Incidence Of Kidney Injury Research Articles

Remote ischemic preconditioning has a neutral effect on the incidence of kidney injury after coronary artery bypass graft surgery

Acute kidney injury (AKI) is a frequent complication of cardiac surgery and usually occurs in patients with preexisting chronic kidney disease (CKD). Remote ischemic preconditioning (RIPC) may mitigate the renal ischemia-reperfusion injury associated with cardiac surgery and may be a preventive strategy for postsurgical AKI. We undertook a randomized controlled trial of RIPC to prevent AKI in 86 patients with CKD (estimated glomerular filtration rate under 60 ml/min per 1.73 m(2)) undergoing coronary artery bypass graft (CABG) surgery. Forty-three patients each were randomized to receive standard care with or without RIPC consisting of three 5-minute cycles of forearm ischemia followed by reperfusion. The primary end point was the development of AKI defined as an increase in serum creatinine concentration over 0.3 mg/dl within 48 h of surgery. Secondary end points included a comparison between the study and control groups of several serum biomarkers of renal injury including cystatin-C, neutrophil gelatinase-associated lipocalin (NGAL), and interleukin-18 (IL-18), and urinary biomarkers including NGAL, IL-18, and kidney injury molecule-1 measured at 6, 12, and 24 h after CABG, and the 72-h serum troponin T concentration area under the curve as a marker of myocardial injury. Clinical and operative characteristics were similar between the preconditioned and control groups. AKI developed in 12 patients in both groups within 48 h of CABG. There were no significant differences between the two groups in the concentrations of any of the serum or urinary biomarkers of renal or cardiac injury after CABG. Thus, RIPC induced by forearm ischemia-reperfusion had no effect on the frequency of AKI after CABG in patients with CKD.

The incidence and predictors of transient acute kidney injury in patients with preoperative normal kidney functions undergoing coronary artery bypass graft surgery

The incidence and predictors of transient acute kidney injury in patients with preoperative normal kidney functions undergoing coronary artery bypass graft surgery

Yield of blood cultures (BC), incidence of systemic inflammatory response syndrome (SIRS) and acute kidney injury (AKI) in patients admitted with acute exacerbation of cystic fibrosis (AECF)

Yield of blood cultures (BC), incidence of systemic inflammatory response syndrome (SIRS) and acute kidney injury (AKI) in patients admitted with acute exacerbation of cystic fibrosis (AECF)

ACUTE KIDNEY INJURY AFTER AORTIC VALVE REPLACEMENT: INCIDENCE, RISK FACTORS AND OUTCOMES

We sought to evaluate the incidence, predictors, and outcomes of acute kidney injury (AKI) in patients undergoing aortic valve replacement (AVR). We retrospectively reviewed 1667 consecutive patients who underwent AVR between 2000-2012. Patient demographic, clinical, and survival were analyzed. AKI

Renal function changes and seasonal temperature in patients undergoing cardiac surgery

Some observations in humans and other mammalians suggest that serum creatinine (SC) and estimated glomerular filtration rate (eGFR) may change during the warm season. The objective of this study is to determine if temperature-dependent seasonal changes in levels of SC and eGFR are detectable in cardiac surgery patients, with associated changes in postoperative acute kidney injury (AKI) incidence. This is a single-center retrospective study based on the institutional database of cardiac surgery in the period 2000–2012. Sixteen-thousand and twenty-three consecutive adult patients undergoing cardiac surgery comprised the study population. Baseline and postoperative SC and eGFR values, and AKI rate according to the month when surgery was performed were measured. The month-related changes SC and eGFR, and AKI rate, were assessed in crude and adjusted models, and their association with the correspondent meteorological data registered at the time of surgery was tested. Patients operated in the six warmest months (May through October) had a significant (p < 0.001) higher value of baseline SC (1.17 ± 0.7 mg/dL) versus the six coldest months (1.12 ± 0.6 mg/dL), and a significantly (p = 0.031) higher value of peak postoperative SC (1.31 ± 0.85 mg/dL) versus the 6 coldest months (1.28 ± 0.89), with maximum values between July and August. A similar behaviour was found for eGFR. After adjustment for other confounders, the AKI rate was not significantly different in the warmest months, even if a trend towards a higher rate in August was observed (odds ratio 1.287, 95% confidence interval 0.96–1.74, p = 0.097). Baseline (p < 0.001) and peak postoperative (p = 0.0054) serum creatinine levels were significantly higher for increasing mean ambient temperature. Humidity and wind speed were negatively associated with pre- and postoperative eGFR. In conclusion, patients operated during the warmest season, have higher levels of SC and lower levels of eGFR, without a correspondent increase in the AKI rate. Different hypotheses underlying this pattern are generated by this study, including a dehydration status, concomitant anemia, and a higher transfusion rate.

