RIFLE Criteria Research Articles

A prospective study of acute kidney injury in intensive care setting according to Rifle definition and its mortality predictors

Background: Acute Kidney Injury (AKI) in ICUs is associated with high morbidity, mortality, prolonged hospital stays, increased costs, and risk of progression to Chronic Kidney Disease (CKD). Early identification of AKI is essential. Aims and Objectives: To determine the incidence of AKI in ICU patients using the RIFLE criteria. · To identify etiological factors and comorbid conditions associated with AKI. · To assess the outcomes of AKI based on the RIFLE criteria. · To explore age, gender, serum creatinine, Fe Na, and urine spot Na as predictors of AKI mortality. Materials and Methods: A prospective observational study was conducted at Al-Ameen Medical College and Hospital, Vijayapura, with 83 patients over two years. ICU patients were monitored for AKI development using the RIFLE criteria. Results: Univariate logistic regression showed oliguria as a significant predictor of mortality (OR: 0.461). Among AKI survivors (n=51), the highest number (41.2%) were aged 50–59 years. In AKI deaths (n=32), most (40.6%) were over 60 years. Sepsis (39.2%) and shock (31.4%) were common in survivors, while sepsis (71.9%) dominated among deaths Conclusion: Early identification of high-risk AKI patients is crucial. Infections and hypotension drive significant mortality risk. Oliguric patients and those on ventilation require close monitoring. Timely diagnosis and management, especially of infections and multi-organ dysfunction, are key to improving outcomes. Haemodialysis was the preferred treatment.

Acute renal failure in patients with infective endocarditis

Abstract Background/Introduction Acute kidney failure (AKF) appears in a high percentage of patients with infective endocarditis (IE), becoming a complication related to the mortality of the disease and delayed recovery of patients. Purpose To investigate the factors that are related to the development of AKF in patients with IE. Methods Study of all cases of IE consecutively diagnosed in an university hospital between 2005 and 2021. A disease extension protocol was carried out using imaging tests and the levels of potentially nephrotoxic antibiotics were monitored. Furthermore, starting in 2010, a multidisciplinary committee (MC) was created to follow patients with EI. Factors potentially related to the development of AKF during hospital admission according to RIFLE criteria were analyzed using a binary logistic regression analysis. Results 305 cases were included, 96.7% of them meeting definitive IE criteria. The median age was 66 (54-74.5) years, 75.4% male. The most frequent microorganism was S. aureus (66; 21.6%), 172 (56.4%) underwent surgery and 107 patients (35.1%) died. 149 cases (45.3%) developed AKF, with no differences before (45.3%) and after the creation of the CM. The variables related in the multivariate analysis to the appearance of AKF were age (OR 1.01; 95% CI: 1.01-1.05; p= 0.006), baseline creatinine (OR= 1.53; 95% CI = 1.22-1.68; p<0.001). ), peripheral embolism (OR=1.86; 95% CI = 1.07-3.22; p= 0.027), the development of heart failure (OR=1.98; 95% CI = 1.12-3.22; p= 0.017) and left ventricular systolic dysfunction (OR= 4.02; 95% CI = 1.09-14.85; p= 0.037). None of the other variables analyzed, including the type of microorganism and the use of nephrotoxic antibiotics, were related to the development of AKF. Conclusions In a hospital center with a protocol for the study and treatment of infective endocarditis, the development of AKF is related to age, baseline creatinine, peripheral embolism, and the development of heart failure.

Comparative study of acute kidney injury in pararenal aortic aneurysm: open surgical versus endovascular repair.

