Outcomes Of Acute Kidney Injury Research Articles

Comparison of clinical characteristics and outcomes of acute kidney injury in the elderly and younger hospitalized patients

Data regarding the epidemiology, causes, and outcomes of acute kidney injury (AKI) are limited, especially in the elderly population. We aimed to investigate the clinical characteristics and early outcomes of AKI and to compare them between elderly and young patients hospitalized in an internal medicine clinic.
 Methods. This single-center retrospective study included patients with AKI who were hospitalized in a tertiary hospital. AKI was identified according to the Kidney Disease Improving Global Outcomes criteria. Sociodemographic, clinical, and laboratory data were recorded. Renal recovery, need for dialysis, and in-hospital mortality were compared between the elderly (>60 years) and younger (≤60 years) patients.
 Results. A total of 454 patients (327 elderly and 127 younger) were included in the study. The frequency of AKI in hospitalized patients was 12%. The most common cause of AKI was prerenal (61%). Prerenal AKI due to absolute intravascular volume reduction was the most important cause in both groups. Compared with the elderly patients, younger patients exhibited an increased rate of renal AKI (23% vs. 39%, p=0.001) and an increased need for dialysis during hospitalization (21% vs. 31.5% p=0.027). The incidence of vasculitis and glomerulonephritis was higher in younger patients with renal AKI than in the elderly patients (12% vs. 1.3% for vasculitis and 24% vs. 4% for glomerulonephritis p=0.001). Twenty-four percent of patients required dialysis during hospital stay and 10% required dialysis at discharge. The overall in-hospital mortality was 6,4%. Considering the AKI pathophysiology, the highest mortality rate was observed in AKI patients with renal origin (3.5%). There were no significant differences between elderly and younger patients based on renal recovery (complete recovery, 41% vs. 50%; progression 59% vs. 50%, p=0,073), hospital mortality (5.5% vs. 6.7%, p=0.634), and the need for dialysis at discharge (14% vs. 8.8%, p=0.082).
 Conclusions. In our study, we concluded that there was no significant difference between elderly and younger hospitalized patients according to the early outcomes of AKI. However, the younger patients had a higher rate of renal AKI with a more severe course.

A novel acute kidney injury scoring system for renal and clinical outcomes in pediatric heart transplant patients.

The development of acute kidney injury (AKI) has been associated with worse outcomes in children after heart transplantation. Our study compares the application of a cumulative six-point Kidney Diseases Improving Global Outcomes (KDIGO) AKI scoring system, utilizing both creatinine and urine output criteria that we term as the AKI-6 criteria, to traditional AKI staging as a predictor for clinical and renal outcomes in the pediatric heart transplant recipients. We conducted a retrospective single-center chart review on 155 pediatric patients who underwent heart transplantation from May 2014 to December 2021. The primary independent variable was the presence of severe AKI. Severe AKI by KDIGO was defined as Stage ≥2, whereas severe AKI by AKI-6 was defined as cumulative scores ≥4 or Stage 3 AKI based on either KDIGO criterion alone. Primary outcomes included actuarial survival and renal dysfunction by 1-year post-transplant, defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2 . In total, 140 (90%) patients developed AKI; 98 (63%) patients developed severe AKI by KDIGO, and 60 (39%) by AKI-6. Severe AKI by AKI-6 was associated with worse actuarial survival following heart transplantation compared with KDIGO (p = 0.01). Of the 143 patients with 1-year creatinine data, 6 (11%) patients out of 54 with severe AKI by AKI-6 had evidence of renal dysfunction (p = 0.01), compared with 6 (7%) patients out of 88 by KDIGO (p = 0.3). AKI-6 scoring provides greater prognostic utility for actuarial survival and renal dysfunction by 1-year post-heart transplantation in pediatric patients than traditional KDIGO staging.

Safety and efficacy of cerebral embolic protection devices for patients undergoing transcatheter aortic valve replacement: An updated meta‐analysis

