Incidence Of Renal Replacement Therapy Research Articles

Balanced Crystalloid Solution or Normal Saline in Fluid Resuscitation in Critically Ill Patients: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials

Background: Both balanced crystalloid solution and normal saline are commonly used for fluid therapy in critically ill patients. However, the association between the types of crystalloid solution and patient outcomes remains inconclusive. Materials and Methods: The authors performed a search using Pubmed, Embase, and Cochrane Central Register through January 2022. Randomized controlled trials (RCTs) comparing balanced crystalloids and normal saline in non-perioperative fluid resuscitation for critically ill adult patients were included. The primary outcome was 30-day mortality. A trial sequential analysis (TSA) was performed to assess the effect of each type of fluid on the outcomes. Secondary outcomes included the incidence of acute kidney injury (AKI), renal replacement therapy (RRT), and other pre-specified outcomes. Results: Ten RCTs were identified and included 36,233 participants. Between the balanced crystalloids and the normal saline group, there were no significant differences in mortality at 30 days (relative risk [RR] 0.95, 95% confidence interval [CI] 0.89 to 1.02, I²=0), the incidence of AKI (RR 0.95, 95% CI 0.90 to 1.01, I²=0), and RRT (RR 0.93, 95% CI 0.86 to 1.01, I²=13). However, patients receiving balanced crystalloids demonstrated a significantly lower serum chloride level than the patients receiving normal saline (MD –1.95, 95% CI –3.45 to –0.45, I²=99). There was also no mortality difference in the sepsis and traumatic brain injury subgroups. The TSA confirmed the absence of an effect on mortality at 30 days and the incidence of AKI. Conclusion: In critically ill patients, the use of balanced crystalloids does not decrease 30-day mortality or the incidence of AKI and RRT. However, data in specific subgroups of patients were underpowered and further studies are required. There were signals of benefit and risk of the balanced salt solution in the subgroups of sepsis and traumatic brain injury. Trial registration: The present study was registered in the PROSPERO database, CRD42021275796. Keywords: Balanced crystalloid; Normal saline; Critically ill patients; Mortality; Acute kidney injury

Impact of Albumin Therapy in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

Introduction: Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Due to the limited understanding of this disease, research has quickly extended towards identifying biomarkers to predict its prognosis and progression. Aim: To explore the impact of albumin infusion on critically ill COVID-19 patients. Materials and Methods: In this retrospective cohort study, a total of 150 severe COVID-19 patients aged 18 to 65 years were enrolled. These patients were categorised into the no albumin infusion group (n=61), consisting of those who did not undergo albumin transfusion during their treatment, and the albumin infusion group (n=89), comprising patients who received albumin transfusion as part of their treatment protocol. Assessments of hospitalisation included the Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE-II) scores obtained at baseline and day 5. Unpaired t-tests, Chi-square tests, and paired t-tests were used for analysis. Results: The mean values of Haemoglobin (Hb), eosinophils, Random Blood Sugar (RBS), Mean Corpuscular Volume (MCV), total protein, serum urea, serum bilirubin, Prothrombin Time (PT), International Normalised Ratio (INR), Interleukin 6 (IL-6), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and D-dimer exhibited significant differences between the two groups. The average duration of vasopressor usage and Intensive Care Unit (ICU) stay were significantly reduced in the albumin infusion group (3.50±1.55 days and 8.70±4.20 days, respectively) compared to no albumin infusion group (4.33±1.05 days and 12.80±3.43 days, respectively). The albumin infusion group also displayed a lower incidence of Renal Replacement Therapy (RRT) and poorer ICU outcomes. Conclusion: The intravenous administration of albumin did not exhibit a significant impact on mortality. However, albumin transfusion in patients with severe COVID-19 who initially had albumin levels <3 g/dL demonstrated a notable reduction in the requirement for vasopressors, RRT, and the length of ICU stay

Trends in the Incidence of Renal Replacement Therapy due to Rapidly Progressive Glomerulonephritis in Japan, 2006-2021.

