Statins use and the risk of acute kidney injury: a meta-analysis

The association between statins use and the risk of acute kidney injury (AKI) remains elusive. We aimed to evaluate the association of statins use with AKI risk by performing a meta-analysis. Twenty-one studies were included in our meta-analysis by searching electronic databases according to predefined criteria. No significant association between statins use and AKI risk was observed in overall populations, Caucasians, Asians, and patients undergoing cardiac and elective surgery (p?=?0.816, 0.981, 0.18, 0.709, and 0.122). Statins use decreased the risk of contrast-induced AKI (CIN) (p?=?0.005) and increased AKI risk in patients with community acquired pneumonia (CAP) (p?=?0.006). Meta-regression analyses showed almost no impact on the pooled ORs of age and study length for overall populations. Exclusion of any single study had little impact on the pooled ORs. In conclusion, statins use is not associated with the risk of AKI in overall populations, Caucasians, Asians, and patients undergoing cardiac and elective surgery. Statins use decreases the risk of CIN and may increase the risk of AKI in CAP patients.     

Preoperative serum cystatin C combined with dipstick proteinuria predicts acute kidney injury after cardiac surgery

Background: Acute kidney injury (AKI) is common following cardiac surgery and is associated with poor outcomes. However, the detection of those preoperative patients who will develop AKI is still difficult. In this study, we compared serum cystatin C combined with dipstick proteinuria as early markers to predict AKI available before surgery. Methods: We prospectively followed 616 patients undergoing cardiac surgery and identified 179 that developed AKI, defined as an increase in serum creatinine (SCr) of ≥?0.3?mg/dL or ≥?50% increase in creatinine level. Preoperative values for cystatin C were categorized into quartiles. We defined proteinuria, measured with a dipstick, as mild (trace to 1+) or heavy (2?+?to 4+). Univariate as well as multivariate regression was performed. Cystatin C combined with dipstick proteinuria before surgery was assessed for its' predictive value of AKI using receiver operating characteristic (ROC) curves. Results: The final cohort consisted of 616 patients aged 60.7?±?13.2 years, and baseline SCr was 75.8?±?26.4?μmol/L, estimated glomerular filtration rate (eGFR) 96.3?±?29.0?mL/min/1.73?m² and cystatin C 1.05?±?0.33?mg/L. Patients in higher cystatin C quartiles were older (p?p?=?0.021), hyperuricemia (p?p?p?=?0.002). Those with heavy proteinuria were more often to have diabetes mellitus (p?=?0.010), hyperuricemia (p?=?0.043), worse cardiac function (p?p?p?p?p?p?p?p?Conclusion: These data suggest that preoperative serum cystatin C combined with dipstick proteinuria may improve prediction of AKI among patients undergoing cardiac surgery.     

加速康复外科方案和标准治疗方案对腹部手术患者术后急性肾损伤影响的比较Meta分析

目的 通过Meta分析比较加速康复外科(ERAS)方案和标准治疗方案对腹部手术患者术后急性肾损伤(AKI)的影响.方法 通过PubMed、Embase、Cochrane Library数据库和参考文献列表进行检索,识别从建库至2020年9月符合纳入标准的相关研究.采用风险比(RR)、均数差(MD)和相应的95％可信区间...     

嗜铬细胞瘤患者术后急性肾功能损伤的危险因素分析

目的探究嗜铬细胞瘤患者术后急性肾功能损伤(AKI)的独立危险因素。方法收集2005年1月至2017年10月行嗜铬细胞瘤手术患者的人口学信息、术前症状、合并症、实验室检查、肿瘤的位置和直径、手术时间、血管活性药物的使用情况、出入量、血流动力学指标等。采用Logistic回归模型分析嗜铬细胞瘤患者术后AKI的独立危险因素。结果共纳入308例患者,其中42例(13.6%)患者术后出现AKI。在单因素Logistic回归分析中,男性、糖尿病史、术前白蛋白40 g/L、术前肌酐95μmol/L、肿瘤直径10 cm、手术时间120 min、术中使用血管收缩药、术中人工胶体液输注≥2 000 ml、输注异体血、出血量≥1 000 ml和SBP70%基础值累计时间10 min与嗜铬细胞瘤患者术后AKI相关;多因素Logistic回归分析显示,男性、白蛋白40 g/L、术中出血量≥1 000 ml和SBP70%基础值累计时间10 min是嗜铬细胞瘤术后AKI的独立危险因素。结论男性、白蛋白40 g/L、术中出血量≥1 000 ml和SBP70%基础值累计时间10 min是嗜铬细胞瘤患者术后AKI的独立危险因素。     

