Acute kidney injury is under‐recognised and under‐reported in hospitalised patients in Australia

Acute kidney injury (AKI) in hospitalised patients is associated with adverse outcomes; however, it remains unrecognised and under‐reported. A total of 48 045 serum creatinine results from 8129 tertiary hospital inpatients were reviewed. The prevalence of AKI was 4.33%. Mortality was significantly higher in patients with AKI (16.76%) compared to those without AKI (1.88%, P < 0.001). Documentation of AKI in discharge summaries was poor.     

Risk factors for acute kidney injury in critically ill patients with torso injury: A retrospective observational single-center study

Acute kidney injury (AKI) is common in trauma patients and associated with poor outcomes. Identifying AKI risk factors in trauma patients is important for risk stratification and provision of optimal intensive care unit (ICU) treatment. This study identified AKI risk factors in patients admitted to critical care after sustaining torso injuries.We performed a retrospective chart review involving 380 patients who sustained torso injuries from January 2016 to December 2019. Patients were included if they were aged >15 years, admitted to an ICU, survived for >48 hours, and had thoracic and/or abdominal injuries and no end-stage renal disease. AKI was defined according to the Kidney Disease Improving Global Outcomes definition and staging system. Clinical and laboratory variables were compared between the AKI and non-AKI groups (n = 72 and 308, respectively). AKI risk factors were assessed using multivariate logistic regression analysis.AKI occurred in 72 (18.9%) patients and was associated with higher mortality than non-AKI patients (26% vs 4%, P < .001). Multivariate logistic regression analysis identified bowel injury, cumulative fluid balance >2.5 L for 24 hours, lactate levels, and vasopressor use (adjusted odds ratio: 2.953, 2.058, 1.170, and 2.910; 95% confidence interval: 1.410–6.181, 1.017–4.164, 1.019–1.343, and 1.414–5.987; P = .004, .045, .026, and .004, respectively) as independent risk factors for AKI.AKI in patients admitted to the ICU with torso injury had a substantial mortality. Recognizing risk factors at an early stage could aid risk stratification and provision of optimal ICU care.     

Prevalence and short‐term outcome of acute kidney injury in patients with acute‐on‐chronic liver failure: A meta‐analysis

Acute kidney injury (AKI) in patients with acute‐on‐chronic liver failure (ACLF) is a distinct syndrome to that in patients with cirrhosis, yet is less characterized. The aim of this meta‐analysis was to investigate the impact of AKI on outcome of ACLF. We searched PubMed, Web of Science and Cochrane Library for original articles that evaluated the impact of AKI on outcome of ACLF from 2011 to 2019. Odds ratio (OR) with 95% confidence interval (CI) for 1‐month and 3‐month mortality was calculated. The response rate of vasoconstrictor for hepatorenal syndrome (HRS)‐AKI was assessed. Eight relevant articles with 3610 patients were included. The prevalence of AKI in ACLF patients was 41% (95% CI 32%‐50%). The presence of AKI was significantly associated with 1‐month mortality of ACLF (OR 3.98, 95% CI 3.09‐5.12; P < .001) and 3‐month mortality (OR 4.98, 95% CI 3.59‐6.92; P < .001). Additionally, patients with AKI stage ≥2 showed a higher 3‐month mortality than stage 1 (OR 3.89, 95% CI 2.60‐5.82; P < .001), and those of stage 3 had a higher mortality than stage ≤2 (OR 3.77, 95% CI 2.10‐6.77; P < .001). The pooled response rate of vasoconstrictors was 32% (95% CI 26%‐37%). This meta‐analysis indicated that about 40% of ACLF patients complicated with AKI and the presence of AKI substantially increased the short‐term mortality, together with a poor response rate of vasoconstrictors for HRS‐AKI.     