Objective Patients with rapidly progressive glomerulonephritis (RPGN) are at a high risk of progression to end-stage kidney disease (ESKD), requiring renal replacement therapy (RRT). The present study examined recent trends in the incidence of RRT due to RPGN in Japan. Methods The number of patients with incident RRT due to RPGN by sex from 2006 to 2021 was extracted from the Japanese Society of Dialysis Therapy Registry. The incidence rates of RRT were calculated for four-year periods with the census population as the denominator. Standardized incidence ratios (SIRs) and age-specific incidence rates were also calculated. Results From 2006 to 2021, the crude number of patients with incident RRT due to RPGN increased by 34% and 58% in men and women, respectively. The SIRs decreased significantly in 2010-2013 relative to the first period (2006-2009) for both men (0.90 [95% confidence interval {CI} 0.85-0.96]) and women (0.92 [0.86-0.99]) but then increased to 1.01 (0.96-1.07) for men and 1.20 (1.13-1.27) for women in 2018-2021. In the older age groups (≥70 years old), age-specific incidence rates initially decreased in 2010-2013 but increased thereafter, peaking in 2018-2021. Conclusion From 2006 to 2021, the number of patients with incident RRT due to RPGN increased, with an increase in the age-specific incidence of RRT due to RPGN in the older age groups (≥70 years old), suggesting that the number of patients with incident RRT due to RPGN will continue to increase as the population ages in Japan.

RESTRICTIVE FLUID RESUSCITATION IN SEPTIC SHOCK PATIENTS HAS LOWER MORTALITY AND ORGAN DYSFUNCTION RATES THAN STANDARD THERAPY.

Background : The influence of restrictive fluid resuscitation and the early administration of vasopressors on the clinical outcomes in patients with septic shock are not fully understood. The purpose of this study was to evaluate the effects of restrictive fluid management on mortality and organ dysfunction in patients with septic shock. Methods : This study included consecutive patients with septic shock in need of fluid resuscitation. Based on the fluid management provided in the initial resuscitation phase, a comparison was made between a restrictive group and a standard fluid management group. The primary outcome was in-hospital death, whereas secondary outcomes included organ dysfunction and other adverse events. Results : A total of 238 patients were included in this study. Restrictive fluid management was administered to 59.2% of patients, whereas 40.8% received standard fluid management. Restrictive resuscitation was associated with a lower in-hospital mortality rate (24.8% vs. 52.6%), as well as a shorter median intensive care unit stay (8.0 vs. 11.0 days). The restrictive strategy was associated with a significantly lower prevalence of new-onset acute kidney injury (25.5% vs. 51.5%) and a decrease in the incidence of renal replacement therapy (20.6% vs. 40.2%). The standard group had a higher risk of the need for mechanical ventilation and a significantly lower median number of days without a ventilator than the restrictive group. The median duration of vasopressor-free days in the restrictive group was significantly longer than that in the standard group (25.0 vs. 18.0). The administration rate of inotropes in the restrictive group was significantly lower than that in the standard group. A multivariate logistic regression model showed that restrictive fluid management (odds ratio [OR], 0.312; 95% confidence interval [CI], 0.098-0.994) and vasopressor-free days (OR, 0.807; 95% CI, 0.765-0.851) protect against in-hospital death, whereas Acute Physiology and Chronic Health Evaluation II scores (OR, 1.121; 95% CI, 1.018-1.234) were independent risk factors for in-hospital death. Conclusions : Restrictive fluid resuscitation and early vasopressor protocol in patients with septic shock are associated with better outcomes, indicating that this regimen is feasible and safe.

Effect of Terlipressin Treatment on the Incidence of Renal Replacement Therapy in Patients with Hepatorenal Syndrome and Fluid Overload: A Post Hoc Analysis of the Phase 3 CONFIRM Study

Effect of Terlipressin Treatment on the Incidence of Renal Replacement Therapy in Patients with Hepatorenal Syndrome and Fluid Overload: A Post Hoc Analysis of the Phase 3 CONFIRM Study

Neurocognitive Function with Conventional Hemodialysis versus Post-Dilution Hemofiltration as Initial Treatment in ESKD Patients: A Randomized Controlled Trial – The DA-VINCI Study

