Kidney Injury In Patients Research Articles

Association between serum magnesium concentrations and the risk of developing acute kidney injury in patients with cirrhosis: a retrospective cohort study based on the MIMIC-IV database

Background In various disease contexts, magnesium abnormalities are associated with acute kidney injury (AKI) incidence. However, this association remains unclear and has not been systematically investigated in patients with cirrhosis. Hence, we aimed to elucidate the association between admission serum magnesium levels and AKI incidence in intensive care unit (ICU)-admitted cirrhotic patients. Methods A retrospective cohort study was conducted using MIMIC-IV2.2 data, focusing on critically ill patients with cirrhosis. We employed univariable and multivariable logistic regression and restricted cubic spline analyses to robustly address our research objectives. To further substantiate the findings, subgroup and sensitivity analyses were also conducted. Results Among the 3,228 enrolled ICU-admitted cirrhotic patients, 34.4% were female, and the overall AKI incidence was 68.6% (2,213/3,228). Multivariable logistic regression analysis revealed an independent relationship between elevated serum magnesium levels and increased AKI risk (OR = 1.55 [95% CI = 1.15–2.09], p = 0.004). Compared with individuals with serum magnesium levels < 1.6 mg/dL, individuals with serum magnesium levels in Q2 (1.6–2.6 mg/dL) and Q3 (≥2.6 mg/dL) had adjusted ORs for AKI of 1.89 (95% CI = 1.34–2.65, p < 0.001) and 2.19 (95% CI = 1.27–3.75, p = 0.005), respectively. The restricted cubic spline analysis revealed that AKI risk increased linearly with increasing serum magnesium levels. Subgroup analysis revealed that the association between serum magnesium levels and AKI incidence was remarkably stable in subgroup analysis (all P interaction >0.05). Conclusions High serum magnesium concentrations were significantly associated with an increased AKI risk in ICU-admitted patients with cirrhosis. Further randomized trials are needed to confirm this association.

Association between preoperative proton pump inhibitor use and postoperative acute kidney injury in patients undergoing major surgery

Background Acute kidney injury (AKI) is a severe postoperative complication in patients undergoing major surgery. Proton pump inhibitors (PPIs) are used preoperatively as prophylaxis for postoperative gastrointestinal bleeding. Whether preoperative PPI use is associated with an increased risk of postoperative AKI remains uncertain. Methods This retrospective cohort study used electronic medical records from the clinical data warehouse of Peking University First Hospital to screen all adult hospitalizations undergoing major surgery between 1 January 2018 and 31 December 2020. Exposure was preoperative PPI use, defined as PPI use within 7 days before major surgery. The primary outcome was postoperative AKI, defined as AKI occurring within 7 days after major surgery; secondary outcomes included in-hospital AKI and in-hospital mortality. Results A total of 21,533 patients were included in the study (mean [SD] age, 57.8 [15.0] years; 51.2% male), of which 944 (4.4%) were prescribed PPI within 7 days before major surgery (PPI users). Overall, 72 PPI users (7.6%) and 356 non-users (1.7%) developed postoperative AKI. After adjustment, preoperative PPI use was associated with an increased risk of postoperative AKI (adjusted OR, 1.47; 95% CI, 1.04–2.07) and in-hospital AKI (adjusted OR, 1.41; 95% CI, 1.03–1.94). Moreover, subgroup analyses showed that the risk of PPI on postoperative AKI was amplified by the concomitant use of non-steroidal anti-inflammatory drugs or diuretics. No significant difference was observed between preoperative PPI use and in-hospital mortality in the fully adjusted model (adjusted OR 1.63; 95% CI, 0.55–4.85). Conclusions Preoperative PPI use was associated with an increased risk of AKI in patients undergoing major surgery. This risk may be enhanced by the concomitant use of other nephrotoxic drugs. Clinicians should weigh the pros and cons before initiating PPI prophylaxis.

Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis

An association between serum creatine kinase (CK) levels and the risk of kidney failure in patients with exertional rhabdomyolysis (ERM) has been suggested. However, the actual incidence of AKI in hospitalized patients with ERM along with the contributing cofactors that may increase the risk of AKI have rarely been investigated. To examine the incidence of kidney injury in hospitalized patients with ERM and to identify additional cofactors that might contribute to the development of kidney injury in patients with ERM. This retrospective cohort study was conducted in a diverse community population of patients 18 years or older with ERM who were hospitalized across Kaiser Permanente Northern California between January 1, 2009, and December 31, 2019. Patients were initially identified through electronic screening for all-cause rhabdomyolysis admissions, followed by manual medical record reviews to verify their eligibility for the study. The diagnosis of AKI and chronic kidney disease (CKD) was determined using KDIGO (Kidney Disease Improving Global Outcomes) criteria and confirmed by medical record review. Data analysis was performed from October 1, 2023, to January 31, 2024. History of strenuous physical exercise before hospitalization for ERM. Development of AKI, CKD, and compartment syndrome and number of deaths. Among 3790 patients hospitalized for rhabdomyolysis between 2009 and 2019 in Kaiser Permanente Northern California, 200 (mean [SD] age, 30.5 [8.5] years; 145 [72.5%] male) were confirmed to have ERM via medical record review. Seventeen patients (8.5%) developed AKI, none developed CKD, 1 (0.5%) developed compartment syndrome, and there were no fatalities. There was no association between serum CK levels and the risk of AKI. However, the risk of AKI was significantly higher in patients with ERM who used nonsteroidal anti-inflammatory drugs (NSAIDs) before admission (11 of 17 with AKI [64.7%] vs 40 of 183 without AKI [21.9%], P < .001) or experienced dehydration (9 of 183 without AKI [52.9%] vs 9 of 17 with AKI [4.9%], P < .001). This analysis suggests that eliminating preadmission NSAID use and dehydration could reduce the risk of potential AKI in patients with ERM by 92.6% (95% CI, 85.7%-96.1%) in this population. The findings of this cohort study of hospitalized patients with ERM suggest that serum CK elevation alone is insufficient as an indicator of AKI in patients with ERM. Concurrent risk factors, such as NSAID use or dehydration, may be associated with AKI development in patients with ERM.

The Association of Noninvasively Derived Tissue Perfusion Pressure With Acute Kidney Injury in Patients With Circulatory Compromise.

The Association of Noninvasively Derived Tissue Perfusion Pressure With Acute Kidney Injury in Patients With Circulatory Compromise.

Using machine learning to predict the risk of short-term and long-term death in acute kidney injury patients after commencing CRRT

BackgroundThe mortality rate and prognosis of short-term and long-term acute kidney injury (AKI) patients who undergo continuous renal replacement therapy (CRRT) are different. Setting up risk stratification tools for both short-term and long-term deaths is highly important for clinicians.MethodA total of 1535 AKI patients receiving CRRT were included in this study, with 1144 from the training set (the Dryad database) and 391 from the validation set (MIMIC IV database). A model for predicting mortality within 10 and 90 days was built using nine different machine learning (ML) algorithms. AUROC, F1-score, accuracy, sensitivity, specificity, precision, and calibration curves were used to assess the predictive performance of various ML models.ResultsA total of 420 (31.1%) deaths occurred within 10 days, and 1080 (68.8%) deaths occurred within 90 days. The random forest (RF) model performed best in both predicting 10-day (AUROC: 0.80, 95% CI: 0.74–0.84; accuracy: 0.72, 95% CI: 0.67–0.76; F1-score: 0.59) and 90-day mortality (AUROC: 0.78, 95% CI: 0.73–0.83; accuracy: 0.73, 95% CI: 0.69–0.78; F1-score: 0.80). The importance of the feature shows that SOFA scores are rated as the most important risk factor for both 10-day and 90-day mortality.ConclusionOur study, utilizing multiple machine learning models, estimates the risk of short-term and long-term mortality among AKI patients who commence CRRT. The results demonstrated that the prognostic factors for short-term and long-term mortality are different. The RF model has the best prediction performance and has valuable potential for clinical application.

