Overall Incidence Of Acute Kidney Injury Research Articles

Sarcopenia, a Risk Predictor of Postoperative Acute Kidney Injury in Elderly Patients after Hip Fracture Surgery: A Retrospective Analysis

Background and Objectives: Hip fracture surgery, which affects quality of life, can be a major challenge in geriatric populations. Although sarcopenia is known to be associated with postoperative outcomes, there are few studies on the association between sarcopenia and postoperative acute kidney injury (AKI) in this population. We investigated the association between sarcopenia and postoperative AKI in elderly patients following hip fracture surgery. Materials and Methods: We retrospectively reviewed the records of patients who underwent hip fracture surgery at our institution from March 2019 to December 2021. Patients under the age of 65, patients with no preoperative computed tomography (CT) scans and patients with inappropriate cross-sectional images for measurement were excluded. The psoas-lumbar vertebral index (PLVI), which is the ratio of the average area of both psoas muscles to the area of the fourth lumbar vertebral body, was measured from preoperative CT scans. Sarcopenia was defined as a PLVI within the lowest 25% for each sex, and patients were categorized into sarcopenic and nonsarcopenic groups. The occurrence of AKI was determined based on the serum creatinine level within postoperative day 7 using the Kidney Disease Improving Global Outcomes (KDIGO) guidelines. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between clinical variables and the occurrence of AKI. Results: Among the 348 enrolled patients, 92 patients were excluded, and 256 patients were analyzed. The PLVI cutoff values for defining sarcopenia lower than 25% for male and female patients were 0.57 and 0.43, respectively. The overall incidence of AKI was 18.4% (47 patients), and AKI occurred more frequently in sarcopenic patients than in nonsarcopenic patients (29.7% vs. 14.6%, p = 0.007). According to the multivariate logistic regression, which included all variables with a p value < 0.05 in the univariate analysis and adjusted for age, body mass index (BMI) and American Society of Anesthesiologists (ASA) physical status, sarcopenia was revealed to be an independent predictor of postoperative AKI (odds ratio = 5.10, 95% confidence interval = 1.77–14.77; p = 0.003). Conclusions: Preoperative sarcopenia, which corresponds to the lowest quartile of PLVI values, is associated with postoperative AKI among elderly patients who underwent hip fracture surgery.

Incidence of acute kidney injury in patients with acute ischaemic stroke undergoing CT angiography (CTA) and CT perfusion (CTP): a systematic review and meta-analysis

Background and purposeWe conducted a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in patients undergoing CT angiography (CTA) and CT perfusion (CTP) for acute...

Association of piperacillin and vancomycin exposure on acute kidney injury during combination therapy.

Acute kidney injury (AKI) is a well-documented adverse effect observed with piperacillin/tazobactam in combination with vancomycin. The pharmacokinetics of these antibiotics when given in combination have not been previously evaluated. The purpose of this study was to compare the exposure of vancomycin + piperacillin/tazobactam in patients with and without AKI. Ninety adult patients, who received at least 72 h of vancomycin + piperacillin/tazobactam combination therapy and had available serum concentrations of vancomycin and piperacillin were included in the study. Nephrotoxicity was defined as a 1.5-fold increase in serum creatinine within 7 days from baseline. Median daily AUCs were calculated in those with nephrotoxicity (vancomycin + piperacillin/tazobactam 'N') versus those without nephrotoxicity (vancomycin + piperacillin/tazobactam 'WN') during the first 7 days of combination therapy. The overall incidence of AKI in those receiving vancomycin + piperacillin/tazobactam was 20% (18/90). The median daily vancomycin AUCs did not differ between the vancomycin + piperacillin/tazobactam 'WN' and vancomycin + piperacillin/tazobactam 'N' groups. Although not statistically significant, the median daily vancomycin AUCs in the vancomycin + piperacillin/tazobactam 'N' group were numerically greater on Day 5 and trended downwards thereafter. For the piperacillin group, the median daily AUCs did not vary between groups, except on Day 7 where the vancomycin + piperacillin/tazobactam 'WN' group had statistically greater median piperacillin AUC than the vancomycin + piperacillin/tazobactam 'N' group (P = 0.046). Utilizing serum creatinine-defined AKI, our study did not find any significant differences in vancomycin and piperacillin/tazobactam exposure between the groups with and without nephrotoxicity. These data indicate that vancomycin + piperacillin/tazobactam should not be avoided due to the risk of overexposure; instead, clinicians should continue to use these therapies cautiously.