高血压脑出血术后急性肾损伤相关危险因素分析

目的通过病例对照研究,分析发生高血压脑出血术后急性肾损伤(acute kidney injury,AKI)的相关危险因素。方法选择2014年11月1日至2017年2月28日高血压脑出血接受外科手术治疗的患者211例,男139例,女72例,年龄28～86岁,根据术后是否发生AKI分为两组:AKI组和非AKI组。统计术后AKI发生率、术后30d全因死亡率及GOS评分、ICU停留时间、住院时间和住院费用。采用Logistic回归分析术后发生AKI的相关危险因素。结果术后发生AKI 38例,AKI发生率为18%;与非AKI组比较,AKI组术后7d全因死亡率明显升高(P0.01)、术后30d全因死亡率明显升高(P0.01),术后30dGOS评分明显降低(P0.01),术后ICU留观时间明显延长(P0.01);两组住院时间、住院费用差异无统计学意义。多因素Logistic回归分析结果显示,术中输血(OR=13.98,95%CI 4.23～46.17,P0.01)和术中使用甘露醇(OR=3.55,95%CI 1.60～7.89,P0.01)是高血压脑出血术后AKI的独立危险因素。结论高血压脑出血术后AKI的发生率为18%,术中输血和使用甘露醇可能是高血压脑出血术后发生AKI的独立危险因素,并且术后AKI患者术后7d及30d全因死亡率明显升高。     

Early postoperative hypoalbuminemia is a risk factor for postoperative acute kidney injury following hip fracture surgery

IntroductionAcute kidney injury (AKI) is a common and serious complication after hip fracture surgery in older adults. Hypoalbuminemia is a known independent risk factor for AKI. However, few studies have investigated the relationship between early postoperative hypoalbuminemia and AKI after hip fracture surgery. Therefore, we sought to determine the incidence of and risk factors for AKI and the effects of early postoperative hypoalbuminemia on AKI incidence after surgery for hip fractures, especially intertrochanteric fractures of the proximal femur.Patients and methodsIn this retrospective cohort study from a single center, we reviewed the medical records of 481 consecutive patients (>60 years) who underwent surgery for intertrochanteric fracture of the proximal femur. Multiple logistic regression was performed to identify independent risk factors for AKI. After determining the cut-off value of the minimal level of postoperative serum albumin during the first two postoperative days, we divided the patients into two groups: group 1 included 251 patients whose minimal early postoperative serum albumin level was <2.9 g/dL during the first two postoperative days; and group 2 included 230 patients whose minimal early postoperative serum albumin level was ≥2.9 g/dL. The incidence of AKI was analyzed using inverse probability of treatment weighting (IPTW), propensity score matching (PSM), and propensity score matching weighting (PSMW) analyses.ResultsThe incidence of AKI, defined based on the Kidney Disease Improving Global Outcomes criteria, was 11.8% (n = 57). Chronic kidney disease and the minimal early postoperative serum albumin level <2.9 g/dL at any point during the first two postoperative days were independent risk factors for AKI. The IPTW, PSM, and PSMW analyses comparing the incidence of AKI between the two groups revealed that the minimal early postoperative serum albumin level <2.9 g/dL was significantly associated with AKI development (P < 0.001, P = 0.025, and P = 0.011, respectively).ConclusionThe incidence of postoperative AKI was 11.8%. Our findings demonstrate that early postoperative hypoalbuminemia is an independent risk factor for AKI in patients undergoing surgery for intertrochanteric fracture of the proximal femur.     

