Acute Kidney Injury In Hospital Research Articles

Urine protein to creatinine ratio remains informative despite non-steady state serum creatinine during AKI

IntroductionExperts have cautioned that assessment of proteinuria using urine protein to creatinine ratios (UPCRs) are not valid during acute kidney injury (AKI) since reduced urine creatinine in the denominator may artificially inflate the ratio. However, there is little empiric data assessing this theoretical concern. MethodsHere, we retrospectively examined changes in UPCRs measured during episodes of severe AKI and assessed whether the magnitude and direction of these changes associate with how the serum creatinine level is changing at the time of UPCR collection. We repeated these analyses comparing hospitalization UPCRs with pre/post hospitalization UPCRs where available. ResultsAmong 329 adults hospitalized with stage 2 or 3 AKI (defined as peak:nadir serum creatinine during hospitalization ≥2) at the University of California, San Francisco 1/1/2014 to 12/31/2021 with multiple UPCRs measured during AKI hospitalization, UPCR values were similar whether the serum creatinine was rising or falling at the time of measurement (median difference 0.06 g/g, IQR -0.26 to 0.50 g/g). There was no association between the difference in serum creatinine slopes when the UPCRs were collected and the difference in UPCR values (UPCR 0.05 g/g higher per mg/dL/day serum creatinine slope, 95% CI -0.36 to 0.47, p=0.80). UPCRs measured during hospitalization demonstrated positive and negative predictive values suggesting utility in appraising clinically relevant outpatient UPCR levels. ConclusionDespite non-steady state serum creatinine at the time of collection, UPCRs measured during AKI hospitalizations may be more informative than previously believed and should not be wholly disregarded.

Hospital readmission for acute kidney injury is independently associated with de novo end-stage renal disease after liver transplantation.

End-stage renal disease (ESRD) after liver transplantation (LT) is associated with high morbidity and mortality. The consequences of hospitalizations for post-LT acute kidney injury (AKI) are poorly understood. Using linked Medicare claims and transplant registry data, we analyzed adult liver alone recipients not receiving pre-transplant dialysis between 1/1/2007-12/31/2016. Covariate-adjusted Cox proportional hazards models stratified by center evaluated factors associated with AKI readmission during the first post-LT year, and whether AKI readmission was associated with de novo early (<1y) or late (≥1y) ESRD post-LT. The cohort included 10,559 patients and was 64.5% male, 72.5% White, 8.1% Black and 14.0% Hispanic with median age 62 years. Overall, 2,875 (27.2%) patients had ≥1 AKI hospitalization during the first year. eGFR at LT was associated with AKI readmission (aHR 1.16 per 10mL/min/1.73m2 decrease; p<0.001). The aHR for early ESRD in patients with ≥1 AKI readmission <90 days post-LT was 1.90 (p<0.001). The aHRs for late ESRD with 1 and ≥2 prior AKI readmissions were 1.57 and 2.80 respectively (p<0.001). AKI readmissions in the first post-LT year impact over one-quarter of recipients. These increase the risk of subsequent ESRD, but may represent an opportunity to intervene and mitigate further renal dysfunction.

#2146 Gender difference in hospital-acute kidney injury epidemiology and outcome: not just a matter of sex