Pararenal abdominal aortic aneurysms (PR-AAA), constituting around 15%-20% of AAA patients, are defined as having no neck between the aneurysm and the renal arteries. Due to an insufficient sealing zone, open surgical repair (OSR) is the gold standard, while EVAR is reserved for those unfit for surgery. Renal outcomes disturb long-term survival, and they have massive socioeconomic and quality of life implications, especially if patients require dialysis. This study aims to elucidate any difference between EVAR and OSR of PR-AAA, excluding suprarenal aneurysms, with specific emphasis on renal dysfunction over the short and long term. An existing database of PR-AAA between 2002 and 2023 was used to glean information regarding the therapeutic option used. Renal events were defined by the RIFLE criteria. Out of 1,563 aortic interventions, we identified 179 PR-AAA, of which 99 high-risk patients had an aortic neck of less than 10 mm with complete follow-up. We excluded patients with fenestrated EVAR (FEVAR), branched EVAR (BEVAR), or chimney EVAR (Ch-EVAR) and any patients requiring visceral artery reimplantation. In total, 63 patients underwent EVAR, and 36 required OSR. 17.46% of patients who underwent EVAR experienced acute kidney injury (AKI) compared with 36.11% of the OSR group (P = 0.037). The mean post-op creatinine for OSR was 109.88 µmol/L, and for EVAR was 127.06 µmol/L (P = 0.192). The mean difference between long-term (9-12 years) creatinine values in OSR was 14.29 µmol/L (P = 0.191), and the mean difference for EVAR was 25.05 µmol/L (P = 0.024). Furthermore, 27.8% of OSR patients who underwent Left Renal Vein Division and Ligation (LRVDL) experienced an AKI, while 50% who did not undergo LRVDL experienced an AKI (P = 0.382). Thirty-day morbidity in the EVAR group (20.97%) was significantly lower than in the OSR group (42.62%) (P = 0.022). Moreover, 3.17% in EVAR group and 7.14% in OSR group had aneurysm-related mortality (P = 0.584). The rate of renal events for OSR is higher, while the rate of endovascular renal events was lower. Our study shows that PR-AAA undergoing OSR may benefit from endovascular repair.

Transitions and Long-Term Clinical Outcomes in Patients Admitted in Intensive Care Units Receiving Continuous Renal Replacement Therapy.

Introduction: Acute kidney injury (AKI) significantly disrupts vital renal functions and is a common and serious condition in intensive care units (ICUs). AKI leads to extended hospital stays, increases mortality rates, and often necessitates nephrology consultations. Continuous renal replacement therapy (CRRT) plays a central role in managing AKI, requiring a multidisciplinary approach involving nephrologists, intensivists, and anesthesiologists. This study examines the clinical profile and progression of AKI in ICU patients requiring CRRT, with a focus on CRRT indications and modalities. Materials and Methods: We conducted a single-center retrospective observational study on ICU patients with AKI requiring CRRT from January to December 2019. AKI diagnosis followed the RIFLE criteria, and patients who received CRRT for less than 36 h were excluded. Data collected included demographics, hemodynamic parameters, and renal function parameters, with follow-ups at 1 week, 1 month, 6 months, and 12 months. Statistical analyses evaluated outcomes and transitions between CRRT and other renal replacement therapies. Results: Among 123 evaluated patients, 95 met inclusion criteria. Fifteen patients received CRRT for less than 36 h, with an early mortality rate of 80%. The final cohort comprised 80 patients who underwent CRRT for over 36 h, with a mean age of 65.3 years (SD = 13.6) and a Charlson index of 6.4. Patients were categorized based on primary diagnosis into heart failure, cardiac surgery, sepsis, other surgeries, and miscellanea groups. Mortality rates were highest in the heart failure and miscellanea groups. Significant variability was observed in therapy transitions and long-term outcomes. Continuous venovenous hemodiafiltration (CVVHDF) was the most frequently used CRRT modality. Conclusions: This study highlights the variability in CRRT practices and the poor prognosis for critically ill patients with AKI requiring CRRT. Timely nephrology consultation and tailored treatment plans may improve patient outcomes and optimize CRRT utilization. Future research should focus on refining CRRT protocols and exploring preventive strategies for AKI.

Incidence of Acute Kidney Injury and Mortality Post Successful Cardiac Surgery in a Kashmiri Cohort: A Prospective Comparison of the RIFLE and KDIGO Criteria.

Background and objectives In critically ill patients, acute kidney injury (AKI) influences mortality and morbidity. Few studies have looked at mortality and the frequency of AKI following successful heart and thoracic operations. The current study investigates the association between AKI and mortality rates among patients undergoing post-cardiac surgery care within the Cardiology & Cardio Vascular Thoracic Surgery (CVTS) Intensive Care Unit (ICU). Methodology In this prospective research, 124 patients who underwent successful cardiovascular and thoracic procedures between June 2022 and June 2023 were admitted to the CVTS ICU. To determine mortality, we contrasted the two scoring methods, Kidney Disease-Improving Global Outcomes (KDIGO) and Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE). Results Based on the KDIGO criteria, AKI was identified in 37.90% (n = 47) of the patients, and it was identified in 15.32% (n = 19) of the patients utilizing RIFLE. Notably, patients diagnosed with AKI using either the RIFLE criteria or KDIGO criteria exhibited considerably higher mortality rates (p< 0.001). Receiver operating characteristic (ROC) analysis demonstrated the effectiveness of both scoring systems in identifying mortality (area under the ROC curve for RIFLE = 0.224 and KDIGO = 0.150). Conclusion Post-cardiac surgery, AKI escalates both mortality and morbidity rates. Despite KDIGO detecting more severe renal injury and mortality, both scoring systems exhibit comparable sensitivity and specificity in predicting death among patients undergoing various cardiovascular and thoracic procedures.

