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Risk Assessment of Acute Kidney Injury

Veronica Fassio, Sherrie L Aspinall, Xinhua Zhao, Donald R Miller, Jasvinder A Singh, Chester B Good, Francesca E Cunningham
OBJECTIVES: To describe the prevalence and incidence of opioid and nonsteroidal anti-inflammatory drug (NSAID) use before and since the start of the Veterans Health Administration (VHA) Opioid Safety Initiative (OSI) and to assess rates of adverse events (AEs). STUDY DESIGN: Historical cohort study. METHODS: The OSI began in August 2012 and was fully implemented by the end of fiscal year (FY) 2013. The study timeframe was categorized into baseline (FY 2011-2012), transition (FY 2013), and postimplementation (FY 2014-2015) phases...
March 1, 2018: American Journal of Managed Care
Song-Jian He, Qiang Liu, Hua-Qiu Li, Fang Tian, Shi-Yu Chen, Jian-Xin Weng
Background: The prevention of cardiac surgery-associated acute kidney injury (CSA-AKI) by statins remains controversial. Therefore, the present meta-analysis including randomized controlled trials (RCTs) was performed to assess the effect of perioperative statin on CSA-AKI. Methods: Two reviewers independently searched for RCTs about perioperative statin for prevention of CSA-AKI. The primary endpoint was CSA-AKI. Relative risk was calculated between statin and placebo for preventing CSA-AKI using the random-effect model or fixed-effect model according to different heterogeneity...
2018: Therapeutics and Clinical Risk Management
Michael Z L Zhu, Andrew Martin, Andrew D Cochrane, Julian A Smith, Amanda G Thrift, Gerard K Harrop, Jennifer P Ngo, Roger G Evans
Background: Acute kidney injury (AKI) is common after cardiac surgery and profoundly affects postoperative mortality and morbidity. There are no validated methods to assess risk of AKI intraoperatively. Methods: We determined the association between postoperative AKI and intraoperative urinary oxygen tension (PO2), measured via a fiber optic probe in the tip of the urinary catheter, in 65 patients undergoing high-risk cardiac surgery requiring cardiopulmonary bypass (CPB)...
March 14, 2018: Nephrology, Dialysis, Transplantation
Simin Dashti-Khavidaki, Hossein Khalili, Mohsen Nasiri-Toosi
There was no report of nephrotoxicity during clinical trials assessed sofosbuvir for treatment of hepatitis C (HCV) infection. This may be due to excluding patients with severe kidney dysfunction, as a main population at risk for drug-induced nephrotoxicity from these studies. There are some reports of acute kidney injury (AKI) possibly related to sofosbuvir-containing treatments from real-life experiences. Areas covered: Available data on epidemiology, type, and possible risk factors for nephrotoxicity of sofosbuvir-containing treatment are reviewed...
March 14, 2018: Expert Review of Clinical Pharmacology
Subir Bhatia, Shilpkumar Arora, Sravya M Bhatia, Mohammed Al-Hijji, Yogesh N V Reddy, Parshva Patel, Charanjit S Rihal, Bernard J Gersh, Abhishek Deshmukh
BACKGROUND: Chronic kidney disease (CKD) remains an independent predictor of cardiovascular morbidity and mortality. CKD complicates referral for percutaneous coronary intervention (PCI) in non-ST-segment-elevation myocardial infarction (NSTEMI) patients because of the risk for acute kidney injury and the need for dialysis, with American College of Cardiology/American Heart Association guidelines underscoring the limited data on these patients. METHODS AND RESULTS: Using the National Inpatient Sample to analyze hospitalizations in the United States from 2004 to 2014, we sought to assess PCI utilization and in-hospital outcomes in NSTEMI admissions with CKD...
March 10, 2018: Journal of the American Heart Association
Vincent Johan Nijenhuis, Joyce Peper, Veronique M M Vorselaars, Martin J Swaans, Thom De Kroon, Jan A S Van der Heyden, Benno J W M Rensing, Robin Heijmen, Willem-Jan W Bos, Jurrien M Ten Berg
Transcatheter aortic valve implantation (TAVI) is associated with acute kidney injury (AKI), but can also improve the kidney function (IKF). We assessed the effects of kidney function changes in relation to baseline kidney function on 2-year clinical outcomes after TAVI. In total, 639 consecutive patients with aortic stenosis who underwent TAVI were stratified into 3 groups according to the ratio of serum creatinine post- to pre-TAVI: IKF (≤0.80; n = 95 [15%]), stable kidney function (0.80 to 1.5; n = 477 [75%]), and AKI (≥1...
February 12, 2018: American Journal of Cardiology
Brendan Bowman, Sijie Zheng, Alex Yang, Brigitte Schiller, José A Morfín, Melvin Seek, Robert S Lockridge
Dialysis care in the United States continues to move toward an emphasis on continuous quality improvement and performance benchmarking. Government- and industry-sponsored programs have evolved to assess and incentivize outcomes for many components of end-stage renal disease care. One aspect that remains largely unaddressed at a systemic level is the high-risk transition period from chronic kidney disease and acute kidney injury to permanent dialysis dependence. Incident dialysis patients experience disproportionately high mortality and hospitalization rates coupled with high costs...
