High Risk Of Acute Renal Failure Research Articles

The Influence of Solid Organ Transplant on Inpatient Complications, Length of Stay, and Hospital Costs in Reverse Shoulder Arthroplasty Patients.

With innovations in transplant medicine and longer life expectancies in solid organ transplant (SOT) recipients, the incidence of shoulder arthroplasty is predictably rising in this population. Reverse shoulder arthroplasty (RSA) has become increasingly popular due to advances in prosthetic design with expanded indications. While previous studies have examined shoulder arthroplasty in SOT patients, information specifically related to RSA patients is largely unexplored. We aim to analyze the demographics and characteristics of SOT patients who have undergone RSA while assessing inpatient complication rates, length of stay (LOS), and hospital costs in these patients compared to a matched cohort of non-transplant patients. The National Inpatient Sample (NIS) Database was utilized to identify all patients undergoing RSA from 2016 to 2019. We generated propensity-matched groups based on pre-operative variables (diabetes, tobacco use, sex, age, and obesity) to compare complications, LOS, and inpatient costs between the SOT and control groups. T-tests and Chi-squared tests were performed where appropriate and odds ratios were calculated. We identified 59925 patients who underwent RSA. Among those, 59769 patients (99.7%) did not have a SOT and 156 patients (0.26%) had a history of SOT. Patients in the SOT group were younger than the control group (67.0 versus 71.4 years, p<0.001). The SOT group were more likely males compared to the control group (53.8% versus 39.3%, p<0.001). Following 1:1 matching, there were 156 patients in each group. The SOT group had a higher risk of acute renal failure (ARF) compared to the control group (OR 9.41, 95% CI (2.13-41.49), p<0.001). The LOS (p<0.001) and inpatient costs (p<0.001) were higher in the SOT group. For RSA, SOT patients are younger and more likely male compared to those without SOT. Inpatient medical and surgical complications are similar between SOT and non-SOT patients, except SOT patients have a higher risk of ARF. SOT patients tend to have longer LOS and higher inpatient costs than non-SOT patients.

Hemofiltration and Hemodialysis in the Prevention and Treatment of Acute Renal Failure after Cardiac Surgery under Extracorporeal Circulation

Objective: to analyze the efficiency of hemofiltration (HF) in the stage of extracorporeal circulation (EC) during cardiac surgery in order to prevent acute renal function lowering and the development of acute renal failure (ARF). Materials and methods. The risk of postoperative ARF requiring renal replacement therapy (RRT) was preoperatively assessed by the summed Cleveland risk score and percentage (2005). HF during EC was used in patients at high risk for ARF. The procedure was performed, by combining 2 extracorporeal circuits: EC and a Diapact®CRRT apparatus. With evolving ARF, Stage 3 after Risk, Injury, Failure, Loss of Kidney Function, End-stage Renal Disease (RIFLE), 2004, and Acute Kidney Injury Network (AKIN), 2007, continuous venovenous hemofiltration (CVVHF) and continuous high-flow hemodialysis (CHFHD) were done in the dialysate recirculation mode after surgery under EC. The Mann-Whitney non-parametric test was used to estimate the significance of intergroup differences. The results are presented: median (lower quartile; upper quartile), the differences considered to be significant atpResults. HF during EC; 6 patients were aged 65.5 (range 57—70) years with chronic kidney disease, preoperative glomerular filtration rate (GFR) was 50 (range 41.5—65) ml/min/1.73 m2 using the Cockroft-Gault formula. The maximum GFR decrease by 2.9 (range 0.7—7) ml/min/1.73 m2 was seen after EC. A control group comprised 12 patients aged 73 (range 63—75) years. There was a postoperative GFR reduction by 17 (range 13.7—22) ml/min/1.73 m2. One patient from the control group developed ARF and multiple organ dysfunction, which required CVVHF and CHFHD. Conclusion. The use of intraoperative HF in patients at high risk for renal function lowering is likely to prevent a considerable GFR reduction and ARF after surgery under EC.