Acute kidney injury and its predictors in surgery of malignant kidney tumors

Aim. To analyze our own results of the course of early postoperative period in patients who underwent surgical treatment of kidney tumors: partial nephrectomy (PN) and radical nephrectomy (RN) and to identify risk factors for the development of acute kidney injury (AKI).Materials and methods. The study included 399 patients, of which 276 patients (69.17 %) underwent PN, 123 (30.83 %) underwent RN. According to the clinical stage of the disease, patients in the PN and RN groups were distributed as follows: cT1a – 160 (91.95 %) and 14 (8.05 %), cT1b – 99 (61.11 %) and 63 (38.89 %) and cT2a – 17 (26.98 %) and 46 (73.02 %), respectively. Operations were performed with open (1.0 %), laparoscopic (39.35 %) and robot-assisted (59.65 %) accesses. AKI was evaluated by the changes in serum creatinine and glomerular filtration rate before surgery and 1–3 days after in accordance with KDIGO criteria.Results. The overall incidence of AKI after surgical treatment for kidney cancer at stages cT1a–cT2a was 27.57 %. The incidence of AKI after RN was 65.04 %, after PN – 11.23 %. At stages cT1a, cT1b, cT2a, after nephron-sparing surgery and radical treatment, this indicator was 9.37; 11.11; 29.41 % and 71.43; 63.49; 65.22 %, respectively. For warm ischemia time below 15 and 20 minutes, AKI incidence did not exceed 8.3 and 13.2 %, respectively. For warm ischemia time >30 min, a dramatic increase in AKI incidence was observed.Conclusion. To preserve kidney function, PN is the operation of choice in surgical treatment of kidney tumors at stages cT1–cT2a. After RN, AKI development was observed 6 times more often than after PN. The following statistically significant predictors of AKI after PN were identified: presence of initial chronic kidney disease in patients, tumor size, operative time above 190 minutes, type of kidney ischemia used, and warm ischemia time above 25 minutes.

Incidence of Post-laparotomy Acute Kidney Injury Among Abdominal Trauma Patients and Its Associated Risk Factors at King Abdulaziz Medical City, Riyadh.

Background This research study investigates the prevalence of acute kidney injury (AKI) in trauma patients undergoing emergency laparotomies. AKI is a common complication in major surgeries and is associated with various adverse effects. The study aims to explore the relationship between AKI and other comorbidities in this specific context. Methodology This is a retrospective cohort study. All patients who had laparotomy after abdominal trauma at King Abdulaziz Medical City (KAMC) and met the inclusion criteria were included in the study. Nonprobability consecutive sampling was used.Data were collected by chart review using the Best-Care system at KAMC. Descriptive statistics were used to summarize and describe the characteristics of the study participants. Frequencies and percentages were calculated for categorical variables, such as comorbidities. For continuous variables, mean and standard deviations were calculated and tabulated.All statistical calculations were performed using IBM SPSS Statistics for Windows, Version 27.0 (IBM Corp., Armonk, NY, USA). Results This research study included 152 patients who underwent laparotomy, and the majority of patients (146, 96%)did not experience AKI. Several comorbidities were observed, with hypertension and diabetes being the most prevalent at 37 (24.3%) and 35 (23%), respectively. Intraoperative hypotension was experienced by 23 (15.1%) patients, while 129 (84.9%) did not have this issue. Norepinephrine was the most common vasopressor used (25.7%), followed by ephedrine and a combination of norepinephrine and epinephrine. Gender and age groups did not show significant associations with AKI, comorbidities like diabetes, heart failure, and chronic kidney disease (CKD) demonstrated significant relationships with AKI. There was no significant difference in eGFR and serum creatinine baseline levels between patients meeting AKI criteria and those who did not. Conclusions The low overall incidence of AKI in this patient population is encouraging. However, healthcare professionals must be aware of the significant impact of comorbidities such as diabetes, heart failure, and CKD on AKI development. Vigilant monitoring of postoperative kidney function, particularly serum creatinine levels within the first 48 hours, is essential for early detection and timely intervention. By understanding and addressing these risk factors, healthcare providers can take proactive steps to prevent and manage AKI in patients undergoing laparotomy, ultimately leading to improved patient outcomes and reduced healthcare costs.

Incidence of, and Risk Factors and Outcomes Associated with, Acute Kidney Injury in COVID-19 at the National Kidney and Transplant Institute, Philippines.

