Acute kidney injury in the elderly hospitalized patients

Objective: We aimed to evaluate acute kidney injury (AKI), occurrence of recovery and risk factors associated with permanent kidney injury and mortality in the elderly individuals. Design: Evidence for this study was obtained from retrospective cohort study from our center. Patients: A total of 193 patients (>65 years, mean age: 79.99?±?6.93) with acute kidney injury were enrolled in this study between 2011 and 2012. Patients with kidney failure or renal replacement therapy (RRT) history at admission were excluded. Intervention: Main outcome measurements: serum creatinine (SCr), estimated GFR (with CKD-Epi) and complete blood counts were evaluated at baseline and daily basis thereafter. The AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) classification. Results: Among 193 patients, 43 (22%) patients required RRT. Mortality rate was 18% (n?=?36) SCr levels were restored within 9.9?±?6.7days on average (8–39 days). Sixteen patients (12.7%) required RRT after discharge. The mean hospital stay was 10.1?±?8.6 days (7–41 days). Mortality rate of patients who have no renal recovery was higher (44.8% vs. 4.8%) than renal recovery group (p?0.01). Conclusion: The AKI represents a frequent complication in the elderly patients with longer hospital stay and increased mortality and morbidity. Our results show that dialytic support requirement is an independent predictor of permeant kidney injury in the elderly AKI patients. Older age, low diastolic blood pressure, high CRP and low hemoglobin levels were independent risk factors for mortality.     

Acute kidney injury in peripheral arterial surgery patients: a cohort study

Abstract

Purpose: The aim of the study was to evaluate the prevalence of acute kidney injury (AKI) in a cohort of surgically treated patients with peripheral artery disease (PAD) and its association with the short-term and long-term outcome. Materials and methods: We conducted a retrospective cohort study on all the consecutive PAD inpatients in 2008. Data on the patients’ demographic characteristics, medical history, treatment, outcome and laboratory tests measurements were retrieved from the medical records. Results: We analyzed 166 patients (71.6% males, mean age 63.2 years?±?SD 10.7 years) and found an AKI prevalence of 12.7%. The AKI patients’ group had more chronic kidney disease (CKD) (23.8% vs. 6.2%, p?=?0.005), diabetes mellitus (DM) (61.9% vs. 33.1%, p?=?0.011) and a higher length of hospital stay (19.48 vs. 15.42 days, p?=?0.047). At one year, the mortality was 33.3% in the AKI group compared to 1.3% in non-AKI group, with a strong association between AKI and death (OR?=?35.7; 95%CI?=?6.7 to 189) and AKI and major cardiovascular events (OR?=?29.1; 95% CI?=?6.8 to 123.4). There was no significant difference in terms of age, cardiovascular disease and medication between the two groups. Conclusions: AKI was associated with a poorer one-year outcome after the surgery of PAD patients. In our study, the presence of previous chronic kidney disease and type 2 diabetes increased the incidence of acute kidney injury after surgery.     

The role of adipocytokines on depressive symptoms of patients with chronic kidney disease

Abstract

Objective: The aim of this study is to evaluate depression and anxiety scores among chronic kidney disease (CKD) patients and to search the changes of serum concentrations of adipokines with respect to emotional disturbances of CKD patients. Patients and methods: 150 patients recruited into this cross-sectional analytic study. Study groups were control, hemodialysis, predialysis, peritoneal dialysis and kidney transplantation groups. Fasting morning serum leptin, ghrelin, acylated ghrelin, neuropeptide Y, adiponectin, resistin levels of all of the groups were measured using ELISA (Sandwich) method. A screening interview based on the Structured Clinical Interview for DSM-IV and self-report scales (The Beck Depression [BDI] and The Beck Anxiety Inventory [BAI] and Brief Symptom Inventory [BSI] which is self report scales) were administered and conducted by a trained interviewer. Results: BDI scores were significantly higher in hemodialysis and predialysis groups compared to control group (p?=?0.009). Somatization sub scores of BSI were significantly higher in hemodialysis and peritoneal dialysis groups compared to control group (p?=?0.041). Also positive symptom distress index scores of BSI were significantly higher in hemodialysis and transplantation groups compared to control group (p?=?0.047). BDI score were significantly negatively correlated with duration of education (r?=??0.165, p?=?0.045), positively correlated with presence of protein energy wasting (r?=?0.198, p?=?0.016), and resistin levels (r?=?0.233, p?=?0.004). Conclusion: CKD patients had higher BDI, BSI-somatization, BSI-positive symptom distress index scores compared to control group. High serum resistin levels, presence of protein energy wasting might have a role in development of depressive disorders of patients with chronic kidney disease.     

