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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
Zaccaria Ricci, Stefano Romagnoli, Luca Di Chiara
The association between pediatric cardiac surgery, acute kidney injury (AKI), and clinical outcomes has been studied several times in the recent literature. In this issue of Critical Care an interesting and original study analyzed the path from causal AKI entities to clinical AKI consequences through the application of structural equation modeling. The authors described the complex connections linking duration of cardiopulmonary bypass, cross clamp-time, and descriptors of low cardiac output syndrome to AKI modeled as a complex variable composed of post-operative serum creatinine increase of 50 % over baseline, urine output <0...
2016: Critical Care: the Official Journal of the Critical Care Forum
Nicholas M Selby, Richard J Fluck, Nitin V Kolhe, Maarten W Taal
Nicholas Selby and colleagues describe how the definition of acute kidney injury brings opportunities and challenges in identifying patients at higher risk of adverse outcomes.
September 2016: PLoS Medicine
David E Leaf, Sushrut S Waikar
Acute kidney injury (AKI) is an increasingly common and feared complication in hospitalized patients. The selection of appropriate primary and secondary end points is critical to the design and eventual success of clinical trials aimed at preventing and treating AKI. In this article, we provide an overview of AKI definitions and suggestions on the rational selection of end points for clinical trials in various settings, including the prevention of contrast-induced AKI, prevention of cardiac surgery-associated AKI, treatment of established AKI, and treatment of dialysis-requiring AKI...
September 3, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Simon Sawhney, Angharad Marks, Nick Fluck, Adeera Levin, Gordon Prescott, Corri Black
BACKGROUND: The long-term prognosis after acute kidney injury (AKI) is variable. It is unclear how the prognosis of AKI and its relationship to prognostic factors (baseline kidney function, AKI severity, prior AKI episodes, and recovery of kidney function) change as follow-up progresses. STUDY DESIGN: Observational cohort study. SETTING & PARTICIPANTS: The Grampian Laboratory Outcomes Morbidity and Mortality Study II (GLOMMS-II) is a large regional population cohort with complete serial biochemistry and outcome data capture through data linkage...
August 20, 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ha-Jung Kim, Won-Uk Koh, Sae-Gyeol Kim, Hyeok-Seong Park, Jun-Gol Song, Young-Jin Ro, Hong-Seuk Yang
Hypoalbuminemia has been reported to be an independent risk factor for acute kidney injury (AKI). However, little is known about the relationship between the albumin level and the incidence of AKI in patients undergoing total knee arthroplasty (TKA). The aim of our study was to assess incidence and risk factors for AKI and to evaluate the relationship between albumin level and AKI following TKA.The study included a retrospective review of medical records of 1309 consecutive patients who underwent TKA between January 2008 and December 2014...
August 2016: Medicine (Baltimore)
David G Warnock, T Clark Powell, Edward D Siew, John P Donnelly, Henry E Wang, Ravindra L Mehta
BACKGROUND: Patterns of acute kidney injury (AKI) can be distinguished by the rate of changes in the serum creation concentrations during hospitalizations. We hypothesized that the timing and values of minimum and maximum serum creatinine (sCr) could be used to distinguish between transient hospital-associated AKI (THA-AKI) and hospital-acquired AKI (HA-AKI). MATERIALS AND METHODS: We evaluated adults admitted to 2 regionally distinct academic medical centers. Peak sCr during the hospitalization was used to define AKI, using absolute changes and timing from the minimum sCr...
July 26, 2016: Nephron
Yuan-Hui Liu, Sheng-Qi Wang, Jin-Hua Xue, Yong Liu, Ji-Yan Chen, Guo-Feng Li, Peng-Cheng He, Ning Tan
BACKGROUND: Acute kidney injury (AKI) is a major global health issue, associated with poor short-term and long-term outcomes. Research on AKI is increasing with numerous articles published. However, the quantity and quality of research production in the field of AKI is unclear. METHODS AND ANALYSIS: To analyse the characteristics of the most cited articles on AKI and to provide information about achievements and developments in AKI, we searched the Science Citation Index Expanded for citations of AKI articles...
