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Abstract Objective To assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria - pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes -, and determining factors associated with acute kidney injury as well as its outcome. Methodology This was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted. Results The study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005-1.009), sepsis (PR 1.641, 95% CI: 1.128-2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095-2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681-3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%. Conclusion Older children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Severity of Illness Index , Intensive Care Units, Pediatric , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Intensive Care UnitsABSTRACT
Resumo Fundamento: A síndrome cardiorrenal tipo 1 associa-se a maior mortalidade em pacientes com insuficiência cardíaca (IC). No entanto, há escassez de publicações comparando critérios diagnósticos de lesão renal aguda (LRA). Objetivos: Analisar o perfil clinicofuncional de pacientes com IC e fatores associados a ocorrência de lesão renal aguda (LRA). Métodos: Estudo de coorte retrospectivo, em hospital terciário de região com baixo desenvolvimento econômico que incluiu pacientes com IC descompensada ou infarto agudo do miocárdio (IAM) recente, sendo avaliadas características clínicas, laboratoriais e ecocardiográficas comparativamente em pacientes com e sem LRA classificada pelos critérios Acute Kidney Network (AKIN) e Kidney Disease: Improving Global Outcomes (KDIGO). Nível de significância estatística com valor de p < 0,05. Resultados: Entre 81 pacientes, 61,73% evoluíram com LRA. A média de creatinina foi 1,79±1,0 mg/dL e de ureia 81,5±46,0 mg/dL, sendo maior no grupo com LRA (p < 0,05). Não foi evidenciada relação entre alterações cardíacas e redução da função renal. A doença renal crônica se associou a maior ocorrência de LRA (38% x 3,23% sem LRA, p = 0,001). Não houve diferença do KDIGO com relação ao critério AKIN. Os pacientes que desenvolveram LRA apresentaram maior mortalidade (32% x 9,8% no grupo sem LRA, p = 0,04, com odds ratio (OR) de 8,187 e intervalo de confiança 1,402-17,190, p = 0,020). Conclusão: Nessa casuística de pacientes com IC, a ocorrência de LRA foi elevada e foi fator de risco independente de mortalidade. As alterações cardíacas não se associaram à ocorrência de LRA, e os critérios diagnósticos KDIGO e AKIN apresentaram performance similar.
Abstract Background: Type 1 cardiorenal syndrome is associated with higher mortality in heart failure patients. However, few studies have compared the diagnostic criteria of acute kidney injury (AKI) in this population. Objective: To assess clinical and functional features and factors associated AKI in patients with heart failure. Method: Retrospective, cohort study on patients with decompensated heart failure or recent acute myocardial infarction, conducted in a tertiary hospital in a low-income region of Brazil. Clinical, laboratory and echocardiographic features were compared between patients with and without AKI according to the Acute Kidney Network (AKIN) and Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The level of statistical significance was set at p < 0.05. Results: Of 81 patients, 61.73% had AKI. Mean creatinine and urea levels were 1.79±1.0 mg/dL and 81.5±46.0 mg/dL, respectively, and higher in the group with AKI (p < 0.05). No evidence of a relationship between cardiac changes and reduced renal function. Chronic renal disease was associated with higher prevalence of AKI. Higher mortality was observed in patients with AKI than in patients without AKI (32.0% vs. 9.8%, p = 0.04, OR 8.187 ad 95% confidence interval 1.402-17.190, p = 0.020). Conclusion: In this population of patients with heart failure, AKI was highly prevalent and considered an independent risk factor for mortality. Cardiac changes were not associated with AKI, and the KDIGO and AKIN criteria showed similar performance.
Subject(s)
Humans , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardio-Renal Syndrome/epidemiology , Brazil/epidemiology , Incidence , Retrospective Studies , Risk Factors , Cohort Studies , Renal Dialysis , Hospital Mortality , Kidney/physiologyABSTRACT
Abstract Objective: To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. Materials and methods: Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. Results: A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. Conclusion: Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit.