AbstractBackground and AimsCerebral embolic protection (CEP) devices are employed to capture embolic debris and reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). Evidence is mixed regarding the safety and efficacy of CEP. We aimed to summarize the safety and effectiveness of CEP use during TAVR.MethodsElectronic databases, including PubMed, PubMed Central, Scopus, Cochrane Library, and Embase, were searched using relevant search terms for articles relating to CEP. All relevant data from 20 studies were extracted into a standardized form. Statistical analyses were performed using Revman 5.4. Odds ratio (OR) or mean differences (MDs) were used to estimate the desired outcome with a 95% confidence interval (CI).ResultsTwenty studies (eight randomized controlled trials [RCTs]) involving 210,871 patients (19,261 in the CEP group and 191,610 in TAVR without the CEP group) were included. The use of CEP was associated with a lower odds of 30‐day mortality by 39% (OR: 0.61, 95% CI: 0.53–0.70) and stroke by 31% (OR: 0.69, 95% CI: 0.52–0.92). Comparing devices, benefit in terms of mortality and stroke was observed with the use of the Sentinel device (Boston Scientific), but not among other devices. No differences were observed in the outcomes of acute kidney injury, major or life‐threatening bleeding events, or major vascular complications between groups. When only RCTs were included, there were no observed differences in the primary or secondary outcomes for CEP versus no CEP use during TAVR.ConclusionsThe totality of evidence suggests a net benefit for the use of CEP, weighted by studies in which the Sentinal device was used. However, given the RCT subanalysis, additional evidence is needed to identify patients at the highest risk of stroke for optimal decision‐making.

Outcome of Acute Kidney Injury (AKI) in Coronavirus Disease 2019 (COVID-19) patients

Outcome of Acute Kidney Injury (AKI) in Coronavirus Disease 2019 (COVID-19) patients

Clinical Features and Predictive Nomogram of Acute Kidney Injury in Aging Population Infected with SARS-CoV-2 Omicron Variant.

Since little is known about the acute kidney injury (AKI) in aging population infected with SARS-CoV-2 Omicron variant, we investigated the incidence, clinical features, risk factors and mid-term outcomes of AKI in hospitalized geriatric patients with and without COVID-19 and established a prediction model for mortality. A real-time data from the Shanghai Ninth People's Hospital information system of inpatients with COVID-19 from 1 April 2022 to 30 June 2022 were extracted. Clinical spectrum, laboratory results, and clinical prognosis were included for the risk analyses. Moreover, Cox and Lasso regression analyses were applied to predict the 90-day death and a nomogram was established. A total of 1607 SARS-CoV-2 infected patients were enrolled; hypertension was the most common comorbidity, followed by chronic cardiovascular disease, diabetes mellitus, and lung disease. Most of the participants were non-vaccinated and the mean age of patients was 82.6 years old (range, 60-103 years). The AKI incidence was higher in relatively older patients (16.29% vs 3.63% in patients older than 80 years and 60 to 80 years, respectively). Linear regression models identified some variables associated with the incidence of AKI, such as older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment. In this cohort, 11 patients died in-hospital and 21 patients died at 90-day follow-up. The predictive nomogram of 90-day death achieved a good C-index of 0.823 by using 5 predictor variables: ICU admission, D-dimer, peak of serum creatinine, rate of serum creatinine decline and white blood cell count (WBC). Older age, clinical spectrum, D-dimer level, number of comorbidities, baseline eGFR, and antibiotic or corticosteroid treatment are clinical risk factors for the incidence of AKI in geriatric COVID-19 patients. The prediction nomogram achieved an excellent performance at the prediction of 90-day mortality.

Risk Factors and Outcome of Acute Kidney Injury in Critical COVID-19 patients in Karachi, Pakistan: A Single center, Retrospective study

Introduction: The severe acute respiratory syndrome coronavirus2 (SARS-CoV2) is a novel beta-coronaviridae family and its effects on the kidneys have been reported which included the increased requirement of renal replacement therapy during the Covid-19 pandemic. Our study is,thus, designed to determine the risk factors of AKI in critically ill patients with covid-19 and their outcomes&#x0D; Method and Material: It is a retrospective observational study of COVID-19 patients admitted in SIDH&amp;RC(specialized facility center for COVID-19) from July 2020 to July 2021. The patients were divided into two groups; one with confirmed critical COVID-19 and had AKI during hospital stay and the other group who have confirmed critical COVID-19 and did not had AKI during hospital stay.&#x0D; Results: Total 232 patients included in this study who were critical at the time of admission in which 92(39.65%) of the patients had AKI during hospital stay. Most of the patients who had AKI were male 55(59.8%). We found that in this population mortality was not significant in critical COVID-19 patients with AKI. However, patients with AKI had worst survival distribution compared to non-AKI patients (p&lt;0.05). Patients with AKI required mechanical ventilation compared to non-AKI patients (70.7% vs 50.7%, p&lt;0.05) along with significant chances of occurrence of complications as superimposed bacterial infections (78.3% vs 52.9%, p&lt;0.05), NSTEMI (33.7% vs 13.6%, p&lt;0.05), septic shock (66.3% vs 38.6%, p&lt;0.05) and progression to severe ARDS (78.3% vs 60.7%, p&lt;0.05). &#x0D; Conclusion: We found that patients with AKI had a worst survival distribution than non AKI in Critical COVID-19 patients