Abstract Background and Aims Hospital Acute kidney injury (H-AKI) is a complex entity associated with an increased risk of complications and mortality. Its occurrence and outcome are influenced by several patient and organizational-related factors. Due to the biological and genetic differences, sex may greatly influence the kidney function. However, the impact of sex on H-AKI risk and related consequences is still unclear. This retrospective study aimed to assess H-AKI epidemiology and outcomes in a large cohort of hospitalized patients, with a focus on the association with patients' sex. Method From adult patients admitted to two large University Hospitals in Italy between 2016 and 2019, we collected clinical data, serum creatinine (sCr), comorbidities and primary diagnoses as codified in the hospital discharge form (HDF), and data on discharge, length of hospital stay (LOS), and death. Patients with Chronic kidney disease (CKD) stage 5 reported on HDF were excluded. We defined and graded AKI according to the KDIGO criteria, by comparing the peak sCr to the lowest sCr during hospitalization under the assumption that the lowest sCr would represent baseline kidney function. The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-based equation. Results We analyzed 87,087 patients, with an average age of 69.2 ± 17.7 years of whom 43467 (49.9%) were males and 43620 females (50.1%). Female patients were older than males (69.9 ± 16.5 vs 68.5 ± 18.9 years, p &amp;lt; 0.001), had less prevalence of diabetes mellitus (DM) [3797 (8.7%) vs 4695 (11.8%), p &amp;lt; 0.001] and CKD [2609 (6%) vs 3340 (7.7%), p = 0.001] and higher prevalence of heart failure (HF) [4083 (9.3%) vs 3729 (8.6%), p &amp;lt; 0.001]. Admission eGFR was lower in females than males [82.6 (54.5-99.1) vs 84.2 (57.8-99.0) ml/min, p &amp;lt; 0.001] (see Fig. 1). Overall, 17946 patients (20.6%) developed H-AKI, with a higher incidence in females (21.4% vs. 19.8%, p = 0.000). Females with H-AKI were older and exhibited more heart failure, while males presented more acute myocardial ischemia and sepsis. The male/female ratio varied across AKI severity, with stage 3 AKI more frequent in males. AKI awareness, as evaluated by comparing the incidence of AKI diagnosed according to the sCr changes with AKI diagnoses codified on HDF, showed a higher rate of undetection in females. Moreover, when we stratified our cohort according to the age quartiles, we observed that for each AKI stage in the 1st age quartile H-AKI incidence was higher in males, in the second quartile there was no difference between male and female patients, while in the last quartiles, AKI incidence was higher in females (Fig. 2). This tendency was also confirmed by Kaplan-Meier analysis. However, when we separately analyzed the risk of developing AKI in the different quartiles with multivariate logistic regression analysis we found that while in the youngest quartiles the risk of developing AKI was not correlated with sex, in the elderly, female sex was an independent risk factor for developing AKI (3rd quartile OR 1.30, IC 1.21-1.39; 4th quartile OR 1.46 IC 1.38-1.59, adjusted for age, DM, HF, CKD, admission to ICU, sCr, LOS). The analysis of outcomes among AKI patients (Fig. 3) showed that mortality was the same for the youngest patients, while it was higher in male patients for the 3rd and 4th age quartile. A similar trend was found for ICU admission and LOS. Conclusion Sex emerges as a significant determinant of H-AKI development. However, the relationship between sex and H-AKI is not linear. Indeed, AKI incidence, severity, and outcomes vary between males and females across different age groups, probably reflecting the modifications of health status occurring during a lifetime. Consideration of gender differences is crucial in studying AKI to ensure accurate and equitable diagnosis and management.

Acute kidney injury events in patients with diabetes using sodium glucose transporter 2 inhibitors: a meta-analysis of cohort studies.

To conduct a meta-analysis of cohort studies to explore the association between acute kidney injury (AKI) and the effect of sodium glucose transporter 2inhibitors (SGLT2 inhibitors) in patients with type 2 diabetes mellitus (T2DM). PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were comprehensively searched for eligible studies until April 4, 2023 on the association between AKI and use of SGLT2 inhibitors in T2DM patients. Odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method. A total of 10 cohort studies (20 cohorts) and 526,863 participants were included in the meta-analysis. Compared with other glucose-lowering drugs (oGLDs), SGLT2 inhibitors were associated with a decreased risk of AKI (OR = 0.50, 95% CI 0.38-0.66, I2 = 96%). Meanwhile, SGLT2 inhibitors demonstrated a significant reduction in the incidence of AKI hospitalization compared with oGLDs (OR = 0.54, 95% CI 0.43-0.68, I2 = 92.0%). The result was consistent across different subgroups, and was robust to sensitivity analysis. Compared with oGLDs, SGLT2 inhibitors reduced the risk of suffering AKI and AKI hospitalization in the real-world setting. Vigilance to the occurrence of AKI should not be an obstacle to discourage clinicians from prescribing SGLT2 inhibitors.