Incidence of Acute Kidney Injury Post Transcatheter Aortic Valve Implantation (TAVI): A Single-Center Experience.

Transcatheter aortic valve implantation (TAVI) has dramatically changed the approach to treating aortic stenosis, particularly for patients unsuitable for surgical aortic valve replacement. Nevertheless, the possibility of quick deterioration of kidney function, known as acute kidney injury (AKI), post operation is considered one of the complications. The study aimed to determine the incidence of AKI in adults post TAVI. This retrospective cohort study focuses on patients who underwent the TAVI procedure at the King Faisal Cardiac Center at the Ministry of National Guard Health Affairs (MNGHA) in Jeddah, Saudi Arabia, from May 2016 to December 2022. Acute kidney injury post TAVI was defined based on RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Chi-square tests and independent sample t-tests were used to compare clinical and demographic characteristics between patients who developed AKI with those who did not, using an alpha of 5%. The study involved 103 adult patients. Among them, 11 (10.7%) developed AKI post TAVI within seven days of the procedure, while 92 (89.3%) did not. Findings also revealed that patients with hyperlipidemia and a previous history of kidney diseases faced a higher risk of AKI post TAVI. Despite its valuable insights, the study has limitations due to its retrospective nature and small sample size. The study emphasizes the importance of identifying patients with hyperlipidemia and pre-existing kidney conditions and closely monitoring renal function. While some preventive methods did not significantly impact AKI occurrences, further research is needed to refine preventive strategies.

To Evaluate the Role of Comorbidities in the Development of Acute Kidney Injury in Intensive Care Patients at a Tertiary Care Hospital in Bangladesh

Background: Indeed, AKI is a common complication in ICU patients, and it is associated with an increase in morbidity and mortality as well as healthcare costs. Recognizing AKI risk factors in LMIC settings is important for intervention approaches. Objectives: The objectives of this study are as follows: To determine the incidence of AKI based on RIFLE criteria among the critically ill patients in a tertiary care hospital in Bangladesh and to analyze the impact of the presence of comorbidities on the development of AKI in these patients. Methods: This prospective observational study was carried out at the ICU of Community Based Medical College in Bangladesh from January to December 2023. The target subjects were adult patients who were admitted to the ICU for a period of 24 to 48 hours. Patients with AKI were categorized using RIFLE criteria based on serum creatinine and urine output. For the univariate and multivariate logistic regression, demographic data, comorbidities, and clinical characteristics were collected. Results: In the present study of 22 patients with a mean age of 42.16 years and 63.6% of male patients, 86.4 percent of the patients had AKI according to both serum creatinine and urine output criteria. Sepsis/septic shock ([OR] 2. 2, [CI] 0. 8–5. 8) and cardiac etiology ([OR] 2. 7, [CI] 1. 0–7.1) were significant predictors of AKI. The study revealed that respiratory disease [OR. = 3.56, 95% confidence interval (CI): 0.33–38.78] and hematologic malignancy [OR. = 4.20, 95% CI: 0.40–43.82] were the comorbid conditions most closely associated with AKI. Conclusions: This research shows a very high prevalence rate of AKI among the clients in critical conditions in Bangladesh. Sepsis, cardiac dysfunction, respiratory disease, and hematologic malignancies emerged as significant factors. The results are therefore informative for programs aimed at improving AKI awareness, early detection activities, and prevention efforts in low-resource settings.

Long-term outcomes of total arch replacement with bilateral antegrade cerebral perfusion using the "arch first" approach.

To report outcomes of total arch replacement (TAR) with hypothermic circulatory arrest and bilateral antegrade cerebral perfusion (bACP) using an "arch first" approach for acute Type A aortic dissection (ATAAD). The "arch first" approach involved revascularization of the aortic arch branch vessels with uninterrupted ACP, before lower body circulatory arrest, while the patient was cooling. This was an observational study of aortic surgeries from 2010 to 2021. All patients who underwent TAR with bACP for ATAAD were included. Short-term and long-term outcomes were reported utilizing descriptive statistics and Kaplan-Meier survival estimation. A total of 215 patients were identified who underwent TAR + bACP for ATAAD. Age was 59.0 [49.0-67.0] years and 35.3% were female. 73 patients (34.0%) underwent a concomitant aortic root replacement, 188 (87.4%) had aortic cannulation, circulatory arrest time was 37.0 [26.0-52.0] minutes, and nadir temperature was 20.8 [19.4-22.5] degrees Celsius. 35 patients (16.3%) had operative mortality (STS definition), 17 (7.9%) had a new stroke, 79 (36.7%) had prolonged mechanical ventilation (>24h), 35 (16.3%) had acute renal failure (by RIFLE criteria), and 128 (59.5%) had blood product transfusions. One-year survival was 77.1%, while 5-years survival was 67.1%. During follow-up, there were 23 (10.7%) reinterventions involving the descending thoracic aorta - either thoracic endovascular aortic repair or open thoracoabdominal aortic replacement. Among patients with ATAAD, short-term postoperative outcomes after TAR + bACP using the "arch first" approach are acceptable. Moreover, this operative strategy may furnish long-term durability, with a reasonably low reintervention rate and satisfactory overall survival.