HMGB1 Is a Prognostic Factor for Mortality in Acute Kidney Injury Requiring Renal Replacement Therapy

Instruction: High mobility group box 1 (HMGB1) is a pro-inflammatory cytokine that reportedly causes kidney injury and other organ damage in rodent acute kidney injury (AKI) models. However, it remains unclear whether HMGB1 is associated with clinical AKI and related outcomes. This study aimed to evaluate the association with HMGB1 and prognosis of AKI requiring continuous renal replacement therapy (CRRT). Methods: AKI patients treated with CRRT in our intensive care unit were enrolled consecutively during 2013–2016. Plasma HMGB1 was measured on initiation. Classic initiation was defined as presenting at least one of the following conventional indications: hyperkalemia (K ≥6.5 mEq/L), severe acidosis (pH <7.15), uremia (UN >100 mg/dL), and diuretics-resistant pulmonary edema. Early initiation was defined as presenting no conventional indications. The primary outcome was defined as 90-day mortality. Results: A total of 177 AKI patients were enrolled in this study. HMGB1 was significantly associated with the primary outcome (hazard ratio, 1.06; 95% CI, 1.04–1.08). When the patients were divided into two-by-two groups by the timing of CRRT initiation and the HMBG1 cutoff value obtained by receiver operating curve (ROC) analysis, the high HMGB1 group (>10 ng/mL) with classic initiation was significantly associated with the primary outcome compared with the others, even after adjusting for other factors including the nonrenal serial organ failure assessment (SOFA) score. Conclusion: HMGB1 was associated with 90-day mortality in AKI patients requiring CRRT. Notably, the highest mortality was observed in the high HMGB1 group with classic initiation. These findings suggest that CRRT should be considered for AKI patients with high HMGB1, regardless of the conventional indications.

Predicting outcomes of acute kidney injury in critically ill patients using machine learning

Acute Kidney Injury (AKI) is a sudden episode of kidney failure that is frequently seen in critically ill patients. AKI has been linked to chronic kidney disease (CKD) and mortality. We developed machine learning-based prediction models to predict outcomes following AKI stage 3 events in the intensive care unit. We conducted a prospective observational study that used the medical records of ICU patients diagnosed with AKI stage 3. A random forest algorithm was used to develop two models that can predict patients who will progress to CKD after three and six months of experiencing AKI stage 3. To predict mortality, two survival prediction models have been presented using random survival forests and survival XGBoost. We evaluated established CKD prediction models using AUCROC, and AUPR curves and compared them with the baseline logistic regression models. The mortality prediction models were evaluated with an external test set, and the C-indices were compared to baseline COXPH. We included 101 critically ill patients who experienced AKI stage 3. To increase the training set for the mortality prediction task, an unlabeled dataset has been added. The RF (AUPR: 0.895 and 0.848) and XGBoost (c-index: 0.8248) models have a better performance than the baseline models in predicting CKD and mortality, respectively Machine learning-based models can assist clinicians in making clinical decisions regarding critically ill patients with severe AKI who are likely to develop CKD following discharge. Additionally, we have shown better performance when unlabeled data are incorporated into the survival analysis task.

Metabolomics in Acute Kidney Injury: The Clinical Perspective.

Acute kidney injury (AKI) affects increasing numbers of hospitalized patients worldwide. The diagnosis of AKI is made too late in most individuals since it is still based on dynamic changes in serum creatinine. In recent years, new AKI biomarkers have been identified; however, none of these can reliably replace serum creatinine yet. Metabolomic profiling (metabolomics) allows the concomitant detection and quantification of large numbers of metabolites from biological specimens. The current article aims to summarize clinical studies on metabolomics in AKI diagnosis and risk prediction. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, and Scopus, and the period lasted from 1940 until 2022. The following terms were utilized: 'AKI' OR 'Acute Kidney Injury' OR 'Acute Renal Failure' AND 'metabolomics' OR 'metabolic profiling' OR 'omics' AND 'risk' OR 'death' OR 'survival' OR 'dialysis' OR 'KRT' OR 'kidney replacement therapy' OR 'RRT' OR 'renal replacement therapy' OR 'recovery of kidney function' OR 'renal recovery' OR 'kidney recovery' OR 'outcome'. Studies on AKI risk prediction were only selected if metabolomic profiling allowed differentiation between subjects that fulfilled a risk category (death or KRT or recovery of kidney function) and those who did not. Experimental (animal-based) studies were not included. In total, eight studies were identified. Six studies were related to the diagnosis of AKI; two studies were performed on metabolic analysis in AKI risk (death) prediction. Metabolomics studies in AKI already helped to identify new biomarkers for AKI diagnosis. The data on metabolomics for AKI risk prediction (death, KRT, recovery of kidney function), however, are very limited. Both the heterogenous etiology and the high degree of pathogenetic complexity of AKI most likely require integrated approaches such as metabolomics and/or additional types of '-omics' studies to improve clinical outcomes in AKI.

