Risk Of AKI Research Articles

Association between perioperative platelet distribution width changes and postoperative acute kidney injury in patients with renal insufficiency: a retrospective study

BackgroundAcute kidney injury (AKI) is a major complication following cardiac surgery with a high incidence in those with existing kidney dysfunction. Platelet distribution width (PDW) reflects variability in platelet size and serves as an indicator of platelet activation. Recent investigations linked PDW changes to kidney pathology, suggesting its utility in identifying individuals at risk for AKI, thus necessitating exploration of its predictive value.MethodsPatients with preoperative renal dysfunction [15 ≤ estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2] who underwent cardiac surgery from January 2018 to December 2021 were retrospectively enrolled. PDW values were measured preoperatively and again upon admission to the ICU immediately after cardiac surgery, with the change in PDW (dPDW) defined as the difference between these two measurements. The primary outcome was postoperative AKI, defined base on the Kidney Disease: Improving Global Outcomes (KDIGO) definition and staging criteria. Multivariate regression models were performed to identify the association between dPDW and AKI and its potential trend. Restricted cubic spline analysis assessed non-linear associations between dPDW and AKI. The Youden index identified an optimal dPDW cut-off for AKI prediction. Subgroup analysis was performed to elucidate the consistency of these associations across the various subgroups.ResultsAKI occurred in 53.10% (513/966) of patients, accompanied by significant PDW increases in cases of AKI (P < 0.001). After adjusting confounders, dPDW was identified as a significant risk factor for AKI [odds ratio (OR) = 1.09, 95% confidence interval (CI): (1.02 ~ 1.16), P = 0.012]. Patients in the highest dPDW quartile (Q4) had a 195% higher AKI risk compared to those in the lowest quartile (Q1) (OR = 2.95, 95% CI:1.78 ∼ 4.90, P < 0.001). Trend analysis indicates that the risk of AKI increased with higher dPDW quartiles (P for trend < 0.001). Youden index showed that dRDW = 1.1 was identified as the optimal diagnostic cut-off value for AKI. Subgroup analyses and interaction tests showed a robust association between dPDW and AKI in all subgroups (P for interaction > 0.05).ConclusionsThis study underscored perioperative PDW changes as a significant predictor of postoperative AKI in patients with renal insufficiency, highlighting its potential in refining risk stratification and management strategies.Clinical trial numberNot applicable for this observational retrospective study.

SGLT2-'eyes' on the reno-protection prize: reduction of post-PCI contrast-associated AKI in diabetic patients using SGLT2 inhibitors

Abstract Background Chronic therapy with sodium-glucose cotransporter 2 inhibitors (SGLT2i) is associated with long term reno-protective benefits. There are limited data on the benefits of these agents against the risk of contrast-associated acute kidney injury (CA-AKI). Purpose The goal of our study was to assess the comparative efficacy of SGLT2i for the prevention of CA-AKI in diabetic patients undergoing PCI. Methods The study population included all diabetic patients enrolled in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium Percutaneous Coronary Intervention (BMC2PCI) registry, a clinical registry of all PCI cases at non-federal hospitals in the state of Michigan, USA. Included patients underwent PCI between January 2022 and September 2023. Patients on dialysis were excluded. Predicted AKI risk was calculated using a previously validated and published machine learning BMC2 risk model. The primary outcome of CA-AKI was defined as an elevation in serum creatinine of ≥0.5 mg/dL following PCI. Risk-adjusted AKI rates were estimated by the product of event observed/expected ratio and overall collaborative AKI rate. Propensity matching on 23 covariates was used to adjust for the non-random use of SGLT2i. Results A total of 19,078 diabetic patients were included, of whom 3,087 (16.2%) were prescribed SGLT2i prior to PCI. Patients treated with SGLT2i were younger (66.1 vs 68.3 years), more likely to be men (73.3% vs 65.3%), have heart failure (50.4% vs 42.4%), have prior PCI (58.4% vs 48.8%), and have co-prescription of insulin (43.8% vs 37.3%) (p&amp;lt;0.001 for all). After propensity matching, no significant baseline difference between cohorts remained, with an absolute standardized difference less than 10% on all covariates. The pre-procedural use of SGLT2i was associated with a lower incidence of CA-AKI in unadjusted analysis (2.7% vs 3.8%, p=0.003) and after adjusting for the baseline predicted risk of CA-AKI (2.2% vs 2.8%, adjusted OR 0.69, 95% CI 0.54-0.89, p=0.0045). In a propensity-matched analysis, the use of SGLT2i was strongly associated with a reduced adjusted risk for CA-AKI (2.2 % vs 2.8%, adjusted OR 0.72, 95% CI 0.62-0.84, p=0.026). Conclusions Among patients with diabetes presenting for PCI, pre-procedural use of SGLT2i was associated with a significant reduction in the risk of CA-AKI. These results should compel further investigation into the beneficial effects of SGLT2 inhibitors in reducing the risk of CA-AKI.