(1) Background: Acute kidney injury (AKI) in COVID-19 leads to an increase in patient mortality, especially among chronic kidney disease (CKD) patients. (2) Methods: A retrospective cohort of 519 adults admitted from 1 March 2020 to 1 March 2022 were reviewed for baseline characteristics and their association with renal outcomes. Patients were divided into diagnosed CKD, undiagnosed CKD, and normal eGFR. Chronic dialysis and kidney-transplant patients were excluded. Kaplan-Meier survival analysis at 7, 14, and 30 days from admission was performed. (3) Results: The overall incidence of AKI was 45.66%; the proportions among patients with diagnosed CKD, undiagnosed CKD, and normal eGFR were 76.64%, 38.75%, and 7.59%, respectively (p < 0.0001). Multivariate analysis showed that being male and inotrope use were significant risk factors for AKI, while higher eGFR was protective. AKI was associated with dialysis, invasive ventilation (p < 0.0001), prolonged hospitalization (p = 0.0001), and mortality (p < 0.0001). Renal recovery was 64%, 59%, and 23% in stages 1, 2, and 3 AKI, respectively, until 14 days from discharge (p < 0.0001). Patient survival was lower in cases of AKI: 83.16%, 70.59%, and 47.5% compared to non-AKI figures of 91.27%, 87.82%, and 76.95% at 7, 14, and 30 days respectively(p = 0.0001). (4) Conclusion: There was a higher incidence of AKI with worsening renal function. Intensified preventive measures for AKI are crucial to prevent its devastating consequences.

Impact of Intraoperative Fluid Balance and Norepinephrine on Postoperative Acute Kidney Injury after Cystectomy and Urinary Diversion over Two Decades: A Retrospective Observational Cohort Study

The use of norepinephrine and the restriction of intraoperative hydration have gained increasing acceptance over the last few decades. Recently, there have been concerns regarding the impact of this approach on renal function. The objective of this study was to examine the influence of norepinephrine, intraoperative fluid administration and their interaction on acute kidney injury (AKI) after cystectomy. In our cohort of 1488 consecutive patients scheduled for cystectomies and urinary diversions, the overall incidence of AKI was 21.6% (95%-CI: 19.6% to 23.8%) and increased by an average of 0.6% (95%—CI: 0.1% to 1.1%, p = 0.025) per year since 2000. The fluid and vasopressor regimes were characterized by an annual decrease in fluid balance (−0.24 mL·kg−1·h−1, 95%—CI: −0.26 to −0.22, p &lt; 0.001) and an annual increase in the amount of norepinephrine of 0.002 µg·kg−1·min−1 (95%—CI: 0.0016 to 0.0024, p &lt; 0.001). The interaction between the fluid balance and norepinephrine levels resulted in a U-shaped association with the risk of AKI; however, the magnitude and shape depended on the reference categories of confounders (age and BMI). We conclude that decreased intraoperative fluid balance combined with increased norepinephrine administration was associated with an increased risk of AKI. However, other potential drivers of the observed increase in AKI incidence need to be further investigated in the future.

Acute Kidney Injury Incidence With Bayesian Dosing Software Versus 2-Level First-Order Area Under the Curve-Based Dosing of Vancomycin With Piperacillin-Tazobactam.

Background: Two methods of area under the curve (AUC) dosing are recommended in vancomycin consensus guidelines: first-order calculations utilizing 2 vancomycin concentrations or a Bayesian approach. It is unknown if there is a difference in acute kidney injury (AKI) between the 2 dosing strategies for patients receiving concomitant piperacillin-tazobactam and vancomycin (VPT). Objective: The objective of this study was to compare incidence of AKI in patients being administered VPT with first-order calculations versus model-informed precision dosing (MIPD)/Bayesian dosing. Methods: This was a single-center, retrospective, observational study at a community hospital. Patients who received VPT therapy for at least 48 hours were included. The primary outcome was overall incidence of AKI. Secondary outcomes included percentage target attainment with initial regimen, average serum creatinine increase, time to AKI, usable vancomycin levels, and need for temporary dialysis or intensive care unit admission. Results: There were 100 patients included (50 in the first-order group and 50 in the MIPD/Bayesian group). The overall incidence of AKI was lower in the MIPD/Bayesian group (12% vs 28%, P = 0.046). There was no difference in average serum creatinine increase, time to AKI, need for temporary dialysis, or intensive care unit admission. Patients in the MIPD/Bayesian group had a higher percentage of target attainment (46% vs 18%, P = 0.003) and usable vancomycin levels (98% vs 60%, P < 0.001). Conclusion and Relevance: In patients receiving VPT, model-informed precision dosing with Bayesian modeling resulted in a lower rate of AKI, higher target attainment, and more usable vancomycin levels compared with first-order AUC dosing. The small sample and retrospective nature of this study reinforces the need for additional data.

