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Predictors of AKI

Samer A Naffouje, Kiara A Tulla, Regina Chorley, Nancy Armstrong, George I Salti
Introduction: Acute kidney injury (AKI) following cardiovascular surgery has been shown to increase costs and overall morbidity and mortality. The incidence, risk factors, and outcomes of AKI following other types of major surgeries have not been as well characterized. We sought to study the incidence of AKI following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) per the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Materials and methods: Patients undergoing CRS and HIPEC between 2013 and 2015 were included...
November 2018: Annals of Medicine and Surgery
Emmanuel Canet, Rinaldo Bellomo
PURPOSE OF REVIEW: The present article reviews the recent literature on the main aspects of perioperative acute kidney injury (AKI). RECENT FINDINGS: AKI occurs in 1 in every 10 surgical patients, with cardiac, orthopedic, and major abdominal surgeries being the procedures associated with the highest risk. Overall, complex operations, bleeding, and hemodynamic instability are the most consistent procedure-related risk factors for AKI. AKI increases hospital stay, mortality, and chronic kidney disease, gradually with severity...
October 10, 2018: Current Opinion in Critical Care
Junseok Jeon, Do Hee Kim, Song In Baeg, Eun Jeong Lee, Chi Ryang Chung, Kyeongman Jeon, Jung Eun Lee, Wooseong Huh, Gee Young Suh, Yoon-Goo Kim, Dae Joong Kim, Ha Young Oh, Hye Ryoun Jang
BACKGROUND: Despite aggressive application of continuous renal replacement therapy (CRRT) in critically ill patients with acute kidney injury (AKI), there is no consensus on diuretic therapy when discontinuation of CRRT is attempted. The effect of diuretics on discontinuation of CRRT in critically ill patients was evaluated. METHODS: This retrospective cohort study enrolled 1176 adult patients who survived for more than 3 days after discontinuing CRRT between 2009 and 2014...
October 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Yu-Hsiang Chou, Tzong-Shinn Chu, Shuei-Liong Lin
Acute kidney injury (AKI) can increase the risk of developing incident chronic kidney disease (CKD). The severity, frequency and duration of AKI are crucial predictors of poor renal outcome. A repair process after AKI can be adaptive and kidney recovers completely after a mild injury. However, severe injury will lead to a maladaptive repair, which frequently progresses to nephron loss, vascular rarefaction, chronic inflammation and fibrosis. Although different mechanisms underlying AKI-CKD transition have been extensively discussed, no definite intervention has been proved effective to block or to retard the transition until recently...
October 2018: Nephrology
Yavuz Karabağ, Metin Çağdaş, Ibrahim Rencuzogullari, Süleyman Karakoyun, İnanç Artaç, Doğan İliş, Mahmut Yesin, Handan Çiftçi, Halil Ibrahim Erdoğdu, Ibrahim Halil Tanboğa
BACKGROUND: The relationship between acute kidney injury (AKI) and C-reactive protein (CRP) and albumin has been previously demonstrated in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). However, to our knowledge, CRP to albumin ratio (CAR), a newly introduced inflammation-based risk score, has not yet been studied. In this study, we aimed to investigate the possible relationship between the CAR and AKI. METHOD: A total of 815 consecutive STEMI patients treated with pPCI were reviewed...
September 9, 2018: Heart, Lung & Circulation
Wuhua Jiang, Jiawei Yu, Jiarui Xu, Bo Shen, Yimei Wang, Zhe Luo, Chunsheng Wang, Xiaoqiang Ding, Jie Teng
BACKGROUND: The association between pre-operative cardiac catheterization and cardiac surgery associated acute kidney injury (CSA-AKI) has been reported inconsistently. The purpose of this study is to evaluate the effect of the catheterization timing and contrast media dose on the incidence of postoperative acute kidney injury. METHODS: Patients who underwent cardiac catheterization and cardiac surgery successively from January 2015 to December 2015 were prospectively enrolled in this study...
October 5, 2018: BMC Cardiovascular Disorders
Alejandro Lemor, Gabriel A Hernandez, Nish Patel, Vanessa Blumer, Karan Sud, Mauricio G Cohen, Eduardo De Marchena, Annapoorna S Kini, Samin K Sharma, Carlos E Alfonso
BACKGROUND: Despite improvements in acute care and survival after non-ST-elevation acute coronary syndrome (NSTE-ACS) hospitalization, early readmissions remain common, and have significant clinical and financial impact. OBJECTIVES: Determine the predictors and etiologies of 30-day readmissions in NSTE-ACS. METHOD: The study cohort was derived from the National Readmission Database 2014 identifying patients with a primary diagnosis of NSTE-ACS using ICD9 code...