2016: BMJ Open
Riccardo Maria Fagugli, Francesco Patera, Sara Battistoni, Giovanni Tripepi
Acute kidney injury requiring dialysis (AKI-D) treatment has significantly increased in incidence over the years, with more than 400 new cases per million population/y, 2/3 of which concern noncritically ill patients. In these patients, there are little data on mortality or on information of care organization and its impact on outcome. Specialty training and integrated teams, as well as a high volume of activity, seem to be linked to better hospital outcome. The study investigates mortality of patients admitted to and in-care of nephrology (NEPHROpts), a closed-staff organization, and to other medical wards (MEDpts), representing a model of open-staff organization...
July 2016: Medicine (Baltimore)
David G Warnock
Acute Kidney Injury (AKI) is associated with short- and long-term outcomes that reflect the severity of the injury. Recent studies have suggested that 'early' initiation of renal replacement therapy may alter the course of AKI and improve short-term outcomes like inpatient mortality. The current Kidney Disease Improving Global Outcomes (KDIGO) consensus definition of AKI has been criticized for misclassification bias, lack of sensitivity and the static manner in which AKI stages are defined. This editorial reviews various approaches to improving the specificity and sensitivity of the KDIGO AKI criteria, and also concludes that a staging system based on creatinine trajectories would be better suited for developing a prognostic index for real-time, dynamic risk assessment that the current KDIGO staging criteria...
July 26, 2016: Nephrology, Dialysis, Transplantation
Nicolas Viallet, Vincent Brunot, Nils Kuster, Delphine Daubin, Noémie Besnard, Laura Platon, Aurèle Buzançais, Romaric Larcher, Olivier Jonquet, Kada Klouche
BACKGROUND: In acute kidney injury (AKI), useless continuation of renal replacement therapy (RRT) may delay renal recovery and impair patient's outcome. In this study, we aimed to identify predictive parameters that may help to a successful RRT weaning for AKI patients. METHODS: We studied 54 surviving AKI patients in which a weaning of RRT was attempted. On the day of weaning (D0) and the following 2 days (D1 and D2), SAPS II and SOFA scores, 24-h diuresis, 24-h urinary creatinine and urea (UCr and UUr), creatinine and urea generation rates (CrGR and UrGR) and clearances (CrCl and UrCl) were collected...
December 2016: Annals of Intensive Care
Yanhong Yuan, Chunlin Wang, Xinghua Shao, Qin Wang, Xiajing Che, Minfang Zhang, Yuanyuan Xie, Lei Tian, Zhaohui Ni, Shan Mou
BACKGROUND: Acute-on-chronic renal injury was commonly seen in clinical practice. Reversibility of acute-on-chronic renal injury had not yet been carefully explored. This study tested whether urinary biomarkers could be used as a noninvasive prognostic marker in patients with acute-on-chronic renal injury. METHODS: 108 adult patients with pre-existing chronic kidney disease presenting with acute-on-chronic renal injury were included. Urinary retinol-binding protein (uRBP), N-Acetyl-b-D-Glucosaminidase (uNAG) and albumin (uALB) was quantified...
July 7, 2016: Journal of Nephrology
Claudio Ronco
The RIFLE classification was introduced in 2004 to describe the presence of acute kidney injury (AKI) and to define its clinical stage, based upon the serum creatinine level and urine output. The same criteria, although slightly modified, are used in the other scoring systems AKIN and KDIGO. Mortality and morbidity remain high in AKI, suggesting that current diagnostic methods are suboptimal, poorly accurate, and often timely inadequate in detecting the presence of early kidney injury. Conversely, a growing body of evidence indicates that new AKI biomarkers can be used to both rule out AKI and to assess high-risk conditions or the presence of subclinical forms...
2016: Critical Care: the Official Journal of the Critical Care Forum
Sarah Faubel, Pratik B Shah
Acute kidney injury (AKI) that requires renal replacement therapy is associated with a mortality rate that exceeds 50% in the intensive care unit, which is greater than other serious illnesses such as acute lung injury and myocardial infarction. Much information is now available regarding the complications of AKI that contribute to mortality and may be usefully categorized as "traditional" and "nontraditional". Traditional complications are the long-recognized complications of AKI such as hyperkalemia, acidosis, and volume overload, which may be typically corrected with renal replacement therapy...
