Comparison of the accuracy of RIFLE, AKIN and KDIGO criteria in predicting early death after liver transplantation / 器官移植

Objective To compare the accuracy of three acute kidney injury (AKI) criteria of RIFLE, Acute Kidney Injury Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) in predicting the early (30 d) postoperative death of liver transplant recipients. Methods Clinical data of 173 liver transplant recipients were retrospectively analyzed. The incidence of postoperative AKI was calculated according to the three criteria of RIFLE, AKIN and KDIGO. The all-cause fatality rate and cause of death at postoperative 30 d were analyzed. The risk factors of death within 30 d after operation were analyzed by binary Logistic regression. The prediction accuracy of three criteria for death within 30 d after operation was compared by the receiver operating characteristic (ROC) curve. Results According to the RIFLE, AKIN and KDIGO criteria, the incidences of postoperative AKI were 48.0%, 51.4% and 53.8%, respectively. Thirteen patients died within 30 d after operation and the fatality rate was 7.5%. RIFLE, AKIN and KDIGO stages were the independent risk factors for death within 30 d after operation (all P < 0.05). The area under the curve (AUC) of RIFLE, AKIN and KDIGO stages to predict death within 30 d after liver transplantation were 0.828, 0.766 and 0.844, respectively. There was a statistically significant difference between AKIN and KDIGO (P < 0.05). Conclusions KDIGO criterion is better for predicting early death after liver transplantation. However, as a tool, the comparative selection among these three criteria still needs the evidence support from a large multicenter sample.

The Impact Of Antihypertensive Drug Therapy In Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

Objective: Hypertension (HTN) is both a cause and an effect of chronic kidney disease (CKD). To adequately control blood pressure (BP) in CKD, choosing antihypertensive strategies with the highest nephro-protective effect is crucial for preventing or reversing end-stage renal disease (ESRD) progression and reducing cardiovascular disease (CVD) risk. The present study was therefore designed to evaluate the impact of clinical use of antihypertensive drug therapy in patients with CKD and ESRD. Methods: It is a prospective observational cohort study. The patients were divided into two cohorts i.e.; non-dialysis dependent (NDD) and dialysis-dependent (DD) CKD. This study was conducted for six months in the Nephrology department, Osmania General Hospital, Hyderabad, India. The data collected and entered into Microsoft Excel (2007) and mean, SD and range were calculated using SPSS version 25. Results: Antihypertensive drugs were prescribed alone or in combination based on the co-morbidities associated with CKD and HTN. Loop diuretics (Furosemide and Torsemide) and calcium channel blocker (Amlodipine, Nifedipine and Cilnidipine) were most commonly prescribed antihypertensive drugs. Triple therapy (44.11%) was prescribed mostly in both the cohorts (NDD = 16.66%+DD = 27.45%) of which calcium channel blockers+loop diuretic+sympatholytic accounts for 19.16% (NDD = 5.88%+DD = 13.73%).  Conclusion: The practice of prescribing antihypertensive drugs for the management of HTN and to achieve BP targets in CKD and ESRD remains uncertain. The development of new and revised guidelines is needed to reduce inappropriate variations in practice and promote better delivery of evidence-based treatment.

Analysis of prescription pattern of antihypertensives in various stages of chronic kidney disease

Background: Chronic kidney disease (CKD) is an emerging health problem and is one of the major causes of mortality. Hypertension is closely linked with CKD and both these conditions cause severe cardiovascular events. Hence blood pressure control is pertinent in all stages of CKD. This plays a major role in preventing its progression to end stage kidney disease and death. The objectives of the study were to analyse the class, dosing schedule of antihypertensive prescribed in Chronic Kidney Disease and the incidence of monotherapy and combination therapy.Methods: This study designed as a cross sectional study was conducted in Nephrology department of a tertiary care center and antihypertensive prescription pattern of 364 CKD patients was analyzed. Demographic details, the co-morbid factors and the details of drugs received by each patient were recorded from their outpatient/ inpatient charts. Data collected were entered in MS excel sheet and descriptive analysis done using SPSS software.Results: Calcium Channel Blocker (CCB) was the most commonly prescribed antihypertensive (70.6%) in all stages and the most common CCB was Cilnidipine (54%) with the dosing schedule of 20mg twice daily (56.4%). Incidence of combination therapy was 71.7% and CCB+AA (Alpha agonist) was the commonest combination prescribed in all stages except stage 1.Conclusions: CCBSs were widely prescribed as antihypertensive in CKD irrespective of the stages. Cilnidpine was the routinely prescribed CCB and seemed to be well tolerated by the patients. The protocol followed in this tertiary care center was in accordance with the standard guidelines by Kidney Disease Improving Global outcomes 2012.