October 2, 2018: Catheterization and Cardiovascular Interventions
Arthur C Y Yeung, Andrew Morozov, Francis P Robertson, Barry J Fuller, Brian R Davidson
BACKGROUND: Acute kidney injury (AKI) is common after orthotopic liver transplantation (OLT) usually occurring early post-transplant. Multiple causes include graft preservation injury, blood loss, hypotension but also severity of recipient liver disease. Early intervention in AKI has both short and long term patient benefits. Unfortunately there are no current clinical biomarkers of early AKI. AIM: To assess the value of NGAL in predicting AKI following OLT. METHODS: Ovid MEDLINE and EMBASE were searched between the years of 2000 and 2017 for studies using keywords: Neutrophil Gelatinase Associated Lipocalin or NGAL variants combined with synonyms for liver transplantation...
September 28, 2018: International Journal of Surgery
Lorenzo Azzalini, Soledad Ojeda, Ozan M Demir, Joseph Dens, Masaki Tanabe, Alessio La Manna, Susanna Benincasa, Barbara Bellini, Enrico Poletti, Davide Maccagni, Francisco Hidalgo, Jorge Chavarría, Joren Maeremans, Giacomo Gravina, Eligio Miccichè, Guido D'Agosta, Giuseppe Venuti, Corrado Tamburino, Manuel Pan, Mauro Carlino, Antonio Colombo
BACKGROUND: Chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is associated with high contrast volumes, which can be particularly deleterious in patients with chronic kidney disease (CKD). We aimed to study the outcomes of CTO PCI in subjects with vs without CKD, and the impact of contrast-induced acute kidney injury (CI-AKI). METHODS: This multicentre registry included patients who underwent CTO PCI at 5 centres. CI-AKI was defined as an increase in serum creatinine ≥0...
October 2018: Canadian Journal of Cardiology
Ryan C Hoogmoed, Himanshu J Patel, Karen M Kim, David M Williams, G Michael Deeb, Bo Yang
BACKGROUND: Mechanisms contributing to acute kidney injury (AKI) after acute type B aortic dissection (ABAD) include renal malperfusion or underlying renal dysfunction. We characterized AKI after ABAD and evaluated its potential for adverse clinical and aortic outcomes. METHODS: 478 patients without prior dialysis requirement (mean age 62.1 years, 60.5% male) presented with ABAD (1995-2016). Renal malperfusion was identified in 87 (18.2%). AKI was assessed by the KDIGO criteria...
September 21, 2018: Annals of Thoracic Surgery
Mudit Kaushal, Joseph Schwartz, Nitish Gupta, Jay Im, Jonathan Leff, William A Jakobleff, Galina Leyvi
OBJECTIVE: Investigate how a multitude of patient demographics and extracorporeal membranous oxygenation (ECMO)-related complications affect 30-day survival or survival to discharge. DESIGN: Retrospective observational study. SETTING: Urban university hospital, quaternary care center. PARTICIPANTS: Patients who underwent ECMO circulatory support from January 2012 to May 2016. INTERVENTIONS: Date-based data extraction, univariate and multivariate regression analysis...
August 23, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Michael A Fierro, Eric I Ehieli, Mary Cooter, Austin Traylor, Mark Stafford-Smith, Madhav Swaminathan
OBJECTIVES: Acute kidney injury (AKI) is a common complication of cardiac surgery, and early detection is difficult. This study was performed to determine the sensitivity, specificity, positive predictive value, negative predictive value, and statistical performance of renal angina (RA) as an early predictor of AKI in an adult cardiac surgical patient population. DESIGN: Retrospective, nonrandomized, observational study. SETTING: A single, university-affiliated, quaternary medical center...
August 11, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Shuang Cui, Liling Wu, Xiaodan Feng, Huanjuan Su, Zhanmei Zhou, Weihong Luo, Cailing Su, Yajing Li, Meng Shi, Zhichen Yang, Wei Cao
One of the major obstacles to prevent AKI-CKD transition is the lack of effective methods to follow and predict the ongoing kidney injury after an AKI episode. In the present study, we test the utility of urinary angiotensinogen (UAGT) for dynamically evaluating renal structural changes and predicting AKI-CKD progression by using both mild and severe bilateral renal ischemia/reperfusion injury mice. UAGT returns to pre-ischemic levels 14 days after mild AKI followed by kidney architecture restoration, whereas sustained increase in UAGT accompanies by ongoing renal fibrosis after severe AKI...
October 15, 2018: Clinical Science (1979-)
Alberto Martini, Shivaram Cumarasamy, Alp Tuna Beksac, Ronney Abaza, Daniel D Eun, Akshay Bhandari, Ashok K Hemal, James R Porter, Ketan K Badani
BACKGROUND: Decreased functional outcome after partial nephrectomy is associated with overall mortality. OBJECTIVE: To create a model that predicts ≥25% reduction from baseline estimated glomerular filtration rate (eGFR) in patients undergoing robot-assisted partial nephrectomy (RAPN) and to investigate the role of acute kidney injury (AKI) in this patient population. DESIGN, SETTING, AND PARTICIPANTS: A total of 999 patients were identified from a multi-institutional database...