#5282 ACUTE KIDNEY INJURY IN INFECTIOUS DISEASE BY CORONAVIRUS IN BRAZIL: A STUDY ON INCIDENCE, RISK FACTORS, AND PROGNOSIS

Abstract Background and Aims Although diffuse alveolar damage and acute respiratory failure are the main features of COVID-19 disease in its severe form, renal involvement is frequent (4-37%). To assess the incidence of acute kidney injury (AKI) in Brazilian patients hospitalized with COVID-19 and to identify both the risk factors associated with its onset and those associated with its prognosis. Method This is a prospective cohort study of patients hospitalized with COVID-19 at a public and tertiary university hospital in São Paulo from March 2020 to May 2021, encompassing the first and second waves of the pandemic. Patients were followed up until the clinical outcome (discharge or death). The evaluation of renal function was performed by measuring serum creatinine and urinary output and the diagnosis of AKI was performed according to the KDIGO 2012 criteria. The occurrence of AKI was established as the dependent variable, using the Chi-Square Test for the comparison of categorical variables and the t Test for continuous variables. Afterwards, a multivariate analysis was performed using the logistic regression model, with calculations of the Odds Ratio (OR), including in the model all the variables that showed association with the outcome (p≤0.20). A similar procedure was performed after establishing death as the dependent variable. Results 887 patients with COVID-19 were analyzed, 54.6% were admitted to the intensive care unit (ICU) and 45.4% were admitted to the ward. The overall incidence of AKI was 48.1%, more frequent in the ICU (83.8 vs 17.1%, p&amp;lt;0.0001). Upon hospital admission, 487 patients were submitted to urine test I, of which 58.5% had hematuria and 51.5% had proteinuria. The overall mortality was 38.9%. The average time for the diagnosis of AKI was 6 days and AKI KDIGO 3 was the most frequent (60.2%). Acute renal support was indicated in 58.8% of patients. According to logistic regression, the risk factors for AKI were the use of diuretics (OR 2.2, CI 1.2-4.1, p&amp;lt;0.05), mechanical ventilation (OR 12.9, CI 4.3-38.2, p&amp;lt;0.05), VAD (OR 2.7, CI 0.9-7.7, p = 0.06), dyslipidemia (OR 0.54, CI 0.3-1.05, p = 0.07), proteinuria (OR 2, CI 1.1-3.4, p&amp;lt;0.05), hematuria (OR 2, CI 1.1-3.5, p&amp;lt;0.05), CKD (OR 2.6, CI 1.2-5.5, p&amp;lt;0.05), older age (OR 1.03, CI 1-1.07, p&amp;lt;0.05), CPK (OR 1.02, CI 1-1.07, p&amp;lt;0.05) and D-dimer (OR 1.02, CI 1.01-1.09, p&amp;lt;0.05). The risk factors for death were arterial hypertension (OR 1.7, CI 1-3, p = 0.05), use of mechanical ventilation (OR 12.9, CI 4.3-38.2, p&amp;lt;0.05), presence of proteinuria (OR 1.6, CI 0.9-2.7, p = 0.07), presence of AKI (OR 6, CI 2.9-12.2, p&amp;lt;0.05), mainly KDIGO 3 (OR 0.6, CI 0.2-1.3, p = 0.2), high D-dimer (OR 1, CI 1, p = 0.05), SOFA score (1.35, CI 1.1-1.6, p&amp;lt;0.05) and ATN-ISS score (OR 996.4, CI 4.8-203271, p&amp;lt;0.05). Finally, the variables that showed the difference in the profile of patients between the two waves of the pandemic were identified, being less frequent in the second wave male gender (OR 0.51, CI 0.35-0.74, p&amp;lt;0.05) and Caucasian ethnicity (OR 0.47, CI 0.2-0.8, p&amp;lt;0.05), and more frequent in the second wave the use of mechanical ventilation (OR 1.57, CI 1-2.3, p&amp;lt;0.05), proteinuria (OR 1.44, CI 1-2.1, p&amp;lt;0.05), higher D-dimer values (OR 1.09, CI 1-1.1, p&amp;lt;0.05) and ATN-ISS score (OR 40.9, CI 1.7-948.1, p&amp;lt;0.05). Conclusion AKI associated with severe COVID-19 in Brazil was more frequent than in the Chinese, European, and North American cohorts, and the risk factors associated with its development are the use of diuretics, mechanical ventilation, VAD, dyslipidemia, proteinuria, hematuria, CKD, older age, elevated CPK and D-dimer. Mortality was high and higher in patients with arterial hypertension, on mechanical ventilation, with proteinuria, with AKI, mainly KDIGO 3, high D-dimer, and higher SOFA and ATN-ISS. In the second wave, AKI severity was greater, but mortality was similar to that of the first wave, which may reflect both the effectiveness of vaccines against SARS-CoV-2, as well as the constant learning that frontline professionals have built throughout the pandemic, to provide greater support to its patients.

Insertion of a urinary catheter on admission lowers acute kidney injury incidence in patients with hip fractures.