Clinical characteristics and long‐term outcome of acute kidney injury in patients with HBV‐related acute‐on‐chronic liver failure

Acute kidney injury (AKI) is a common complication in patients with decompensated cirrhosis and is also an important cause for poor outcome. This study aimed at investigating the clinical characteristics and long‐term prognosis of AKI in patients with hepatitis B virus (HBV)‐related acute‐on‐chronic liver failure (ACLF). A total of 1167 patients with HBV‐related ACLF from January 2010 to January 2015 were enrolled and divided into two groups, AKI group (n=308) and non‐AKI group (n=859). All patients were followed up to investigate clinical characteristics, long‐term overall survival (OS) and risk factors. AKI occurrence was found to be 26.4% in patients with HBV‐related ACLF. The patients in the AKI group and the non‐AKI group had a 30‐day OS of 44.8% and 70.3%, 90‐day OS of 17.9% and 55.4%, and 1‐year OS of 15.6% and 51.2%, respectively. Significant differences were observed in the 30‐day, 90‐day and 1‐year OS among subgroups with different AKI stages. It was found that high WBC, neutrophil, ALT and MELD score were risk factors for 30‐day mortality, whereas hepatic encephalopathy, high MELD score, mean arterial pressure and PLT were risk factors for 90‐day mortality. Two criteria, the KDIGO and AKIN, showed parallel results in staging AKI in patients with HBV‐related ACLF (κ=0.807, P<.001). AKI is closely associated with increased short‐term mortality in Chinese HBV‐related ACLF patients, particularly in those with infection and high MELD score. Both KDIGO and AKIN criteria can be used for staging AKI in patients with HBV‐related ACLF.     

Acute kidney injury after percutaneous coronary intervention: Rationale of the AKI‐MATRIX (acute kidney injury‐minimizing adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX) sub‐study

Acute kidney injury (AKI) is an important complication of both diagnostic cardiac catheterization and percutaneous coronary intervention (PCI). A large body of evidence supports that AKI is related to volume of contrast used. Despite several measures are available to reduce the impact of contrast media on AKI, its incidence remains significant as other mechanisms of renal damage are involved. A new paradigm is established according to which bleeding prevention is at least as important as preventing recurrent ischemic events in the management of patients with acute coronary syndromes (ACS) undergoing an invasive approach. Periprocedural bleeding, which is consistently reduced by radial approach, is emerging as a risk factor for the development of AKI. Therefore, the role of vascular access as a measure to prevent AKI needs to be systematically assessed in randomized studies. To date, no prospective comparison on renal outcomes has been carried out in randomized trials between radial and femoral approach. The M inimizing A dverse hemorrhagic events by TR ansradial access site and systemic I mplementation of Angio X (MATRIX) trial (ClinicalTrials.gov identifier: NCT01433627) has been designed to test whether to minimize bleeding events by using radial access and bivalirudin, across the whole spectrum of patients with ACS undergoing PCI, will result in improved outcomes with respect to both ischemic and bleeding complications. The AKI‐MATRIX sub‐study will provide a unique opportunity to assess whether the advantages of radial approach may even contribute to the reduction of the risk of AKI in patients with ACS. © 2015 Wiley Periodicals, Inc.     

Acute kidney injury in acute liver failure: a review

Acute liver failure is a rare and often devastating condition consequent on massive liver cell necrosis that frequently affects young, previously healthy individuals resulting in altered cognitive function, coagulopathy and peripheral vasodilation. These patients frequently develop concurrent acute kidney injury (AKI). This abrupt and sustained decline in renal function, through a number of pathogenic mechanisms such as renal hypoperfusion, direct drug-induced nephrotoxicity or sepsis/systemic inflammatory response contributes to increased morbidity and is strongly associated with a worse prognosis. Improved understanding of the pathophysiology AKI in the context of acute liver failure may be beneficial in a number of areas; the development of new and sensitive biomarkers of renal dysfunction, refining prognosis and organ allocation, and ultimately leading to the development of novel treatment strategies, these issues are discussed in more detail in this expert review.     