Exenatide and sitagliptin are not associated with increased risk of acute renal failure: a retrospective claims analysis

This study evaluated whether the risk of acute renal failure (ARF) increases with exenatide and sitagliptin use. A retrospective cohort study of a large medical and pharmacy claims database was performed. Data for 4 91 539 patients were analysed. Cox proportional hazard models were used to compare the risk of ARF between diabetic and non-diabetic subjects and between diabetic patients treated with exenatide, sitagliptin and control medications. Adjusted Cox analyses showed diabetic subjects had a higher risk of ARF [HR 1.51, confidence interval (CI) 1.26-1.81, p < 0.001] than non-diabetic controls. Compared with diabetic controls, neither exenatide (HR 0.77, CI 0.42-1.41, p = 0.40) nor sitagliptin (HR 1.17, CI 0.82-1.65, p = 0.39) increased the risk of ARF. Our study revealed an increased incidence of ARF in diabetic versus non-diabetic patients but no association between use of exenatide or sitagliptin and ARF. Because of the limitations of this observational analysis, we cannot exclude the possibility of a very small increased risk.

Acute renal failure in severe pancreatitis: A population-based study

Introduction. Acute pancreatitis (AP) is a common illness with varied mortality and morbidity. Patients with AP complicated with acute renal failure (ARF) have higher mortality than patients with AP alone. Although ARF has been proposed as a leading mortality cause for AP patients admitted to the ICU, few studies have directly analyzed the relationship between AP and ARF.Methods. We performed a retrospective study using the population-based database from the Taiwan National Health Insurance Research Database (NHIRD). In the period from 1 January 2005 to 31 December 2005, every patient with AP admitted to the ICU was included and assessed for the presence of ARF and mortality risk.Results. In year 2005, there were a total of 221,101 admissions to the ICU. There were 1,734 patients with AP, of which 261 (15.05%) patients also had a diagnosis of ARF. Compared to sepsis and other critical illness, patients with AP had a higher risk of having a diagnosis of ARF, and patients with both diagnoses had a higher mortality rate in the same ICU hospitalization.Conclusion. AP is associated with a higher risk of ARF, and, when both conditions exist, a higher risk of mortality is present.

Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis

Purpose Acute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF. Methods Thirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated. Results The median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (>10 000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL. Conclusions The peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.

Development and Validation of a Prediction Score for Postoperative Acute Renal Failure Following Liver Resection

To develop and validate a score to predict postoperative acute renal failure (ARF) after liver resection. Postoperative ARF after major surgery is associated with morbidity and mortality. Early identification of patients at risk of ARF is important in order to provide protective kidney treatment. Postoperative ARF was prospectively assessed in consecutive patients undergoing liver resection. In randomly selected two-third of the total number of patients, multivariate logistic regression analysis was used to develop a new prediction score (including a full and a reduced model), based on the preoperative parameters of age, gender, preexisting chronic renal dysfunction, cardiovascular disease, diabetes, bilirubin, and alanine aminotransferase (ALT) levels. In the remaining last third of the patients, the new score was validated by calibrating the accuracy of the score (ClinicalTrials.gov NCT 00743132). Postoperative ARF occurred in 15.1% (86 of 569 consecutive patients) from 2002 to 2007 and was highly associated with mortality (22.5% vs. 0.8% without ARF, P < 0.001). In the 380 (two-third of the population) patients selected for the development of the prediction score, preoperatively elevated ALT, preexisting cardiovascular disease, chronic renal failure, and diabetes were the strongest predictors of ARF. Validating the full prediction model (0-22 points) to the remaining 189 patients (one-third of the population), the risk could be predicted accurately (mean predicted risk of 11.5% vs. an observed risk of 14.8%) without significant differences between predicted and observed risks across different risk categories (P = 0.98). Prediction with the reduced model including the 4 strongest predictors (0-7 points) was almost as accurate as with the full model (11.4% predicted vs. 14.8% observed) and also without significant differences across different risk categories (P = 0.75). The new prediction score (the full as well as the reduced model) accurately predicted postoperative ARF after liver resection. The use of these scores allows early identification of patients at high risk of ARF, and may support decision making for protective kidney interventions perioperatively.

Effects of a predominantly hydroxyethyl starch (HES)-based and a predominantly non HES-based fluid therapy on renal function in surgical ICU patients

To compare the effects of predominantly hydroxyethyl starch (HES 6% 130/0.4)-based with predominantly gelatin 4%-based fluid therapy on renal function in surgical intensive care unit (ICU) patients. Before-after, retrospective, study of surgical ICU patients. All patients admitted from January to June 2005 formed the HES group, with HES 130/0.4 as the standard colloid of choice. All patients admitted from January to June 2006 formed the GEL group, with gelatin 4% as the primary colloid. Acute renal failure (ARF) was defined as new need for renal replacement therapy (RRT) or at least a two-fold increase in baseline creatinine. There were 1383 patients in the HES group and 1528 in the GEL group; 118 and 87, in each group respectively, had severe sepsis. The incidence of ARF and ICU and hospital mortality rates were similar in the two groups. In a post-hoc multivariable analysis, cumulative doses >33 ml/kg of either HES (OR = 1.85, 95% CI: 1.01-3.41, p < 0.001) or gelatin (OR = 1.99, 95% CI: 1.05-3.79, p = 0.035) were associated with a higher risk of ARF. The incidence of ARF was similar in patients who received predominantly HES (6% 130/.04) fluid therapy and in those who received predominantly gelatin 4%. Moderate cumulative doses of modern HES or gelatin solutions may be associated with a higher risk of ARF.