Acute kidney injury (AKI) is a common adverse event in patients undergoing hip fracture repair surgery, increasing morbidity and mortality. Our study hypothesis was that routine insertion of a urinary catheter, on admission to the hospital or immediately before surgery, will reduce AKI incidence in hip fracture patients. Determined by alternating days of admission, a urinary catheter was inserted routinely on admission (catheter group) or as needed (non-catheter group) in 250 consecutive patients who presented with a hip fracture to our emergency department. The incidence of AKI according to the KDIGO criteria and morbidity and mortality were compared between the study groups. The overall incidence of AKI was 11.6% (29/250). The catheter group (N = 122) had a significantly lower rate of AKI (6.6% vs. 16% p = 0.018). At 12-month follow-up, the overall mortality was 10.8% (27/250), in-hospital 7.4% (2/27), short-term (within 30days) 7.4% (2/27), and long-term (30days to 1year) 85.8% (23/27). All in-hospital mortality occurred in the AKI group. Patients with no AKI had a better survival rate; however, the difference was not significant (p-value = 0.21). Mortality rate was lower in the catheter group but not significant (8.2% compared with 13.8% in the non-catheter group, p = 0.225). Post-operative respiratory and cardiac complications were more frequent in the AKI group (p = 0.02 and 0.043 accordingly). Insertion of a urinary catheter upon admission or before surgery lowered AKI incidence significantly. Peri-operative AKI was associated with higher rates of post-operative complications and worse survival.

Acute kidney injury after major non-cardiac surgery: Incidence and risk factors

Acute kidney injury (AKI) is a major post-surgical complication that contributes to morbidity and mortality. AKI is welldocumented after cardiac surgery. However, less is known regarding the incidence and risk factors following major non-cardiac surgery.Globally the incidence of AKI post major surgery has been evaluated; however, there are no data available for South Africa (SA). To ascertain the incidence of AKI after major non-cardiac surgery at a tertiary academic SA hospital. Secondary outcomes wereto identify perioperative risk factors that are associated with an elevated risk to develop AKI in the postoperative period. The study was conducted at Tygerberg Hospital, a single tertiary centre in Cape Town, SA. Perioperative records of adults whounderwent major non-cardiac surgery were retrospectively collected. Variables pertaining to potential risk factors for AKI were captured,and serum creatinine levels were recorded up to 7 days postoperatively and compared with baseline measurements to determine whetherAKI had developed. Descriptive statistics along with logistic regression analysis were used to interpret results. The overall incidence of AKI was 11.2% (95% confidence interval (CI) 9.8 - 12.6). Based on surgical discipline, trauma surgery(19%), followed by abdominal (18.5%) and vascular surgery (17%) had the highest incidence. Independent AKI risk factors wereidentified after multivariate analysis. These were: chronic obstructive pulmonary disease (odds ratio (OR) 2.19; 95% CI 1.09 - 4.37;p=0.005), trauma surgery (OR 3.00; 95% CI 1.59 - 5.64; p=0.001), abdominal surgery (OR 2.14; 95% CI 1.33 - 3.45; p=0.002), vascularsurgery (OR 2.42; 95% CI 1.31 - 4.45; p=0.004), urology procedures (OR 2.45; 95% CI 1.31 - 4.45; p=0.005), red blood cell transfusion(OR 1.81; 95% CI 1.21 - 2.70; p=0.004), emergency surgery (OR 1.74; 95% CI 1.15 - 2.65; p=0.009) and inotrope use (OR 2.77; 95% CI1.80 - 4.26; p<0.001). The results of our study are in keeping with international literature regarding the incidence of AKI after major non-cardiacsurgery. The risk factor profile, however, is in several regards different from what has been found elsewhere.

Acute kidney injury in coronavirus infectious disease: a study of incidence, risk factors, and prognosis during the first wave of the disease in Brazil.

Acute kidney injury (AKI) is one of the main complications of COVID-19 caused by SARS-CoV-2. This study aimed to evaluate the incidence of AKI in Brazilian hospitalized patients diagnosed with COVID-19 and identify the risk factors associated with its onset and those associated with its prognosis. A prospective cohort study of hospitalized patients diagnosed with COVID-19 at a public and tertiary university hospital in São Paulo from March to December 2020. There were 347 patients hospitalized with COVID-19, 52.4% were admitted to the intensive care unit (ICU) and 47.6% were admitted to the wards. The overall incidence of AKI was 46.4%, more frequent in the ICU (68.1% vs 22.4, p < 0.01) and the overall mortality was 36.1%. Acute kidney replacement therapy was indicated in 46.6% of patients with AKI. In the general population, the factors associated with AKI were older age (OR 1.03, CI 1-1.05, p < 0.05), mechanical ventilation (OR 1.23, CI 1.06-1.83, p < 0.05), presence of proteinuria (OR 1.46, CI 1.22-1.93, p < 0.05), and use of vasoactive drugs (OR 1.26, CI 1.07-1.92, p < 0.05). Mortality was higher in the elderly (OR 1.08, CI 1.04-1.11, p < 0.05), in those with AKI (OR 1.12, CI 1.02-2.05, p < 0.05), particularly KDIGO stage 3 AKI (OR 1.10, CI 1.22-2.05, p < 0.05) and in need of mechanical ventilation (OR 1.13, CI 1.03-1.60, p < 0.05). AKI was frequent in hospitalized patients with COVID-19 and the factors associated with its development were older age, mechanical ventilation, use of vasoactive drugs, and presence of proteinuria, being a risk factor for death.