Risk Score for Predicting AKI from Contrast-Enhanced CT (Pre-CT AKI score): Training and Validation from Retrospective Cohort.

The lack of a recognized risk evaluation for Contrast-associated acute kidney injury (CA-AKI) after contrast-enhanced computed tomography (CECT) makes it challenging to counsel patients before the procedure. This study aims to identify the incidence of CA-AKI post CECT, assess the associated risk factors, develop and validate a predictive score. All adult patients who underwent CECT in 2018 to 2022 were included in the training cohort while those in 2023 formed the external validation cohort. Exclusions applied to patients with CKD stage 5, recent dialysis, or incomplete data. Multiple logistic regression was employed to identify risk factors. The area under the receiver operating characteristic curve (AUROC) was used to evaluate both internal and external validation. From 21,878 enrolled patients, 6,042 and 2,463 met the inclusion criteria for the training and validation cohorts with a mean eGFR of 86.0 (26.4) and 81.4 (27.6) mL/min/1.73 m2, respectively. In the training cohort, 492 patients (8.1%) developed CA-AKI, and 49 (0.8%) required dialysis. Independent risk factors for CA-AKI included male gender, clinical setting, hemoglobin levels of <10 g/dL, and baseline eGFR less than 90 mL/min/1.73 m2. The model, using a weighted integer score derived from these factors, exhibited an AUROC of 0.715 (95% CI: 0.692-0.743) in the training cohort and 0.706 (95% CI: 0.663-0.748) in the validation cohort. CECT can lead to CA-AKI in specific populations. The Pre-CT AKI risk score for CA-AKI following CECT demonstrated good discriminative power and can be easily applied in clinical practice.

Effect of a Perioperative Hypotension Avoidance Strategy vs. a Hypertension Avoidance Strategy on the Risk of AKI

Effect of a Perioperative Hypotension Avoidance Strategy vs. a Hypertension Avoidance Strategy on the Risk of AKI

Preoperative Ionized Calcium Levels and Risk of AKI after Cardiac Surgery

Preoperative Ionized Calcium Levels and Risk of AKI after Cardiac Surgery

Impact of SGLT2 Inhibitors on the Risk of Postoperative AKI

Impact of SGLT2 Inhibitors on the Risk of Postoperative AKI

Urinary Waxy Casts Are Associated with Glomerular Etiology of AKI and Greater Risk for AKI Severity and Post-AKI Chronicity

Urinary Waxy Casts Are Associated with Glomerular Etiology of AKI and Greater Risk for AKI Severity and Post-AKI Chronicity

Using Machine-Learning Algorithms to Predict the Risk of AKI and CKD during the COVID-19 Pandemic Based on National Electronic Health Records

Using Machine-Learning Algorithms to Predict the Risk of AKI and CKD during the COVID-19 Pandemic Based on National Electronic Health Records

Exposure to Glucagon-Like Peptide 1 Receptor Agonists Does Not Increase the Risk of AKI Associated with Anticancer Therapy

Exposure to Glucagon-Like Peptide 1 Receptor Agonists Does Not Increase the Risk of AKI Associated with Anticancer Therapy

Higher Spot Urinary Sodium Concentration Is Associated with Better Decongestion and Lower Risk of AKI in Acute Heart Failure

Higher Spot Urinary Sodium Concentration Is Associated with Better Decongestion and Lower Risk of AKI in Acute Heart Failure

Iron metabolism indexes as predictors of the incidence of cardiac surgery-associated acute kidney surgery