Intraoperative Normal Saline Administration and Acute Kidney Injury in Patients Undergoing Liver Transplantation

Normal saline is still used in patients undergoing living donor liver transplantation (LDLT) with normonatremia. We investigated whether the normal saline administered during LDLT is associated with the increased risk of acute kidney injury (AKI) compared with the balanced crystalloids. We reviewed 1011 cases undergoing LDLT. The primary exposure variable was normal saline administered intraoperatively compared with the balanced crystalloid. To compare the risk of AKI after adjusting for potential confounders of baseline characteristics and surgical parameters, a propensity score matching analysis was performed. As a sensitivity analysis, ordinal logistic regression analysis was performed for AKI using inverse probability of treatment weighting (IPTW). The incidence of AKI was significantly higher in the saline group (n = 88/174, 50.6%) than in the balanced group (n = 67/174, 38.5%) after matching (P = .010). The incidence of stage 2 or 3 AKI was also significantly higher in the saline group (n = 26/174, 14.9%) than in the balanced group (n = 43/174, 24.7%) after matching (P = .022). The length of hospital stay was significantly longer in the saline group than in the balanced group after matching. Ordinal logistic regression analysis using IPTW showed that the saline group showed a significant association of saline administration with the risk of AKI (odds ratio 1.23, 95% CI 1.05-1.28, P = .013). Our propensity score analysis using propensity score matching and IPTW showed that normal saline administration during LDLT is associated with a high risk of postoperative AKI and longer hospital stays. However, our results should be interpreted carefully due to the relatively long period of data collection.

Prevalence of in Hospital Acute Kidney Injury in Patients Having Admission Hyperuricemia

Prevalence of in Hospital Acute Kidney Injury in Patients Having Admission Hyperuricemia

Association of HIV and viral suppression status with hospital acute kidney injury in the era of antiretroviral therapy

In the modern era, it is unknown if people that are virally suppressed with HIV (PWH) are at increased risk for acute kidney injury (AKI) compared to people without HIV and no studies have compared the risk of AKI by viral suppression status. Here, we determined the associations of HIV status and AKI among PWH with and without viral suppression compared to people without HIV. An observational cohort study of PWH and people without HIV hospitalized in a large New York City health system between 2010-2019 was conducted. Multivariable Cox proportional hazards models were used to determine associations between HIV status and risk of AKI, severe AKI and development of chronic kidney disease (CKD). Among 173,884 hospitalized patients, 4,718 had HIV; 2,532 (53.7%) were virally suppressed and 2,186 (46.3%) were not suppressed. Compared to people without HIV, PWH with and without viral suppression were at increased risk of AKI (adjusted hazard ratio 1.27, 95% confidence interval 1.15, 1.40 and 1.73, 1.58, 1.90, respectively) and AKI requiring kidney replacement therapy (1.89, 1.27, 2.84 and 1.87, 1.23, 2.84, respectively). Incremental, graded associations were observed between HIV status and Stage 2 or 3 AKI, and among AKI survivors, and incident CKD. The elevated risk of AKI across ages of PWH was similar in magnitude to older people without HIV. Thus, regardless of virologic control, HIV is an independent risk factor for AKI among hospitalized patients. Future studies should determine the mechanisms by which HIV increases susceptibility to AKI and identify strategies to prevent AKI in PWH.

Association of Longitudinal B-Type Natriuretic Peptide Monitoring With Kidney Failure in Patients With CKD: A Cohort Study