Beyond the Valve: Incidence, Outcomes, and Modifiable Factors of Acute Kidney Injury in Patients with Infective Endocarditis Undergoing Valve Surgery-A Retrospective, Single-Center Study.

Background/Objectives: Infective endocarditis (IE) often requires surgical intervention, with postoperative acute kidney injury (AKI), posing a significant concern. This retrospective study aimed to investigate AKI incidence, its impact on short-term mortality, and identify modifiable factors in patients with IE scheduled for valve surgery. Methods: This single-center study enrolled 130 consecutive IE patients from 2013 to 2021 undergoing valve surgery. The creatinine levels were monitored pre- and postoperatively, and AKI was defined by Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient demographics, comorbidities, procedural details, and complications were recorded. Primary outcomes included AKI incidence; the relevance of creatinine levels for AKI detection; and the association of AKI with 30-, 60-, and 180-day mortality. Modifiable factors contributing to AKI were explored as secondary outcomes. Results: Postoperatively, 35.4% developed AKI. The highest creatinine elevation occurred on the second postoperative day. Best predictive value for AKI was a creatinine level of 1.35 mg/dL on the second day (AUC: 0.901; sensitivity: 0.89, specificity: 0.79). Elevated creatinine levels on the second day were robust predictors for short-term mortality at 30, 60, and 180 days postoperatively (AUC ranging from 0.708 to 0.789). CK-MB levels at 24 h postoperatively and minimum hemoglobin during surgery were identified as independent predictors for AKI in logistic regression. Conclusions: This study highlights the crucial role of creatinine levels in predicting short-term mortality in surgical IE patients. A specific threshold (1.35 mg/dL) provides a practical marker for risk stratification, offering insights for refining perioperative strategies and optimizing outcomes in this challenging patient population.

Effect of Hydration with Bicarbonate Ringer's Solution on Cisplatin-induced Acute Kidney Injury in Patients with Esophageal Cancer: A Retrospective Cohort Study.

Cisplatin (CDDP) often causes acute kidney injury (AKI), and magnesium supplementation has been suggested to be important in preventing CDDP-induced AKI. Sodium bicarbonate Ringer's solution (BRS) is a crystalloid solution composed of various electrolytes, including Mg2+, and can be generally used to supplement missing extracellular fluid and correct metabolic acidosis; however, the clinical outcomes of hydration with BRS for CDDP-induced AKI remain unclear. In this study, we retrospectively compared the effects of BRS and normal saline for hydration in patients undergoing CDDP treatment. We analyzed the incidence rate of AKI (grade ≥ 1), the severity of AKI, the serum magnesium level, and the incidence rate of grade ≥ 3 hematological toxicities (leukopenia, neutropenia, anemia, or thrombocytopenia) following CDDP and fluorouracil (5-FU) administration in 131 in-patients who received CDDP and 5-FU for the first time to treat esophageal cancer. Fifty-six patients (43%) received saline alone, while 75 patients (57%) received BRS for hydration. The incidence rate of AKI (grade ≥ 1) was significantly lower in the BRS group (11%) than that in the saline group (39%, p &lt; 0.001). Moreover, severe AKI (grade ≥ 2) was significantly less common in the BRS group than in the saline group. Although the serum magnesium levels before CDDP administration were not significantly different between the two groups (p = 0.939), the serum magnesium levels on days 2-3 after CDDP administration in the BRS group were significantly higher than those in the saline group (p &lt; 0.001). In contrast, there were no significant differences in the incidence rates of hematological toxicity between the two groups. Multivariate analysis revealed that BRS use was an independent factor that significantly contributed to AKI prevention (odds ratio = 0.061, p &lt; 0.001). Hydration with BRS could prevent CDDP-induced AKI in patients with esophageal cancer.

Hypokalemia, hypomagnesemia, and hyponatremia are associated with acute kidney injury in patients treated with cisplatin.