BackgroundAcute kidney injury (AKI) is a major complication following cardiac surgery. We explored the clinical utility of iron metabolism indexes for identification of patients at risk for AKI after cardiac surgery.MethodsThis prospective observational study included patients who underwent cardiac surgery between March 2023 and June 2023. Iron metabolism indexes were measured upon admission to the intensive care unit. Multivariable logistic regression analyses were performed to explore the relationship between iron metabolism indexes and cardiac surgery-associated AKI (CSA-AKI). Receiver operating characteristic (ROC) curve was used to assess the predictive ability of iron, APACHE II score and the combination of the two indicators. Restricted cubic splines (RCS) was used to further confirm the linear relationship between iron and CSA-AKI.ResultsAmong the 112 recruited patients, 38 (33.9%) were diagnosed with AKI. Multivariable logistic regression analysis indicated that APACHE II score (odds ratio [OR], 1.208; 95% confidence interval [CI], 1.003–1.455, P = 0.036) and iron (OR 1.069; 95% CI 1.009–1.133, P = 0.036) could be used as independent risk factors to predict CSA-AKI. ROC curve analysis showed that iron (area under curve [AUC] = 0.669, 95% CI 0.572–0.757), APACHE II score (AUC = 0.655, 95% CI 0.557–0.744) and iron and APACHE II score combination (AUC = 0.726, 95% CI 0.632–0.807) were predictive indicators for CSA-AKI. RCS further confirmed the linear relationship between iron and CSA-AKI.ConclusionsElevated iron levels were independently associated with higher risk of CSA-AKI, and there was a linear relationship between iron and CSA-AKI.

Fluid resuscitation in children with severe infection and septic shock: a systematic review and meta-analysis.

The current meta-analysis found no significant difference in the mortality rate between the types of resuscitation fluid, and their speed or volume of administration. However, a significantly decreased risk of AKI was found in the BC group. More evidence is needed regarding the speed and volume of administration of fluid boluses in critically ill children.Prospero registration: CRD42020209066. • Balanced crystalloids (BC) may be better than normal saline (NS) for fluid resuscitation in critically ill children. • BC are better than NS for fluid resuscitation in critically ill children as they decrease AKI and hyperchloremia.

Assessing the risk of contrast induced-acute kidney injury (CI-AKI) after enhanced CT scan: Single-centre experience.

Objective: This study was conducted to assess the risk of contrast-induced AKI (CI-AKI), among Saudi patients who underwent enhanced CT scans at a tertiary care hospital; to understand the incidence and the underlying associated factors of CI-AKI. Methods: We conducted a retrospective review of patients who underwent CT scans with IV contrast from 2016 to 2021, at the King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All authors had no access to information that could identify individual participants during or after data collection. The occurrence of AKI was defined using the “Kidney Disease: Improving Global Outcomes” (KDIGO) consensus definition. The exclusion criteria comprised age &lt;18 years and records with missing key clinical information. Statistical Package for the Social Sciences (SPSS) software, version 21 was used for statistical analysis. The prevalence is presented as a percentage with a 95% confidence level. A P-value &lt;0.05 was considered statistically significant. Results: We reviewed 2000 patient files, of which 1430 met the inclusion criteria. According to the KDIGO definition of AKI, the overall incidence CI-AKI in our study cohort was 8.7%. The incidence of CI-AKI varied across baseline CKD stages, with significantly higher occurrences observed in individuals with CKD Stage5 at 24.3% and Stage4 at 15.9%. Statistical analysis confirmed that the likelihood of CI-AKI is significantly influenced by the baseline eGFR levels. This retrospective analysis found that individuals with hypertension have significantly higher odds of CI-AKI (OR = 2.02, p=0.001) compared to those without hypertension. Moreover, individuals with hyperuricemia have significantly higher odds of CI-AKI (OR = 2.78, p&lt;0.001), compared to those without. The association remains significant after adjusting for other variables (OR = 2.40, p&lt;0.001). The presence of diabetes, malignancy, anaemia, and ischemic heart disease did not show a significant association with CI-AKI. Conclusions: Based on the results of this retrospective study, the overall incidence of CI-AKI is around 8.7 %, among patients undergoing enhanced CT scan. The risk is low and highly influenced by patients’ baseline kidney function. Hypertension and Hyperuricemia are risk factors found to be associated with CI-AKI after enhanced CT scan. Diagnostic and clinically relevant enhanced CT scans should not be deferred based on the potential risk of CI-AKI. Furthermore, pre and peri-scan prevention protocols can significantly mitigate the risk of CI-AKI, even among high-risk patients.