Introduction: The ideal modality choice and dialysis prescription during the first renal replacement therapy (RRT) session remain unclear. We conducted a pilot study to determine the safety risk for hemodialysis (HD) versus hemofiltration (HF) and its relationship with neurocognitive assessment on incident RRT patients. Methods: Twenty-four incident RRT patients were included. Patients were randomized to the conventional HD group or post-dilution HF group. Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) tests were applied in all patients before and after session, and brain magnetic resonance image (MRI) was performed in 7 patients from the conventional HD group and 8 patients from the post-dilution HF group before and after the intervention. Results: Baseline characteristics were similar between groups. Compared to conventional HD, post-dilution HF had longer treatment time. There were no significant changes in blood pressure after RRT in both groups. The MMSE test showed no significant differences between groups or within groups. The MOCA test showed an increase in the total score for the post-dilution HF group with no significant changes between groups. The MRI evaluation showed no differences between or within groups. Conclusion: Post-dilution HF is a safe alternative for the first HD session in incident RRT; it allows longer treatment time if ultrafiltration is required and has a similar neurological risk than conventional HD. This is a pilot study and that larger studies are needed to confirm the findings.

Early Clinical Outcomes of Patients With Stress-Induced Cardiomyopathy Receiving Acute Mechanical Support in the US

BackgroundThe role of acute mechanical circulatory support (aMCS) in patients with stress-induced cardiomyopathy (SIC) complicated by cardiogenic shock (CS) is not well studied. Here, we describe the incidence and outcomes of aMCS use in SIC-CS using a large national database. MethodsUsing the Nationwide Readmissions Database from January 2016 to November 2019, we identified patients hospitalized with SIC who received isolated intra-aortic balloon pump (IABP), microaxial flow pump (Impella, Abiomed), or extracorporeal membrane oxygenation (ECMO) during the index hospitalization. ResultsA total of 902 among 94,709 hospitalizations for SIC (1.0%) required aMCS during the index hospitalization: 611 had IABP (67.7%), 189 had Impella (21.0%) and 102 had ECMO (11.3%). Patients with ECMO or Impella had higher in-hospital mortality rates than those with IABP (37.3% vs 29.1% vs 18.5%, respectively). There was an increased adjusted risk of in-hospital death with Impella (adjusted odds ratio [aOR], 1.98; 95% CI, 1.12-3.49) and ECMO (aOR, 4.15; 95% CI, 1.85-9.32) vs IABP. Impella was associated with an increased adjusted risk of 30-day readmission compared to IABP (aOR, 2.53; 95% CI, 1.16-5.51). Patients with ECMO or Impella had a higher incidence of renal replacement therapy and vascular/bleeding complications compared to those who received IABP. ConclusionsIn this nationwide analysis using an administrative database, patients who received ECMO and Impella showed higher rates of in-hospital mortality, renal replacement therapy, and vascular/bleeding complications compared to those who received IABP. Patients with more comorbidities may receive more aggressive hemodynamic support which may account for observed mortality differences. Future prospective studies with objective and universal characterization of baseline clinical and hemodynamic characteristics of patients with CS secondary to SIC are needed.

#3559 THE IMPACT OF OBESITY ON CLINICAL OUTCOMES IN VARIOUS LEVELS OF CO-MORBIDITY OF NON-DIALYSIS CHRONIC KIDNEY DISEASE PATIENTS