#1900 Should we prescind of KDIGO Stage 2 in AKI severity classification?

Abstract Background and Aims The most worldwide used classification system for staging AKI is KDIGO-2012, it was based on a combination of the RIFLE and AKIN criteria. KDIGO severity stages are defined: Stage 1 ↑ in SCr by &amp;gt;0.3 mg/dl or increase in SCr to &amp;gt;1.5x baseline. Stage 2 ↑ in SCr ≥2.0–2.9x baseline. Stage 3 ↑ in SCr ≥3.0x baseline, ↑ in SCr to &amp;gt;4.0 mg/dl, or initiation of RRT. Some authors advocate for the elimination of the Stage 2 level and its incorporation in the severer stage; the justification is that this stage has a smaller number of individuals, and they show poorer clinical outcomes. We tested this hypothesis in a real-world setting. Method We retrospectively included all patients admitted to nephrology ward and nephrology consultations with AKI diagnosis by KDIGO-2012 classification, during a 3-y period. We compared clinical outcomes between KDIGO-AKI Stage 2 and 3. We excluded need for HD (because it is a criterion for Stage 3) and HD dependence at discharge (a consequence of initiating HD). In addition, we calculated the proportion of patients classified in Stage 2 by the rate of SCr increment, that were re-classified into Stage 3 by KDIGO criteria. Results 1130 individuals met inclusion criteria. 458 (41%) Stage-1, 148 (13%) Stage-2, 524 (46%) in Stage-3. We found no statistically significant differences in age, Charlson's Index, HTN and DM prevalence, hospitalization in medical wards, and hospital acquired AKI between groups. We found significant differences in sex distribution (61% Stage-2, 70% Stage-3) (see Table A: Features). Hospital stay was significantly shorter in Stage1-15d (±12) but not significantly different between Stage-2 19d (±16) and Stage-3 20d (±17). Median of time to nephrology consultation was 6-7d in all groups. Rate of in-hospital mortality incremented gradually in every severity stage: 9% Stage-1, 18% Stage-2 and 31% Stage-3 (see Table B: Results). When using only the rate of SCr increment as the classification criterion, 265 (24%) of patients would have been catalogued in the moderate AKI stratum. Of the 117 patients that were reclassified as AKI Stage-3, 36 needed HD, and 81 reached a SCr &amp;gt;4.0 mg/dl. Conclusion The proportion of subjects classified in KDIGO AKI Stage-2 is small but not negligible. We found that Stage-2 individuals show longer hospital stay and increased mortality than Stage-1, and slightly better outcomes than Stage-3; therefore, we consider that an increase in SCr ≥2.0–2.9x from baseline still leads to deleterious consequences. We also observed that possibly KDIGO AKI Stage 3 criteria lead to a skew to classification in the severer stage, (almost half of individuals are reclassified). With these findings, should we prescind of KDIGO Stage-2 in AKI severity classification?

Determinants of acute kidney injury during high-power mechanical ventilation: secondary analysis from experimental data