Cisplatin-associated acute kidney injury (C-AKI) is common. Predictive factors include age >60 years, hypertension, cisplatin dose, diabetes, and serum albumin < 3.5 g/L. The association between C-AKI and hypokalemia, hypomagnesemia or hyponatremia has not been well characterized. Data from a previous retrospective observational study was obtained. Patients were separated into three groups with similar cisplatin doses and schedules. Group A received cisplatin 60-100 mg/m2 every three weeks with laboratory assessments before treatment, group B received cisplatin 60-75 mg/m2 every three weeks with laboratory assessments before days 1 and 8 and group C had weekly cisplatin 40 mg/m2 with weekly laboratories assessments. The association between hypomagnesemia, hypokalemia, hyponatremia, and risk of AKI was determined using a counting process specification of Cox's regression models. A total of 1301 patients were separated into groups A (n = 713), B (n = 204), and C (n = 384). The proportion of patients with at least one event of hypokalemia, hypomagnesemia, or hyponatremia was lower in group A (29.2%, 57.6%, 36.2%) compared to groups B (43.6%, 67.2%, 59.8%) and C (49.0%, 78.7%, 51.0%). The incidence of all grade C-AKI was 35.6% (group A), 46.6% (group B), and 18.2% (group C). In group A, the risk of AKI doubled with hyponatremia or hypomagnesemia and tripled with hypokalemia. This association was not seen with other groups. Among patients with the highest doses of cisplatin, the presence of one electrolyte disorder was associated with an increased risk of C-AKI. Other studies are needed to characterize the presence of an electrolyte disorder as a predictive risk factor of C-AKI in this subpopulation.

PATHOGENESIS, DIAGNOSIS AND TREATMENT OF ACUTE RENAL INJURY IN PATIENTS WITH CORONAVIRUS INFECTION COVID-19

The review article presents an analysis of scientific articles indexed in the PubMed and Web of Science databases on the pathophysiological and clinical features of acute renal injury in patients with a new coronavirus infection. In addition to the direct damaging effects of the SARS-CoV-2 virus on the kidneys and the systemic consequence of viral infection, there are common damaging factors of acute renal injury for all critical conditions. Data on the direct damaging effects of the virus and the systemic consequence of viral infection are contradictory and require further research. Hypovolemia is common in the early stages of COVID-19, so emergency fluid administration is critical for the prevention and treatment of acute kidney injury in patients with novel coronavirus infection. Optimization of liquid volume in order to prevent and prevent the progression of AKI to a severe degree requiring renal replacement therapy is of particular importance when resources are limited in a pandemic.

A Study on the Etiology and Outcome of Acute Kidney Injury Patients in the Nephrology Center of the Combined Military Hospital in Dhaka

A Study on the Etiology and Outcome of Acute Kidney Injury Patients in the Nephrology Center of the Combined Military Hospital in Dhaka

Epithelial CEBPD activates fibronectin and enhances macrophage adhesion in renal ischemia-reperfusion injury

Ischemia-reperfusion injury (IRI) is a cause of acute kidney injury in patients after renal transplantation and leads to high morbidity and mortality. Damaged kidney resident cells release cytokines and chemokines, which rapidly recruit leukocytes. Fibronectin (FN-1) contributes to immune cell migration, adhesion and growth in inflamed tissues. CCAAT/enhancer-binding protein delta is responsive to inflammatory cytokines and stresses and plays functional roles in cell motility, extracellular matrix production and immune responses. We found that the expression of CCAAT/enhancer-binding protein delta was increased in renal epithelial cells in IRI mice compared with sham mice. Following IRI, the colocalization of FN-1 with the macrophage marker F4/80 was increased in renal injury model wild-type mice but was significantly attenuated in Cebpd-deficient mice. Inactivation of CEBPD can repress hypoxia-induced FN-1 expression in HK-2 cells. Moreover, the inactivation of CEBPD and FN-1 also reduces macrophage accumulation in HK-2 cells. These findings suggest that the involvement of CEBPD in macrophage accumulation through the activation of FN-1 expression and the inhibition of CEBPD can protect against renal IRI.

The incidence, risk factors, and prognosis of acute kidney injury in patients after cardiac surgery.