Identifying Patients at Risk of Acute Kidney Injury among Patients Receiving Immune Checkpoint Inhibitors: A Machine Learning Approach.

Background: The benefits of immune checkpoint inhibitors (ICPis) in the treatment of patients with malignancies emerged recently, but immune-related adverse events (IRAEs), including acute kidney injury (AKI), cannot be ignored. The present study established and validated an ICPi-AKI prediction model based on machine learning algorithms to achieve early prediction of AKI events and timely intervention adjustment. Methods: We performed a retrospective study based on data from the First Medical Center of the PLA General Hospital. Patients with malignancy who received at least one dose of ICPi between January 2014 and December 2019 were included in the study. The characteristics of available variables were included after case review, and the baseline characteristics and clinical data of ICPi AKI and non-AKI patients were compared. After variable preprocessing, eight machine learning algorithms were used to construct a full variable availability model. Variable simplification models were constructed after screening important variables using the random forest recursive feature elimination method, and the performance of different machine learning methods and two types of modeling strategies were evaluated using multiple indicators. Results: Among the 1616 patients receiving checkpoint inhibitors, the overall incidence of AKI was 6.9% during the total follow-up time. Sixty-eight patients were associated with ICPi treatment after chart review, primarily in AKI stage 1 (70.5%), with a median time from first ICPi administration to AKI of 12.7 (IQR 2 to 56) weeks. The demographic characteristics, comorbidities, and proportions of malignancy types were similar between the ICPi-AKI and non-AKI groups, but there were significant differences in multiple characteristics, such as concomitant medications and laboratory test indicators. For model performance evaluation and comparison, the AUC values of all 38 variable availability models ranged from 0.7204-0.8241, and the AUC values of the simplicity model constructed using 16 significant variables ranged from 0.7528-0.8315. The neural networks model (NNs) and support vector machine (SVM) model had the best performance in the two types of modeling strategies, respectively; however, there was no significant difference in model performance comparison (p &gt; 0.05). In addition, compared with the full variable availability model, the performance of the variable simplicity model was slightly improved. We also found that concomitant medications contributed more to the model prediction performance by screening the optimal feature combination. Conclusion: We successfully developed a machine learning-based ICPi-AKI prediction model and validated the best prediction performance of each machine model. It is reasonable to believe that clinical decision models driven by artificial intelligence can improve AKI prediction in patients with malignancies treated with ICPi. These models can be used to assist clinicians in the early identification of patients at high risk of AKI, support effective prevention and intervention, and ultimately improve the overall benefit of antitumor therapy in the target population.

A novel risk model based on white blood cell-related biomarkers for acute kidney injury prediction in patients with ischemic stroke admitted to the intensive care unit.

Conventional systemic inflammatory biomarkers could predict prognosis in patients with ischemic stroke (IS) admitted to the intensive care unit (ICU). Acute kidney injury (AKI) is common in patients with IS admitted to ICU, but few studies have used systemic inflammatory biomarkers to predict AKI in critically ill patients with IS. This study aimed to establish a risk model based on white blood cell (WBC)-related biomarkers to predict AKI in critically ill patients with IS. Data were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) for a training cohort, and data were extracted from the Medical Information Mart for eICU Collaborative Research Database (eICU-CRD) for a validation cohort. Logistic regression analysis was used to determine the significant predictors of WBC-related biomarkers on AKI prediction, and a risk model was established based on those significant indicators in multivariate logistic regression. The receiver operating characteristics (ROC) curve was utilized to obtain the best cut-off value of the risk model. The Kaplan-Meier curve was used to evaluate the prognosis-predictive ability of the risk model. The overall incidence of AKI was 28.4% in the training cohort and 33.2% in the validation cohort. WBC to lymphocyte ratio (WLR), WBC to basophils ratio (WBR), WBC to hemoglobin ratio (WHR), and neutrophil to lymphocyte ratio (NLR) could independently predict AKI, and a novel risk model was established based on WLR, WBR, WHR, and NLR. This risk model depicted good prediction performance both in AKI and other clinical outcomes including hemorrhage, persistent AKI, AKI progression, ICU mortality, and in-hospital mortality both in the training set and in the validation set. A risk model based on WBC-related indicators exhibited good AKI prediction performance in critically ill patients with IS which could provide a risk stratification tool for clinicians in the ICU.