Platelet-leukocyte aggregates – a predictor for acute kidney injury after cardiac surgery

BackgroundAcute kidney injury (AKI) is one of the most common complications after cardiac surgery. However, effective biomarker used for early diagnosis of AKI has not been identified. Platelet-leukocyte aggregates (PLAs) participate in inflammation and coagulation, leading to vascular lesions and tissue destruction. We designed a prospective study to assess whether PLAs can serve as a good biomarker for early diagnosis of AKI after cardiac surgery.MethodsPatients with rheumatic heart disease scheduled to undergo valve replacement surgery were enrolled. Blood samples were collected at five timepoints as follows: (a) At baseline. (b) At the end of extracorporeal circulation. (c) Arrival at intensive care unit (ICU). (d) Four-hours after the admission to ICU. (e) Twenty hours after the admission to ICU. After collection, the samples were immediately used for PLAs measurement by flow cytometry.ResultsA total of 244 patients were registered, and 15 of them were diagnosed with AKI according to the serum creatinine of KDIGO guidelines. The PLAs levels in AKI group were significantly increased 20 h after surgery (two-way repeated measure analysis of variance, p < 0.01) compared with that at baseline. Patients whose preoperative PLAs were higher than 6.8% showed increased risk of developing AKI (multivariate logistic regression; p = 0.01; adjusted odds ratio, 1.05; 95% confidence interval, 1.01–1.09).ConclusionPLAs is an independent risk factor for AKI after valve replacement among patients with rheumatic heart disease.     

Periprocedural effects of statins on the incidence of contrast-induced acute kidney injury: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: The reports on the efficacy of statins for the prevention of contrast-induced acute kidney injury (CIAKI) remain controversial. The objective of this meta-analysis was to assess the effect of statins for the prevention of CIAKI. Methods: Comprehensive literature searches for randomized controlled trials (RCTs) of periprocedural statin treatment for prevention of CIAKI were performed using MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials Systematic Reviews and clinicaltrials.gov from inception until May 2014. The primary outcome was the incidence of CIAKI. Results: Thirteen prospective RCTs were included in our analysis. Of 5803 patients with contrast exposures, 304 patients (5.2%) had CIAKI. Patients in the statin group had an overall lower incidence of CIAKI (3.6%) compared to the control group (6.9%). Intravenous (IV) fluid hydration was used in both groups of all included studies for prevention of CIAKI. There was a significant protective effect of periprocedural statins on the incidence of CIAKI when compared to the control group [risk ratios (RRs): 0.49; 95% CI: 0.37–0.66, I² of 25%]. Conclusions: Our study demonstrates a statistically significant protective effect of statin treatment during procedures with contrast exposures. This finding suggests the use of statins in addition to standard IV crystalloid hydration may be beneficial in the prevention of CIAKI.     

Risk factor for acute kidney injury in patients with chronic kidney disease receiving valve surgery with cardiopulmonary bypass

IntroductionAcute kidney injury (AKI) after cardiopulmonary bypass (CPB) in patients with pre-existing impaired renal function carries deleterious outcomes but is not frequently evaluated. The optimal CPB strategy for preventing AKI in this vulnerable patient group is still controversial.MethodsA total of 156 patients with preoperative estimated glomerular filtration rate (e-GFR) <30 ml/min but not on chronic dialysis receiving valve operation under CPB were included in the present study. Postoperative AKI was defined as KDIGO (Kidney Disease Improving Global Outcomes) stage 3. Hospital mortality and two-year renal function evolution were compared between patients with postoperative AKI and those without AKI. Risk factors for the development of postoperative AKI were also studied.ResultsThe incidence of postoperative KDIGO-3 was high (44.2%). Hospital mortality was higher in the AKI group (30.4%) than in the non-AKI group (8.0%). Among the hospital survivors, renal function deterioration to permanent dialysis at two years was also more common in AKI group (14.5%) than in non-AKI group (4.6%). Univariate logistic regression for postoperative AKI revealed male gender, increased age, height, weight, BSA, and BMI, high preoperative serum creatinine, prolonged CPB duration, and decreased CPB target temperature as risk factors. However, multivariate analysis revealed only high preoperative serum creatinine and decreased CPB target temperature as significant risk factors for postoperative AKI.ConclusionTo prevent postoperative AKI in CKD patients, low CPB target temperature is avoided, especially for those with high preoperative serum creatinine levels.     