Acute kidney injury (AKI) represents a significant complication following cardiac surgery, associated with increased morbidity and mortality rates. Despite its clinical importance, there is a lack of universally applicable and reliable methods for the early identification and diagnosis of AKI. This study aimed to examine the incidence of AKI after cardiac surgery, identify associated risk factors, and evaluate the prognosis of patients with AKI. This retrospective study included adult patients who underwent cardiac surgery at Changhai Hospital between January 7, 2021, and December 31, 2021. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Perioperative data were retrospectively obtained from electronic health records. Logistic regression analyses were used to identify independent risk factors for AKI. The 30-day survival was assessed using the Kaplan-Meier method, and differences between survival curves for different AKI severity levels were compared using the log-rank test. Postoperative AKI occurred in 257 patients (29.6%), categorized as stage 1 (179 patients, 20.6%), stage 2 (39 patients, 4.5%), and stage 3 (39 patients, 4.5%). The key independent risk factors for AKI included increased mean platelet volume (MPV) and the volume of intraoperative cryoprecipitate transfusions. The 30-day mortality rate was 3.2%. Kaplan-Meier analysis showed a lower survival rate in the AKI group (89.1%) compared to the non-AKI group (100%, P < 0.001). AKI was notably prevalent following cardiac surgery in this study, significantly impacting survival rates. Notably, MPV and administration of cryoprecipitate may have new considerable predictive significance. Proactive identification and management of high-risk individuals are essential for reducing postoperative complications and mortality.

Impact of once-daily versus multiple-daily dosing of gentamicin on the incidence of acute kidney injury in patients treated with synergistic combinations of antibiotics

BackgroundGentamicin is a commonly used antibiotic with synergistic effects that is administered once or multiple times daily. However, the influence of the daily administration frequency on renal function has not yet been identified. This study aimed to investigate the effect of the daily dosing frequency on worsening renal function in patients receiving gentamicin.MethodsThis study included 35 patients undergoing gentamicin treatment who had at least one serum trough level measured and underwent therapeutic drug monitoring (TDM). We evaluated the influence of daily dosing frequency on gentamicin trough concentration and the risk of acute kidney injury (AKI).ResultsCompared to patients who received gentamicin once-daily dosing (n = 22), patients who received multiple-daily dosing (n = 13) had significantly higher initial and minimum trough concentrations after TDM. The proportion of patients with trough concentrations lower than 1.0 µg/mL was significantly higher in the once-daily dosing group at the initial trough concentration, whereas there was no significant difference at the minimum trough concentration after TDM. AKI developed in nine patients; however, there was no significant difference in the incidence of AKI according to the frequency of daily gentamicin dosing. In contrast, a higher minimum trough concentration after TDM was found to be a risk factor for AKI development with an odds ratio of 9.2 (95% confidence intervals; 1.3–65.5).ConclusionA higher trough concentration of gentamicin correlated with a higher incidence of AKI. The risk of developing AKI may be reduced by choosing a once-daily dosing regimen or implementing TDM.

Acute kidney injury of mild to moderate severity in patients with COVID-19

THE AIM: to study the incidence of mild to moderate acute kidney injury in patients with COVID-19.PATIENTS AND METHODS. The data of the case histories of 200 patients hospitalized in the infectious diseases department of the Naro-Fominsk Regional Hospital of the Moscow region for COVID-19 were analyzed, mainly with mild to moderate severity of lung damage according to computed tomography, which do not require respiratory support and renal replacement therapy.RESULTS. Despite the fact that the analyzed group of patients did not have the most severe course of COVID-19, the first stage of acute kidney injury was detected in 22.5% of patients, which was manifested by a temporary decrease in hourly diuresis, increased creatinine, urea, proteinuria and erythrocyturia.CONCLUSION. The development of acute kidney injury was most often associated with older age, coronary heart disease, arterial hypertension, diabetes mellitus and obesity.