Diuretics associated acute kidney injury: clinical and pathological analysis

Objective: In order to evaluate the clinical and pathological characteristics of diuretics associated acute kidney injury (AKI) and its management. Methods: We performed a retrospective study including 131 cases that diagnosed as diuretics associated AKI from 1 January 1999 to 1 January 2010 in Ruijin Hospital affiliated to Shanghai Jiao Tong University. Drug applications and its related clinical, laboratory and histological data were collected. Results: The male to female ratio was 2:1. The proportion of ages <20 years, 20–40 years, 40–60 years and ≥60 years were 6.9%, 17.6%, 27.5% and 48.1% respectively. Most patients (96.2%) had at least one complication of which chronic kidney disease (CKD) occurred most frequently (72 in 131, 55.0%). We divided all the patients to diuretic group (N?=?131) and non-diuretic group (N?=?185) based on diuretics history. We found patients in diuretic group had higher rates of CVD (38.9% vs. 18.4%), hypertension (42.0% vs. 29.2%), CKD (55.0% vs. 27.0%) and DM (17.6% vs. 4.3%) than non-diuretic group. Of 131 diuretics associated AKI, 36 cases (27.5%) were caused by diuretics only, 39 cases (29.8%) were caused by the combination of diuretics and other drugs like antibiotics, contrast media, ACEI or NSAIDs, and 56 cases (42.7%) had other AKI risk factors such as operation, infection, acute heart failure or hepatorenal syndrome. In addition, our data suggested the severity of RIFLE classification and pathological injury of glomerular basement membrane was higher in large-dosage furosemide group (>?=?120?mg/d) than in low-dosage group (<120?mg/d). The most common lesion induced by diuretics was vacuolar degeneration of tubular epithelial cell. Logistic regression analysis showed predictors of all-cause mortality were age, gender, RIFLE classification when AKI onset. Age and RIFLE classification were predictive factor of non-complete recovery. Conclusion: This article firstly focuses on diuretics associated AKI, whose onset was related to aging, primary diseases and diuretic dosage. The combination of diuretics with other drugs such as antibiotics, contrast media, ACEI, NSAIDs, etc. would synergistically induced AKI. The pathological lesion of diuretics associated AKI may be mostly manifested vacuolar degeneration of tubular epithelial cell. Aging, gender, severity of RIFLE classification may be predictive factors of all-cause mortality of diuretics associated AKI.     

Recurrent acute kidney injury in elderly patients is common and associated with 1-year mortality

Background

Acute kidney injury (AKI) is common among elderly patients after a first hospitalized AKI. Patients who recover are at risk for recurrence, but recurrent geriatric AKI is not well-studied.

Methods

This was a retrospective, 12-month cohort study using data from the National Clinical Research Center for Geriatric Diseases. Recurrent AKI was defined as a new spontaneous rise of?≥?0.3 mg/dl (≥?26.5 µmol/L) within 48 h or a 50% increase in serum creatinine (Scr) from the baseline within 7 days after the previous AKI episode. The outcome measured was 12-month mortality.