May 2016: Advances in Chronic Kidney Disease
S Wang, C Zhang, L Hu, C Yang
Acute kidney injury (AKI) is a common and severe clinical condition with a heavy healthy burden around the world. In spite of supportive therapies, the mortality associated with AKI remains high. Our limited understanding of the complex cell death mechanism in the process of AKI impedes the development of desirable therapeutics. Necroptosis is a recently identified novel form of cell death contributing to numerable diseases and tissue damages. Increasing evidence has suggested that necroptosis has an important role in the pathogenesis of various types of AKI...
2016: Cell Death & Disease
Michael Almond
The Bywaters seminal 1941 British Medical Journal paper on the crush syndrome was important both for its written content and for using a photomicrograph demonstrating pigmented casts in the renal tubules. He appeared to be reporting the first cases of renal failure secondary to crushing injuries. Most at this point would have been content yet Bywaters demonstrated both determination and humility by publishing a letter in the BMJ 4 months later. This letter, now almost forgotten and rarely referenced, significantly corrected his original paper...
February 2016: Giornale Italiano di Nefrologia: Organo Ufficiale Della Società Italiana di Nefrologia
Kent Doi, Hamid Rabb
Acute kidney injury (AKI) is a common complication in critically ill patients and subsequently worsens outcomes. Although many drugs to prevent and treat AKI have shown benefits in preclinical models, no specific agent has been shown to benefit AKI in humans. Moreover, despite remarkable advances in dialysis techniques that enable management of AKI in hemodynamically unstable patients with shock, dialysis-requiring severe AKI is still associated with an unacceptably high mortality rate. Thus, focusing only on kidney damage and loss of renal function has not been sufficient to improve outcomes of patients with AKI...
March 2016: Kidney International
Martin Hermann Bernardi, Daniel Schmidlin, Robin Ristl, Clemens Heitzinger, Arno Schiferer, Thomas Neugebauer, Thomas Wrba, Michael Hiesmayr, Wilfred Druml, Andrea Lassnigg
BACKGROUND AND OBJECTIVES: A knowledge of baseline serum creatinine (bSCr) is mandatory for diagnosing and staging AKI. With often missing values, bSCr is estimated by back-calculation using several equations designed for the estimation of GFR, assuming a "true" GFR of 75 ml/min per 1.73 m(2). Using a data set from a large cardiac surgery cohort, we tested the appropriateness of such an approach and compared estimated and measured bSCr. Moreover, we designed a novel data-driven model (estimated serum creatinine [eSCr]) for estimating bSCr...
March 7, 2016: Clinical Journal of the American Society of Nephrology: CJASN
Manish Kaushik, Jason Chon Jun Choo
Acute kidney injury (AKI) is a well-recognized complication in hospitalized patients, with associated mortality and morbidity. Studies that aim to prevent or reverse AKI using pharmacological and interventional therapies in clinical practice have been disappointing. Work is continuing to identify potentially modifiable risk factors for AKI. Early identification and modification of these risk factors may help prevent or favorably influence the outcome of AKI. The role of uric acid as a potential risk factor is being revisited in chronic kidney disease and AKI...
February 2016: Clinical Kidney Journal
N V Kolhe, A W Muirhead, S R Wilkes, R J Fluck, M W Taal
AIMS: Epidemiology studies of acute kidney injury (AKI) have focused on cases requiring dialysis but those not requiring dialysis represent the majority. To address this gap, we interrogated hospital episode statistics (HES) to investigate population trends in temporal epidemiology of AKI not requiring dialysis between 1998 and 2013. METHODOLOGY: In this retrospective observational study of HES data covering the entire English National Health Service, we identified 1,136,167 AKI events, not requiring dialysis, diagnosed between 1998 and 2013...
April 2016: International Journal of Clinical Practice
David E Leaf, Anand Srivastava, Xiaoxi Zeng, Gearoid M McMahon, Heather E Croy, Mallika L Mendu, Allen Kachalia, Sushrut S Waikar
BACKGROUND: The patterns, performance characteristics, and yield of diagnostic tests ordered for the evaluation of acute kidney injury (AKI) have not been rigorously evaluated. METHODS: We characterized the frequency of AKI diagnostic testing for urine, blood, radiology, and pathology tests in all adult inpatients who were admitted with or developed AKI (N = 4903 patients with 5731 AKI episodes) during a single calendar year. We assessed the frequency of abnormal test results overall and by AKI stage...
January 15, 2016: BMC Nephrology
2016-01-18 12:37:37
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