Clinical profile of acute kidney injury in patients admitted to medical wards in a tertiary care setting

Background: Acute kidney injury (AKI) is a global problem. Its incidence varies in different geographical region as well as the targeted population under the study. Most common causes are sepsis, volume depletion, nephrotoxic medication, and illnesses related to the heart and liver. In developing countries, it can be due to snake bite, malaria, and secondary to poisonings. Objectives: The study is conducted to analyze the types, etiological factors, and comorbidities associated with AKI in patients admitted into the medical wards in a tertiary care hospital. Materials and Methods: A total of 60 patients were selected based on the Kidney Disease Improving Global Outcomes criteria of AKI. An increase in serum creatinine >0.3 mg/dl or >1.5 times the baseline and a fall of urine output <0.5 ml/kg/h for 6–12 h were the criteria for selection. A history of volume depletion, nephrotoxic drugs, febrile illness, trauma, surgeries, diabetes mellitus, hypertension, and any history of cardiovascular, renal, and liver disorders was taken. Patients were classified into pre-renal, renal, and post-renal as per etiologies found during the study. Data collected were analyzed statistically. Results: Of 60 patients, 39 were males and 21 were females. The mean age of the study group was 60 ± 5. Diabetes and hypertension were the most common comorbidities. Infections were found to be most common cause which included diarrheal illness (12 patients) followed by urinary tract infection (10 patients) and community-acquired pneumonia (8 patients). Nonsteroidal anti-inflammatory drug abuse was seen in 12 patients, and an equal number of patients had chronic kidney disease and 6 patients had coronary artery disease. Conclusion: Pre-renal AKI is one of the common complications in the hospitalized patients. The key to management lies in high index of suspicion and early intervention while the injury is still reversible.

Early prediction of acute kidney injury using serum phosphorus as a biomarker in pediatric cardiac surgical patients

Background: Acute kidney injury (AKI) is a strong predictor of morbidity and mortality after cardiac surgery. Lack of valid early biomarkers for predicting AKI has hampered the ability to take therapeutic measures for preventive cause. Hyperphosphatemia that occurs in AKI due to renal excretion defect was not studied in this context and could be simple marker of AKI. Therefore, we tested role of serum phosphorus in prediction of AKI as a biomarker after cardiac surgery in children. Methodology: We prospectively evaluated 51 children aged between 3 weeks and 12 years undergoing elective cardiac surgery. Serum creatinine and phosphorus were measured preoperatively and postoperatively at 24 and 48 h. As per the Kidney Disease Improving Global Outcomes criteria, patients were grouped into AKI and non-AKI on the basis of the development of AKI within 48 h postsurgery. The postoperative diagnostic performance of phosphorus thresholds was analyzed by the area under receiver operating characteristic curves (AUC-ROC). Results: From 51 children included, 10 developed AKI. In AKI group, serum phosphorus increased significantly from 4.47 ± 0.43 baseline to 6.29 ± 0.32 at 24 h postsurgery (P = 0.01) while serum creatinine increased from baseline 0.33 (0.24–0.46) to 0.49 (0.26–0.91) at 24 h which is statistically insignificant (P = 0.16). ROC analysis showed that serum phosphorus at 24 h, the AUC was 0.84 with sensitivity 0.75 and specificity 0.93 for a cutoff value of 6.4 mg/dl. Whereas serum phosphorus at 48 h, the AUC was 0.86 with sensitivity 66.67% and specificity 97.62% for a cutoff value of 5.4 mg/dl. Conclusion: Serum phosphorus can be an alternative biomarker as early as 24 h for early prediction of AKI in pediatric cardiac surgery.