Resumo Objetivo: Identificar os fatores de risco para o desenvolvimento de lesão renal aguda, mortalidade a curto e em longo prazo de pacientes com lesão renal aguda após internação em Unidade de Terapia Intensiva Pediátrica. Materiais e métodos: Análise retrospectiva de pacientes internados em unidade de terapia intensiva pediátrica de janeiro de 2004 a dezembro de 2008. Lesão renal aguda foi definida pelo critério KDIGO. Fatores de risco para lesão renal aguda, mortalidade hospitalar e em longo prazo foram obtidos através de análise multivariada por regressão logística. Mortalidade em longo prazo (até 2011) foi obtida através de busca no banco de dados da instituição e contato telefônico com parentes dos pacientes. Resultados: Foram avaliados 434 pacientes e a incidência de lesão renal aguda foi de 64%. A maioria dos episódios de lesão renal aguda (78%) ocorreu nas primeiras 24 horas após internação na Unidade de Terapia Intensiva Pediátrica. Os fatores de risco para o desenvolvimento de lesão renal aguda encontrados foram: baixo volume de diurese, menoridade, uso de ventilação mecânica, droga vasoativa, diurético e anfotericina. Menor peso, balanço hídrico positivo, lesão renal aguda, uso de dopamina e ventilação mecânica foram fatores de risco independentes para mortalidade hospitalar. A mortalidade em longo prazo foi de 17,8%. Pressão arterial sistólica, escore PRISM, baixo volume de diurese e ventilação mecânica foram fatores de risco independentes associados à mortalidade em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica. Conclusão: Lesão renal aguda foi um evento frequente, precoce e esteve associada à mortalidade hospitalar e em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica.
Subject(s)
Humans , Child , Intensive Care Units, Pediatric , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Retrospective Studies , Risk Factors , Hospital Mortality , Intensive Care Units , Length of StayABSTRACT
Acute kidney injury (AKI) is a frequent complication of snakebite envenomation, which is still little known in sub-Saharan Africa. This study aims to describe the clinical, biological and ultrasonographic aspects of AKI following severe snakebite envenomation managed in the intensive care unit. Method: A prospective observational survey was performed in Benin over a period of 18 months. All patients suffering severe snakebite envenomation (SBE) were included. The diagnosis of AKI was made using the KDIGO criteria. Kidney ultrasound exam was performed in all patients to assess internal bleeding and morphological and structural abnormalities of the kidneys. Results: Fifty-one cases of severe SBE were included. All patients presented inflammatory syndrome and showed abnormal WBCT whereas bleeding was found in 46 of them (90%). The median time to hospital presentation was three days. The majority of patients were male (M/F sex ratio = 1.55) and the median age was 26. Sixteen patients (31%) showed AKI according to the KDIGO criteria. Severe AKI (KDIGO stage 2 and 3) was observed in three patients, including one stage 2 and two stage 3. Kidney ultrasound revealed three cases of kidney capsular hematoma (6%), two cases of kidney hypertrophy (3%), three cases of kidney injury (4%), two stage 1 KDIGO and one stage 2 KDIGO. Only one patient benefited from hemodialysis. All patients showing AKI recovered without sequels. The median duration of hospital stays was four days. Seven patients died (14%) including four among the 16 AKI patients. Antivenom has been administered to 41 patients (80%). The comparison between patients without and with AKI did not show any significant difference except gender (p = 10-2). Conclusion: AKI is a common complication of severe snakebite envenomation. Resulting from inflammatory and hemorrhagic disorders, AKI may prove to be a short-term life-threatening factor.(AU)
Subject(s)
Animals , Viper Venoms , Clinical Laboratory Techniques , Renal Insufficiency , Antivenins , Biological FactorsABSTRACT
La insuficiencia renal aguda es el síndrome caracterizado por una disminución brusca, sostenida y potencialmente reversible de la velocidad de filtración glomerular y de las funciones tubulares, afectando de forma global la función renal. Comprende una serie de eventos que se inician con la presencia de factores de riesgo que conducen hacia las fases de progresión de la insuficiencia renal aguda (estrés, lesión e insuficiencia renal), que culmina con la necesidad de terapias de reemplazo renal o muerte. Actualmente, el uso de biomarcadores que diferencien entre un daño funcional temprano o daño estructural de inicio tardío del riñón, le permite al médico realizar un diagnóstico y manejo oportuno antes de que se establezcan las fases previas a la insuficiencia renal, mejorando así la sobrevida de estos pacientes. Esta revisión busca integrar evidencia científica disponible que describe las fases previas de la insuficiencia renal aguda, revisando sus posibles causas, clasificaciones y métodos actuales de diagnóstico, junto con las principales recomendaciones vigentes para su manejo.