Both hypervolemia and hypovolemia are associated with chronic kidney disease (CKD) progression. Although longitudinal monitoring of B-type natriuretic peptide (BNP) may aid physicians' decision making about the optimization of volume status, its clinical benefit remains uncertain in CKD. This study assessed the association between BNP monitoring and the risk of incident kidney replacement therapy (KRT). Retrospective cohort study. A total of 2,998 outpatients with stages 3-5 of nondialyzed CKD referred to the department of nephrology at an academic hospital. BNP monitoring. KRT, acute kidney injury (AKI), and heart failure hospitalization. Marginal structural models, which create a balanced pseudo population at each time point, were applied to account for potential time-dependent confounders. Inverse probability weighted pooled logistic regression models were employed to estimate hazard ratios. At baseline, the median age and estimated glomerular filtration rate were 66 years and 38.1mL/min/1.73m2, respectively. During the follow-up period (median, 5.9 [IQR, 2.8-9.9] years), 449 patients required KRT, 765 had AKI, and 236 were hospitalized for heart failure. After adjustment for time-updated clinical characteristics and physician-specific practice styles, BNP monitoring was associated with lower risks of KRT (HR, 0.44 [95% CI, 0.21-0.92]), AKI (HR, 0.36 [95% CI, 0.18-0.72]), and heart failure hospitalization (HR, 0.37 [95% CI, 0.14-0.95]). The association between BNP monitoring and KRT was attenuated after additional adjustment for AKI or heart failure hospitalization as a time-varying covariate. Residual confounding by measured and unmeasured variables or indications for BNP measurements. BNP monitoring was associated with a lower risk of KRT among patients with CKD that did not require dialysis. This association is potentially mediated through a reduced risk of AKI or heart failure hospitalization. Both volume overload and volume depletion are deleterious to kidney function. B-type natriuretic peptide (BNP) is a biomarker that reflects volume status not only in heart failure but also in nondialysis chronic kidney disease (CKD). Although longitudinal BNP monitoring may aid physicians' decision making about the optimization of volume status, its clinical benefit remains uncertain in CKD. In this cohort study analyzing 2,998 patients with nondialyzed CKD, BNP monitoring was associated with a lower risk of kidney replacement therapy, acute kidney injury, and heart failure hospitalization over the follow-up period. The association with kidney replacement therapy may be mediated through a reduced risk of acute kidney injury or heart failure hospitalization. BNP monitoring may aid physicians in optimal fluid management, potentially conferring better kidney outcomes.

Impact of initial fluid resuscitation volume on clinical outcomes in patients with heart failure and septic shock

BackgroundFluid resuscitation is a key treatment for sepsis, but limited data exists in patients with existing heart failure (HF) and septic shock. The objective of this study was to determine the impact of initial fluid resuscitation volume on outcomes in HF patients with reduced or mildly reduced left ventricular ejection fraction (LVEF) with septic shock. MethodsThis multicenter, retrospective, cohort study included patients with known HF (LVEF ≤50%) presenting with septic shock. Patients were divided into two groups based on the volume of fluid resuscitation in the first 6 h; <30 mL/kg or ≥30 mL/kg. The primary outcome was a composite of in-hospital mortality or renal replacement therapy (RRT) within 7 days. Secondary outcomes included acute kidney injury (AKI), initiation of mechanical ventilation, and length of stay (LOS). All related data were collected and compared between the two groups. A generalized logistic mixed model was used to assess the association between fluid groups and the primary outcome while adjusting for baseline LVEF, Acute Physiology and Chronic Health Evaluation (APACHE) II score, inappropriate empiric antibiotics, and receipt of corticosteroids. ResultsOne hundred and fifty-four patients were included (93 patients in <30 mL/kg group and 61 patients in ≥30 mL/kg group). The median weight-based volume in the first 6 h was 17.7 (12.2–23.0) mL/kg in the <30 mL/kg group vs. 40.5 (34.2–53.1) mL/kg in the ≥30 mL/kg group (P <0.01). No statistical difference was detected in the composite of in-hospital mortality or RRT between the <30 mL/kg group compared to the ≥30 mL/kg group (55.9% vs. 45.9%, P=0.25), respectively. The <30 mL/kg group had a higher incidence of AKI, mechanical ventilation, and longer hospital LOS. ConclusionsIn patients with known reduced or mildly reduced LVEF presenting with septic shock, no difference was detected for in-hospital mortality or RRT in patients who received ≥30 mL/kg of resuscitation fluid compared to less fluid, although this study was underpowered to detect a difference. Importantly, ≥30 mL/kg fluid did not result in a higher need for mechanical ventilation.