Abstract Background and Aims Obesity is a major issue with an estimated prevalence of 1.9 billion adults worldwide. Obesity is an important risk factor for premature death and the development of non-communicable diseases such as diabetes mellitus (DM), heart diseases, and chronic kidney disease (CKD). However, mounting evidence in the literature describes a reverse association whereby obesity may have a protective effect on mortality; this is sometimes referred to as the “obesity paradox”. Several reports question the concept of obesity paradox claiming methodology flaws such as collider stratification bias. In this study, we aimed to examine the effects of obesity on the combined outcomes of all-cause mortality (ACM) and renal replacement therapy (RRT) incidence in a cohort of patients with non-dialysis dependent CKD (NDD-CKD) by correcting for major risk factors to reduce the risk of bias. Method This retrospective study was undertaken on all patients with a documented body mass index (BMI) in the Salford Kidney Study database from October 2002 until December 2016. Patients were grouped according to their BMI into normal weight [BMI 18.5-24.9 kg/m2], overweight [BMI 25–29.9 kg/m2 and obese [BMI> 30 kg/m2]. Patients were also grouped according to their level of co-morbidity into 4 groups: group 1 had CKD only; group 2 had CKD and heart failure (HF); group 3 had CKD and DM; and group 4 had CKD, DM, and HF. Univariate Cox regression as well as three stepwise models of multivariate analysis were performed to study the strength of association between BMI categories and combined outcomes (incidence of RRT and ACM) across the 4 groups of different clusters of co-morbidity. Results A total of 2416 patients were included in the analysis. The median age of the cohort was 67.3 years [IQR 55.9-75.6], 61.8% were male, and 96.4% were of white ethnicity. The median BMI was 28.1 kg/m2 [IQR 24.7-32.6] and the median estimated glomerular filtration rate (eGFR) was 30.7 ml/min/1.73m2 [IQR 20.4-43.5]. At baseline, patients with increasing level of co-morbidity tended to be older with higher prevalence of hypertension (HTN), angina, myocardial infarction (MI), and stroke with lower baseline eGFR. The risk of combined outcomes followed the same trend in the three BMI groups, risk is higher with higher index of co-morbidity (p <0.001). Further analysis of four subgroups of co-morbidity was undertaken. A univariate Cox regression analysis for group 1 [CKD only, n = 1351], and group 2 [CKD and HF, n = 227] showed that patients with obesity had significant lower rates of combined outcomes compared to patients with normal BMI (HR 0.75; 95%CI = 0.63-0.89; p = 0.001 and HR 0.56; 95%CI = 0.38-0.82; p = 0.003 for group 1 and group 2 respectively). In multivariate models, obesity consistently proved to be a strong protective factor against combined outcomes (HR 0.77; 95%CI = 0.65-0.92; p = 0.005 for group 1 and HR 0.53; 95%CI = 0.34-0.83; p = 0.005 for group 2). This was independent of age, gender, HTN, angina, stroke, MI, and prescription of statins and angiotensin converting enzyme inhibitors. For group 3 [CKD and DM, n = 614], and group 4 [CKD, DM, and HF, n = 190], there was no significant difference in the combined outcomes between the different BMI groups when using univariate Cox regression analysis (for patients with obesity: HR 0.78; 95%CI = 0.61-1.01; p = 0.060 and HR 0.70; 95%CI = 0.43-1.16; p = 0.166 for both groups respectively). There was no significant difference in the incidence of RRT in any of the four groups. Conclusion In our largely white NDD-CKD cohort of patients, there was evidence of increasing risk of RRT or ACM as comorbidity increased irrespective of BMI. This is not surprising as ACM would be expected to increase as the burden of disease increases. However, when comparing the effect of BMI within groups, obesity was protective against combined outcomes in group 1 (CKD only) and group 2 (CKD+HF). This ‘protective’ effect was not seen in patients who had concomitant diabetes. These data suggest that diabetes is a potent predictor of outcomes irrespective of BMI, however, in patients without diabetes, obesity may play a protective role.

#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<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

Terlipressin in combination with albumin as a therapy for hepatorenal syndrome in patients aged 65 years or older

Introduction and ObjectivesClinical data for older patients with advanced liver disease are limited. This post hoc analysis evaluated the efficacy and safety of terlipressin in patients aged ≥65 years with hepatorenal syndrome using data from 3 Phase III, randomized, placebo-controlled studies (OT-0401, REVERSE, CONFIRM). Patients and MethodsThe pooled population of patients aged ≥65 years (terlipressin, n = 54; placebo, n = 36) was evaluated for hepatorenal syndrome reversal—defined as a serum creatinine level ≤1.5 mg/dL (≤132.6 μmol/L) while receiving terlipressin or placebo, without renal replacement therapy, liver transplantation, or death—and the incidence of renal replacement therapy (RRT). Safety analyses included an assessment of adverse events. ResultsHepatorenal syndrome reversal was almost 2-times higher in terlipressin-treated patients compared with patients who received placebo (31.5% vs 16.7%; P = 0.143). Among surviving patients, the need for RRT was significantly reduced in the terlipressin group, with an almost 3-times lower incidence of RRT versus the placebo group (Day 90: 25.0% vs 70.6%; P = 0.005). Among 23 liver-transplant-listed patients, significantly fewer patients in the terlipressin versus placebo group needed RRT by Days 30 and 60 (P = 0.027 each). Fewer patients in the terlipressin group needed RRT post-transplant (P = 0.011). More terlipressin-treated patients who were listed for and received a liver transplant were alive and RRT-free by Day 90. No new safety signals were revealed in the older subpopulation compared with previously published data. ConclusionsTerlipressin therapy may lead to clinical improvements in highly vulnerable patients aged ≥65 years with hepatorenal syndrome. Clinical trial numbersOT-0401, NCT00089570; REVERSE, NCT01143246; CONFIRM, NCT02770716