Epidemiology of acute kidney injury in surgical intensive care at University Hospital in Egypt. A prospective observational study

IntroductionThe acute kidney injury (AKI) incidence in ICU patients varies widely from 3% to 30%, with mortality ranging from 36% to 90%, depending on the type of ICU, study population, the period during which the study is conducted, and the criteria used to define AKI.There have been many studies about the epidemiology and risk factors of AKI in critically ill patients in the different regions of the world. However, little data on the epidemiology of AKI in critically ill patients are available in Egypt.ObjectivesThe aim of this study was to assess the incidence of AKI among critical ill patients using RIFEL [risk (R), injury (I), failure (F), loss (L), and end-stage kidney disease (E)] classification and to determine the risk factors and outcome of patients who developed AKI in our surgical ICU.MethodsWe conducted a 6-month prospective observational study in the surgical ICU. Patients were classified daily using the RIFLE criteria. Patients were considered as having new AKI if they did not have AKI on ICU admission and subsequently reached at least class risk during their follow-up. Deterioration of AKI was diagnosed if the patient had increased in RIFLE class compared to the initial classification.ResultsOne hundred and twelve patients were studied. AKI occurred in 40 (35.7%) of patients. The most common risk factors for AKI are APACHE II score (acute physiology and chronic health evaluation score, version II.) and sepsis. APACHEII was lower in non-AKI group than AKI group (17.3 ± 7.5 versus 22.4 ± 7.4, p = 0.001), and sepsis was more common in AKI patients than non-AKI patients (77.5% versus 49% p = 0.004). Patients with AKI had a mortality rate of 67.5% which was more in patients with failure compared with risk patients. APACHEII, AKI, and needs for mechanical ventilation were independent risks for mortality.

Impact of transfusion of packed red blood cells on mid-term outcomes after transcatheter aortic valve implantation

Purpose: The adverse impact of bleeding and transfusion of packed red blood cells (PRBC) on outcome after PCI is well documented. Same holds true for bleeding and access site complications after TAVI. However, data on the impact of anemia and PRBC transfusions on outcome after TAVI are scarce. We sought to evaluate these aspects in a retrospective single-center analysis. Methods: TAVI was performed in 500 consecutive patients at high risk for surgery employing 1st and 2nd generation devices via transfemoral or transapical access. Outcomes were analysed according to the Valve Academic Research Consortium definitions with emphasis on anemia, PRBC transfusion, and its impact on survival. 12.0% of TAVI patients suffered from major/life-threatening bleeding or access site complications and were excluded from analysis. Median follow-up duration was 351 days. Patients who received PRBC transfusions (PRBC) were compared to those who did not (noPRBC). Results: Overall, 41.8% of patients received PRBC transfusions during the postoperative course after TAVI (19.4% 1-2 PRBC, 12.6% 3-4 PRBC, 9.8% > 4 PRBC), irrespective of access (transapical: 43.4% vs. transfemoral: 40.6%, p=n.s.). Variables at baseline differed significantly between PRBC and noPRBC patients with regard to risk profile (STS-PROM 8.8±6.1% vs. 6.8±4.9%, p=0.020), anemia (84.5% vs. 47.2%, p<0.001), and atrial fibrillation (39.1% vs. 29.6%, p=0.045). The incidence of stage-3 kidney injury (5.1% vs. 0.7%, p<0.001) and major stroke (5.1% vs. 1.1%, p=0.044) was higher in the PRBC group. Survival was impaired in PRBC patients (log-rank p<0.001) and correlated with the number of PRBC transfusions. Adjusted Cox regression identified PRBC transfusion as predictor of 30-day (HR 4.7, 95% CI 1.6-13.4, p=0.004) and 1-year (HR 1.7, 95% CI 1.1-2.7, p=0.030) mortality. Body-mass-index (HR 0.9, 95% CI 0.9-1.0, p=0.005), atrial fibrillation (HR 1.5, 95% CI 1.0-2.3, p=0.048), estimated GFR (HR 0.99, 95% CI 0.98-1.0, p=0.004), baseline hemoglobin (HR 0.9, 95% CI 0.7-1.2, p<0.001), and peripheral vascular disease (HR 1.6, 95% CI 1.1-12.5, p=0.025) were found as predictors for PRBC transfusion. Conclusions: PRBC transfusions were frequently required after TAVI but only in part driven by access site complications and independent of access route. However, patients requiring transfusion of PRBC displayed poorer short- and mid-term outcomes. Anemia at baseline was a strong predictor for transfusion, underscoring the need for valid risk stratification tools to identify patients at risk for transfusion during the preprocedural assessment before TAVI.

