the incidence of postoperative acute kidney injury (AKI) and preoperative GGT/ALT is studied in hepatectomized hepatitis B- or C– associated HCC patients. MethodsA total of 253 hepatitis B or C virus-related HCC patients undergoing hepatectomy between September 2012 and August 2016 at our hospital were included in the retrospective study. Serum ALT and GGT value were recorded, and the GGT/ALT was computed. AKI was defined that based on the “Kidney Disease Improving Global Outcomes (KDIGO) criteria”. ResultsAKI was observed in 22 (8.7%) patients. Mean GGT/ALT of patients with AKI was significantly higher than in those without it (6.0 vs 2.1, P<0.001). Multivariate analysis revealed an increase in GGT/ALT as an independent risk factor for AKI in hepatitis B- or C- associated HCC patients, particularly in patients with Barcelona Clinic Liver Cancer (BCLC) stage 0 or A staged HCC (odds ratio (OR) 1.400, P<0.001). Multivariate analysis showed that ALT (OR 0.966, P=0.044) was somewhat inversely associated with the incidence of AKI in hepatitis B- or C- associated HCC patients. The best cutoff point of GGT/ALT was 2.92. Multivariate analysis showed that preoperative GGT/ALT ≥2.92 predicted poor prognosis of postoperative AKI in patients with HCC after hepatectomy (odds ratio 17.697, P<0.001). After propensity score matching, preoperative GGT/ALT ≥2.92 remained an independent risk factor for AKI in HCC patients (OR 13.947, P=0.003). ConclusionsThe GGT/ALT of patients with AKI was significantly higher than those without it. Evaluation of GGT/ALT before surgery can be a helpful predictive tool for postoperative AKI in hepatitis B- or C– associated HCC patients undergoing hepatectomy, particularly in patients with BCLC stage 0 or A staged HCC. Hepatitis B- or C- associated HCC patients with low ALT especially within the normal range may have a high risk of AKI. However, the reason remains to be elucidated.

A Salivary Urea Nitrogen Dipstick to Detect Obstetric-Related Acute Kidney Disease in Malawi

IntroductionObstetric-related acute kidney injury (AKI) is associated with adverse outcomes for mother and fetus, particularly in low-income countries. However, laboratory-independent tools to facilitate diagnosis are lacking. We assessed the diagnostic performance of a salivary urea nitrogen (SUN) dipstick to detect obstetric-related acute kidney disease in Malawi.MethodsWomen at high risk for AKI admitted to an obstetric unit in Blantyre, Malawi, were recruited between 21 September and 11 December 2015. Patients underwent serum creatinine (SCr) testing alongside measurement of SUN using a dipstick on admission, and every 48 hours thereafter if evidence of kidney disease was found.ResultsA total of 301 patients were included (mean age 25.9 years, 11% HIV positive). Of the patients, 23 (7.6%) had AKI, stage 1 in 47.8%, most commonly due to preeclampsia/eclampsia. Mean presenting SCr values were 108.8 ± 21.8 μmol/l (1.23 ± 0.25 mg/dl), 118 ± 34.45 μmol/l (1.33 ± 0.39 mg/dl), and 136.1 ± 30.4 μmol/l (1.54 ± 0.34 mg/dl) in AKI stages 1 to 3 respectively. SUN > 14 mg/dl had a sensitivity of 12.82% and a specificity of 97.33% to detect acute kidney disease; the area under the receiver operating characteristic curve was 0.551. In patients with normal SUN on admission, perinatal mortality was 11.8%, and was 25.0% if SUN was > 14 mg/dl (P = 0.18).ConclusionThe SUN dipstick was specific but insensitive when used to diagnose obstetric-related AKI. Limited biochemical derangement and low salivary urea concentrations due to physiological changes in pregnancy, as opposed to a technical limitation of the dipstick itself, are the likely reason for the lack of sensitivity in this study.

The assessment of acute kidney injury in critically ill patients

Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. The availability of several biomarkers of kidney injury offers new tools for its early recognition and management. The early identification of high-risk patients provides an opportunity to develop strategies for the prevention, early diagnosis and treatment of AKI. Despite progress in critical care medicine over the past decade, the treatment strategies for AKI in critically ill patients, such as when to start renal replacement therapy, remain controversial. A recently proposed risk prediction score for AKI, based on routinely available clinical variables, presents a new means of identifying patients at high risk of AKI.

Study of Acute Kidney Injury on 309 Hypertensive Inpatients with ACEI/ARB – Diuretic Treatment

BackgroundThe present study investigated risk factors for acute kidney injury (AKI) in patients found to be hypertensive during hospitalization who were prescribed angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists (ARB) + diuretic combinations, in order to determine which type of diuretic or combination of diuretics used in ACE/ARB-treated patients leads to a higher risk of acute kidney injury. MethodData on basic information, medical history, diagnostic information and medications prescribed were obtained from the patients' medical records. Retrospective analysis of potential risk factors and ACEI/ARB + diuretic use with AKI was performed. ResultsMultivariate analysis showed initial risk factors for AKI to be chronic kidney disease and poor cardiac function. In univariate analysis, patients whose baseline serum creatinine was between 115 and 265 μmol/L also had a higher risk of AKI. The combination of furosemide and spironolactone produced only approximately a third of the risk of AKI as the combination of hydrochlorothiazide and spironolactone. ConclusionsChronic kidney disease and poor cardiac function are major risk factors for AKI in hypertensive inpatients using ACEI/ARB + diuretic therapy. The combination of thiazide diuretic and aldosterone antagonist had a higher risk of AKI than other single diuretics or diuretic combinations.