Abstract 283: Outcomes Among Heart Failure Patients Hospitalized For Aortic Dissection: Insight From The National Inpatient Sample

Background: Aortic dissection is a significant cause of morbidity and mortality among hospitalized patients. Previous studies suggested that heart failure (HF) is a significant complication of aortic dissection which oftentimes lead to poor outcomes due to delays in diagnosis and overall increase disease burden. However, there is paucity of data regarding the outcomes of hospitalized aortic dissection patients with comorbid HF. Methods: We utilized the National Inpatient Sample (NIS) Database of the years 2018-2020 in conducting a retrospective cohort study. All analyses were done through StataBE 17.0. Our outcomes of interests were risk for in-hospital mortality, acute kidney injury (AKI) and hospital length of stay (LOS) among hospitalized aortic dissection patients with comorbid HF. Results: A total of 149,026 hospitalized aortic dissection patients were identified in our study, of which 10.27% (n= 15,305/149,026) had HF. Among those, 6390 met our inclusion criteria. The overall in-hospital mortality among aortic dissection patients was 4.14% (n=6,170/149,026). Among those with concomitant HF, the mortality rate was significantly higher at 6.37%(n=407/6390) (p=0.00). After adjusting for possible patient and hospital level confounders, concomitant HF among aortic dissection patients was deemed to be an independent predictor of overall in-hospital mortality (aOR 2.21; 95% CI, 1.46-3.36; p=0.00) and it was found that systolic (aOR 2.47; 95% CI, 1.42-4.29; p=0.00) and diastolic HF (aOR 2.11; 95% CI, 1.08-4.13; p=0.03) were associated with higher in-hospital mortality compared to those with combined HF (aOR 1.48; 95% CI, 0.44-4.95; p=0.52). Further, concomitant HF increased the risk for the development of in-hospital AKI (aOR 3.16; 95% CI, 2.35-4.24; p=0.00) and longer LOS (aOR 4.16; 95% CI, 2.92-5.40; p=0.00), regardless of HF subtype. Conclusion: Our analysis showed that comorbid HF increased the risk for in-hospital mortality, risk for AKI and longer hospital LOS. On subgroup analysis, systolic and diastolic HF were associated with increased risk for in-hospital mortality and all three HF subtypes increased the risk for AKI and were associated with a longer hospital LOS.

Readmission and Mortality After Hospitalization With Acute Kidney Injury

Acute kidney injury (AKI) carries high rates of morbidity and mortality. This study quantified various short- and long-term outcomes after hospitalization with AKI. Retrospective propensity score (PS)-matched cohort study. Optum Clinformatics, a national claims database, was used to identify patients hospitalized with and without an AKI discharge diagnosis between January 2007 and September2020. Among patients with prior continuous enrollment for at least 2years without AKI hospitalization, 471,176 patients hospitalized with AKI were identified and PS-matched to 471,176 patients hospitalized without AKI. All-cause and selected-cause rehospitalizations and mortality 90 and 365 days after index hospitalization. After PS matching, rehospitalization and death incidences were estimated using the cumulative incidence function method and compared using Gray's test. The association of AKI hospitalization with each outcome was tested using Cox models for all-cause mortality and, with mortality as competing risk, cause-specific hazard modeling for all-cause and selected-cause rehospitalization. Overall and stratified analyses were performed to evaluate for interaction between an AKI hospitalization and preexisting chronic kidney disease (CKD). After PS matching, AKI was associated with higher rates of rehospitalization for any cause (hazard ratio [HR], 1.62; 95% CI, 1.60-1.65), end-stage renal disease (HR, 6.21; 95% CI, 1.04-36.92), heart failure (HR, 2.81; 95% CI, 2.66, 2.97), sepsis (HR, 2.62; 95% CI, 2.49-2.75), pneumonia (HR, 1.47; 95% CI, 1.37-1.57), myocardial infarction (HR, 1.48; 95% CI, 1.33-1.65), and volume depletion (HR, 1.64; 95% CI, 1.37-1.96) at 90 days after discharge compared with the group without AKI, with similar findings at 365 days. Mortality rate was higher in the group with AKI than in the group without AKI at 90 (HR, 2.66; 95% CI, 2.61-2.72) and 365 days (HR, 2.11; 95% CI, 2.08-2.14). The higher risk of outcomes persisted when participants were stratified by CKD status (P<0.01). Causal associations between AKI and the reported outcomes cannot be inferred. AKI during hospitalization in patients with and without CKD is associated with increased risk of 90- and 365-day all-cause/selected-cause rehospitalization and death.