BackgroundThe individual components of mechanical ventilation may have distinct effects on kidney perfusion and on the risk of developing acute kidney injury; we aimed to explore ventilatory predictors of acute kidney failure and the hemodynamic changes consequent to experimental high-power mechanical ventilation.MethodsSecondary analysis of two animal studies focused on the outcomes of different mechanical power settings, including 78 pigs mechanically ventilated with high mechanical power for 48 h. The animals were categorized in four groups in accordance with the RIFLE criteria for acute kidney injury (AKI), using the end-experimental creatinine: (1) NO AKI: no increase in creatinine; (2) RIFLE 1-Risk: increase of creatinine of > 50%; (3) RIFLE 2-Injury: two-fold increase of creatinine; (4) RIFLE 3-Failure: three-fold increase of creatinine;ResultsThe main ventilatory parameter associated with AKI was the positive end-expiratory pressure (PEEP) component of mechanical power. At 30 min from the initiation of high mechanical power ventilation, the heart rate and the pulmonary artery pressure progressively increased from group NO AKI to group RIFLE 3. At 48 h, the hemodynamic variables associated with AKI were the heart rate, cardiac output, mean perfusion pressure (the difference between mean arterial and central venous pressures) and central venous pressure. Linear regression and receiving operator characteristic analyses showed that PEEP-induced changes in mean perfusion pressure (mainly due to an increase in CVP) had the strongest association with AKI.ConclusionsIn an experimental setting of ventilation with high mechanical power, higher PEEP had the strongest association with AKI. The most likely physiological determinant of AKI was an increase of pleural pressure and CVP with reduced mean perfusion pressure. These changes resulted from PEEP per se and from increase in fluid administration to compensate for hemodynamic impairment consequent to high PEEP;

Acute kidney injury in neonatal intensive care unit and the significance of nRIFLE criteria on diagnosis and prognosis

Objectives: The objective of this study is to identify factors that affect the severity of acute kidney injury (AKI) using neonatal RIFLE (Risk, Injury, Failure, Loss of function, End-stage kidney disease) criteria; to identify the impact of these criteria and the factors on mortality rates and to determine the one-year clinical outcome. Methods: Five hundred and thirty-two inpatients who were admitted to Gazi University, Faculty of Medicine, Neonatal Intensive Care Unit (NICU) between 2006 and 2016 have been examined retrospectively. Results: Acute kidney injury developed in the first month of life in 85 (16%) patients. Thirty-nine (7.35%) of the cases were term and 46 (8.65%) were preterm. Among these patients, 33 (38.8%) were in the risk group, 18 (21%) in the injury group, and 34 (40%) in the failure group. Metabolic acidosis and edema were the most commonly seen findings as acute kidney injury scores increased. According to the neonatal RIFLE (nRIFLE) criteria, the severity of AKI was significantly correlated (p &amp;lt; 0.05) with metabolic acidosis (71%) and edema (50.5%). There was a positive correlation between urinary output and pH, bicarbonate, glomerular filtration rate, and sodium values in patients with AKI, while a negative correlation between urinary output and BUN, creatinine, potassium, phosphorus, and uric acid was found. Regarding the nRIFLE criteria, the frequency of hyponatremia and hyperpotassemia was increased as the AKI severity score was increasing (p &amp;lt; 0.05). The mortality rate was 54% in the newborn period and factors that significantly affect mortality were the need for mechanical ventilation, sepsis, nephrotoxicity, and acidosis (p &amp;lt; 0.05). Conclusions: The nRIFLE criteria based on urinary output is a guide for clinicians to diagnose AKI. There is a need to work on new markers in future studies.

Effect of potential risk factors on renal functions in simultaneous bilateral total knee arthroplasty.

This retrospective study investigated the risk factors leading to a decrease in Renal glomerular filtration rate (eGFR) and the development of acute kidney injury (AKI) during the early postoperative period in patients undergoing simultaneous bilateral total knee arthroplasty (SBTKA). SBTKA was performed on 862 patients between 2014 and 2021 in a single center, by a single surgeon. The risk factors affecting the development of AKI were analyzed by monitoring the changes in pre-and postoperative serum creatinine (Scr) levels and eGFR values. RIFLE criteria were used to evaluate the kidney functions of the patients, who were followed up for an average of 6 months. While there was no decrease in eGFR or AKI in 818 patients postoperatively, eGFR decreased and AKI of different stages developed in 44 patients, according to the RIFLE criteria. Of the 44 patients with AKI, 31 had Risk, 9 had Injury, 3 had Failure, and one had Loss of kidney function. Two patients with American Society of Anaesthesiologists (ASA) class IV died due to deepening of postoperative renal dysfunction. We found that the direct risk factors in SBTKA in terms of eGFR decrease and AKI development include long operation time, increased need for blood transfusion, and diabetic nephropathy, while increased body mass index (BMI) is an indirect risk factor. When planning for a SBTKA, we presume that a thorough analysis of these factors will decrease AKI risk.

Oncological and functional outcomes of patients who underwent open partial nephrectomy for kidney tumor.