Evaluation of neonatal acute kidney injury (AKI) after emergency gastrointestinal surgery

BackgroundThe overall incidence of acute kidney injury (AKI) in neonates undergoing emergency gastrointestinal surgery is yet to be determined. The study aims are to analyze our experience in emergency gastrointestinal surgery for neonates and to evaluate the incidence of AKI. MethodsWe conducted a retrospective study of neonates undergoing emergency gastrointestinal surgery between June 31, 2018 and May 10, 2022 (N = 329). The primary outcome was the overall incidence of AKI. The diagnostic AKI was based on the Modified Kidney Disease: Improving Global Outcomes (KDIGO) definition of neonatal AKI. The secondary outcomes, including the postoperative length of hospital stay (PLOS), 24-h mortality, in-hospital mortality, and total in-hospital cost, were analyzed. The risk factors associated with the development of postoperative AKI were also analyzed. ResultsThe incidence of postoperative AKI was 9.1% (30/329). No significant differences were detected in the 24-h mortality and in-hospital mortality between the two cohorts. In the final model, patients undergoing mechanical ventilation before surgery, vasopressor support, surgical duration, intraoperative oliguria and preoperative lowest serum creatinine (SCr), were independently associated with AKI. ConclusionOur study found that patients undergoing mechanical ventilation before surgery, vasopressor support, surgical duration, intraoperative oliguria and preoperative lowest SCr were independently associated with postoperative AKI in neonates who accepted emergency gastrointestinal surgeries.

Risk Factors for Acute Kidney Injury and Chronic Kidney Disease in Pediatric Heart Transplant Population

<h3>Purpose</h3> Children undergoing heart transplantation are at increased risk for the development of both acute kidney injury (AKI) and chronic kidney disease (CKD). The incidence of AKI followed by CKD in the pediatric heart transplant population is known, however, limited pediatric studies have assessed risk factors contributing to post transplantation AKI and the long-term development of CKD. We aimed to assess the incidence of AKI and evaluate risk factors for development of CKD at 1 and 3 years in a large cohort of pediatric heart transplant recipients. <h3>Methods</h3> A retrospective observational study of 122 patients who underwent pediatric heart transplant from infancy to age 18 years was performed with longitudinal follow up three years post transplant from the year 2009 to 2017. AKI was defined as >0.3mg/dl increase from baseline serum creatinine: KDIGO AKI and CKD grading criteria were used. Patients with an initial AKI episode were analysed 90 days from the time of AKI. This eGFR at this 90 day time point was termed as residual renal insufficiency (RRI) if GFR satisfied KDIGO CKD staging 2-5. Of the patients that developed RRI, the CKD incidence and risk factors were analysed 1year and 3 years post transplant. <h3>Results</h3> 60 out of the 122 patients had an overall incidence of AKI of 49%. Out of the AKI patients 45% were male and 33% were female. The mean time to AKI development was 14.8+/- 28 days. 10% of those who had AKI required renal replacement therapy. Of the 60 patients that developed AKI, 28% met our criteria for residual renal insufficiency. In the AKI sub-group, incidence of CKD post heart transplant was 12 % at 1 year and 13% at 3 years. Older age at transplant (<i>p</i>< 0.02) and patients with congenital heart disease (p<0.03) had higher risk of developing AKI. Only 8 out of the 60 patients had full data sets at 3 year follow up. <h3>Conclusion</h3> Estimated creatinine clearance 90 days after AKI may aid in evaluating those children at risk for CKD. Close monitoring of older patients and those with congenital heart disease may potentially decrease progression of AKI to CKD.

PCRRT Expert Committee ICONIC Position Paper on Prescribing Kidney Replacement Therapy in Critically Sick Children With Acute Liver Failure.

Management of acute liver failure (ALF) and acute on chronic liver failure (ACLF) in the pediatric population can be challenging. Kidney manifestations of liver failure, such as hepatorenal syndrome (HRS) and acute kidney injury (AKI), are increasingly prevalent and may portend a poor prognosis. The overall incidence of AKI in children with ALF has not been well-established, partially due to the difficulty of precisely estimating kidney function in these patients. The true incidence of AKI in pediatric patients may still be underestimated due to decreased creatinine production in patients with advanced liver dysfunction and those with critical conditions including shock and cardiovascular compromise with poor kidney perfusion. Current treatment for kidney dysfunction secondary to liver failure include conservative management, intravenous fluids, and kidney replacement therapy (KRT). Despite the paucity of evidence-based recommendations concerning the application of KRT in children with kidney dysfunction in the setting of ALF, expert clinical opinions have been evaluated regarding the optimal modalities and timing of KRT, dialysis/replacement solutions, blood and dialysate flow rates and dialysis dose, and anticoagulation methods.