Socioeconomic Influences on the Outcomes of Dialysis-Requiring Acute Kidney Injury in Brazil

BackgroundWhile research suggests that socioeconomic deprivation is linked to a higher incidence of acute kidney injury (AKI) and worse outcomes in high-income countries, there is limited knowledge about these epidemiological factors in developing countries. Additionally, the impact of medical institution administration (private versus public) on AKI outcomes remains to be determined.MethodsWe studied 15,186 pediatric and adult patients with dialysis-requiring AKI (AKI-D) admitted to private and public hospitals in Rio de Janeiro, Brazil. According to Brazil's demographic census, socioeconomic indicators were derived from patient zip codes. Propensity score matching analysis and a mixed-effect Cox regression were used to assess the impact of socioeconomic indicators and hospital governance on patient survival.ResultsCrude mortality rates were higher in private versus public hospitals (71.8% vs. 59.5%, p < 0.001) and were associated with significant differences in age (75 [IQR, 61–83] vs. 53 [IQR, 31–66]), baseline renal function (prevalence of chronic kidney disease: 33.2% vs. 23%, p < 0.001), comorbidities (Charlson score: 2.03 ± 0.87 vs. 1.72 ± 0.75, p < 0.001), and severity of presentation (mechanical ventilation: 76.5% vs. 58% and vasopressors: 72.8% vs. 50.5%, p < 0.001). After adjustments and propensity score matching, we found no effect of different hospital administrations or socioeconomic factors on mortality. Baseline characteristics and the severity of presentation primarily influenced AKI-D prognosis.ConclusionsDespite significant racial and socioeconomic differences in hospital governance, these indicators had no independent influence on mortality. Future epidemiological studies should investigate these relevant assumptions to allow healthcare systems to manage this severe syndrome promptly.

#5352 INCIDENT ACUTE KIDNEY INJURY AND THE RISK OF DEMENTIA: THE STOCKHOLM CREATININE MEASUREMENTS (SCREAM) PROJECT

Abstract Background and Aims Preclinical studies suggest that acute kidney injury (AKI) leads to biochemical and pathological changes in the brain. However, whether developing AKI associates with the risk of dementia is not well explored. We here aimed to evaluate the association between developing AKI and the subsequent risk of dementia in general population. Method We included all adults with age ≥65 years, free from dementia diagnosis and with known kidney function in Stockholm during 2006-2019. The exposure was AKI (time varying): prevalent history of AKI was ascertained by clinical diagnoses, and new/incident AKI events during observation by both clinical diagnoses and transient creatinine elevations according to KDIGO criteria. The outcome was dementia diagnosis, first via confirmed cases in the Swedish registry of cognitive/dementia disorders (SveDem) and enriched with cases identified by two issued diagnoses of dementia in outpatient care or initiation of specific anti-dementia medications. We considered death, migration, and end of follow-up as censoring events and also explored risk associations with specific dementia subtypes. The association between developing AKI and study outcomes was evaluated through time-varying multivariate Cox regression, accounting for recurrent AKI events through weighted cumulative exposure metrics. Results We included 354,612 individuals with median 76 years (55% women). During median follow-up of 8.1 (IQR: 3.7, 12.1) years, there were 48,624 (14%) persons suffering at least one episode of AKI, and 47,765 (13%) diagnoses of dementia were recorded. The rate of dementia cases was 37.13 per 1000 person-year (95% CI 36.06-38.22) after developing AKI, which was approximately 2 times higher than the rate observed during the periods without AKI (18.47 [18.3-18.64]). After multivariable adjustment, developing AKI was associated with a 48% higher risk of having dementia [adjusted HR 1.48 (95%CI 1.43-1.53)]. This pattern was consistent for the dementia subtypes: the HRs for Alzheimer's dementia, Parkinson's disease dementia, and vascular dementia were 1.14 (1.07-1.21), 1.90 (1.37-2.65) and 1.24 (1.15-1.33) higher, respectively, after developing AKI. Among persons with recurrent AKIs, each additional AKI event was associated a 4% higher risk of dementia (adjusted HR: 1.04, 95% CI: 1.03-1.05). We observed similar results across subgroups of sex, baseline kidney function, history of hypertension, diabetes, and cardiovascular disease. Conclusion In this region-representative cohort, participants who experienced AKI were at increased risk of receiving a diagnosis of dementia.