To report long-term functional and oncological outcomes of OPN Methods: We enrolled 182 patients who underwent consecutive OPN with a diagnosis of kidney tumor in our clinic between April 2002 and February 2020 and were selected from our prospective OPN database. Preoperative demographic and clinical characteristics, intraoperative and pathological results, and patients' postoperative functional and oncological follow-up data were retrospectively analyzed. Overall survival (OS) and disease- free survival (DFS) were evaluated using Kaplan-Meier survival analysis. The time-dependent variation between preoperative and postoperative functional results was statistically analyzed and presented in a graph. The mean age was 54.4 ± 10.8 yr, and the median age-adjusted Charlson comorbidity index (ACCI) was 1 (interquartile range [IQR] 0-1). The mean tumor size was 3.1 ± 1.2 cm, and the median RENAL score was 6 (IQR 5-8). The most common malign histopathological subtype was clear cell carcinoma with 76.6%, and five cases (3.4%) had positive surgical margins (PSMs). The most common surgical techniques were the retroperitoneal approach (98.9%) and cold ischemia (88.5%). Estimated glomerular filtration rate (eGFR) preservation was 92% (80.8-99.3, IQR), which translates to 32% chronic kidney disease (CKD) upstaging. Acute kidney injury (AKI) was detected in 27 (14.8%) patients according to RIFLE criteria. The intraoperative complication rate was 5.5%, and the postoperative overall complication rate (Clavien-Dindo 1-5) was 30.2%. Major complications (Clavien-Dindo 3-5) were observed in 13 (7.1%) patients. The median oncological follow-up was 42 mo (21.3- 84.6, IQR), and the 5- and 10-yr OS were 90.1% and 78.6%, 5 and 10-yr DFS were 99.4% and 92.1%, respectively. No local recurrence was observed in 5 (3.4%) patients with PSMs; only one had distant metastasis in the 8th postoperative month. The retrospective design, the small number of patients who underwent PN based on mandatory indication, and one type of surgical approach may limit the generalizability of our findings. This study confirms excellent long-term oncologic and functional outcomes after OPN in a cohort of patients selected from a single institution. In light of the information provided by the literature and our study, our recommendation is to push the limits of PN under every technically feasible condition in the treatment of kidney tumors to protect the kidney reserve and achieve near-perfect oncological results.

Creatinine Reduction Ratio Is a Prognostic Factor for Acute Kidney Injury following Cardiac Surgery with Cardiopulmonary Bypass: A Single-Center Retrospective Cohort Study.

Acute kidney injury (AKI) after cardiac surgery is a common complication that can lead to death. We previously reported that the creatinine reduction ratio (CRR) serves as a useful prognostic factor for AKI. The primary objective of this study was to determine the predictors of AKI after surgery. The secondary objective was to determine the reliability of the CRR for short- and long-term outcomes. We retrospectively collected information about cardiac surgery patients who underwent cardiopulmonary bypass. Patients were divided into AKI and non-AKI groups based on the AKIN and RIFLE criteria. We analyzed the two groups regarding the preoperative patient data and operative information. The CRR was calculated as follows: (preoperative creatinine-postoperative creatinine)/preoperative creatinine. The prognostic factors of AKI-CS were surgery time, CPB time, aorta clamp time, platelet transfusion, and CRR < 20%. In the multivariate logistical analysis, CRR was an independent predictor of AKI (adjusted odds ratio: 0.90 [0.87-0.93], p < 0.001). However, there were no significant differences in CRR in terms of the rate of new onset chronic kidney disease (CKD). After cardiac surgery with cardiopulmonary bypass, CRR has good diagnostic power for predicting perioperative AKI. However, we cannot use it as a prognostic factor over a long-term period.

Comparison of early continuous hemodiafiltration vs. delayed continuous hemodiafiltration in patients of acute kidney injury (AKI) with septic shock

Introduction: Acute kidney injury (AKI) is a common clinical condition among critically ill patients, incredibly complicated with sepsis. The study aims to compare mortality rates in early and late renal replacement therapy initiation in critically ill patients with AKI and septic shock. Methods and Material: We carried out a retrospective, randomized, single-centre study of early vs. late RRT-implementation strategies for critically ill patients with sepsis and AKI in ICU at our Institute for one year (July 2017 to July 2018). AKI was defined and categorized by RIFLE criteria. Results: A total of 59 deaths were observed by day 28 (25 in the early RRT group and 34 in the delayed RRT group). The survival rates were estimated using the Kaplan–Meier method and compared with a log-rank test (p=0.007). The Kaplan–Meier estimate of the overall survival at day 28 was 49.1% (95% CI, 45.0 to 52.9). Conclusions: Among critically ill patients with sepsis with AKI, we observed reduced 28-day mortality in early RRT than delayed RRT initiation. Our study proves the benefit of early implementation of CRRT over delayed therapy with better 28-day survival in the early RRT group.