September 14, 2018: European Urology
Lin Pu, Jingyuan Liu, Yang Luo, Hui Zeng, Hebing Guo, Jingjing Hao, Ningning Yin, Yufeng Liu, Haofeng Xiong, Jian Xiong, Ang Li
To describe the epidemiology, outcomes, and risk factors of acute kidney injury (AKI) among human immunodeficiency virus (HIV)-infected patients admitted to the intensive care unit (ICU).We reviewed all the HIV-infected admissions to the ICU at Beijing Ditan hospital in the time span from June 2005 to May 2017 and collected demographic, clinical, and laboratory data for our sample. AKI was diagnosed and classified according to the Kidney Disease Improving Global Outcomes (KIDIGO) criteria. We analyzed the incidence of AKI and its associated mortality...
October 2018: AIDS Patient Care and STDs
Ying-Ying Chen, Vin-Cent Wu, Wei-Chieh Huang, Yu-Chang Yeh, Mai-Szu Wu, Chiu-Ching Huang, Kwan-Dun Wu, Ji-Tseng Fang, Chih-Jen Wu
(1) Background: Norepinephrine (NE) is the first-line vasoactive agent used in septic shock patients; however, the effect of norepinephrine on dialysis-required septic acute kidney injury (AKI-D) patients is uncertain. (2) Methods: To evaluate the impact of NE on 90-day mortality and renal recovery in septic AKI-D patients, we enrolled patients in intensive care units from 30 hospitals in Taiwan. (3) Results: 372 patients were enrolled and were divided into norepinephrine users and non-users. After adjustment by Inverse probability of treatment weighted (IPTW), there was no significant difference of baseline comorbidities between the two groups...
September 12, 2018: Journal of Clinical Medicine
Toshiki Kuno, Yohei Numasawa, Mitsuaki Sawano, Toshiomi Katsuki, Masaki Kodaira, Ikuko Ueda, Masahiro Suzuki, Shigetaka Noma, Koji Negishi, Shiro Ishikawa, Hiroaki Miyata, Keiichi Fukuda, Shun Kohsaka
BACKGROUND: Limiting the contrast volume to creatinine clearance (V/CrCl) ratio is crucial for preventing contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). However, the incidence of CI-AKI and the distribution of V/CrCl ratios may vary according to patient body habitus. OBJECTIVE: We aimed to identify the clinical factors predicting CI-AKI in patients with different body mass indexes (BMIs). METHODS: We evaluated 8782 consecutive patients undergoing PCI and who were registered in a large Japanese database...
2018: PloS One
Malte Kölling, Harald Seeger, George Haddad, Andreas Kistler, Albina Nowak, Robert Faulhaber-Walter, Jan Kielstein, Hermann Haller, Danilo Fliser, Thomas Mueller, Rudolf P Wüthrich, Johan M Lorenzen
Introduction: Circular RNAs (circRNAs) have recently been described as novel noncoding regulators of gene expression. They might have an impact on microRNA expression by their sponging activity. The detectability in blood of these RNA transcripts has been demonstrated in patients with cancer and cardiovascular disease. We tested the hypothesis that circulating circRNAs in blood of critically ill patients with acute kidney injury (AKI) at inception of renal replacement therapy may also be dysregulated and associated with patient survival...
September 2018: KI Reports
Lorenzo Azzalini, Luz María Vilca, Francesca Lombardo, Enrico Poletti, Alessandra Laricchia, Alessandro Beneduce, Davide Maccagni, Ozan M Demir, Massimo Slavich, Francesco Giannini, Mauro Carlino, Alberto Margonato, Alberto Cappelletti, Antonio Colombo
BACKGROUND: There is controversy as to whether iso-osmolar contrast media (IOCM) are associated with lower risk of contrast-induced acute kidney injury (CI-AKI), compared with low-osmolar contrast media (LOCM). We aimed to evaluate if a differential risk of CI-AKI exists after percutaneous coronary intervention (PCI) according to different contrast media (CM) types. METHODS: We performed a single-center retrospective study in a cohort of all-comers undergoing PCI between January 2012 and December 2016...
September 1, 2018: International Journal of Cardiology
Laura Gellis, Kimberlee Gauvreau, Michael Ferguson, Lisa Bergersen, Keri Shafer, Diego Porras
BACKGROUND: Adults with congenital heart disease (ACHD) are vulnerable to contrast-induced acute kidney injury (CI-AKI) after cardiac catheterization. The aim of this study was to identify risk factors for clinically significant CI-AKI and evaluate the predictive value of contrast volume to estimated glomerular filtration rate ratio (V/eGFR) for the risk of CI-AKI following catheterization in the ACHD population. METHODS: ACHD patients who underwent catheterization at Boston Children's hospital between 1/2011 and 1/2017 were retrospectively analyzed...
September 9, 2018: Catheterization and Cardiovascular Interventions
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