Acute kidney injury is a syndrome characterized by a sudden, sustained, and potentially reversible decrease in glomerular filtration rate and tubular function, which globally impacts renal function. It comprises of a series of events starting with the presence of risk factors, then evolving towards acute kidney injury progression, characterized by stress, injury, and renal failure, culminating with either the use of renal replacement therapy or death. Currently, the use of biomarkers that differentiate between the initial functional deterioration and late-onset structural damage of the kidney enables the clinician to perform an early diagnosis and indicate treatment before the stages of acute kidney injury progression are established, thus increasing survival rates.
Subject(s)
Humans , Biomarkers/metabolism , Renal Replacement Therapy , Acute Kidney Injury/diagnosis , Survival Rate , Disease Progression , Early Diagnosis , Acute Kidney Injury/physiopathology , Acute Kidney Injury/therapyABSTRACT
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.
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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.
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INTRODUCCIÓN: El trastorno del metabolismo óseo y mineral constituye una grave complicación de la IRC. Respecto al fósforo, las nuevas Guías KDIGO sugieren disminuirla hiperfosfatemia, sin recomendar un valor determinado. Sin embargo, en Argentina se continúa utilizando como indicador de calidad dialítica (IndCalDial) un valor de fósforo igual o inferior a 5 mg.dl. Nuestro objetivo fue evaluar si un valor fijo de fosfatemia es válido como IndCalDial. MATERIAL Y MÉTODOS: Se realizó un estudio multicéntrico, de corte transversal. Se incluyeron pacientes mayores de 18 años, con más de 90 días en hemodiálisis crónica. Se tabularon datos demográficos y de laboratorio. Según el reactivo empleado en la determinación de fósforo, en 4 centros el límite superior de referencia fue 4.5 mg.dl (Grupo F4.5) y en tres 5.6 mg.dl (Grupo F5.6). RESULTADOS: Se incluyeron 334 pacientes. Edad, sexo, porcentaje con FAV, diabéticos, tiempo en diálisis, Kt/V, Hemoglobina y Albúmina, resultaron semejantes a los del Registro Nacional de Diálisis. La mediana de fosfatemia fue 5.2 mg.dl, (rango: 2.3 a 10.6). Los pacientes hiperfosfatémicos fueron más jóvenes y presentaron mejores niveles de Albúmina. De considerarse como IndCalDial: Fósforo menor a 5 mg.dl, 21 pacientes del Grupo F4.5 (n=154) con fosfatemia entre 4.5 y 5.0 mg.dl no recibirían tratamiento, mientras que en el Grupo F5.6 (n=180), 32 pacientes con fosfatemia entre 5.1 y 5.6 mg.dl deberían recibir tratamiento, a pesar de presentar normofosfatemia. CONCLUSIONES: Debería estandarizarse la determinación de fosfatemia, previo a utilizar un valor fijo como IndCalDial
Subject(s)
Humans , Renal Dialysis , Hyperphosphatemia , Phosphorus/analysis , Phosphorus/metabolism , Quality Indicators, Health CareABSTRACT
Introducción: El trastorno del metabolismo óseo y mineral constituye una grave complicación de la insuficiencia renal crónica. Respecto al fósforo, las nuevas Guías KDIGO sugieren disminuir la hiperfosfatemia, sin recomendar un valor determinado. Sin embargo, en Argentina se utiliza como indicador de calidad dialítica (IndCalDial) un valor de fósforo igual o inferior a 5 mg/dL. Nuestro objetivo fue evaluar si dicho objetivo es actualmente válido como IndCalDial. Material y métodos: Estudio multicéntrico, de corte transversal. Se incluyeron pacientes mayores de 18 años, con más de 90 días en hemodiálisis. Se tabularon datos demográficos y de laboratorio, comparándose normofosfatémicos contra hiperfosfatémicos. Según el método, en 3 centros el límite superior de referencia fue 4.5 mg/dL y en cuatro 5.6 mg/dL, éstos últimos se analizaron como grupo separado F 5.6. Resultados: Se incluyeron 333 pacientes. Edad, sexo, porcentaje FAV, diabéticos, tiempo en diálisis, Kt/V, Hemoglobina y Albumina, fueron semejantes a los datos del registro. La mediana de fosfatemia fue 5.2 mg/dL, (rango: 2.3 a 10.6). Los pacientes hiperfosfatémicos presentaron menor edad, menos tiempo en diálisis y cifras mayores de hemoglobina y Albumina. En el grupo F 5.6 (n = 203), según KDIGO sólo el 33.7 % necesitaría tratamiento. De aplicarse el IndCalDial (fósforo menor a 5 mg/dL), el porcentaje sería de 55%, es decir, un 21.3% de pacientes normofosfatémicos deberían ser tratados. Conclusiones: Debería estandarizarse la determinación de fosfatemia, previo a utilizar un valor fijo como IndCalDial.