Results

Among 1711 study patients, 652 developed AKI. Of the 429 AKI survivors in whom recovery could be assessed, 314 patients recovered to their baseline renal function, and 115 patients developed chronic kidney disease (CKD). Of the group that recovered renal function, 90 patients (28.7%) subsequently developed recurrent AKI, while 224 (71.3%) did not. Of the 429 survivors with AKI, 103 patients (24.0%) died within 12 months. Multivariate logistic regression analysis revealed that recurrent AKI was significantly associated with coronary disease (odds ratio [OR?=?2.008; 95% confidence interval [CI] 1.024–3.938; P?=?0.042), a need for mechanical ventilation (OR?=?2.265; 95% CI 1.267–4.051; P?=?0.006) and high blood urea nitrogen levels (OR?=?1.036; 95% CI 1.002–1.072; P?=?0.040) at the first AKI event. Kaplan–Meier curves showed the 12-month survival of patients with non-recurrent AKI was better than that of patients with CKD, and survival of patients with recurrent AKI was worse than that of patients with CKD (log rank P?<?0.001). In the multivariate Cox regression analysis, mortality at 12 month was higher in the patient with recurrent AKI as compared with those with a single episode (HR?=?3.375; 95% CI 2.241–5.083; P?<?0.001).

Conclusion

Recurrent AKI is common among elderly patients who recovered their renal function post-AKI and is associated with significantly higher 12-month mortality compared with CKD patients.

     

Incidence and mortality of postoperative acute kidney injury in non-dialysis patients: comparison between the AKIN and KDIGO criteria

Objectives This retrospective study determines whether the kidney disease: improving global outcomes (KDIGO) criteria are superior to acute kidney injury network (AKIN) criteria in detecting non-dialysis AKI events and predicting mortality in chronic kidney disease (CKD) patients after surgery. Methods Surgical patients who were admitted to the intensive care unit were enrolled. Non-dialysis AKI cases were defined using either KDIGO or AKIN creatinine criteria and stratified by CKD stages. The adjusted hazard ratios (AHRs) for in-hospital mortality are compared to those without AKI. The cumulative survival curves and the predictability for mortality are accessed by Kaplan–Meier method and calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve, respectively. Results From a total of 826 postoperative patients, the overall in-hospital mortality rate was 11.6% (96 cases) and that for AKI according to KDIGO and AKIN criteria was 30.0% (248 cases) and 31.0% (256 cases). The cumulative survival curve stratified by CKD and AKI stages were comparable between KDIGO and AKIN criteria. The discriminative power for mortality stratified by CKD stages for KDIGO and AKIN criteria are as followed: all subjects: 0.678 versus 0.670 (both ps?<0.001); non-CKD: 0.800 versus 0.809 (both ps?<0.001); early-stage CKD: 0.676 versus 0.676 (both ps?<0.001); late-stage CKD: 0.674 versus 0.660 (ps were?<0.001 and 0.003). Conclusion The KDIGO criteria are superior to AKIN criteria in predicting mortality after surgery, especially in those with advanced CKD.     

MCP-1 and soluble TWEAK levels are independently associated with coronary artery disease severity in patients with chronic kidney disease

Abstract

Purpose: Patients diagnosed with chronic kidney disease (CKD) have a greater rate of cardiovascular mortality when compared with the general population. The soluble form of TNF-like weak inducer of apoptosis (TWEAK) and monocyte chemoattractan protein 1 (MCP-1) play important roles in cellular proliferation, migration and apoptosis. The current study aimed to analyze whether soluble TWEAK (sTWEAK) and MCP-1 levels are associated with the severity of coronary arterial disease (CAD) in CKD patients. Methods: Ninety-seven patients diagnosed with CKD stages 2–3 according to their estimated glomerular filtration rate and the presence of kidney injury were included in the study. Plasma sTWEAK and MCP-1 concentrations were determined using commercially available ELISA kits. Coronary angiographies were performed through femoral artery access using the Judkins technique. Results: Correlation analysis of sTWEAK and Gensini scores showed significant association (p?<?0.01, r²?=?0.287). Also significant correlation has been found in MCP-1 levels and Gensini scores (p?<?0.01, r²?=?0.414). When patients were divided into two groups with a limit of 17 according to their Gensini score, sTWEAK levels indicated a statistically significant difference (p?<?0.01). Conclusions: Our findings support a relationship between sTWEAK and MCP-1 levels and CAD in CKD stages 2–3 patients.     