Incidence and risk factors for acute kidney injury in children with congenital heart disease undergoing cardiac surgery in a tertiary care center.

Objective: To determine the incidence and risk factors associated with acute kidney injury (AKI) in children with congenital heart diseases (CHDs) who underwent cardiac surgery in a tertiary care center. Study Design: Cross-sectional study. Setting: Paediatric Cardiac Intensive Care Unit (PCICU) of National Institute of Cardiovascular diseases, Karachi, Pakistan. Period: November 2022 to May 2023. Material &amp; Methods: We included patients of both genders and any age who underwent open or closed heart surgery for congenital heart defects. All patients undergoing CHD repairs were monitored for the total duration of PCICU stay. The development of AKI was labeled as per RIFLE criteria, and management thereafter was performed as per standard institutional protocols. Results: In a total of 93 patients with CHD, there were 50 (53.8%) males and 43 (46.2%) females. The mean age was 9.71±9.14 year ranging between 3 months to 60 years. There were 6 (6.5%) patients who developed AKI post-surgery. Overall, mortality was noted in 7 (7.5%) patients. Cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were significantly higher among patients who developed post-surgery AKI (&lt;0.001). Moreover, post-surgery AKI was significantly associated with intra-operative hypotension (p&lt;0.001), post-operative hypotension (p&lt;0.001), and post-operative sepsis (p&lt;0.001). It was also found that AKI had significant association with higher post-operative inotropic scores (p&lt;0.001), prolonged duration of mechanical ventilation (p&lt;0.001), and length of PCICU stay (p&lt;0.001). Mortality had significant association with AKI (33.3% vs. 5.7%, p=0.013). Conclusion: We noted the incidence of AKI among patient who underwent cardiac repairs to be 6.5%. CPB time and ACC time were significantly higher among patients who developed post-surgery AKI. Post-surgery AKI was significantly associated with intra-operative hypotension, post-operative hypotension, and post-operative sepsis. Mortality was significant high among cases that had AKI.

A-126 Evaluation of NMR-based GFR Estimation in Dosing of High-dose Methotrexate

Abstract Background The cytotoxic agent methotrexate (MTX) is mainly used in oncology and rheumatology. MTX is 80%–90% excreted unchanged in the urine, thus, impaired renal excretion because of kidney disease leads to accumulation and prolonged exposure, with a consequent increased risk of myelosuppressive and other toxic adverse effects. Direct kidney damage from MTX crystal precipitation and tubular injury may also occur. Therefore, precise and accurate measurement of renal function prior to MTX administration is of paramount importance to determine accurate dosing and to minimize such adverse risks. Commonly used estimated glomerular filtration rate (eGFR) equations perform poorly in patients with cachexia and at later stages of life—the typical oncology patient. Here we evaluate the feasibility of applying the recently introduced nuclear magnetic resonance (NMR)-based GFR equation (GFRNMR) using creatinine, cystatin C, myo-inositol, and valine, in oncology patients receiving high-dose MTX. Methods A series of residual sera from patients scheduled to receive high-dose MTX infusion for oncological indications were collected from two sites: n = 52 sera from the University Hospital Regensburg (Regensburg, Germany), at four time points (t0h, t24h, t42h, and t48h), and n = 10 cross-sectionally from the Mayo Clinic (MN). Standard drug-monitoring trough levels were used as a reference. Serum was prepared and NMR-measured in five replicates for all samples. GFRNMR was compared with the current standard GFR equations: i) CKD-EPI2021Cr (creatinine) and ii) CKD-EPI2021CrCys (creatinine and cystatin-C). Coefficient of determination for linear regression, kappa coefficient for categorical regression and bootstrapped confidence intervals were calculated. Results MTX was shown not to increase the GFRNMR failure rate or affect the intra-assay precision of GFRNMR. When monitoring eGFR during high-dose MTX treatment, MTX affected GFR according to the RIFLE criteria for AKI in 13 cycles in 9 patients; 1/13 were classified as ‘risk’ (creatinine increased 1.5-fold) and 1/13 were classified as ‘injury’ (creatinine increased 2.0-fold). Using MTX clearance as a surrogate for measured GFR, GFRNMR was shown to reflect the MTX plasma clearance constant k more accurately (using a fitting function c = c0*e−kt) with r = 0.758 (95% CI 0.36–0.92, P = 0.004) compared to CKD-EPI2021Cr (r = 0.401, 95%CI −0.19–0.78, P = 0.176) and CKD-EPI2021CrCyc (r = 0.632, 95% CI 0.12–0.88). Conclusion The robustness of GFRNMR test results is not affected by HD-MTX treatment. Compared to standard eGFR equations, GFRNMR is more closely associated with MTX renal clearance rates and may therefore be a novel method to improve the accuracy of MTX dosing in the future.

