scholarly journals Acute kidney injury (AKI) in patients with Covid-19 infection is associated with ventilatory management with elevated positive end-expiratory pressure (PEEP)

2021 ◽  
Author(s):  
Davide Ottolina ◽  
Luca Zazzeron ◽  
Letizia Trevisi ◽  
Andrea Agarossi ◽  
Riccardo Colombo ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Distress Syndrome ◽  
Clinical Course ◽  
Kidney Injury ◽  
High Peep ◽  
Positive End Expiratory Pressure ◽  
Icu Patients ◽  
Factors Associated ◽  
Ventilatory Management ◽  
Overall Mortality

Abstract Background Acute kidney injury (AKI) in Covid-19 patients admitted to the intensive care unit (ICU) is common, and its severity may be associated with unfavorable outcomes. Severe Covid-19 fulfills the diagnostic criteria for acute respiratory distress syndrome (ARDS); however, it is unclear whether there is any relationship between ventilatory management and AKI development in Covid-19 ICU patients. Purpose To describe the clinical course and outcomes of Covid-19 ICU patients, focusing on ventilatory management and factors associated with AKI development. Methods Single-center, retrospective observational study, which assessed AKI incidence in Covid-19 ICU patients divided by positive end expiratory pressure (PEEP) tertiles, with median levels of 9.6 (low), 12.0 (medium), and 14.7 cmH2O (high-PEEP). Results Overall mortality was 51.5%. AKI (KDIGO stage 2 or 3) occurred in 38% of 101 patients. Among the AKI patients, 19 (53%) required continuous renal replacement therapy (CRRT). In AKI patients, mortality was significantly higher versus non-AKI (81% vs. 33%, p < 0.0001). The incidence of AKI in low-, medium-, or high-PEEP patients were 16%, 38%, and 59%, respectively (p = 0.002). In a multivariate analysis, high-PEEP patients showed a higher risk of developing AKI than low-PEEP patients (OR = 4.96 [1.1–21.9] 95% CI p < 0.05). ICU mortality rate was higher in high-PEEP patients, compared to medium-PEEP or low-PEEP patients (69% vs. 44% and 42%, respectively; p = 0.057). Conclusion The use of high PEEP in Covid-19 ICU patients is associated with a fivefold higher risk of AKI, leading to higher mortality. The cause and effect relationship needs further analysis. Graphic abstract

scholarly journals Factors associated with acute kidney injury in acute respiratory distress syndrome

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Anupol Panitchote ◽  
Omar Mehkri ◽  
Andrei Hastings ◽  
Tarik Hanane ◽  
Sevag Demirjian ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Kidney Injury ◽  
Factors Associated

scholarly journals P0309IMPACT OF ACUTE KIDNEY INJURY ON CLINICAL COURSE AND TREATMENT RESPONSE IN PATIENTS WITH MINIMAL CHANGE NEPHROTIC SYNDROME

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hiroki Okushima ◽  
Yukimasa Iwata ◽  
Taisuke Takatsuka ◽  
Daisuke Yoshimura ◽  
Tomohiro Kawamura ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Nephrotic Syndrome ◽  
Proportional Hazards ◽  
Clinical Course ◽  
Kidney Injury ◽  
Minimal Change Nephrotic Syndrome ◽  
Cox Proportional Hazards ◽  
Minimal Change ◽  
Factors Associated ◽  
The Mean

Abstract Background and Aims Minimal change nephrotic syndrome (MCNS) has acute onset and is occasionally complicated with acute kidney injury (AKI) in its clinical course. Few studies concerning factors associated with AKI and impact of AKI on clinical course and response to treatments are available to date. Thus, we assessed the prevalence of and factors associated with AKI and its effect on clinical course in MCNS patients. Method Single center retrospective cohort study was conducted on 72 biopsy-proven MCNS patients presented to Osaka General Medical Center, between January 2006 and December 2016. Multivariate logistic regression analysis and Cox proportional hazards analysis were used to assess contributing factors to AKI and its effect on the duration until remission. Results Median age was 58 years and 50% were male. At first presentation, the mean albumin and total cholesterol were 1.7±0.5g/dl and 402±118mg/dl, respectively. The mean urinary protein and eGFR were 12.8±8.2g/gCr and 60.1±29.4ml/min/1.73m2, respectively. A total of 29 patients (40%) had AKI and 10 of them needed renal replacement therapy (RRT). Corticosteroid and cyclosporine A were used in 66 (91%) and 3 (4%) patients, respectively for initial treatment and 3 patients (4%) received neither. 67 patients (93%) achieved complete remission (CR) with a median duration of 18 days after treatment, while 20 of those relapsed during the median follow-up period of 38 months. Logistic regression analysis revealed that older age, lower albumin, and higher urinary protein were significantly associated with AKI. Furthermore, patients with AKI had longer duration to CR induction compared with those without AKI (Log-rank test: p=0.03). Cox proportional hazards analysis showed that older age and RRT induction were associated with the delay of CR. Conclusion AKI occasionally occurs in patients with MCNS and need for RRT is associated with the delay of CR.