#6578 ACUTE KIDNEY INJURY IN PATIENTS WITH VENTRICULAR SEPTAL RUPTURE: A SINGLE CENTER STUDY

Abstract Background and Aims Ventricular septal rupture (VSR) is an infrequent but dreaded complication of acute myocardial infarction(AMI). Acute kidney injury(AKI) is one of the major determinants of morbidity and mortality in these patients. Renal replacement therapy (RRT) is, in this set of patients of high-risk nature and can be prolonged. Focused data on the management of AKI in patients with VSR from developing countries is scarce. We present a large cohort of patients presenting with VSR from a tertiary care Centre in South India, evaluating the incidence of AKI, RRT, and short-term outcomes in this cohort. Method Observational study of all adult patients diagnosed with VSR following AMI over 5 years in a single centre in Chennai, India. Demographic characteristics, co-morbidities,clinical and laboratory,Serial renal function tests and urine output was noted. eGFR was calculated using the CKD-EPI formula.AKI definition and staging -KDIGO clinical Practice Guidelines. Data analysis was done using the IBM SPSS version 24. P-value less than 0.05 is used to indicate statistical significance. Results During the study period, 3024 patients presented to our hospital with acute coronary syndrome (ACS) and seventy patients presented with VSR (2.3%). Of these, forty-seven (67.1%) developed AKI. A nephrology consult was obtained for thirty-three (70%) patients. Older age, higher total count and lower systolic blood pressure were significantly associated with the occurrence of AKI. The mortality in the AKI group was significantly higher (63.8%). VSR closure was done in 12.7% and 21.7% of the AKI and non-AKI groups respectively. Surgical VSR repair was done in 61.7% and 60.8% of the patients with and without AKI respectively. Most of the patients (26, 55.3%) presented with KDIGO stage 3 AKI and all were oliguric. 10 and 11 patients were staged into KDIGO stages 1 and 2 respectively. 26 patients with Stage 3 AKI, only 14 (29.7%%) of them received nephrology consult.. RRT was initiated in fifteen patients (31.9%). The indications for RRT were oliguria, pulmonary oedema, metabolic acidosis, and worsening electrolyte disturbance.Acute peritoneal dialysis was initiated in 11 patients (73.3%) using a 43cm swan neck double cuffed tunnelled Tenckhoff peritoneal dialysis catheter placed at the bedside. Percutaneous peritoneal dialysis catheter insertion by a nephrologist was done in and the rest was inserted by open laparotomy technique by a trained general surgeon. All 11 were initiated on urgent low volume supine exchanges. Of these ten patients had manual exchanges done by a trained peritoneal dialysis nurse and one patient was put on automated peritoneal dialysis. The average volume per dwell was 500 ml±250 ml which was gradually increased if there was no leak. The total average peritoneal dialysis volume per day was 10L±2 L. The strength of bags (1.36%, 2.25%, 3.86%) dextrose was determined based on volume status and patients’ hemodynamics. No patient had a leak or peritoneal dialysis-related peritonitis. All patients’ peritoneal dialysis catheter was immobilized with a tight abdominal dressing. One patient continued continuous ambulatory peritoneal dialysis at home as there was no recovery of renal function and was lost to follow up. Sustained low-efficiency dialysis was performed on four patients. Duration of Sustained low-efficiency dialysis ranged from 6-8 hours with average blood flows of 150 ml/min and average fluid removal between 1.5-3L. Unfractionated heparin was used in three patients, and one was heparin free saline dialysis. Discharge eGFR in the AKI group was significantly lower as compared to the non-AKI group. (38 vs 104ml/min/1.73m2, p&amp;lt;0.001). Follow up was done on 14 at 3 months, The mean eGFR was 57.8ml/min/1.73 m2 when compared to 81.8 ml/min/1.73 m2. Conclusion The incidence of AKI is high and is associated with a high rate of mortality in patients with VSR. Peritoneal dialysis is a safe and effective option for those patients requiring RRT. Follow up of AKI patients at three months did not show a significant decline in renal function