Introduction: Bone and mineral metabolism disorder is a serious complication of Chronic Kidney Disease. Concerning phosphorus, the new KDIGO Guidelines suggest a reduction of hyperphosphatemia, but they do not recommend a specific value. However, in Argentina, a phosphorus value of 5 mg/dL or less is used as a dialysis quality indicator (DiaQualInd). Our objective was to evaluate whether this goal is currently valid as a DiaQualInd. Methods: A multicentric, cross-sectional study was conducted. Patients older than 18 were included, with more than 90 days undergoing hemodialysis. Demographic and laboratory data were tabulated, comparing normophosphatemic with hyperphosphatemic values. According to this method, in 3 centers the upper reference limit was 4.5 mg/dL and in 4 centers it was 5.6 mg/dL. The latter were analyzed as a separate group (F 5.6). Results: There were 333 patients included in this study. Age, sex, AVF percentage, diabetes, time on dialysis, Kt/V, hemoglobin and albumin were similar to the registry data. The median phosphatemia was 5.2 mg/dL, (range: 2.3 to 10.6). The hyperphosphatemic patients were the youngest, spent less time on dialysis and showed higher hemoglobin and albumin values. In group F 5.6 (n = 203), according to KDIGO only 33.7% would need treatment. If this DiaQualInd were to be applied (phosphorus lower than 5 mg/dL), the percentage would be 55%, that is, 21.3% of normophosphatemic patients should be treated. Conclusions: Phosphatemia determination should be standardized before using a fixed value such as DiaQualInd
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Objective To investigate the impact of early initiation of continuous renal replacement therapy (CRRT) based on Kidney Disease: Improving Global Outcomes (KDIGO) classification on the prognosis of critically ill patients with acute kidney injury (AKI). Methods A retrospective analysis of clinical data of patients diagnosed as AKI in Department of Critical Care Medicine of Zhejiang Provincial People's Hospital from January 2011 to January 2015 was conducted. All patients included should be 18 years old or older, having stayed in intensive care unit (ICU) for more than 48 hours, and received CRRT. All subjects were divided into three groups according to their renal function before CRRT according to the KDIGO-AKI guideline: AKI-stage 1 group, AKI-stage 2 group and AKI-stage 3 group. The general condition, original disease, severity of disease, duration of mechanical ventilation, the length of ICU or hospital stay, 28-day survival rate and in-hospital mortality rate were compared among these three groups. Additionally, risk factors for the 28-day survival rate and hospital mortality of critically ill patients with AKI were screened by logistic regression analysis. Results A total of 258 critically ill patients with AKI were enrolled, with 64 cases in AKI-stage 1 group, 62 cases in AKI-stage 2 group, and 132 cases in AKI-stage 3 group. 116 patients survived with 28-day survival rate of 44.96%. 154 patients died with hospital mortality 59.69%. The precipitating factors of AKI in all three groups (stage 1, stage 2, and stage 3) were similar, with sepsis, heart failure and poisoning (drugs or poison) being the main triggers for AKI, accounting for 35.66%, 19.38% and 13.18%, respectively. There were significant differences in the rate of vasoactive agent usage (31.25%, 41.94%, 50.00%, χ2 = 6.241, P = 0.044), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (20.87±7.37, 17.19±7.02, 22.58±7.95, F = 5.292, P = 0.006) and sequential organ failure assessment (SOFA) score (8.41±3.46, 6.22±2.43, 9.58±3.71, F = 10.328, P = 0.000), while there was no significant difference in gender, age, primary disease, time from ICU admission to the beginning of CRRT, mean arterial pressure (MAP), lactate level or 24-hour lactate clearance rate (LCR), mechanical ventilation time, the length of ICU or hospital stay, 28-day survival rate or hospital mortality among these three groups (all P > 0.05). According to the logistic regression analysis, time from ICU admission to start of CRRT and lactate level were the independent risk factors for 28-day survival rate or hospital mortality of critically ill patients with AKI [odds ratio (OR) for 28-day survival rate was 0.850 and 0.774, 95% confidence interval (95%CI) was 0.752-0.960 and 0.638-0.940, P value was 0.009 and 0.010, respectively; OR for hospital mortality was 0.884 and 0.756, 95%CI was 0.781-1.000 and 0.610-0.939, P value was 0.049 and 0.011, respectively]. Conclusion Early initiation of CRRT based on KDIGO-AKI classification could not improve the prognosis of critically ill patients with AKI, the optimal timing of RRT for such patients remains to be further explored.