Evaluation of acute kidney injury patients in intensive care unit and determining effects of hemodialysis on sepsis

Evaluation of acute kidney injury patients in intensive care unit and determining effects of hemodialysis on sepsis

Predictors of In-hospital Outcomes of Community-acquired versus Hospital-acquired Acute Kidney Injury in Patients Admitted to a Tertiary Care Hospital: A Prospective Study

Abstract Background: Sparse data is available comparing the outcome of Community-acquired acute kidney Injury (CA-AKI) and Hospital-acquired acute kidney injury (HA-AKI). Aims: This study was undertaken to compare the demographic, clinical spectrum and in-hospital outcomes of CA-AKI versus HA-AKI. Patients and Methods: A prospective cohort study was conducted from October 2020 to December 2021 in the inpatient departments (IPDs) of a tertiary-care referral centre in north India. A total of 65 patients with CA-AKI and 32 patients with HA-AKI were enrolled. The characteristics and outcomes of AKI in both groups were compared. Results: The mean age of patients in the CA-AKI and HA-AKI groups was 46.7 years and 45.5 years respectively. The CA-AKI group had significantly higher baseline serum creatinine, serum creatinine at admission, proportion of patients requiring renal replacement therapy, proportion of patients having oligo-anuria and hyperkalemia at presentation. Despite more patients in the CA-AKI group being in AKI-Stage 3 at presentation, in-hospital mortality was observed to be lower in this group. However, on comparing the overall survival, both groups were found to be comparable. The independent predictors of mortality were the presence of lung disease and the requirement of vasopressor support at presentation. Conclusion: It was observed that both recovery and dialysis dependency were more common in patients with CA-AKI. Both groups had comparable overall survival. Only two factors, i.e. the presence of lung disease and the requirement of vasopressor support at presentation predicted the survival of AKI patients. The type of AKI was not an independent predictor of mortality in such patients.

Incidence and outcome of Acute Kidney Injury in patients admitted in a level III ICU in Nepal: A retrospective, observational study

Background and aims: Acute kidney injury (AKI) is associated with increased mortality, morbidity, and hospital stay. AKI is seen in 20-60% of patients admitted to the intensive care unit (ICU), and mortality is as high as 50% if not managed timely. Burden of AKI is more in developing countries as compared to the developed ones. There is a paucity of published literature regarding incidence and outcome of AKI in critically ill patients from lower-middle income countries like Nepal. This study aimed to determine the incidence and outcome of AKI in patients admitted to a level III ICU in Nepal. Methods: This observational study was conducted in the ICU of Hospital for Advanced Medicine and Surgery (HAMS) Hospital, Kathmandu, Nepal. Data over a period of one year was curated from ICU registry. Eligible patients were screened and the incidence of AKI in ICU admitted patients along with their outcomes (length of ICU stay, need of RRT and ICU mortality) were observed. Results: Among 881 patients admitted to the ICU, 660 patients were enrolled for analysis. Of them, 14.2% of patients developed AKI during ICU stay, out of which 5.3% received RRT and 19.1% died. The median (IQR) length of ICU stay for those who developed AKI was 4 (3-7) days. The 34.0% patients who developed AKI had sepsis. Conclusion: Patients admitted to ICU in this study have high incidence of AKI. In patients who developed AKI, sepsis was the leading cause of ICU admission.

297 Exploring Risk Factors for Acute Kidney Injury in Patients Undergoing Cardiac Surgery

Abstract Aim Acute Kidney Injury (AKI) is an important complication following cardiac surgery that has been associated with adverse outcomes. The aim of this work was to investigate the incidence and risk factors for AKI in patients undergoing cardiac surgery at our centre. Method This is a retrospective analysis of 1441 patients who underwent elective or urgent (but not emergency) cardiovascular surgery with use of cardiopulmonary bypass over a 1-year period. Our exclusion criteria were heart transplant, single CABG, congenital repairs or patients on dialysis or renal transplant pre-operatively. Data analysis was performed in R studio. Results The mean age of the patients was 67.7 years. Mean creatinine from a 7-day period before surgery was 90µmol/L compared with the mean peak post operative creatinine of 127 µmol/L (95% CI 33-42, p-value &amp;lt;0.05). As defined by the KDIGO AKI stages, 27% developed an AKI stage 1, 11% developed AKI stage 2 and 1% AKI stage 3. The following variables correlated strongly (P-value &amp;lt;0.001) with post-operative risk of AKI: The comorbidities of diabetes, smoking, and peripheral vascular disease; pre-operative medications: diuretics, calcium channel blockers and SGLT-2 inhibitors and receiving FFP or RBC transfusion postoperatively. Conclusions AKI is a common complication following cardiac surgery. Having an insight into the risk factors for AKI allows an opportunity for intervention preoperatively and can also highlight patients that may require extra vigilance in the perioperative period to reduce its incidence, which may lead to an improvement in outcomes following surgery.