#4314 IMPACT OF ACUTE KIDNEY INJURY ON OUTCOME OF SEVERE FEVER WITH THROMBOCYTOPENIA SYNDROME

Abstract Background and Aims Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease with a high case-fatality rate in East Asia. In addition, acute kidney injury (AKI) has been reported in 14∼36% of the SFTS virus-infected patients. However, the risk factor for AKI and the clinical outcome of AKI in patients with SFTS has not been well understood. Method Patients who confirmed SFTS virus infection during five years from 2016 to 2020 in Kangwon national university hospital were retrospectively reviewed. Their laboratory data and medical records, such as comorbidity, complications, and mortality, were obtained from the electronic medical record. AKI was defined according to KDIGO criteria. The risk factors for death were assessed by Cox proportional hazards regression analysis. Results Of the 53 patients, 29 (54.7%) were male, and the mean age was 66.5 years. Twenty-seven (50.9%) patients were defined as AKI; 17 patients were AKI stage 1, 5 patients were AKI stage 2, and 5 patients were AKI stage 3. Of these, 5 patients underwent dialysis and all of them needed continuous renal replacement therapy. Patients with AKI were significantly older and had a higher proportion of diabetes (p = 0.041 and p = 0.019, respectively). In baseline laboratory tests, levels of aspartate aminotransferase, alanine aminotransferase and c-reactive protein were higher in AKI group (p = 0.011, p = 0.019, and p = 0.012, respectively). Among 53 patients, nine died due to SFTS, and the fatality rate was 15.1%. The AKI group (29.6%) had a higher mortality rate than the no AKI group (3.8%). In univariate analysis, higher levels of white blood cells, blood urea nitrogen, creatinine, and alkaline phosphatase were risk factors for death. In multivariate analysis, leukocytosis and AKI stage 3 were independent risk factors for death. Conclusion AKI frequently occurs among patients with SFTS. In patients with AKI stage 3, the mortality rate is significantly higher than no or mild AKI, so special attention should be paid when it occurs.

Clinical Considerations for Patients Experiencing Acute Kidney Injury Following Percutaneous Nephrolithotomy.

Acute kidney injury (AKI) is a common postoperative outcome in urology patients undergoing surgery for nephrolithiasis. The objective of this study was to determine the prevalence of postoperative AKI and its degrees of severity, identify risk factors, and understand the resultant outcomes of AKI in patients with nephrolithiasis undergoing percutaneous nephrolithotomy (PCNL). A cohort of patients admitted between 2012 and 2019 to a single tertiary-care institution who had undergone PCNL was retrospectively analyzed. Among 417 (n = 326 patients) encounters, 24.9% (n = 104) had AKI. Approximately one-quarter of AKI patients (n = 18) progressed to Stage 2 or higher AKI. Hypertension, peripheral vascular disease, chronic kidney disease, and chronic anemia were significant risk factors of post-PCNL AKI. Corticosteroids and antifungals were associated with increased odds of AKI. Cardiovascular, neurologic complications, sepsis, and prolonged intensive care unit (ICU) stay percentages were higher in AKI patients. Hospital and ICU length of stay was greater in the AKI group. Provided the limited literature regarding postoperative AKI following PCNL, and the detriment that AKI can have on clinical outcomes, it is important to continue studying this topic to better understand how to optimize patient care to address patient- and procedure-specific risk factors.

#3719 INCIDENCE, OUTCOMES AND RISK FACTORS OF ACUTE KIDNEY INJURY IN PATIENTS THAT UNDERWENT TRANSCATHETER AORTIC VALVE REPLACEMENT

Abstract Background and Aims The incidence of acute kidney injury (AKI) in transcatheter aortic valve replacement (TAVR) varied among different centers and populations. The studies about the AKI in TAVR in Asian population were relatively scarce. Here, we reported the first descriptive study of AKI in patients underwent TAVR in Thailand. We also analyzed the risk factors of AKI in patients underwent TAVR. Method We reviewed the medical records of patients underwent TAVR in Chulabhorn hospital from August 2019 to September 2022. Baseline characteristics, serum creatinine and estimated glomerular filtration rate (eGFR) at baseline, day 2, day 7 and at discharge were recorded. Patients who did not have serum creatinine measured at day 2 or day 7 were excluded from our study. Patients who already underwent hemodialysis or peritoneal dialysis before TAVR also excluded from our study. We used the definition of AKI by KDIGO guideline. Outcome of AKI including 30-day mortality, 1-year mortality and renal replacement therapy were also recorded. Results We included 113 patients who underwent TAVR, all of which had the diagnosis of severe symptomatic aortic stenosis. 56 patients (49.6%) were male patients. The mean age was 80.2 +/- 5.6 years. The average length of stay was 9.9 days. 54 patients (47.8%) had pre-existing chronic kidney disease (CKD) before underwent TAVR. Other co-morbidities were hypertension (81/113 = 71.7%), dyslipidemia (71/113 = 62.8%), prior myocardial infarction (53/113 = 46.9%), diabetes (36/113 = 31.9%), and prior stroke or transient ischemic attack (5/113 = 4.4%). AKI occurred in seven patients (6.2%). Four patients (4/7 = 57.1%) underwent acute dialysis after TAVR. 30-day mortality rate was 0% and 1-year mortality rate was 1.8%. The 1-year mortality rate in patient with AKI was 14.3% compared with 0.9% in patient without AKI. The univariate analysis revealed that age, prior myocardial infarction, pre-existing CKD and pre-TAVR serum creatinine were risk factors for developing AKI after TAVR. Conclusion This is the first study exploring incidence, outcomes and risk factors of AKI in patients underwent TAVR in Thailand. The incidence of AKI was 6.2%, relatively low compared with previous study.