Ultrasonography in Acute Kidney Injury.

Advances in the use of ultrasonography can enhance our ability to better characterize acute kidney injury (AKI). AKI is a clinical syndrome characterized by a rapid decrease in kidney excretory function with the accumulation of products of nitrogen metabolism and other clinically unmeasured waste products, and may proceed to include clinical manifestations including decreased urine output, development of metabolic acidosis, and electrolyte abnormalities [1]. The Kidney Disease Improving Global Outcomes (KDIGO) criteria defines AKI (Table 1). Staging severity of AKI guides the physician in respect to medical management and prognosis. The overall incidence of AKI is around 20% of patients hospitalized worldwide, and around 50% in intensive care unit (ICU) patients [2, 3]. AKI has been found to have increasing morbidity and mortality, no matter the cause of admission, as well as an in-hospital mortality of close to 50% [4]. In a large study of 8 ICUs over 8 years, Kellum et al. found that AKI was associated with increasing mortality rate with worsening AKI stage. A decrease in urine output alone, without an increase in serum creatinine, was associated with decreased 1-year survival [5]. Recurrent AKI has also been associated with increased mortality, further demonstrating the importance of detecting, monitoring, and diagnosing AKI [6].

Risk factors for polymyxin B-associated acute kidney injury

ObjectivesThis study aimed to assess the current incidence and risk factors for polymyxin B-associated acute kidney injury (AKI) in Chinese hospitals for a more effective clinical use for polymyxin B. MethodsThis multicenter, retrospective cohort study included patients from 14 Chinese teaching hospitals who received polymyxin B therapy. Univariate and multivariate logistic regression models were used to determine the factors associated with polymyxin B-associated incident AKI. Furthermore, a multivariate logistic regression model was used to identify the independent risk factors for AKI. ResultsA total of 251 patients were included in the analysis. The overall incidence of AKI was 33.5%. A multivariate logistic regression model identified the loading dose (hazard ratio (HR), 1.84; 95% confidence interval (CI), 1.01–3.38; P = 0.0491) and the use of two or more nephrotoxic drugs (HR, 3.56; 95% CI, 1.55–8.18; P = 0.0029) as independent risk factors for the occurrence of AKI. Meanwhile, the estimated glomerular filtration rate had a protective effect (HR, 0.99; 95% CI, 0.98–0.99; P = 0.0006) on the occurrence of AKI. The daily dose, cumulative dose, and treatment duration of polymyxin B did not affect the occurrence of AKI. ConclusionsThe use of polymyxin B loading doses and the combined use of multiple nephrotoxic drugs are independent risk factors for polymyxin B-associated AKI. The severity of AKI may be higher in patients with elevated baseline creatinine levels.

Defining kidney outcomes in children with acute lymphoblastic leukemia in the modern era.

To define the incidence of acute kidney injury (AKI), chronic kidney disease (CKD), and hypertension (HTN) in pediatric patients diagnosed with acute lymphoblastic leukemia (ALL) over a recent 9-year period. This study is a retrospective cohort study of all pediatric patients diagnosed with ALL at Nationwide Children's Hospital from January 1, 2008, to December 31, 2016. Patient demographic and clinical data including serum creatinine and blood pressure were collected at diagnosis up to 9years post diagnosis. A total of 222 patients were identified for this study. The overall incidence of AKI in our cohort was high, with 101 subjects (45.5%, CI 38.8-52.3%) developing AKI at least once. CKD status could only be determined in 214 patients due to limited later GFR data. The incidence of CKD was low with only 5 of 214 patients developing CKD (2.3%, CI: 0.8-5.4%). The overall incidence of HTN at diagnosis was 45.6% (95% CI: 59.1-72%), and at 1month post diagnosis was 65.8% (95% CI: 59.1-72.0%). Chronic HTN could only be determined in 216 patients due to limited blood pressure data. Chronic HTN was noted in 34.3% of patients (74/216, 95% CI: 28-41%). Among children with ALL, the incidence of AKI is relatively high at the time of diagnosis. However, development of CKD is relatively rare, suggesting good mid-term kidney prognosis. There is a high incidence of HTN at the time of diagnosis, 1month post diagnosis, and chronic HTN that often goes untreated. A higher resolution version of the Graphical abstract is available as Supplementary information.