scholarly journals Mortality and associated risk factors in patients with blood culture positive sepsis and acute kidney injury requiring continuous renal replacement therapy—A retrospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249561
Author(s):  
Mikko J. Järvisalo ◽  
Tapio Hellman ◽  
Panu Uusalo
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Blood Culture ◽  
Continuous Renal Replacement Therapy ◽  
Kidney Injury ◽  
Icu Mortality ◽  
Factors Associated ◽  
Culture Positive ◽  
Overall Mortality

Objectives Septic acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) carries a mortality risk nearing 50%. Risk factors associated with mortality in AKI patients undergoing CRRT with blood culture positive sepsis remain unclear as sepsis has been defined according to consensus criteria in previous studies. Methods Risk factors associated with intensive care unit (ICU), 90-day and overall mortality were studied in a retrospective cohort of 126 patients with blood culture positive sepsis and coincident severe AKI requiring CRRT. Comprehensive laboratory and clinical data were gathered at ICU admission and CRRT initiation. Results 38 different causative pathogens for sepsis and associated AKI were identified. ICU mortality was 30%, 90-day mortality 45% and one-year mortality 50%. Immunosuppression, history of heart failure, APACHE II and SAPS II scores, C-reactive protein and lactate at CRRT initiation were independently associated with mortality in multivariable Cox proportional hazards models. Blood lactate showed good predictive power for ICU mortality in receiver operating characteristic curve analyses with AUCs of 0.76 (95%CI 0.66–0.85) for lactate at ICU admission and 0.84 (95%CI 0.72–0.95) at CRRT initiation. Conclusions Our study shows for the first time that lactate measured at CRRT initiation is predictive of ICU mortality and independently associated with overall mortality in patients with blood culture positive sepsis and AKI requiring CRRT. Microbial etiology for septic AKI requiring CRRT is diverse.

scholarly journals Frailty status among older critically ill patients with severe acute kidney injury

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
William Beaubien-Souligny ◽  
Alan Yang ◽  
Gerald Lebovic ◽  
Ron Wald ◽  
Sean M. Bagshaw
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Frailty Scale ◽  
Factors Associated ◽  
Frailty Status ◽  
Physiological Variables

Abstract Background Frailty status among critically ill patients with acute kidney injury (AKI) is not well described despite its importance for prognostication and informed decision-making on life-sustaining therapies. In this study, we aim to describe the epidemiology of frailty in a cohort of older critically ill patients with severe AKI, the outcomes of patients with pre-existing frailty before AKI and the factors associated with a worsening frailty status among survivors. Methods This was a secondary analysis of a prospective multicentre observational study that enrolled older (age > 65 years) critically ill patients with AKI. The clinical frailty scale (CFS) score was captured at baseline, at 6 months and at 12 months among survivors. Frailty was defined as a CFS score of ≥ 5. Demographic, clinical and physiological variables associated with frailty as baseline were described. Multivariable Cox proportional hazard models were constructed to describe the association between frailty and 90-day mortality. Demographic and clinical factors associated with worsening frailty status at 6 months and 12 months were described using multivariable logistic regression analysis and multistate models. Results Among the 462 patients in our cohort, median (IQR) baseline CFS score was 4 (3–5), with 141 (31%) patients considered frail. Pre-existing frailty was associated with greater hazard of 90-day mortality (59% (n = 83) for frail vs. 31% (n = 100) for non-frail; adjusted hazards ratio [HR] 1.49; 95% CI 1.11–2.01, p = 0.008). At 6 months, 68 patients (28% of survivors) were frail. Of these, 57% (n = 39) were not classified as frail at baseline. Between 6 and 12 months of follow-up, 9 (4% of survivors) patients transitioned from a frail to a not frail status while 10 (4% of survivors) patients became frail and 11 (5% of survivors) patients died. In multivariable analysis, age was independently associated with worsening CFS score from baseline to 6 months (adjusted odds ratio [OR] 1.08; 95% CI 1.03–1.13, p = 0.003). Conclusions Pre-existing frailty is an independent risk factor for mortality among older critically ill patients with severe AKI. A substantial proportion of survivors experience declining function and worsened frailty status within one year.

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