Predictive value of perioperative NT-proBNP levels for acute kidney injury in patients with compromised renal function undergoing cardiac surgery: a case control study

BackgroundAcute kidney injury (AKI) significantly increases morbidity and mortality following cardiac surgery, especially in patients with pre-existing renal impairments. N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a marker of cardiac stress and dysfunction, conditions often exacerbated during cardiac surgery and prevalent in chronic kidney disease (CKD) patients. Elevated NT-proBNP levels can indicate underlying cardiac strain, hemodynamic instability and volume overload. This study evaluated the association between perioperative changes in NT-proBNP levels and the incidence of AKI in this particular patient group.MethodsThis retrospective study involved patients with impaired renal function (eGFR 15–60 ml/min/1.73 m²) who underwent cardiac surgery from July to December 2022. It analyzed the association between the ratio of preoperative and ICU admittance post-surgery NT-proBNP levels and the development of AKI and AKI stage 2–3, based on KDIGO criteria, using multivariate logistic regression models. Restricted cubic spline analysis assessed non-linear associations between NT-proBNP and endpoints. Subgroup analysis was performed to assess the heterogeneity of the association between NT-proBNP and endpoints in subgroups.ResultsAmong the 199 participants, 116 developed postoperative AKI and 16 required renal replacement therapy. Patients with AKI showed significantly higher postoperative NT-proBNP levels compared to those without AKI. Decreased baseline eGFR and increased post/preoperative NT-proBNP ratios were associated with higher AKI risk. Specifically, the highest quantile post/preoperative NT-proBNP ratio indicated an approximately seven-fold increase in AKI risk and a ninefold increase in AKI stage 2–3 risk compared to the lowest quantile. The area under the receiver operating characteristic curve for predicting AKI and AKI stage 2–3 using NT-proBNP were 0.63 and 0.71, respectively, demonstrating moderate accuracy. Subgroup analysis demonstrated that the positive association between endpoints and logarithmic transformed post/preoperative NT-proBNP levels was consistently robust in subgroup analyses stratified by age, sex, surgery, CPB application, hypertension, diabetes status and fluid balance.ConclusionPerioperative NT-proBNP level changes are predictive of postoperative AKI in patients with pre-existing renal deficiencies undergoing cardiac surgery, aiding in risk assessment and patient management.

Does amino acid infusion improve kidney outcomes in patients at high risk for postsurgical AKI?

Does amino acid infusion improve kidney outcomes in patients at high risk for postsurgical AKI?

Acute Kidney Injury in Hospitalized Patients With Exertional Rhabdomyolysis

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

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

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

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.

Renoprotective Effect of Febuxostat on Contrast Induced Acute Kidney Injury in Chronic Kidney Disease Patients Stage 3. Randomized Controlled Trial

Abstract Introduction Contrast induced acute kidney injury (CI-AKI) is known to be a complication of using intravascular contrast injection. Unfortunately, It is associated with adverse outcomes as prolonged length of hospitalization and increased burden of health care costs. So, we aimed to determine the efficacy of febuxostat in prevention of contrast induced acute kidney injury among patients with chronic kidney disease Stage 3 performing percutaneous coronary intervention (PCI). Methods In a randomized controlled trial we enrolled 120 CKD stage 3 Patients with acute coronary syndrome referred to the cardiology department Ain-Shams University hospital for performing PCI and stenting. Patients were randomly assigned to two arms: Group I (study group): Included 60 patients who received Febuxostat added to the traditional treatment (IV hydration and N-acetylcysteine). The patients received Feburic 80 mg within 6- 18 hours before and within 6-18 hours after the coronary intervention (a time gap of 24 hours between two doses).Group II (control group): included 60 patients who received only traditional treatment. Results The incidence of AKI was higher in the control group with a statistically significant difference. We found that Independent Significant risk factors that led to AKI were febuxostate avoidance, DM, high urea level, high creatinine level, CKD stage 3B, high Mehran score and high AKI risk. Conclusion We demonstrated that febuxostat has a renoprotective effect and it can help to reduce the incidence CI-AKI in CKD patients stage 3 performing PCI.

The Risk of Acute Kidney Injury in Patients Undergoing Coronary Angiography

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