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Objective To investigate the incidence and mortality of acute kidney injury (AKI) in posttraumatic patients, and to analyze the risk factors influencing the incidence and outcomes of AKI. Methods Totally 4 221 patients with trauma who were admitted to No. 309 Hospital of PLA between Jan. 2004 and Jan. 2014 were screened and subjected to a retrospective study, and the incidence rate of AKI and mortality were analyzed. Multivariate logistic regression analysis was conducted to identify the risk factors for the incidence and prognosis of the patients with AKI. Results The incidence of AKI in posttraumatic patients in this study was 11. 6% (489/4 221) according to the classification and diagnosis criteria from Kidney Disease:Improving Global Outcomes (KDIGO), and 46. 0% (225/489) of them died prior to hospital discharge. There was an increasing hospital mortality tendency with the increase of AKI severity, with the hospital mortality rates being 30. 1% (84/279), 54. 6% (53/97), and 77. 9% (88/113) in AKI patients with KDIGO 1, 2, and 3 stage, respectively. Multivariate logistic regression analysis showed that increase of age, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores on admission > 17, injury severity score (ISS) on admission > 16, severe head injury, abdominal organ injury, rhabdomyolysis, shock and respiration system dysfunction were risk factors for occurrence of AKI (P25, severe head injury, KDIGO stage 3, cardiovascular and respiratory system dysfunction (P < 0. 05, P < 0. 01). Conclusion AKI is a common clinical complication with high mortality in posttraumatic patients. To prevent severe complications after trauma is the key for improving the prognosis of patients.
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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.
Subject(s)
Acute Kidney Injury , Classification , Mortality , PrognosisABSTRACT
Objective To investigate the prognosis evaluation of acute kidney injury (AKI) by kidney disease staging of Improving Global Outcomes Organization (KDIGO) criteria and neutrophil gelatinase-associated lipocalin (NGAL) in severe sepsis patients treated with continuous blood purification (CBP).Methods In this prospective study, 84 severe sepsis patients treated with venous-venous CBP were selected from January 2013 to December 2014 in emergency intensive care unit of Medical University of China, Shun Yi Hospital and were divided into 3 groups based on the KDIGO staging criteria.Blood NGAL, ICU survival rate and renal function outcome of survivals were compared among groups.Results Compared with KDIGO stage 3, KDIGO stages 1 and 2 hospitalized patients had significantly lower NGAL [(453.9 ± 74.4) ng/mL vs.(789.1 ±86.8) ng/mL, P ＜0.01];Hospitalized survival rate was 92.3％ (24/26) in KDIGO stages 1 and 2 which was significantly higher than 69.0％ (40/58) in KDIGO stage 3 (P =0.026).Renal function improvement rate in KDIGO stages 1 and 2 was significantly higher than that in KDIGO stage 3 [83.3％ (20/24) vs.27.5％ (11/40), P ＜0.01].When the reliability of combination of KDIGO criteria and NGAL for prognosis evaluation was analyzed by ROC curve, the area under curve of survival was 0.703 (95％ confidence interval: 0.648-0.759, P ＜0.01) and area under curve of renal function improvement was 0.679 (95％ confidence interval: 0.627-0.731, P ＜ 0.01).Conclusions In severe sepsis patients complicated with AKI, CBP in KDIGO stages 1 and 2 might improve survival rate and renal function of sepsis patients.Combination of KDIGO criteria and NGAL maybe acted as an indicator of the prognosis in severe sepsis patients with complication of AKI.
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Introducción: El objetivo del trabajo es comparar ensayos de PTH de 2da y 3ra generación en pacientes con función renal normal y en hemodializados crónicos y sus implicancias en el tratamiento de esta última población. Métodos: Se estudiaron 60 pacientes hemodializados crónicos y 40 con función renal normal a quienes se les midió PTH por ambos ensayos. Resultados: En la población con función renal normal la mediana de PTH fue de 51.8 y de 45.6 pg/ml con el ensayo de 2da y 3ra generación respectivamente. En hemodializados crónicos la mediana de PTH fue de 193.9 y de 137.1 pg/ml con los ensayos de 2da y 3ra generación respectivamente. La diferencia entre los ensayos fue de 11.3% y 29.3% en la población con función renal y hemodializados respectivamente. El ensayo de 3ra generación produjo un corrimiento en la cantidad de pacientes que caen en los distintos rangos de PTH según las guías KDIGO, para un valor menor de 2 veces el límite superior de referencia: cambia de 20 a 25 pacientes, entre 2 y 9 veces: cambia de 31 a 32 pacientes y mayor de 9 veces: cambia de 9 a 3 pacientes. Conclusiones: Al aumentar la concentración de PTH aumentan las diferencias entre ambos ensayos, por lo que no se pueden utilizar indistintamente en una población de hemodializados crónicos.Con los ensayos de 3ra generación 11 pacientes (18.3%) modificaron su clasificación de acuerdo a las guías KDIGO lo que implicaría un cambio en el tratamiento.