Clinical Outcomes for Acute Kidney Injury in Acute Myocardial Infarction Patients after Intra-Aortic Balloon Pump Implantation: A Single-Center Observational Study.

Acute kidney injury (AKI) is common after cardiac interventional procedures. The prevalence and clinical outcome of AKI in patients with acute myocardial infarction (AMI) after undergoing intra-aortic balloon pump (IABP) implantation remains unknown. The aim of this study was to investigate the incidence, risk factors, and prognosis of AKI in specific patient populations. We retrospectively reviewed 319 patients with AMI between January 2017 and December 2021 and who had successfully received IABP implantation. The diagnostic and staging criteria used for AKI were based on guidelines from "Kidney Disease Improving Global Outcomes". The composite endpoint included all-cause mortality, recurrent myocardial infarction, rehospitalization for heart failure, and target vessel revascularization. A total of 139 patients (43.6%) developed AKI after receiving IABP implantation. These patients showed a higher incidence of major adverse cardiovascular events (hazard ratio [HR]: 1.55, 95% confidence interval [CI]: 1.06-2.26, p = 0.022) and an increased risk of all-cause mortality (HR: 1.62, 95% CI: 1.07-2.44, p = 0.019). Multivariable regression models found that antibiotic use (odds ratio [OR]: 2.07, 95% CI: 1.14-3.74, p = 0.016), duration of IABP use (OR: 1.24, 95% CI: 1.11-1.39, p 0.001) and initial serum creatinine (SCr) (OR: 1.01, 95% CI: 1.0-1.01, p = 0.01) were independent risk factors for AKI, whereas emergency percutaneous coronary intervention was a protective factor (OR: 0.35, 95% CI: 0.18-0.69, p = 0.003). AMI patients who received IABP implantation are at high risk of AKI. Close monitoring of these patients is critical, including the assessment of renal function before and after IABP implantation. Additional preventive measures are needed to reduce the risk of AKI in these patients.

Impact of care bundles on the occurrence and outcomes of acute kidney injury among patients withST-segment elevation myocardial infarction.

Several reports suggested that compliance with acute kidney injury care bundles among hospitalized patients resulted in improved kidney and patient outcomes. We investigated the effect of acute kidney injury care bundle utilization on the incidence of acute kidney injury and renal outcomes in a large cohort of myocardial infarction patients treated with percutaneous coronary intervention. We included patients withmyocardial infarction admitted following percutaneous coronary intervention between January 2008 and December 2020. From January 2016, acute kidney injury care bundle was implemented in our cardiac intensive care unit. Acute kidney injury care bundle consisted of simple standardized investigations and interventions, including strict monitoring of serum creatinine and urine analysis, planning investigations, treatment, and guidance about seeking nephrologist advice. Patients' records were evaluated for the occurrence of acute kidney injury, its severity, and recovery, before and after the implementation of acute kidney injury care bundle. We included2646 patients (1941 patients in the years 2008-2015 and 705 patients in the years 2016-2020). Implementation of care bundles resulted in a significant decrease in the occurrence of acute kidney injury from 190/1945 to 42/705 (10-6%; p < 0.001), with a trend for lower acute kidney injury score > 1 (20% vs. 25%; p = 0.07) and higher acute kidney injury recovery (62% vs. 45%, p = 0.001). Using a multivariable regression model, the use of care bundles resulted in a 45% decrease in the relative risk for acute kidney injury (HR 0.55, 95% CI 0.37-0.82, p < 0.001). Among patients withST-elevation myocardial infarction, treated with percutaneous coronary intervention and admitted to our cardiac intensive care unit over the period January 2008-December 2020, compliance with acute kidney injury care bundle was independently associated with a significant decrease in occurrence ofacute kidney injury and withbetter renal outcomes following acute kidney injury. Further interventions, such ase-alert systems for acute kidney injury, could improve utilization of the acute kidney injury care bundle and optimize its clinical benefits.

Acute kidney injury in children with haematological malignancy: a territory-wide study.