March 3, 2018: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Neamatollah Ataei, Sonbol Ameli, Mahmoud Yousefifard, Alireza Oraei, Fatemeh Ataei, Behnaz Bazargani, Arash Abbasi, Mostafa Hosseini
Introduction: There is a controversy regarding accuracy of neutrophil gelatinase-associated lipocalin (NGAL) and Cystatin C in early detection of acute kidney injury (AKI). The present study aimed to compare the diagnostic value of two biomarkers in this regard. Method: In the present diagnostic accuracy study, all children between the ages of 1 month to 14 years were entered. Pediatric Risk, Injury Failure, Loss, End-stage renal disease (pRIFLE) criteria was used for identification of children with AKI as the reference test...
2018: Emergency (Tehran, Iran)
Hugh Davies, Gavin D Leslie, David Morgan, Geoff J Dobb
BACKGROUND: The risk of fluid overload and mortality is increased in patients with severe acute kidney injury. Charting of daily fluid balance is a key component of fluid assessment but not without problems affecting accuracy. The introduction of electronic bed scales has made routine patient-weighing easier and focused attention on monitoring fluid-related weight changes. OBJECTIVES: This paper investigated the frequency of compliance in weighing patients daily using electronic bed scales and evaluated the relationship between calculated fluid balance and body weight changes in patients receiving continuous renal replacement therapy (CRRT)...
March 1, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Azra Bihorac, Tezcan Ozrazgat-Baslanti, Ashkan Ebadi, Amir Motaei, Mohcine Madkour, Panagote M Pardalos, Gloria Lipori, William R Hogan, Philip A Efron, Frederick Moore, Lyle L Moldawer, Daisy Zhe Wang, Charles E Hobson, Parisa Rashidi, Xiaolin Li, Petar Momcilovic
MINI: In a single-center cohort of 51,457 adult surgical patients, we have developed and validated an automated machine-learning algorithm that uses existing clinical data in electronic health records to forecast the risk for major complications and death after any type of surgery with high sensitivity and high specificity. OBJECTIVE: To accurately calculate the risk for postoperative complications and death after surgery in the preoperative period using machine-learning modeling of clinical data...
February 27, 2018: Annals of Surgery
Athanasios Saratzis, Virginia Chiocchia, Ahmad Jiffry, Neelam Hassanali, Surjeet Singh, Christopher H Imray, Matthew J Bown, Asif Mahmood
OBJECTIVE/BACKGROUND: Up to 25% of patients undergoing elective endovascular aneurysm repair (EVAR) develop acute kidney injury (AKI), which is associated with short and long-term morbidity and mortality. There is no high quality randomised evidence regarding prevention of EVAR related AKI. METHODS: A novel AKI prevention strategy for EVAR was devised, based on best evidence and an expert consensus group. This included a bolus of high dose sodium bicarbonate (NaHCO3 ) immediately before EVAR (1 mL/kg of 8...
February 23, 2018: European Journal of Vascular and Endovascular Surgery
Yu Zhang, Li Jiang, Baomin Wang, Xiuming Xi
BACKGROUND: Although there were studies to investigate the risk factors for acute kidney injury (AKI) after surgery, most of them focused on one specific type of surgeries. The risk factors for postoperative AKI in patients undergoing all surgeries in intensive care units (ICU) have not been reported. METHODS: Data from 1731 patients undergoing surgery in 30 ICUs of 28 tertiary hospitals in Beijing from March to August 2012 were prospectively collected. AKI was defined and staged by the KDIGO criteria...
February 26, 2018: International Urology and Nephrology
Swapnil Hiremath, Jeanne Françoise Kayibanda, Benjamin J W Chow, Dean Fergusson, Greg A Knoll, Wael Shabana, Brianna Lahey, Olivia McBride, Alexandra Davis, Ayub Akbari
BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) is defined as worsening of renal function after the administration of iodinated contrast material. In patients with cardiovascular disease, kidney disease, and/or diabetes, renin-angiotensin system blockers, non-steroidal anti-inflammatory drugs, diuretics, and metformin can increase the risk of CI-AKI when undergoing contrast imaging. Despite CI-AKI being the leading iatrogenic cause of acute kidney injury, there is a lack of sufficient scientific evidence supporting which drugs should be stopped, when they should be stopped, and when they should be resumed...
February 21, 2018: Systematic Reviews
Adrianna Douvris, Gurpreet Malhi, Swapnil Hiremath, Lauralyn McIntyre, Samuel A Silver, Sean M Bagshaw, Ron Wald, Claudio Ronco, Lindsey Sikora, Catherine Weber, Edward G Clark
BACKGROUND: Hemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g., cool dialysate) may reduce the occurrence of HIRRT, but less is known about interventions to prevent HIRRT in critically ill patients receiving RRT for acute kidney injury (AKI). We sought to evaluate the effectiveness of RRT-related interventions for reducing HIRRT in such patients across RRT modalities...