Analysis of risk factors for progression of acute kidney injury to acute kidney disease

Objective To investigate the risk factors of clinically diagnosed acute kidney injury (AKI) patients progressing to acute kidney disease (AKD). Methods The clinical data of AKI patients admitted to the First Affiliated Hospital of Zhengzhou University from January 1, 2018 to December 31, 2018 were retrospectively analyzed. According to the outcome of the patients, AKI patients were divided into non-acute kidney disease (NAKD) group and AKD group. Clinical characteristics and laboratory data of two groups were compared. The risk factors of AKD in patients with AKI were analyzed by logistic regression, and then the receiver operating characteristic curve (ROC) was drawn to evaluate the predictive value of these risk factors. Results A total of 254 patients with AKI were enrolled, and 186 patients developed AKD with an incidence of 73.2%. The incidences of AKD in stage 1, stage 2 and stage 3 of AKI were 20.0%, 46.7% and 83.5% respectively. Multivariate logistic regression analysis showed increased peak serum creatinine (within 7 days after AKI diagnosis) (OR=2.561, 95%CI 1.584-4.140, P＜0.001), proteinuria (OR=2.952, 95%CI 1.162-7.500, P=0.023) and increased intact parathyroid hormone (OR=1.757, 95%CI 1.104-2.797, P=0.017) were independent risk factors for progression to AKD in patients with AKI. The ROC showed that increased peak serum creatinine (within 7 days after AKI diagnosis) was an important predictor of AKD in patients with AKI (AUC=0.798, P＜0.001). Conclusion Increased peak serum creatinine (within 7 days after AKI diagnosis), proteinuria and increased intact parathyroid hormone are independent risk factors for progression to AKD in patients with AKI, providing new evidences and ideas for clinical preventions and treatments of AKD.     

Hydroxychloroquine/chloroquine and the risk of acute kidney injury in COVID-19 patients: a systematic review and meta-analysis

ObjectivesHydroxychloroquine/chloroquine has been widely used as part of the standard treatment for patients with coronavirus disease 2019 (COVID-19). We conducted a systematic review and meta-analysis to determine whether hydroxychloroquine/chloroquine increases the risk of acute kidney injury (AKI) in COVID-19 patients.MethodsPubMed and Embase were searched for related publications from inception to Dec 31, 2021, including randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) comparing the risk of AKI and/or increased creatinine in COVID-19 patients receiving hydroxychloroquine/chloroquine and other controls (active treatment and placebo). We conducted separate meta-analyses for RCTs and NRSIs based on fixed-effect model, with odds ratios (ORs) being considered as effect sizes.ResultsWe included 21 studies in the analysis, with 12 were RCTs. Based on the RCTs, compared to placebo, the OR was 1.19 (95% confidence interval [CI]: 0.86, 1.64; p = .30, n = 4, moderate quality) for AKI and 1.00 (95%CI: 0.64, 1.56; p = .99, n = 5, moderate quality) for increased creatinine for patients received hydroxychloroquine/chloroquine treatment; compared to active treatment, the odds was 1.28 (95%CI: 0.65, 2.53; p = .47, n = 2, low quality) for AKI and 0.64 (95%CI: 0.13, 3.20; p = .59, n = 1, low quality) for increased creatine. Evidence from NRSIs showed slightly increased odds of AKI, with low quality.ConclusionBased on current available studies which were graded as low to moderate quality, there is insufficient evidence to conclude that hydroxychloroquine/chloroquine use is associated with increased risk of AKI or raised creatinine. Abbreviations: AKI: acute kidney injury; COVID-19: Coronavirus Disease 2019; RCT: randomized controlled trials; NRSI: non-randomized studies of interventions; OR: odds ratios; ROBIS-I: Risk Of Bias In Non-randomized Studies – of Interventions     