Acute Kidney Injury in Polytrauma Patients in Intensive Care Unit: A Prospective Observational Study

Abstract Background Acute Kidney Injury (AKI) is a common complication of severe trauma patients and is associated with increased morbidity and mortality. Injury Severity Score (ISS) &amp;gt; 15 represents approximately 10% of all trauma patients in intensive care unit (ICU). The primary outcome of the study was to correlate between the AKI by using RIFLE criteria and the trauma severity by using ISS. While; the secondary outcomes were; identifying the incidence of AKI in polytrauma patients, the length of ICU and hospital stay and 28 days mortality. Methods This is a prospective observational study which was conducted during the period from May 2020 to September 2020. It Included 60 cases of polytrauma patients who have ISS&amp;gt;15, at Ain shams university hospitals, their ages ranged from 18-70 years. All patients’ data were recorded for: Injury Severity Score (ISS). RIFLE criteria. Length of ICU and hospital stay. 28 days mortality. Results There was no correlation between the incidence of AKI and the severity of the trauma by using ISS. Incidence of AKI the percentage was (45 %) among all the studied cases. According to RIFLE criteria, within this population, patients were classified as (21.7%) of the patients in the Risk stage; (18.3%) of the patients in Injury stage, and (5%) of the patients in Failure stage. There was statistically significant difference between AKI and No AKI regarding risk factors, percentages of sepsis, rhabdomyolysis, drugs, abdominal trauma and hypovolemic shock were higher in AKI patients than No AKI patients. There was no statistically significant difference between AKI patients and No AKI patients regarding mechanical ventilation, ICU stay, Hospital stay and 28 d Mortality. Conclusion The incidence of acute kidney injury in polytrauma patients in the intensive care unit was high and the overall mortality of our patients was as high as that reported in other studies. A better comprehension of risk factors associated with trauma-associated AKI is important, such as rhabdomyolysis, sepsis, abdominal trauma (compartment) and hypovolemic shock.

A CROSS SECTIONAL STUDY TO EVALUATE ACUTE KIDNEY INJURY IN SCRUB TYPHUS PATIENTS

Objective: This study was conducted with the objective of estimating the incidence and severity of acute kidney injury (AKI) in scrub typhus patients. Methods: This was a cross-sectional study conducted on 90 patients diagnosed with scrub typhus in a tertiary care center. Basic demographic and treatment details of the patients were recorded. Routine hematological investigations and biochemical profiles were performed upon admission and follow-up. AKI was defined and classified based on the RIFLE criteria. Results: The mean age of the patients was 49.0±19.5 year and a female preponderance was observed. The hemoglobin level was significantly lower in AKI patients as compared to non-AKI patients. Meanwhile, there was a significant increase in mean TLC count, C-reactive protein, and total bilirubin in AKI patients as compared to non-AKI patients. Was significantly higher as compared to those without AKI. Increasing age, Intensive care unit admission, shock, urinary abnormalities, and mechanical ventilation were the factors significantly associated with AKI. Conclusion: AKI is a frequently reported complication in scrub typhus patients. In evaluating febrile illnesses associated with AKI, scrub typhus should be considered.

Efficacy and safefy of Polymyxin B treatment for neutropenic patients suffering from refractory Gram-negative bacterial bloodstream infection

Objective: To assess the efficacy and safety of polymyxin B in neutropenic patients with hematologic disorders who had refractory gram-negative bacterial bloodstream infection. Methods: From August 2021 to July 2022, we retrospectively analyzed neutropenic patients with refractory gram-negative bacterial bloodstream infection who were treated with polymyxin B in the Department of Hematology of the First Affiliated Hospital of the Soochow University between August 2021 to July 2022. The cumulative response rate was then computed. Results: The study included 27 neutropenic patients with refractory gram-negative bacterial bloodstream infections. Polymyxin B therapy was effective in 22 of 27 patients. The median time between the onset of fever and the delivery of polymyxin B was 3 days [interquartile range (IQR) : 2-5]. The median duration of polymyxin B treatment was 7 days (IQR: 5-11). Polymyxin B therapy had a median antipyretic time of 37 h (IQR: 32-70). The incidence of acute renal dysfunction was 14.8% (four out of 27 cases), all classified as "injury" according to RIFLE criteria. The incidence of hyperpigmentation was 59.3%. Conclusion: Polymyxin B is a viable treatment option for granulocytopenia patients with refractory gram-negative bacterial bloodstream infections.