Prolonged elevated postprandial sugar augments severity in kidney disease: a North Indian hospital-based study

Aim: Diabetes plays a major role in progression of renal failure. The risk-factor profile changes during the progression of chronic kidney disease (CKD) from mild/moderate to end-stage renal disease. The relationship between glycemic indices, blood pressure, body mass index (BMI) and age at diagnosis in Indians has been less investigated. We assessed association of these risk factors with CKD stages in Indian population. Methods: This study was carried out on patients (n?=?162) who were diagnosed with CKD and normal control group (n?=?155). For BMI, National Institutes for Health criteria were used to categorize the patients. Result: The mean age of CKD patients were significantly increased with the advancement of stage. BMI, systolic blood pressure (SBP), postprandial sugar level (PP), urea and creatinine were also significantly higher with elevated stages, whereas no differences were observed in diastolic blood pressure (DBP) and fasting blood sugar (FBS). The logistic regression study gave a significant result (p?=?0.000) when we compared the group of CKD patients with established/prolonged postprandial blood sugar. It was independently associated with mild CKD [odds ratio (OR)?=?5.213, 95% confidence interval (CI)?=?2.06–13.21, p?=?0.000], moderate CKD (OR?=?7.724, 95% CI?=?4.05–14.74, p?=?0.000) and severe CKD (OR?=?7.610, 95% CI?=?4.03–14.36, p?=?0.000). Conclusion: SBP and PP were the best predictors of prevalent nephropathy in this population, while DBP and FBS were found to be less effective. This may have implication for kidney disease risk stratification and protection.     

Chronic kidney disease is not associated with a higher risk for mortality or acute kidney injury in transcatheter aortic valve implantation

Background Transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option for surgical high-risk patients with severe aortic stenosis (AS). Many of these patients suffer from chronic kidney disease (CKD), which substantially increases the risk for acute kidney injury (AKI), need for renal replacement therapy (RRT) and mortality after surgical aortic valve repair. The impact of pre-existing CKD for the outcome of TAVI is still unclear. Methods We retrospectively evaluated 199 consecutive patients with symptomatic high-grade AS undergoing TAVI with the CoreValve prosthesis at our centre. We analysed incidence and predictive factors for AKI, RRT and mortality in patients with and without CKD (defined as an estimated glomerular filtration rate <60 mL/min). Results 26.8% of the patients suffered from AKI, 4.9% needed RRT and 5.5% died. All patients on chronic haemodialysis (n = 10) survived. There were no significant differences between patients with or without CKD concerning the incidence of AKI, RRT and mortality. Age, peripheral vascular disease and the need for blood transfusion were independently associated with AKI. AKI proved to be a predictive factor for mortality. Conclusions Transcatheter aortic valve replacement with the CoreValve prosthesis does not seem to bear an increased risk for patients with CKD. For surgical high-risk patients with severe AS, a more liberal consideration for TAVI as an alternative to open surgery might be justified.     

Urine neutrophil gelatinase-associated lipocalin in septic patients with and without acute kidney injury

Introduction: Urine neutrophil gelatinase-associated lipocalin (uNGAL) is a rapidly emerging biomarker for early detection of acute kidney injury (AKI). We aimed to investigate the prevalence and prognostic value of the early uNGAL in patients with AKI induced by sepsis. Methods: In this prospective cohort study, we analyzed the case records of 126 septic patients with and without AKI and evaluated the uNGAL for early prediction and risk stratification of septic patients with AKI. Results: Of 126 patients analyzed, 58 (46%) developed septic AKI. Men comprised more than half (68%) of the sample population, the mean age (SD) was 57 years. The prognostic accuracy of uNGAL, as quantified by the area under the receiver-operating-characteristic curve (AU-ROC), was highest with peak uNGAL (AU-ROC: 0.86; 95% CI: 0.81–0.93), as compared with the admission uNGAL (AU-ROC: 0.81; 95% CI: 0.73–0.89). The peak uNGAL correlated with the levels of peak blood urea nitrogen (r?=?0.674) and serum creatinine (r?=?0.608), the length of hospital stay (r?=?0.602) and weakly correlated with the number of hemodialysis sessions that each patient received during hospital stay (r?=?0.405). By multivariate analysis, increased peak uNGAL remained independently associated with the development of septic AKI (odds ratio: 32.12; 95% CI: 6.21–90.37; p?Conclusions: uNGAL is independently associated with subsequent AKI among patients with sepsis.     