Metformin use is associated with reduced acute kidney injury following coronary artery bypass grafting in patients with type 2 diabetes: An inverse probability of treatment weighting analysis.

Acute kidney injury (AKI) is a common and serious complication after coronary artery bypass grafting (CABG) surgery. Patients with diabetes are commonly associated with renal microvascular complications and have a greater risk of AKI after CABG surgery. This study aimed to explore whether preoperative metformin administration could reduce the incidence of postoperative AKI following CABG in patients with type 2 diabetes. Patients were retrospectively enrolled in this study between January 2019 and December 2020. AKI after CABG was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. Inverse probability of treatment weighting (IPTW) was applied to minimize baseline differences between the two groups. IPT-weighted P values were analyzed to evaluate the postoperative outcomes between the two groups. A total of 812 patients were enrolled. The patients were divided into the metformin group (203 cases) and the control group (609 cases) according to whether metformin was used preoperatively. After IPTW adjustment, the incidence of AKI in the metformin group was lower than the control group (IPTW-adjusted P < 0.001). In the subgroup analysis, metformin showed significant protective effects in the estimated glomerular filtration rate (eGFR) < 60 mL/min per 1.73 m2 and eGFR 60-90 mL/min per 1.73 m2 subgroups, which was not observed in the eGFR ≥90 mL/min per 1.73 m2 subgroup. No significant differences in the incidence of renal replacement therapy, reoperation due to bleeding, in-hospital mortality, or red blood cell transfusion volume were observed between the two groups. In this study, we provided evidence that preoperative metformin was associated with a significant reduction of postoperative AKI following CABG in patients with diabetes. Metformin showed significant protective effects in patients with mild to moderate renal insufficiency.

Comparison of thrombotic and clinical outcomes in SARS-CoV-2-pneumonia versus other viral pneumonia in an urban academic medical center

BackgroundInfection with viral pneumonia (PNA) is known to offset the coagulation cascade. Recent studies assessing novel SARS-CoV-2 infection observed a high frequency of systemic thrombotic events resulting in ambiguity if severity of infection or specific viral strain drive thrombosis and worsen clinical outcomes. Furthermore, limited data exists addressing SARS-CoV-2 in underrepresented patient populations. ObjectivesAssess clinical outcomes events and death in patients diagnosed with SARS-CoV-2 pneumonia compared to patients with other types of viral pneumonia. MethodsRetrospective cohort study evaluated electronic medical records in adult patients admitted to University of Illinois Hospital and Health Sciences System (UIHHSS) with primary diagnosis of SARS-CoV-2 PNA or other viral (H1N1 or H3N2) PNA between 10/01/2017 and 09/01/2020. Primary composite outcome was the following event incidence rates: death, ICU admission, infection, thrombotic complications, mechanical ventilation, renal replacement therapy, and major bleeding. ResultsOf 257 patient records, 199 and 58 patients had SARS-CoV-2 PNA and other viral PNA, respectively. There was no difference in primary composite outcome. Thrombotic events (n = 6, 3%) occurred solely in SARS-CoV-2 PNA patients in the ICU. A significantly higher incidence of renal replacement therapy (8.5% vs 0%, p=0.016) and mortality (15.6% vs 3.4%, p=0.048) occurred in the SARS-CoV-2 PNA group. Multivariable logistic regression analysis revealed age, presence of SARS-CoV-2, and ICU admission, aOR 1.07, 11.37, and 41.95 respectively, was significantly associated with mortality risk during hospitalization; race and ethnicity were not. ConclusionLow overall incidence of thrombotic events occurred only in the SARS-CoV-2 PNA group. SARS-CoV-2 PNA may lead to higher incidence of clinical events than those observed in H3N2/H1N1 viral pneumonia, and that race/ethnicity does not drive mortality outcomes.