February 22, 2018: Critical Care: the Official Journal of the Critical Care Forum
Masao Iwagami, Hidekazu Moriya, Kent Doi, Hideo Yasunaga, Rei Isshiki, Izumi Sato, Yasuhiro Mochida, Kunihiro Ishioka, Takayasu Ohtake, Sumi Hidaka, Eisei Noiri, Shuzo Kobayashi
Background: Understanding disease seasonality is important for improving clinical practice, hospital resource utilization and community-based preventive care. However, no studies have investigated the seasonality of acute kidney injury (AKI). Methods: In the Tokushukai Medical Database, which includes 38 Japanese community hospitals, we identified hospitalized patients with AKI based on the Kidney Disease: Improving Global Outcomes serum creatinine criteria from January 2012 to December 2014...
February 15, 2018: Nephrology, Dialysis, Transplantation
Joshua B Knight, Evan E Lebovitz, Theresa A Gelzinis, Ibtesam A Hilmi
INTRODUCTION: The purpose of this retrospective case-control study was to investigate preoperative risk factors for unexpected postoperative intensive care unit (ICU) admissions in patients undergoing non-emergent surgical procedures in a tertiary medical centre. METHODS: A medical record review of adult patients undergoing elective non-cardiac and non-transplant major surgical procedures during the period of January 2011 through December 2015 in the operating rooms of a large university hospital was carried out...
February 15, 2018: Anaesthesia, Critical Care & Pain Medicine
Axel Linke, David Holzhey, Helge Möllmann, Ganesh Manoharan, Ulrich Schäfer, Christian Frerker, Stephen G Worthley, A J van Boven, Simon Redwood, Jan Kovac, Christian Butter, Lars Søndergaard, Alexander Lauten, Gerhard Schymik, Thomas Walther
BACKGROUND: The aim of the Portico TAVI (transcatheter aortic valve implantation) system study was to evaluate outcomes ≤1 year after implantation of a novel resheathable, self-expanding TAVI system in a multicenter patient population with severe aortic stenosis (AS). METHODS AND RESULTS: High-risk patients (n=222) with symptomatic severe AS (mean age, 83.0±4.6 years; 74.3% women) were enrolled across 12 centers in Europe and Australia. The study's primary end point was all-cause mortality at 30 days...
February 2018: Circulation. Cardiovascular Interventions
Wan-Jie Gu, Bai-Ling Hou, Joey S W Kwong, Xin Tian, Yue Qian, Yin Cui, Jing Hao, Ju-Chen Li, Zheng-Liang Ma, Xiao-Ping Gu
BACKGROUND: The association between intraoperative hypotension (IOH) and postoperative outcomes is not fully understood. We performed a meta-analysis to determine whether IOH is associated with increased risk of 30-day mortality, major adverse cardiac events (MACEs) and acute kidney injury (AKI) after non-cardiac surgery. METHODS: We searched PubMed and Embase through May 2016 to identify cohort studies that investigated the association between IOH and risk of 30-day mortality, MACEs, or AKI in adult patients after non-cardiac surgery...
May 1, 2018: International Journal of Cardiology
Yongqing Cheng, Tuo Pan, Min Ge, Tao Chen, Jiaxin Ye, Lichong Lu, Cheng Chen, Qiuyan Zong, Yi Ding, Dongjin Wang
PURPOSE: Postoperative vasoplegic shock after cardiac surgery seems to be a frequent complication with poor outcomes. We hypothesized that vasopressin may increase the risk of poor outcomes in patients with preoperative Left Ventricular Dysfunction (pLVD) rather than norepinephrine. The aim of this study was to assess whether vasopressin is superior to norepinephrine to improve outcomes in patients with pLVD after cardiac surgery. METHODS: This retrospective cohort study included 1,156 patients with postoperative vasoplegic shock (mean arterial pressure <65 mmHg resistant to fluid challenge and cardiac index >2...
February 7, 2018: Shock
Hyoungnae Kim, Hyunwook Kim, Misol Lee, Min-Uk Cha, Ki Heon Nam, Seong Yeong An, Su-Young Jung, Jong Hyun Jhee, Seohyun Park, Hae-Ryong Yun, Youn Kyung Kee, Hyung Jung Oh, Jung Tak Park, Tae Ik Chang, Tae-Hyun Yoo, Shin-Wook Kang, Seung Hyeok Han
BACKGROUND: Association between high body mass index (BMI) and survival benefit is confounded by comorbid conditions such as nutritional status and inflammation. Patients with acute kidney injury (AKI), particularly those receiving continuous renal replacement therapy (CRRT), are highly catabolic and more susceptible to loss of energy. Herein, we evaluated whether disease severity can modify the relationship between BMI and mortality. METHODS: We conducted an observational study in 1144 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014...
February 7, 2018: BMC Nephrology
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