The Association of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio to the Prognosis of Acute Kidney Injury Patients

Abstract Background Acute kidney injury (AKI) is an increasingly common problem facing clinicians, especially nephrologists, intensive care physicians, general physicians and surgeons. Acute kidney injury is a heterogeneous group of conditions characterized by a sudden decrease in glomerular filtration rate, manifested by an increase in serum creatinine concentration or oliguria, and classified by stage and cause. Aim of the Work The aim of the study was to evaluate the prognostic ability of the Neutrophil to Lymphocyte ratio, Platelet to Lymphocyte ratio and neutrophil to lymphocyte and platelet ratio in adult patients with acute kidney injury with various etiologies and to evaluate their role in the prediction of both morbidity and mortality over period of three months. Patients and Methods To achieve this goal, we conducted this study on 102 patients who developed acute kidney injury during hospital admission in Ain Shams University hospitals. Results he study found no significant differences between PLR and NLP ratios among different AKI stages. NLP ratio showed an inverse correlation with serum creatinine and a positive correlation with estimated Glomerular Filtration Rate (eGFR), while PLR did not show significant correlation. NLP ratio had the ability to predict the outcome of AKI with significant differences between mortality and recovery cases, while PLR did not have significant ability to predict outcome. NLP ratio showed high sensitivity and specificity in predicting the need for vasopressors, mechanical ventilation, or hemodialysis, while PLR had moderate sensitivity and high specificity in predicting recovery. The study had some limitations, including not enrolling non-AKI control group and not evaluating the effect of certain treatments on the studied markers. Conclusion The study had the advantages of being conducted on relatively large sample size and included patients of variable causes of admission. The included patients had also variable causes of AKI and of different AKI stages. The study had some limitations as we did not enroll non- AKI control group. We did not evaluate the effect of certain treatment modalities as some antibiotics or interventions on the studied markers.

The Risk of Acute Kidney Injury in Patients Undergoing Coronary Angiography

Objective: This study was conducted to estimate the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent CA or PCI at a tertiary care hospital, to understand the incidence and the underlying contributory factors of CI-AKI. Methods: We conducted a retrospective review of patients who underwent CA or PCI from 1st January 2018 to 31st December 2020, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. The exclusion criteria comprised age &lt;18 years, preexisting chronic kidney disease (stage III–V), prior renal transplantation and records with missing key clinical information. Occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. P-value &lt;0.05 was considered statistically significant. Results: We reviewed 825 patient files, of which 754 met the inclusion criteria. According to the KDIGO classification, the mean overall incidence of Stage I CI-AKI in our study cohort was 8.1%, while no patients developed stage II and III AKI. The incidence of CI-AKI was 6.4% in patients &lt;55 years of age (n=264) and 7.8% in the age group of 55-70 years. A significantly higher incidence of 13.3% was seen in patients above the age of 70 years. The increase in the incidence of CI-AKI in patients above 70 years, versus their younger counterparts was statistically significant (P = 0.075). Conclusions: Based on the results of this study and past literature, the overall incidence of CI-AKI is around ≤10%, among patients undergoing CA or PCI; which seems lower than the high risk perception among cardiologists. While CI-AKI is a known post-procedural complication of CA or PCI, the apprehension of the potential risk of CI-AKI, should not defer or obstruct the decision to perform CA or PCI for deserving and needy candidates. Exercising caution among high-risk patients, individual risk-benefit assessment and employing well-established pre and peri-procedural prevention protocols can significantly mitigate the risk of CI-AKI; even among high-risk patients.