Birth cohort effects in incident renal replacement therapy in Japan, 1982-2021.

This study aimed to investigate the long-term trends of incident end-stage kidney disease (ESKD) requiring renal replacement therapy (RRT) in Japan using age-period-cohort analysis and evaluated birth cohort effects for incident ESKD requiring RRT. The number of incident RRT patients aged between 20 and 84years by sex from 1982 to 2021 was extracted from the Japanese Society of Dialysis Therapy registry data. Annual incidence rates of RRT were calculated using census population as denominators, and changes in the incidence rates were evaluated using an age-period-cohort model. The age and survey year period categories generated 20 birth cohorts with 5-year intervals (from 1902-1907 to 1997-2001). The incidence rates of RRT in both sexes initially rose in the birth cohorts born in the early 1900s, and then decelerated and peaked during 1940-1960s in men and 1930-1940s in women, following a steady decline in both sexes. Compared with the reference 1947-1951 birth cohort, the highest cohort rate ratio was 1.14 (95% CI, 1.04-1.25) in the 1967-1971 birth cohort in men and 1.04 (95% CI, 0.98-1.10) in the 1937-1941 birth cohort in women. Significant cohort effects were identified in both sexes, but the peak of RRT was different for each sex. Our findings suggest that men born between 1940 and 1960s and women born between 1930 and 40s may be important target populations to consider when decreasing incidence rates of RRT among the general Japanese population.

Impact of Fluid Balance on Intensive Care Unit Length of Stay in Critically Ill Trauma Patients.

There is significant data in the medical and surgical literature supporting the correlations between positive volume balance and negative outcomes such as AKI, prolonged mechanical ventilation, intensive care unit and hospital length of stay and increased mortality. This single-center, retrospective chart review included adult patients identified from a Trauma Registry database. The primary outcome was the total ICU LOS. Secondary outcomes include hospital LOS, ventilator-free days, incidence of compartment syndrome, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT), and days of vasopressor therapy. In general, baseline characteristics were similar between groups with the exception of mechanism of injury, FAST exam, and disposition from the ED. The ICU LOS was shortest in the negative fluid balance and longest in the positive fluid balance group (4 days vs 6 days, P = .001). Hospital LOS was also shorter in the negative balance group than that of the positive balance group (7 days vs 12 days, P < .001). More patients in the positive balance group experienced acute respiratory distress syndrome compared to the negative balance group (6.3% vs 0%, P = .004). There was no significant difference in the incidence of renal replacement therapy, days of vasopressor therapy, or ventilator-free days. A negative fluid balance at seventy-two hours was associated with a shorter ICU and hospital LOS in critically ill trauma patients. Our observed correlation between positive volume balance and total ICU days merits further exploration with prospective, comparative studies of lower volume resuscitation to key physiologic endpoints compared with routine standard of care.

Trends in the incidence of renal replacement therapy by type of primary kidney disease in Japan, 2006-2020.

Age-standardized incidence of end stage kidney disease requiring renal replacement therapy (RRT) has stabilized in men and declined in women in Japan since 1996. However, recent trends by primary kidney disease are unknown. The present study aimed to examine recent trends in incidence rates of RRT by primary kidney disease in Japan. Numbers of incident RRT patients aged ≥20 years by sex and primary kidney disease from 2006 to 2020 were extracted from the Japanese Society of Dialysis Therapy registry. Using the census population as the denominator, annual incidence rates of RRT were calculated and standardized to the WHO World Standard Population (2000-2025). Average annual percentage change (AAPC) and corresponding 95% confidence intervals (CIs) were calculated for trends using Joinpoint regression analysis. From 2006 to 2020, the crude number of incident RRT patients due to nephrosclerosis increased by 132% for men and 62% for women. Age-standardized incidence rates of RRT due to nephrosclerosis increased significantly, by 3.3% (95% CI: 2.9-3.7) and 1.4% (95% CI: 0.8-1.9) per year for men and women, respectively. The AAPC of chronic glomerulonephritis (-4.4% [95% CI: -5.3 to -3.8] for men and -5.1% [95% CI: -5.5 to -4.6] for women) and diabetic nephropathy (-0.6% [95% CI: -0.9 to -0.3] for men and -2.8% [95% CI: -3.1 to -2.6] for women) significantly decreased from 2006 to 2020. Incident RRT due to chronic glomerulonephritis and diabetic nephropathy decreased, while the number and incident rates of RRT due to nephrosclerosis increased, from 2006 to 2020 in Japan.

Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding.

Prothrombin complex concentrate in cardiac surgery for the treatment of coagulopathic bleeding.

Tricuspid Valve Surgery in Patients Receiving Left Ventricular Assist Devices

Tricuspid regurgitation (TR) is common and related to poor prognosis in patients after left ventricular assist device (LVAD) implantation. The concomitant tricuspid valve surgery (TVS) at the time of LVAD implantation on short and long-term outcomes are controversial in current evidence. This is a single-center, observational, retrospective study. We enrolled patients with moderate-to-severe TR who received LVAD implantations from 2009 to 2020. Postoperative right ventricular failure (RVF), right ventricular assist device (RVAD) use, hospital mortality, new-onset renal replacement therapy (RRT), and acute kidney injury (AKI) were evaluated retrospectively. Sixty-eight patients were included, 36 with and 32 without concomitant TVS. Baseline characteristics did not differ between the two groups. Patients receiving TVS had significantly increased incidences of postoperative RVF (52.8 vs. 25.0%, p = 0.019), RVAD implantation (41.7 vs. 18.8%, p = 0.041), and new-onset RRT (22.2 vs. 0%, p = 0.004). No difference in the incidence of AKI and hospital mortality was detected. Besides, these associations remained consistent in patients who underwent LVAD implantation via median sternotomy. During a median follow-up of 2.76 years, Kaplan-Meier analysis and competing-risk analysis showed that TVS was not associated with better overall survival in patients after LVAD implantation compared with the no-TVS group. Our study suggests that concomitant TVS failed to show benefits in patients receiving LVAD implantation. Even worse, concomitant TVS is associated with significantly increased incidences of RVF, RVAD use, and new-onset of RRT. Considering the small sample size and short follow-up, these findings warrant further study.

Postoperative Fluid Therapy in Adult Cardiac Surgical Patients and Acute Kidney Injury: A Prospective Observational Study

Abstract Background Normal saline (0.9% NS) is a common intravenous fluid used worldwide. Recent studies have shown that NS use is associated with increased incidence of acute kidney injury (AKI) and a need for renal replacement therapy (RRT). The practice is changing toward using balanced solutions to prevent AKI. Postcardiac surgery patients are more prone to develop AKI after cardiopulmonary bypass (CPB). We aim to study the type of fluid administrated, incidence of AKI, need for RRT, and overall outcome of these patients. Methods This prospective observational study was conducted in the cardiothoracic intensive care unit (cardiothoracic and vascular surgery intensive care unit) in a cohort of 197 adult patients who underwent on pump cardiac surgery in our hospital from July 2021 to October 2021 as a pilot study. Data was analyzed using SPSS 20.0 (IBM, Chicago, Illinois, United States). A p-value &lt; 0.05 was considered significant. Results In our study, 58 (29.34%) patients developed AKI in the first three postoperative days and 16 (8.12%) patients required RRT. Incidence of AKI was found to be higher in patients who received NS only, as fluid of choice was 34.48% compared with other intravenous fluids. Patients with AKI had higher positive fluid balance (p &lt; 0.001), longer CPB (p &lt; 0.001), and aortic cross clamp (p = 0.006) times. Intensive care unit and hospital stay and mortality rates were higher in AKI patients than those without AKI (p &lt; 0.001). Conclusion Our study demonstrated that NS was the commonly used crystalloid in our patients and was associated with increased incidence of AKI and RRT when compared with other balanced salts solutions.