成人心脏外科手术相关急性肾损伤的研究进展

心脏外科手术相关急性肾损伤(CSA-AKI)是临床危重症之一,致病因素和发病机制复杂,是临床医生面临的巨大挑战。目前预防及处理CSA-AKI尚存在很多争议。本文重点介绍CSA-AKI的研究进展。     

Incidence and perioperative risk factors for early acute kidney injury after radical cystectomy and urinary diversion

Background

Early postoperative acute kidney injury (AKI) is associated with increased morbidity and mortality following major surgery. Only few reports exist on postoperative AKI and specifically its risk factors after radical cystectomy (RC) and urinary diversion (UD). We aimed to identify risk factors for AKI in patients undergoing RC and UD.

Incidence and risk factors of acute kidney injury in COVID-19 patients with and without acute respiratory distress syndrome (ARDS) during the first wave of COVID-19: a systematic review and Meta-Analysis

BackgroundAcute kidney injury (AKI) is common among patients with COVID-19. However, AKI incidence may increase when COVID-19 patients develop acute respiratory distress syndrome (ARDS). Thus, this systematic review and meta-analysis aimed to assess the incidence and risk factors of AKI, need for kidney replacement therapy (KRT), and mortality rate among COVID-19 patients with and without ARDS from the first wave of COVID-19.MethodsThe databases MEDLINE and EMBASE were searched using relevant keywords. Only articles available in English published between December 1, 2019, and November 1, 2020, were included. Studies that included AKI in COVID-19 patients with or without ARDS were included. Meta-analyses were conducted using random-effects models.ResultsOut of 618 studies identified and screened, 31 studies met the inclusion criteria. A total of 27,500 patients with confirmed COVID-19 were included. The overall incidence of AKI in patients with COVID-19 was 26% (95% CI 19% to 33%). The incidence of AKI was significantly higher among COVID-19 patients with ARDS than COVID-19 patients without ARDS (59% vs. 6%, p < 0.001). Comparing ARDS with non-ARDS COVID-19 cohorts, the need for KRT was also higher in ARDS cohorts (20% vs. 1%). The mortality among COVID-19 patients with AKI was significantly higher (Risk ratio = 4.46; 95% CI 3.31–6; p < 0.00001) than patients without AKI.ConclusionThis study shows that ARDS development in COVID-19-patients leads to a higher incidence of AKI and increased mortality rate. Therefore, healthcare providers should be aware of kidney dysfunction, especially among elderly patients with multiple comorbidities. Early kidney function assessment and treatments are vital in COVID-19 patients with ARDS.     

肝切除术中肾脏局部氧饱和度与术后急性肾损伤的相关性

目的 应用近红外光谱技术（NIRS）监测肝切除术中肾脏局部氧饱和度（rSKO₂）的变化，评估其与术后急性肾损伤（AKI）的相关性。
方法 选择2020年9月至2021年10月择期在全麻下行开腹肝切除术的患者99例，男77例，女22例，年龄60～80岁，BMI 18～30 kg/m²，ASA Ⅱ或Ⅲ级。根据改善全球肾脏病预后（KDIGO）标准判断术后7 d内是否发生AKI，并将患者分为两组：AKI组和非AKI组。记录基础值（T₀）、麻醉诱导即刻（T₁）、手术开始即刻（T₂）、肝门阻断即刻（T₃）、肝门阻断后5 min（T₄）、10 min（T₅）、肝门开放即刻（T₆）、肝门开放后10 min（T₇）、20 min（T₈）、30 min（T₉）、手术结束时（T₁₀）的rSKO₂。记录肝门阻断时间、液体输注量、出血量等术中情况。采用单因素和多因素Logistic回归分析术中rSKO₂与AKI的相关性。
结果 术后7 d内有16例（16%）患者发生AKI。与AKI组比较，非AKI组T₁、T₃—T₇、T₉、T₁₀时rSKO₂水平明显升高（P＜0.05）。术中rSKO₂绝对值低于70%（OR=3.87，95%CI 1.17~15.37，P＜0.05）或下降幅度大于基础值的20%（OR=4.96，95%CI 1.53~18.66，P＜0.05）与术后AKI发生呈正相关。
结论 术中rSKO₂下降与术后AKI发生呈正相关，NIRS监测rSKO₂可以较好地反映患者术中肾脏氧供需状态。     