Serum cystatin C is a potential predictor of short-term mortality and acute kidney injury in acute aortic dissection patients: a retrospective cohort study

BackgroundSerum cystatin C concentration is associated with cardiovascular disease. However, the relationship between cystatin C and acute aortic dissection (AAD) remains unclear. In the current study, we aim to evaluate the predictive value of cystatin C in the occurrence of acute kidney injury (AKI) and the prognosis of AAD patients.MethodsThe patients with AAD admitted to our hospital from November 2019 through January 2022 were consecutively included in the retrospective cohort study. A complete blood cell count, serum biochemistry tests, including cystatin C and creatinine, in-hospital mortality and the incidence of AKI were recorded. All the patients were categorized into four groups according to the quartile of their serum cystatin C levels. Multivariate logistic and Cox regression analyses were conducted to determine the independent risk factors for the incidence of AKI and the prognosis of AAD patients, respectively. Kaplan-Meier analyses and log-rank tests were used to evaluate differences in survival. Receiver operating characteristic (ROC) curves were used to assess the predictive value of cystatin C for short-term mortality and the incidence of AKI in AAD patients.ResultsA total of 357 patients were included in this study. The results showed that the higher the concentration of cystatin C, the higher the level of serum creatinine and the higher the incidence of AKI. Mortality was significantly higher in the group with serum cystatin C levels >1.18 mg/L. Type A AAD, white blood cell count >10×10⁹/L, platelet count <100×10⁹/L, and serum cystatin C concentration >1.18 mg/L [adjusted hazards ratio (HR) =2.405, 95% confidence interval (CI), 1.029–4.063, P=0.041] were independent risk factors for in-hospital mortality. Cystatin C levels >1.18 mg/L remained an independent predictor of AKI in AAD after adjusting for the confounding [odds ratio (OR) 76.489, 95% CI, 25.586–228.660]. The areas under the ROC curves of cystatin C in predicting the mortality and incidence of AKI in AAD patients were 0.655 (95% CI, 0.551–0.760) and 0.807 (95% CI, 0.758–0.856), respectively.ConclusionsIn sum, serum cystatin C concentration is a potential predictor of short-term mortality and the incidence of AKI in AAD patients.     

Postoperative acute kidney injury and early and long-term mortality in acute aortic dissection patients: A meta-analysis

Objective:To evaluate the impact of postoperative acute kidney injury (AKI) on early and long-term mortality in patients with acute aortic dissection by conducting a meta-analysis.Methods:An extensive literature search was performed in PubMed and Embase databases until February 15, 2020. Observational studies that reported the associations between postoperative AKI and early (in-hospital and within 30 days) or long-term mortality in patients with acute aortic dissection were included.Results:Seven studies comprising 1525 acute aortic dissection patients were identified. A random effect meta-analysis showed that postoperative AKI was significantly associated with higher risk of long-term mortality (risk ratio [RR] 2.32; 95% confidence interval [CI] 1.50–3.59). Subgroup analysis revealed that the pooled RR of long-term mortality was 1.42 (95% CI 0.90–2.22) for stage 1 AKI, 1.72 (95% CI 0.95–3.12) for stage 2 AKI, and 4.46 (95% CI 2.72–7.32) for stage 3 AKI, respectively. Furthermore, postoperative stage 3 AKI was associated with an increased risk of early mortality (RR 11.3; 95% CI 4.2–30.5).Conclusions:This meta-analysis provided clinical evidence that postoperative stage 3 AKI is associated with higher risk of early and long-term mortality, even after adjusting important confounding factors. However, the current findings should be interpreted with caution due to the retrospective nature and limited number of studies analyzed.     

肝移植术后患者急性肾损伤危险因素及严重程度分析

目的分析肝移植术后患者急性肾损伤(acute kidney injury, AKI)的危险因素及AKI严重程度的影响因素。方法收集2005年1月—2015年8月在我中心进行肝移植手术患者,排除术前AKI患者,共入组469例,对该组患者术前、术中、术后影响AKI的危险因素及术后4周时的转归进行分析、研究。结果 469例患者中,术后发生AKI者274例(AKI组),无AKI者195例(非AKI组),发病率为58.4%。受体身体质量指数(body mass index, BMI)、术前肌酐水平、冷缺血时间、手术时间、下腔静脉阻断时间、术后乳酸峰值、术后AST峰值等均是发生AKI的危险因素。术后4周AKI组20.4%患者肾功能仍然异常,病死率为3.6%,较非AKI组明显升高(P=0.027)。结论肝移植术后发生AKI的影响因素较多,受体BMI、术前肌酐水平、阻断下腔静脉时间、手术时间、术后乳酸峰值、术后AST峰值均是发生AKI的独立危险因素。术后4周AKI组患者肾功能异常及病死率较非AKI组均明显升高。