Measurement of tubular enzymuria facilitates early detection of acute renal impairment in the intensive care unit

Early detection of acute tubular necrosis (ATN) could permit implementation of salvage therapies and improve patient outcomes in acute renal failure (ARF). The utility of single and combined measurements of urinary tubular enzymes in predicting ARF in critically ill patients has not been evaluated using the receiver-operating characteristic (ROC) plot method. In this prospective pilot study, 26 consecutive critically ill adult patients admitted to the intensive-care unit were studied. Urine samples were collected twice daily for up to 7 days. ARF was defined as an increase in plasma creatinine of > or = 50% and > or = 0.15 mmol/l. ROC plot analysis was applied to the tubular marker data to derive optimum cut-offs for ARF. Four of the 26 study subjects (15.4%) developed ARF. Indexed to urinary creatinine concentration, gamma glutamyl transpeptidase (gamma GT), alkaline phosphatase (AP), N-acetyl-glucosaminidase (NAG), and alpha- and pi-glutathione S-transferase (alpha- and pi-GST) but not lactate dehydrogenase (LDH) were higher in the ARF group on admission (P<0.05). gamma GT, and alpha- and pi-GST remained elevated at 24 h. The onset of ARF based on changes in plasma creatinine varied from 12 h to 4 days (median 36 h). ROC plot analysis showed that gamma GT, pi-GST, alpha-GST, AP and NAG had excellent discriminating power for ARF (AUC 0.950, 0.929, 0.893, 0.863 and 0.845, respectively). The discriminating strength of creatinine clearance, while lower, was still significant (AUC 0.796). Positive and negative predictive values for ARF on admission were 67/100% for gamma GT, 67/90% for AP, 60/95% for alpha-GST, and 67/100% for pi-GST indices. Positive and negative predictive values for ARF for creatinine clearance < or = 23 ml/min were 50 and 91%, respectively. Creatinine clearances tended to be lower in ARF than in non-ARF patients on admission (P=0.06) and were significantly lower (P=0.008) after 12 h. Plasma urea and fractional sodium excretion were unhelpful. Tubular enzymuria on admission to the ICU is useful in predicting ARF. The cheapness and wide availability of automated assays for gamma GT and AP suggests that estimation of these enzymes in random urine samples may be particularly useful for identifying patients at high risk of ARF.

Incidence and Prognostic Importance of Acute Renal Failure After Percutaneous Coronary Intervention

In patients undergoing percutaneous coronary intervention (PCI) in the modern era, the incidence and prognostic implications of acute renal failure (ARF) are unknown. With a retrospective analysis of the Mayo Clinic PCI registry, we determined the incidence of, risk factors for, and prognostic implications of ARF (defined as an increase in serum creatinine [Cr] >0.5 mg/dL from baseline) after PCI. Of 7586 patients, 254 (3.3%) experienced ARF. Among patients with baseline Cr <2.0, the risk of ARF was higher among diabetic than nondiabetic patients, whereas among those with a baseline Cr >2.0, all had a significant risk of ARF. In multivariate analysis, ARF was associated with baseline serum Cr, acute myocardial infarction, shock, and volume of contrast medium administered. Twenty-two percent of patients with ARF died during the index hospitalization compared with only 1.4% of patients without ARF (P<0.0001). After adjustment, ARF remained strongly associated with death. Among hospital survivors with ARF, 1- and 5-year estimated mortality rates were 12.1% and 44.6%, respectively, much greater than the 3.7% and 14.5% mortality rates in patients without ARF (P<0.0001). The overall incidence of ARF after PCI is low. Diabetic patients with baseline Cr values <2.0 mg/dL are at higher risk than nondiabetic patients, whereas all patients with a serum Cr >2.0 are at high risk for ARF. ARF was highly correlated with death during the index hospitalization and after dismissal.