Invited Perspective: Still Hazy? Air Pollution and Acute Kidney Injury.

Invited Perspective: Still Hazy? Air Pollution and Acute Kidney Injury.

Urine neutrophil gelatinase-associated lipocalin as a biomarker of acute kidney injury and prognosis in decompensated chronic liver disease: A prospective study.

Acute kidney injury (AKI) heralds deterioration in patients with decompensated chronic liver disease (DCLD). Serum creatinine (sCr), a component of the model for end-stage liver disease-sodium (MELD-Na) prognostic score, has limitations in patients with DCLD. We evaluated the prognostic role of urine neutrophil gelatinase-associated lipocalin (NGAL) in DCLD and its ability to sub-type AKI. Total 147consecutive patients hospitalized between June 2018 andJune 2020 for complications of DCLD were evaluated. Urine NGAL was estimated and demographic, clinical and biochemical parameters recorded at baseline. Participants were followed up till theend of study period or mortality, whichever came earlier. Primary outcomes included all-cause mortality and time to death after index hospitalization. Secondary outcomes included thepresence and type of AKI, need for intensive care unit (ICU) stay, length of ICU/hospital stay, in-hospital mortality, development of new-onset/recurrent AKI and recurrent hospitalization after index admission. Urine NGAL was highest in acute tubular necrosis (ATN), lowest in pre-renal azotemia (PRA) and intermediate in hepatorenal syndrome (HRS-AKI). Urine NGAL (p = 0.0208) was superior to sCr (p = 0.0388) and inferior to fractionated excretion of sodium (FENa) (p = 0.0013) in stratifying AKI. A cut-off of 203.9ng/mL discriminated between HRS and PRA with sensitivity 77.8% and specificity 68.7%. Urine NGAL correlated with MELD-Na score, need for ICU stay, in-hospital mortality and mortality at three and sixmonths. Two-year survival was significantly lower in patients with urine NGAL > 205ng/mL. Addition of log-urine-NGAL score did not improve predictive performance of MELD-Na. Urine NGAL could identify AKI sub-types and correlated with short-term clinical outcomes, including mortality.

Treatment Challenge in COVID-19 Patients with Acute Kidney Injury in Hospital

Renal, the main characteristic of COVID-19 infection. Acute kidney injury (AKI) has been documented in 20-50% of the hospitalized COVID-19 patients. Renal involvement among COVID-19 patients might be multifactorial. COVID-19 Patients with AKI significantly had higher mortality than patients without AKI. This case series reported severe COVID-19 with respiratory failure and AKI during admission to the hospital. All patients were admitted to the intensive care unit (ICU) and obtained the standard therapeutic protocols according to the COVID-19 severities. The first patient developed AKI in the three days of admission, while the second and third patients had AKI from the first day of admission. The patients had similar complications, including type 1 or 2 respiratory failures, secondary infection with sepsis, hyperpotassemia, and metabolic acidosis. The first and second patients underwent hemodialysis as indicated on these patients. However, the evaluation of their renal functions did not improve after that. The third patient did not receive the hemodialysis therapy and only obtained supportive treatment with adequate fluid therapy. The third patient was getting better on the 16th day of admission. In addition, the renal function test was getting normal after the 16th day of admission. The patient was discharged on the 19th day of admission in stable condition. Early recognition of renal involvement in COVID-19 infection, preventive measures, renal function monitoring, and therapeutic intervention were essential to reduce the morbidity and mortality of COVID-19 patients. Hospitalized patients should be monitored closely for their renal function to prevent renal function deterioration in the future.