The Incidence and Characteristic of Acute Kidney Injury as A Complication of Severe Burn Injury in Patients Receiving Fluid Resuscitation

&#x0D; &#x0D; &#x0D; &#x0D; Background: Acute kidney injury is important factor that can increase mortality in patient with severe burn injury. Knowledge about incidence and characteristic of acute kidney injury among severe burned patients will help medical practitioner to establish appropriate medical decision and health care protocol.&#x0D; Method: PubMed, Cochrane Library, and GoogleTM search yielded 12 articles. The articles were screened by inclusion criteria, exclusion criteria, and full text reading. Five remaining articles appraised in regard of validity, importance, and applicability.&#x0D; Result: Incidence of acute kidney injury among severely burned patients varies from 24.4% to 53.3%. According to the study with best level of evidence, a systematic review, the incidence of AKI is 28.8% (95% CI 26.8%-30.7%). AKI can occur early or late, and may progress. Progressive AKI has highest mortality rate.&#x0D; Conclusion: AKI is common complication among patients with severe burn injury. Approximately one- third to half of patients with severe burn injury will develop AKI in the course of the disease. Early clinical assessment and re-evaluation are important in severe burn injury management.&#x0D; &#x0D; &#x0D; &#x0D;

Definition of Contrast-Induced Acute Kidney Injury Needs an Overhaul

To study the incidence of contrast-induced acute kidney injury, researchers retrospectively compared changes in serum creatinine levels between 773

Incidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients with Community-acquired Pneumonia

Incidence and Prognostic Implications of Acute Kidney Injury on Admission in Patients with Community-acquired Pneumonia

Risk Factors Associated with Kidney Injury and the Impact of Kidney Injury on Overall Survival in Pediatric Recipients Following Allogeneic Stem Cell Transplant

Pediatric allogeneic stem cell transplant (AlloSCT) patients are at substantial risk of developing kidney injury (KI), and KI contributes to transplant-related morbidity and mortality. We compared the estimated creatinine clearance (eCrCl) at 1, 3, 6, 9, and 12 months post-AlloSCT in 170 patients following reduced toxicity conditioning (RTC) versus myeloablative conditioning (MAC) to baseline. eCrCl was calculated using the Schwartz equation. Patients with ≥ 50% drop in eCrCl from the baseline were considered to have KI. Patients received tacrolimus and mycophenolate mofetil (MMF) for graft-versus-host disease (GVHD) prophylaxis. The logistic regression model was used for assessing risk factors for KI. Seventy-six patients (median age = 10.6 years) received RTC AlloSCT; 94 patients (median age = 8.5 years) received MAC AlloSCT. The incidence of KI at 1 month post-AlloSCT was significantly higher in MAC versus RTC AlloSCT (43/94 [45.7%] versus 13/76 [17.1%] P < .0001). There was no statistical difference in KI at 3, 6, 9, and 12 months post-AlloSCT between the 2 conditioning groups. On multivariate analysis, only MAC was a significant risk factor for KI (odds radio [OR] 3.44, 95% confidence interval [CI] 1.59-7.42, P = .002). In multivariate analysis for risk factors affecting overall survival (OS), the following were statistically significant: MAC versus RTC (hazard ratio [HR] 2.66, P = .0008), average versus poor-risk disease status (HR 2.09, P = .004), matched sibling donor (MSD) and matched unrelated donor (MUD) versus umbilical cord blood (UCB) (HR 2.31, P = .013), no KI versus KI (HR 2.00, P = .005). In children, MAC is associated with significant risk of KI in the first month after transplant, and KI in the first month post-AlloSCT is associated with a significantly decreased OS.

Statin use is associated with early recovery of kidney injury after vascular surgery and improved long-term outcome

Acute kidney injury (AKI) after major vascular surgery is an important risk factor for adverse long-term outcomes. The pleiotropic effects of statins may reduce kidney injury caused by perioperative episodes of hypotension and/or suprarenal clamping and improve long-term outcomes. Of 2170 consecutive patients undergoing lower extremity bypass or abdominal aortic surgery from 1995 to 2006, cardiac risk factors and medication were noted. A total of 515/1944 (27%) patients were statin users. Creatinine clearance (CrCl) was assessed preoperatively at 1, 2 and 3 days after surgery. Outcome measures were postoperative AKI and long-term mortality. Postoperative kidney injury was defined as a >10% decrease in CrCl on Day 1 or 2, compared to the baseline. Recovery of kidney function was defined as a CrCl >90% of the baseline value at Day 3 after surgery. Multivariable Cox regression analysis, including baseline cardiovascular risk factors, baseline CrCl and propensity score for statin use, was applied to evaluate the influence of statins on early postoperative kidney injury and long-term survival. AKI occurred in 664 (34%) patients [median -25% CrCl, range (-10% to -71%)]. Of these 664 patients, 313 (47%) had a complete recovery of kidney function at Day 3 after surgery. Age, hypertension, suprarenal cross-clamping and baseline CrCl predicted the development of kidney injury during the postoperative period. The incidence of kidney injury was similar among statin users and non-users (29% versus 25%, OR 1.15, 95% CI 0.9-1.5). However, if kidney function deteriorated, statin use was associated with increased odds of complete kidney function recovery (OR 2.0, 95% CI 1.0-3.8). During a mean follow-up of 6.24 years, half of the patients died (55%). Importantly, statin use was also associated with an improved long-term survival, irrespective of kidney function change (HR 0.60, 95% CI 0.48-0.75). Statin use is associated with improved recovery from AKI after major surgery and has a beneficial effect on long-term survival.