Combined criteria of both serum cystatin c and creatinine for acute kidney injury based on KDIGO and its clinical implications / 实用医学杂志

Objective We aimed to investigate the clinical values of combination of blood creatinine and cystatin C for acute kidney injury(AKI)diagnosi. Methods Total 7 627 patients were studied retrospectively. The AKI was classified by creatinine or cystatin C according to the Kidney Disease:Improving Global Outcomes criteria. Results The maximum levels of cystatin C and creatinine were correlated(Spearman′s rank coefficient 0.699,P < 0.001). The area under a receiver operating characteristic curve of maximum cystatin C value for pre-dicting in-hospital death was 0.761(95% confidence interval 0.693 ~ 0.828). Total 1 004 and 173 patients were classified into AKI by blood creatinine or by cystatin C(13.2% vs.2.3%,P<0.001),respectively.The total inci-dence of AKI was 14.7% diagnosed by the combination of the two markers.In multivariable logistic model,the cre-atinine negative plus cystatin C positive group was associated with a higher in-hospital death compared with the cre-atinine and cystatin C double negative group(OR 15.524,95% confidence interval 5.110 ~ 47.166,P < 0.001). Conclusion Combination of cystatin C increased sensitivity of creatinine for AKI diagnosis and facilitated to iden-tify in-hospital patients with high risk.

Prevalence of chronic kidney disease defined by using CKD-EPI equation and albumin-to-creatinine ratio in the Korean adult population

BACKGROUND/AIMS: An updated chronic kidney disease (CKD) definition and classification were proposed by Kidney Disease: Improving Global Outcomes (KDIGO), with adoption of a new equation to estimate glomerular filtration rate (GFR) and albuminuria to evaluate kidney structural damage. This study was performed to estimate the prevalence of CKD in the Korean adult population as defined and classified by the KDIGO guidelines. METHODS: Cross-sectional samples of the fifth Korean National Health and Nutrition Examination Survey for 2011 to 2012 were examined for adults aged ≥ 19 years. CKD prevalence was determined based on decreased GFR and albuminuria. The GFR was estimated using the CKD Epidemiology Collaboration creatinine equation, and albuminuria was evaluated using the albumin-to-creatinine ratio (ACR) in spot urine. RESULTS: Of the 16,576 subjects participating in the survey, 10,636 (4,758 men, 5,878 women) were included in the present study. The prevalence of CKD was estimated as 7.9% (7.8% in 2011 and 8.0% in 2012, p = 0.770). The prevalence of low, moderately increased, high, and very high CKD risk prognosis was 92.0%, 6.3%, 1.1%, and 0.6%, respectively. The prevalence of albuminuria (ACR ≥ 30 mg/g) in individuals with GFR ≥ 60 mL/min/1.73 m² has reached 5.7%. The odds ratios of hypertension and diabetes to CKD were 3.4 and 3.1 in men, and 2.9 and 2.0 in women (all p < 0.001), respectively. CONCLUSIONS: A large percentage of CKD patients had albuminuria prior to a decrease in GFR. Regular laboratory tests for albuminuria for the high-risk group, and especially for hypertensive or diabetic patients, might improve detection of CKD at an early stage.

Definition and Evaluation of Acute Kidney Injury: Clinical Practice Guidelines / 대한내과학회지

Acute kidney injury (AKI) is a common clinical syndrome that carries a poor prognosis even in cases with seemingly mild or reversible renal dysfunction. Although this potentially devastating disease is associated with increased mortality, early detection and timely intervention may improve clinical outcomes. In this regard, a standardized definition and classification of AKI, reflecting prognosis on the basis of evidence, may allow early recognition and stage-based management of the disease. Nevertheless, there has been considerable variability and inconsistency in the definition and classification of AKI, resulting in failure to bridge the gap between research and clinical practice. The definition of AKI has evolved, with the introduction of the "Risk, Injury, Failure, Loss, and End-stage renal disease" (RIFLE), and "AKI Network" (AKIN) criteria. The recent "Kidney Disease Improving Global Outcomes" (KDIGO) guidelines proposed a uniform definition of AKI, essentially merging the RIFLE and AKIN criteria. This review will focus on the definition and classification of AKI, as proposed by KDIGO in 2012, and their use in clinical practice for clinicians.