Association between high temperature and hospital admissions for kidney diseases: a nationwide study

BACKGROUND AND AIM: High temperatures have a known impact on human morbidity and mortality. Few small time series studies have documented associations between acute kidney injury (AKI) and temperature. Studies conducted on agricultural workers found an association between AKI and chronic kidney disease (CKD) of unknown origin. The association between temperature and kidney diseases was less investigated on the general population and on a large scale. The aim of this study is to evaluate the effect of temperature on kidney diseases hospital admissions in Spain. METHODS: Data on daily hospital admission for AKI and CKD were retrospectively collected from 2004 to 2019 in Spain. A Conditional Poisson regression combined with Distributed Lag Non-Linear Models was applied to evaluate the overall cumulative effect of maximum temperature among the 7 days preceding the admission. Models were adjusted for humidity and national holidays, and analyses were also stratified by age and sex. RESULTS: Overall, 244,348 and 39,448 admissions for AKI and CKD were registered, respectively. We observed a J-shaped curve for the association between AKI and temperature with a minimum morbidity temperature of 7&amp;#xb0;C. The overall cumulative relative risk (RR) at the 99th percentile versus the minimum morbidity temperature percentile was 1.46(95%CI:1.37-1.55). The impact of high temperature remained strong also in the analyses stratified by age and sex with the highest risk observed in the young (&amp;#x3c;65years) population (RR:1.59; 95%CI:1.43-1.75). Concerning CKD, results were not clear and varied by age and sex. An increased risk of being admitted for CKD in association with high temperature was observed among young males. CONCLUSIONS: High temperatures increased the risk of AKI hospital admissions in the general population, whereas less evidences were found for CKD. Dehydration and hyperthermia caused by high temperatures may stress renal function leading to kidney injury. KEYWORDS:Acute kidney injuries; Chronic kidney diseases; Temperature

Long-term Health Care Utilization and Associated Costs After Dialysis-Treated Acute Kidney Injury in Children

Acute kidney injury (AKI) is common among hospitalized children and is associated with increased hospital length of stay and costs. However, there are limited data on postdischarge health care utilization after AKI hospitalization. Our objectives were to evaluate health care utilization and physician follow-up patterns after dialysis-treated AKI in a pediatric population. Retrospective cohort study, using provincial health administrative databases. All children (0-18 years) hospitalized between 1996 and 2017 in Ontario, Canada. Excluded individuals comprised non-Ontario residents; those with metabolic disorders or poisoning; and those who received dialysis or kidney transplant before admission, a kidney transplant by 104 days after discharge, or were receiving dialysis 76-104 days from dialysis start date. Episodes of dialysis-treated AKI, identified using validated health administrative codes. AKI survivors were matched to 4 hospitalized controls without dialysis-treated AKI by age, sex, and admission year. Our primary outcome was postdischarge hospitalizations, emergency department visits, and outpatient physician visits. Secondary outcomes included outpatient visits by physician type and composite health care costs. Proportions with≥1 event and rates (per 1,000 person-years). Total and median composite health care costs. Adjusted rate ratios using negative binomial regression models. We included 1,688 pediatric dialysis-treated AKI survivors and 6,752 matched controls. Dialysis-treated AKI survivors had higher rehospitalization and emergency department visit rates during the analyzed follow-up periods (0-1, 0-5, and 0-10 years postdischarge, and throughout follow-up), and higher outpatient visit rates in the 0-1-year follow-up period. The overall adjusted rate ratio for rehospitalization was 1.46 (95% CI, 1.25-1.69; P<0.0001) and for outpatient visits was 1.16 (95% CI, 1.09-1.23; P=0.01). Dialysis-treated AKI survivors also had higher health care costs. Nephrologist follow-up was infrequent among dialysis-treated AKI survivors (18.6% by 1 year postdischarge). Potential miscoding of study exposures or outcomes. Residual uncontrolled confounding. Data for health care costs and emergency department visits was unavailable before 2006 and 2001, respectively. Dialysis-treated AKI survivors had greater postdischarge health care utilization and costs versus hospitalized controls. Strategies are needed to improve follow-up care for children after dialysis-treated AKI to prevent long-term complications.

Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19.

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

Black and White Adults With CKD Hospitalized With Acute Kidney Injury: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study

Few studies have investigated racial disparities in acute kidney injury (AKI), in contrast to the extensive literature on racial differences in the risk of kidney failure. We sought to study potential differences in risk in the setting of chronic kidney disease (CKD). Prospective cohort study. We studied 2,720 self-identified Black or White participants with CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study from July 1, 2013, to December 31,2017. Self-reported race (Black vs White). Hospitalized AKI (≥50% increase from nadir to peak serum creatinine). Cox regression models adjusting for demographics (age and sex), prehospitalization clinical risk factors (diabetes, blood pressure, cardiovascular disease, estimated glomerular filtration rate, proteinuria, receipt of angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers), and socioeconomic status (insurance status and education level). In a subset of participants with genotype data, we adjusted for apolipoprotein L1 gene (APOL1) high-risk status and sickle cell trait. Black participants (n= 1,266) were younger but had a higher burden of prehospitalization clinical risk factors. The incidence rate of first AKI hospitalization among Black participants was 6.3 (95% CI, 5.5-7.2) per 100 person-years versus 5.3 (95% CI, 4.6-6.1) per 100 person-years among White participants. In an unadjusted Cox regression model, Black participants were at a modestly increased risk of incident AKI (HR, 1.22 [95% CI, 1.01-1.48]) compared with White participants. However, this risk was attenuated and no longer significant after adjusting for prehospitalization clinical risk factors (adjusted HR, 1.02 [95% CI, 0.83-1.25]). There were only 11 AKI hospitalizations among individuals with high-risk APOL1 risk status and 14 AKI hospitalizations among individuals with sickle cell trait. Participants were limited to research volunteers and potentially not fully representative of all CKD patients. In this multicenter prospective cohort of CKD patients, racial disparities in AKI incidence were modest and were explained by differences in prehospitalization clinical risk factors.

Association Between Acute Kidney Injury and Dementia in the Atherosclerosis Risk in Communities (ARIC) Study

Acute kidney injury (AKI) causes biochemical changes in the brain in animal models and is associated with adverse neurological complications in hospitalized patients. This study tested the association between AKI and incident dementia in a community-based cohort. Prospective cohort study. Adult participants in the Atherosclerosis Risk in Communities (ARIC) study who experienced hospitalized AKI compared with participants hospitalized for other reasons (primary analysis, mean follow-up period 4.3 years) or participants without hospitalized AKI (secondary analysis). Incident AKI, defined by ICD codes from hospital records. Incident dementia, diagnosed based on a combination of neurocognitive testing, informant interviews, ICD codes, and death certificates. In the primary analysis, we estimated the propensity for hospitalized AKI and matched these participants with those hospitalized for another reason to examine the association of AKI with subsequent onset of dementia (N= 1,708). In the secondary analysis, we estimated the association between time-varying hospitalized AKI and subsequent onset of dementia using multivariable Cox proportional hazards regression models, adjusted for age, sex, race/center, education, smoking status, body mass index, baseline estimated glomerular filtration rate, baseline urinary albumin-creatinine ratio, systolic blood pressure, coronary heart disease, diabetes, hypertension, apolipoprotein E (APOE) ε4 allele, and C-reactive protein. The mean age in the propensity-matched cohort was 76.1 ± 6.5 (SD) years, and 53.2% of the participants were women. People who were hospitalized with AKI had a higher risk of dementia (HR, 1.25 [95% CI, 1.02-1.52]; P= 0.03) compared with those without a hospitalization for AKI. The associations were slightly stronger in the time-varying analysis (HR, 1.69 [95% CI, 1.48-1.92]; P< 0.001). Other risk factors for dementia included older age, male sex, higher albuminuria, diabetes, current smoker status, and presence of the APOE risk alleles. Observational study, with AKI identified through diagnosis codes. Participants who experienced a hospitalization for AKI were at increased risk of dementia.

Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection.

Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.