In onco-nephrology, data on acute kidney injury (AKI) among children with haematological malignancies are scarce. A retrospective cohort study of all patients in Hong Kong diagnosed with haematological malignancies from 2019 to 2021 before 18years of age, was conducted to investigate the epidemiology, risk factors and clinical outcomes of AKI during the first year of treatment. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. We included 130 children with haematological malignancy at median age of 9.4years (IQR, 3.9-14.1). Of these patients, 55.4% were acute lymphoblastic leukemia (ALL), 26.9% were lymphoma and 17.7% were acute myeloid leukemia (AML). Thirty-five patients (26.9%) developed 41 AKI episodes during the first year of diagnosis, corresponding to 32 episodes per 100-patient-year. A total of 56.1% and 29.2% of the AKI episodes occurred during induction and consolidation chemotherapy respectively. Septic shock (n = 12, 29.2%) was the leading cause of AKI; 21 episodes (51.2%) were stage 3 AKI; 12 episodes (29.3%) were stage 2 AKI; and 6 patients required continuous kidney replacement therapies. Tumor lysis syndrome and impaired baseline kidney function were significantly associated with AKI on multivariate analysis (P = 0.01). History of AKI was associated with chemotherapy postponement (37.1% vs. 16.8%, P = 0.01), worse 12-month patient survival (77.1% vs. 94.7%, log rank P = 0.002) and lower disease remission rate at 12-month (68.6% vs. 88.4%, P = 0.007), compared to patients without AKI. AKI is a common complication during treatment of haematological malignancies which is associated with worse treatment outcomes. A regular and dedicated surveillance program for at-risk patients should be studied in children with haematological malignancies for prevention and early detection of AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.

A randomized clinical trial assessing the effect of automated medication-targeted alerts on acute kidney injury outcomes

Acute kidney injury is common among hospitalized individuals, particularly those exposed to certain medications, and is associated with substantial morbidity and mortality. In a pragmatic, open-label, National Institutes of Health-funded, parallel group randomized controlled trial (clinicaltrials.gov NCT02771977), we investigate whether an automated clinical decision support system affects discontinuation rates of potentially nephrotoxic medications and improves outcomes in patients with AKI. Participants included 5060 hospitalized adults with AKI and an active order for any of three classes of medications of interest: non-steroidal anti-inflammatory drugs, renin-angiotensin-aldosterone system inhibitors, or proton pump inhibitors. Within 24 hours of randomization, a medication of interest was discontinued in 61.1% of the alert group versus 55.9% of the usual care group (relative risk 1.08, 1.04 – 1.14, p = 0.0003). The primary outcome – a composite of progression of acute kidney injury, dialysis, or death within 14 days - occurred in 585 (23.1%) of individuals in the alert group and 639 (25.3%) of patients in the usual care group (RR 0.92, 0.83 – 1.01, p = 0.09). Trial Registration Clinicaltrials.gov NCT02771977.

Clindamycin Plus Vancomycin Versus Linezolid for Treatment of Necrotizing Soft Tissue Infection.

Necrotizing soft tissue infections (NSTIs) are life-threatening infections. The aim of this study is to evaluate the safety of clindamycin plus vancomycin versus linezolid as empiric treatment of NSTIs. This was a retrospective, single-center, quasi-experimental study of patients admitted from 1 June 2018 to 30 June 2019 (preintervention) and 1 May 2020 to 15 October 2021 (postintervention). Patients who received surgical management within 24 hours of NSTI diagnosis and at least 1 dose of linezolid or clindamycin were included. The primary endpoint was death at 30 days. The secondary outcomes included rates of acute kidney injury (AKI) and Clostridioides difficile infection (CDI). A total of 274 patients were identified by admission diagnosis code for NSTI or Fournier gangrene; 164 patients met the inclusion criteria. Sixty-two matched pairs were evaluated. There was no difference in rates of 30-day mortality (8.06% vs 6.45%; hazard ratio [HR], 1.67 [95% confidence interval {CI}, .32-10.73]; P = .65). There was no difference in CDI (6.45% vs 1.61%; HR, Infinite [Inf], [95% CI, .66-Inf]; P = .07) but more AKI in the preintervention group (9.68% vs 1.61%; HR, 6 [95% CI, .73-276]; P = .05). In this small, retrospective, single-center, quasi-experimental study, there was no difference in 30-day mortality in patients receiving treatment with clindamycin plus vancomycin versus linezolid in combination with standard gram-negative and anaerobic therapy and surgical debridement for the treatment of NSTIs. A composite outcome of death, AKI, or CDI within 30 days was more common in the clindamycin plus vancomycin group.