Incidence and Risk Factors of Postoperative Acute Kidney Injury in Non- Cardiac Major Surgery.

Acute kidney injury (AKI) occurs in approximately 1-7% of all hospitalized patients. Those patients undergo major surgical procedures are at high risk for AKI due to high volume blood loss, electrolytes disturbance, development of preoperative infection or sepsis and presence of several co-morbidities that may impair renal function. However, published data on postoperative kidney injury are scarce outside the cardiovascular surgery setting. Therefore the study was designed to find out the incidence and risk factors of postoperative acute kidney injury in non-cardiac major surgery. A cross-sectional observational study was conducted in the department of nephrology, BSMMU, Dhaka from January 2014 to December 2014. In this study we found the overall incidence of postoperative AKI 6%. Among the risk factors-male sex, increased age, lengthy operation, exposure to general anesthesia, perioperative hypotension, blood transfusion and use of nephrotoxic drugs (NSAIDs, Aminoglycosides) are important.Faridpur Med. Coll. J. Jul 2016;11(2): 47-49

Association of mannitol (MAN) with cisplatin (CIS)-induced nephrotoxicity (NTX) and cumulative CIS dose (CCD).

6051 Background: CIS is widely used in cancer therapy with CCD linked to survival outcome. CCD, however, is constrained by side effects—particularly NTX (incidence 20-30%). MAN is widely used to prevent CIS NTX despite low level of evidence. Herein, we took advantage of a national shortage of MAN to examine renoprotective effects of MAN in CIS treated patients. Methods: Between 2006-2012, 704 consecutive pts undergoing CIS therapy, with or without MAN, were analyzed. Pt characteristics, oncologic diagnosis, treatment, and renal function data were collected. The primary objective was to compare clinically significant NTX, as defined by &gt; 25% reduction in glomerular filtration rate (GFR) from baseline, between the treatment groups. Cox proportional hazards regression was used to model the hazard of NTX as a function of CIS dose. Results: Of 704 pts, 442 were treated with MAN and 262 without. The median age was 58.9 years. Age (p = 0.83), gender (p = 0.77), and race (p = 0.056) were similar between groups whereas baseline GFR (MAN 91.2 ± 22; CIS 86.3 ± 24; p = 0.005) and diagnoses (p &lt; 0.001) differed. The distribution of diagnoses was: head and neck (25.9%), genitourinary (26.0%), lung (14.3%), gastrointestinal (10.4%), lymphoma (4.5%), and other (18.9%). The mean CIS dose (mg) per cycle in MAN versus CIS only group was 126.1 ± 58 and 109.3 ± 58 respectively (p &lt; 0.001). The CCD (mg) was higher in the MAN compared to the CIS only group (469.8 ± 295 versus 299.0 ± 241; p &lt; 0.001). After adjusting for baseline GFR, age, gender, race, and diagnoses, the MAN group experienced lower risk of &gt; 25% decrease in GFR at any given CCD (HR: 0.68, CI: 0.51-0.91, p = 0.01). Females (HR: 1.72, CI: 1.28-2.32; p = 0.0003), older pts (HR: 1.24, CI: 1.10-1.40; p = 0.0003), and Hispanic pts (HR: 2.39, 1.04-5.50; p = 0.04) were more likely to sustain &gt; 25% reduction in GFR. Conclusions: MAN enhances CCD by protecting against CIS-induced NTX. Pts with MAN experienced a lower risk of clinically significant acute kidney injury (AKI) and received a higher average CIS dose per cycle and CCD. Women, older pts, and Hispanic pts had a higher risk of AKI. Future investigation is warranted to examine whether MAN-associated CCD effects translate into survival advantages.

Intensive Monitoring of Urine Output Is Associated With Increased Detection of Acute Kidney Injury and Improved Outcomes

Urine output (UO) is a vital sign for critically ill patients, but standards for monitoring and reporting vary widely between ICUs. Careful monitoring of UO could lead to earlier recognition of acute kidney injury (AKI) and better fluid management. We sought to determine if the intensity of UO monitoring is associated with outcomes in patients with and those without AKI. This was a retrospective cohort study including 15,724 adults admitted to ICUs from 2000 to 2008. Intensive UO monitoring was defined as hourly recordings and no gaps >3 hours for the first 48 hours after ICU admission. Intensive monitoring for UO was conducted in 4,049 patients (26%), and we found significantly higher rates of AKI (OR, 1.22; P< .001) in these patients. After adjustment for age and severity of illness, intensive UO monitoring was associated with improved survival but only among patients experiencing AKI. With or without AKI, patients with intensive monitoring also had less cumulative fluid volume (2.98L vs3.78 L; P< .001) and less fluid overload (2.49%vs5.68%; P< .001) over the first 72 hours of ICU stay. In this large ICU population, intensive monitoring of UO was associated with improved detection of AKI and reduced 30-day mortality in patients experiencing AKI, as well as less fluid overload for all patients. Our results should help inform clinical decisions and ICU policy about frequency of monitoring of UO, especially for patients at high risk of AKI or fluid overload, or both.