Introduction: This work's objective is to compare third and second generation assays in patients with normal kidney function and in chronic hemodialysis patients, and the implications on the latter. Methods: 60 chronic hemodialysis patients and 40 patients with normal kidney function were studied and their PTH levels were measured for both assays. Results: In patients population with normal kidney function the average on PTH was 51.8 and 45.6 pg/ml with second and third generation assays respectively. In chronic hemodialysis patients the average PTH was 193.9 and 137.1 pg/ml with second and third generation assays respectively. The difference between assays was 11.3% and 29.3% in patients with normal kidney function and in hemodialysis patients respectively. Third generation assay caused a variation in the amount of patients that fall over several PTH ranges according to KDIGO guidelines, for a lesser value of 2 times the reference upper limit: it changes from 20 to 25 patients, between 2 and 9 times: it changes from 31 to 32 patients, and more than 9 times: it changes from 9 to 3 patients. Conclusions: When PTH concentration increases the difference between both assays also increases, for this reason we cannot use them indiscriminately in a chronic hemodialysis patient population. With third generation assays 11 patients (18.3%) changed their classification according to KDIGO guidelines, which will result in a change of treatment.
Subject(s)
Humans , Renal Dialysis , Parathyroid Hormone/therapeutic useABSTRACT
Objective To evaluate the value of Kidney Disease:Improving Global Outcomes (KDIGO) criteria in investigating clinical feature and prognosis of acute kidney injury (AKI) patients with sepsis in ICU.Methods Clinical data of patients with AKI defined by KDIGO criteria in ICU of Wuxi People's Hospital from June 2007 to June 2012 were collected.Clinical characteristics,prognosis and major risk factors of death of septic AKI patients were retrospectively analyzed.Results Of the enrolled 703 AKI patients,395 (56.2％) were caused by sepsis (septic AKI),which indicated that sepsis mainly contributed to the causes of AKI.For septic AKI stratified by KDIGO classification,146(37.0％) patients belonged to AKI Ⅰ,154(39.0％) to AKI Ⅱ,and 95 (24.1％) to AKI Ⅲ.Compared with the patients with non-septic AKI,septic AKI patients had greater APACHE Ⅱ and SOFA score (25.1 ±4.9 vs 20.5 ±6.4,12.9 ±2.6vs 10.4 ± 4.5 ; all P values ＜ 0.05).Although there was no significant difference in baseline serum creatinine [(82.9 ± 22.2) μmol/L vs (83.1 ± 30.O) μmol/L,P ＞ 0.05] between the two groups,patients with sepsis had higher serum creatinine [(143.5 ± 21.6) μmol/L vs (96.2 ± 15.5) μmol/L; P ＜ 0.05],a higher proportion fulfilled KDIGO categories for both AKI Ⅱ and Ⅲ (63.0％ vs 33.1％ ; P ＜ 0.05),a higher renal replacement therapy (RRT) rate (22.3％ vs 6.2％ ; P ＜ 0.05) and a lower proportion of complete renal recovery(74.4％ vs 82.8％) (all P values ＜ 0.05).The 90-day mortality of septic AKI patients was higher than that of non-septic AKI patients (52.2％ vs 34.1％ ; P ＜ 0.05).Septic AKI,graded by KDIGO,was associated with an increased mortality.Logistic regression analysis showed that APACHE Ⅱ score (OR =5.451,95％ CI:3.095-9.416),SOFA score (OR =2.166,95％ CI:1.964-4.515) and RRT (OR =4.021,95％ CI:2.975-6.324) were independent risk factors for mortality of septic AKI patients.Conclusion Septic AKI patients have a higher burden of illness,worse renal function and higher mortality.APACHE Ⅱ score,SOFA score and RRT are independent risk factors to septic AKI mortality.