Role of B-type natriuretic peptide as a marker of mortality in acute kidney injury patients treated with continuous renal replacement therapy

Abstract

Objectives: Acute kidney injury (AKI) treated with continuous renal replacement therapy (CRRT) is associated with poor outcome. Plasma B-type natriuretic peptide (BNP) is a biomarker related to fluid volume overload, and is elevated in AKI patients. The purpose of the study was to assess whether BNP levels at the time of starting CRRT could be used as a predictor of mortality in patients with AKI receiving CRRT. Methods: We conducted a prospective observational cohort study enrolling 149 patients with AKI receiving CRRT. The primary outcome was mortality during CRRT. Results: The median BNP level of 84 (56.3%) patients who expired was significantly higher than that of those who survived (1812.5 vs. 475.0?pg/mL; p?=?0.01). Receiver operating characteristic curves demonstrated BNP levels as a predictor of mortality during CRRT with an area under the curve of 0.77 (p?=?0.000), and the optimal threshold for BNP was 1054?pg/mL. Patients with BNP levels above 1054?pg/mL had a significantly higher mortality (76.6 vs. 34.7%; p?=?0.01). Conclusion: Elevated BNP level is associated with mortality in patients with AKI receiving CRRT.     

Impact of acute kidney injury on renal allograft survival

Background: Acute kidney injury (AKI) is one of the major determinants of graft survival in kidney transplantation (KTx). Renal Transplant recipients are more vulnerable to develop AKI than general population. AKI in the transplant recipient differs from community acquired, in terms of risk factors, etiology and outcome. Our aim was to study the incidence, risk factors, etiology, outcome and the impact of AKI on graft survival.

Methods: A retrospective analysis of 219 renal transplant recipients (both live and deceased donor) was done.

Results: AKI was observed in 112 (51.14%) recipients, with mean age of 41.5?±?11.2 years during follow-up of 43.2?±?12.5 months. Etiologies of AKI were infection (47.32%), rejection (26.78%), calcineurin inhibitor (CNI) toxicity (13.39%), and recurrence of native kidney disease (NKD) (4.46%). New Onset Diabetes After Transplant (NODAT) and deceased donor transplant were the significant risk factors for AKI. During follow-up 70.53% (p?=?.004) of AKI recipients progressed to chronic kidney disease (CKD) in contrast to only 11.21% (p?=?.342) of non AKI recipients. Risk factors for CKD were AKI within first year of transplant (HR: 7.32, 95%CI: 4.37–15.32, p?=?.007), multiple episodes of AKI (HR: 6.92, 95%CI: 3.92–9.63, p?=?.008), infection (HR: 3.62, 95%CI: 2.8–5.75, p?=?.03) and rejection (HR: 9.92 95%CI: 5.56–12.36, p?=?.001).

Conclusion: Renal transplant recipients have high risk for AKI and it hampers long-term graft survival.     

Vitamin D deficiency,insulin resistance,and ventricular hypertrophy in the early stages of chronic kidney disease

Background: Chronic kidney disease (CKD) is associated with markedly increased cardiovascular (CV) risk. This increase is not fully explained by traditional CV risk factors but may in part be mediated by nontraditional risk factors, such as inadequate vitamin D (vit D) levels and insulin resistance (IR). Although IR is shown in nondiabetic CKD, its association with vit D deficiency and vascular disease in this population is unknown and what this study aims to investigate. Materials and methods: The study comprised 67 patients with CKD (eGFR?≥?30?mL/min) and 15 healthy controls matched for age and sex. The phlogosis indexes, vit D levels, IR, carotid intima-media thickness (cIMT), and left ventricular mass index (LVMI) were measured. Results: In our study, the mean value of LVMI and cIMT was significantly higher in patients with eGFR?≥?30?mL/min compared with controls (p?=?0.037 and p?p?=?0.044, p?=?0.012, p?=?0.038). A positive correlation was found between LVMI and IR (r?=?0.704, p?=?0.041) and a negative correlation was found between IR and vit D levels (r?=??0.238, p?=?0.031). Conclusions: In our study, IR and vit D deficiency were found to be independent predictors of left ventricular hypertrophy and atherosclerotic disease. Vitamin D deficiency and IR are thus associated with increased CV risk. More novel approaches to improving IR and vit D supplementation in the CKD population might lead to potential strategies for preventing excess CV mortality.     