Contrast‐Associated Acute Kidney Injury After Endovascular Therapy for Acute Ischemic Stroke: A Meta‐Analysis

Background This study aimed to investigate the incidence of contrast‐associated acute kidney injury (CA‐AKI) and renal replacement therapy (RRT) after endovascular therapy (EVT) for acute ischemic stroke. Methods PubMed, the Cochrane Library, and the Web of Science were searched to identify all relevant studies regarding the incidence of CA‐AKI and RRT in patients with acute ischemic stroke receiving EVT until July 2021. To pool the incidence of CA‐AKI and RRT, a random‐effects model with a double arcsine transformation was used. Subgroup analysis and meta‐regression analysis were used to investigate the relationship of individual study‐level covariates with CA‐AKI and RRT. Results It was found that 15 studies involving 27 246 patients with acute ischemic stroke receiving EVT met the inclusion criteria. The incidence of CA‐AKI was 5.0% (95% CI, 2.1%–8.9%), and the incidence of RRT was 0.2% (95% CI, 0.0%–0.4%). Subgroup analysis showed that the incidence of CA‐AKI was higher when using the European Society of Urogenital Radiology's criteria (6.6%, 95% CI, 3.8%–10.1%) than when using the Kidney Disease: The Improving Global Outcomes criteria (3.0%, 95% CI, 1.0%–6.1%). Meta‐regression analysis confirmed that the presence of diabetes was associated with increased rates of CA‐AKI ( P =0.002); however, the rates of CA‐AKI were not elevated because of impaired baseline estimated glomerular filtration rate ( P =0.518), chronic kidney disease ( P =0.860), or the volume of contrast ( P =0.536). Conclusions The risk of CA‐AKI and RRT secondary to EVT is low for patients with acute ischemic stroke; therefore, treatment should not be delayed for the patients eligible for EVT by waiting for the results of renal function analysis.

Acute Kidney Injury During Extracorporeal Life Support in Cardiogenic Shock: Does Flow Matter?

<h3>Purpose</h3> Minimal data exists regarding the impact of extracorporeal life support (ECLS) flow on incidence of acute kidney injury (AKI). This study examines the predictive role of ECLS flow and other risk factors in the development of AKI. <h3>Methods</h3> We performed a retrospective analysis of 519 patients placed on ECLS at our institution between January 2015 and December 2020 for cardiogenic shock (CS). We calculated ECLS flow index using average flow 72 hours post-cannulation and body surface area. Stages of AKI were determined according to KDIGO guidelines. ECLS flow index, baseline characteristics, and outcomes were compared between patients that did and did not develop AKI. <h3>Results</h3> Of the included cohort, 180 (38.1%) patients developed AKI: 41 (22.8%) had Stage 1 AKI, 26 (14.4%) had Stage 2 AKI, and 113 (62.8%) had Stage 3 AKI. Patients who developed AKI had lower rates of survival to hospital discharge (39.4% vs. 61.3%, p<0.001) and 1-year survival (28.8% vs. 50.0%, p<0.001) compared to those who did not. Stage 3 AKI was the only stage of AKI that was predictive of 1-year mortality (HR=1.59, p=0.001). ECLS flow index ranged from 0.71-3.03 lpm/mm2 with a median of 1.61 lpm/mm2. Patients with Stage 3 AKI had a higher median flow index than the other groups of patients (1.69 vs. 1.57 lpm/mm2, p=0.015). There was no association between flow index and Stage 2 AKI or Stage 1 AKI, while flow index was specifically predictive of Stage 3 AKI (OR=2.01, p=0.021). Patients with higher flow index were more likely to experience neurological adverse events (OR=1.92, p=0.022) and infection (OR=1.80, p=0.043) and less likely to undergo myocardial recovery (OR=0.43, p=0.002). Patients newly initiated on renal replacement therapy (RRT) had higher median flow index (1.69 vs 1.58 lpm/mm2, p=0.018) and patients with Stage 3 AKI on RRT had the lowest 1-year survival compared to patients with Stage 3 AKI who did not receive RRT, Stage 2 AKI, and Stage 1 AKI (19.0% vs 35.0% vs 43.5% vs 38.2%, p=0.047). <h3>Conclusion</h3> In our cohort, AKI is common and Stage 3 AKI is associated with worse outcomes compared to all other stages of AKI. In this study, higher ELCS flow indices were associated with increased likelihood of Stage 3 AKI and RRT incidence, suggesting that baseline sickness rather than ECLS flow has a significant impact on AKI development. These results indicate that lower flow indices may not pose increased risk of renal injury.