根治性肾切除术后发生急性肾功能不全的危险因素分析

目的:探讨根治性肾切除术后患者发生急性肾功能不全(AKI)的危险因素。方法:回顾性分析2013年2月至2017年9月因肾细胞癌于复旦大学附属中山医院行根治性肾切除术的920例患者的临床资料,男612例,女308例。中位年龄60(20~75)岁。伴高血压病313例(34.0%),糖尿病132例(14.3%)。有吸烟史111例(12.1%)。术前肾功能分期1~2期829例(90.1%),3~5期91例(9.9%)。术前血红蛋白低于正常值下限391例(42.5%),白细胞计数升高66例(7.2%),血小板计数升高72例(7.8%)。白蛋白低于正常值下限65例(7.1%),乳酸脱氢酶升高73例(7.9%)。尿素氮升高48例(5.2%),尿酸升高123例(13.4%),尿蛋白阳性88例(9.7%)。所有患者均行根治性肾切除术,其中开放手术496例(53.9%),腹腔镜手术424例(46.1%)。随访患者术后48 h内血肌酐变化情况。根据KDIGO标准定义AKI,采用logistic回归分析患者术后发生2~3期AKI的危险因素。结果:本组920例患者住院期间发生1~3期AKI分别为627例(68.2%)、42例(4.6%)和10例(1.1%)。单因素分析结果显示糖尿病(OR=2.34,P=0.01)、尿蛋白阳性(OR=2.22,P=0.04)、白细胞计数升高(OR=2.54,P=0.02)与术后发生2~3期AKI显著相关,多因素logistic回归分析结果显示糖尿病(OR=2.51,P=0.01)和白细胞计数升高(OR=2.69,P=0.02)为术后发生2~3期AKI的独立危险因素。结论:患有糖尿病及术前白细胞计数升高的肾癌患者行根治性肾切除术后更容易发生2~3期AKI。     

老年患者胃肠道肿瘤术后急性肾损伤的危险因素

目的 分析老年患者胃肠道肿瘤术后急性肾损伤（AKI）的危险因素。
方法 回顾性收集2018年9月至2021年12月行胃肠道肿瘤手术的老年患者343例，男251例，女92例，年龄65～85岁，ASA Ⅰ—Ⅲ级。根据术后是否发生AKI分为两组：AKI组（n=63）和非AKI组（n=280）。查阅电子病历系统收集年龄、心功能分级、高血压、糖尿病、冠心病、低蛋白血症、术前1周贫血程度，手术类型、术前肌酐、肾小球滤过率、尿酸和尿素氮水平、术中和术后转归等情况。单因素分析后将P<0.1的变量纳入二元逻辑回归进行多因素分析，筛选AKI的独立预测因素并建立风险预测模型，通过Medcalr软件绘制受试者工作特征（ROC）曲线。
结果 有63例（18.4%）患者发生术后AKI。单因素分析结果显示，与非AKI组比较，AKI组年龄明显增大，心功能分级明显升高，术前高血压、糖尿病、冠心病、低蛋白血症、轻中度贫血比例明显升高（P<0.1）。多因素Logistic回归分析显示，术前高血压（OR=2.119，95%CI 1.181～3.800，P=0.012）、冠心病（OR=2.931，95%CI 1.024～8.386，P=0.045）、低蛋白血症（OR=2.640，95%CI 1.107～6.295，P=0.029）、轻度贫血（OR=3.890，95%CI 1.922～7.875，P<0.001）、中度贫血（OR=3.089，95%CI 1.437～6.637，P=0.004）为术后AKI的独立危险因素，最后根据各独立预测因素建立术后AKI的风险预测模型ROC曲线下面积为0.740（95%CI 0.690～0.785，P<0.001），敏感性为79.4%，特异性为56.1%。
结论 术前存在高血压、冠心病、低蛋白血症、轻中度贫血为胃肠道肿瘤手术老年患者术后AKI的独立危险因素。