High rate of acute kidney injury in patients with chronic kidney disease and hepatitis C virus genotype 4 treated with direct-acting antiviral agents

Background

Direct-acting antivirals (DAAs) have significantly improved the efficacy and safety of treating chronic hepatitis C (CHC), but their effectiveness and safety among patients with chronic kidney disease (CKD) remains poorly understood. Sofosbuvir/daclatasvir regimen is supposed to be used for patients with creatinine clearance more than 30 mL/min, while ombitasvir/paritaprevir/ritonavir regimen is used for patients with creatinine clearance less than 30 mL/min.

Aim

The aim of the study was to assess the safety and efficacy of DAAs among patients with CKD.

Methods

Eighteen CKD stage 2–3b patients received sofosbuvir for 3 months. In addition, 42 CKD stage-4 patients received ritonavir-boosted paritaprevir plus ombitasvir for 3 months. Finally, ribavirin was added for 30 of them.

Results

The patients’age was 49.2?±?12 years. Baseline serum creatinine was 3.76?±?1.67 mg/dL. Fifty patients were HCV genotype 4. A 3-month sustained viral response was achieved in 56 patients and 49 patients achieved a 6-month viral response. There were 11 relapsers. Acute kidney injury (AKI) upon CKD (AKI/CKD) occurred in 28 patients, of which 20 needed hemodialysis. Fifteen/28 recovered from AKI, whereas 13 were maintained on hemodialysis. In multivariate analysis, there were only two independent risk factors for developing AKI/CKD, i.e., being cirrhotic as defined by baseline abdominal ultrasound findings [odds ratio 4.15 (1.33–12.97); p?=?0.013] and having had as DAA therapy OMV/PTV/RTV [odds ratio 7.35 (1.84–29.35); p?=?0.001].

Conclusion

Treatment of HCV among stage 2, 3a, and 3b patients was achieved safely with a sofosbuvir-based regimen. We recommend that stage-4 patients wait until starting hemodialysis or transplantation.

     

Prediction of major adverse kidney events in critically ill burn patients

Objective

We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients.

Septic acute kidney injury in critically ill patients – a single-center study on its incidence,clinical characteristics,and outcome predictors

Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed. Results In total, 3687 patients were included and 54.7% patients developed AKI. Sepsis was the most common cause of AKI (49.2%). Compared to those without AKI, AKI patients had higher disease severity, more physiological and biochemical disturbance, and carried significant co-morbidities. Ninety-day mortality increased with severity of AKI (16.7, 27.5, and 48.3% for KDIGO stage 1, 2, and 3 AKI, p?<?0.001). Full renal recovery was achieved in 71.6% of AKI patients. Compared with non-septic AKI, septic AKI was associated with higher disease severity and required more aggressive support. Non-recovery of renal function occurred in 2.5% of patients with septic AKI, compared with 6.4% in non-septic AKI (p?<?0.001). Cox regression analysis showed that age, emergency ICU admission, post-operative cases, admission diagnosis, etiology of AKI, disease severity score, mechanical ventilation, vasopressor support, and blood parameters (like albumin, potassium and pH) independently predicted 90-day mortality. Conclusions AKI, especially septic AKI is common in critically ill Chinese patients and is associated with poor patient outcome. Etiology of AKI has a significant impact on 90-day mortality and may affect renal outcome.     

Impact of Mild Acute Kidney Injury (AKI) on Outcome after Open Repair of Aortic Aneurysms

Recently, mild AKI has been considered as a risk factor for mortality in different scenarios. We conducted a retrospective analysis of the risk factors for two distinct definitions of AKI after elective repair of aortic aneurysms. Logistic regression was carried out to identify independent risk factors for AKI (defined as $25% or $50% increase in baseline SCr within 48 h after surgery, AKI 25% and AKI 50%, respectively) and for mortality. Of 77 patients studied (mean age 68 ± 10, 83% male), 57% developed AKI 25% and 33.7% AKI 50%. There were no differences between AKI and control groups regarding comorbidities and diameter of aneurysms. However, AKI patients needed a supra-renal aortic cross-clamping more frequently and were more severely ill. Overall in-hospital mortality was 27.3%, which was markedly higher in those requiring a supra-renal aortic cross-clamping. The risk factors for AKI 25% were supra-renal aortic cross-clamping (odds ratio 5.51, 95% CI 1.05–36.12, p?=?0.04) and duration of operation for AKI 25% (OR 6.67, 95% CI 2.23–19.9, p < 0.001). For AKI 50%, in addition to those factors, post-operative use of vasoactive drugs remained as an independent factor (OR 6.13, 95% CI 1.64–22.8, p?=?0.005). The risk factors associated with mortality were need of supra-renal aortic cross-clamping (OR 9.6, 95% CI 1.37–67.88, p?=?0.02), development of AKI 50% (OR 8.84, 95% CI 1.31–59.39, p?=?0.02), baseline GFR lower than 49 mL/min (OR 17.07, 95% CI 2.00–145.23, p?=?0.009), and serum glucose > 118 mg/dL in the post-operative period (OR 19.99, 95% CI 2.32–172.28, p?=?0.006). An increase of at least 50% in baseline SCr is a common event after surgical repair of aortic aneurysms, particularly when a supra-renal aortic cross-clamping is needed. Along with baseline moderate chronic renal failure, AKI is an independent factor contributing to the high mortality found in this scenario.     

Low levels of high-density lipoproteins are associated with acute kidney injury following revascularization for chronic limb ischemia

Abstract

Objectives: Perioperative acute kidney injury (AKI) is not uncommon, following revascularization. HDL has been shown to reduce organ injury in animal models. The aim of the study is to examine the association of HDL on AKI in patients undergoing revascularization for chronic limb ischemia. Methods: All patients who underwent revascularization between June 2001 and December 2009 were analyzed. Patients on dialysis and with incomplete data were excluded. Patients were grouped for HDL < or ≥40?mg/dL. Univariate and multivariate analysis were used to identify factors associated with AKI. Results: A total of 684 patients were included. Eighty-two (12.0%) patients developed postoperative AKI (15.7% in low HDL group vs. 6.3% in high HDL group, p?<?0.001). The AKI group were more likely to be older (71.5?±?10.1 vs. 68.0?±?10.8, p?=?0.01), ASA 4 class (26% vs. 14%, p?<?0.001), to have albumin <3?g/dL (59% vs. 32%, p?<?0.001), low HDL levels (79% vs. 58%, p?<?0.001), DM (61% vs. 44%, p?=?0.005), CAD (67% vs. 55%, p?=?0.003), preoperative chronic kidney disease (CKD) stage III–IV (55% vs.39%, p?<?0.001), to present with critical limb ischemia (82% vs. 63%, p?=?0.001), and to be on ACEI (67% vs. 51%, p?=?0.006). Multivariate logistic regression analysis showed low HDL (Odds Ratio (OR) 1.66 [1.23–2.24]) and serum albumin levels <3?g/dL (OR 1.66 [1.29–2.13], p?<?0.001) were independently associated with increased odds for developing AKI. Propensity score analyses showed low HDL was independently associated with increased odds of AKI (OR 2.4 (1.4–4.2)). Conclusions: AKI following revascularization is not uncommon (12.0%), and lower concentrations of HDL and serum albumin are associated with increased odds of postoperative AKI. There was also a trend of higher prevalence of AKI among those with pre-existing CKD.