scholarly journals Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation

2019 ◽  
Vol 37 (03) ◽  
pp. 341-348 ◽  
Author(s):  
Michelle C. Starr ◽  
Louis Boohaker ◽  
Laurie C. Eldredge ◽  
Shina Menon ◽  
Russell Griffin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Gestational Age ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Multiple Factors

Abstract Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA). Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality. Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001). Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.

scholarly journals Incidence of Acute Kidney Injury Among Infants in the Neonatal Intensive Care Unit Receiving Vancomycin With Either Piperacillin/Tazobactam or Cefepime

2020 ◽  
Vol 25 (6) ◽  
pp. 521-527
Author(s):  
Jenna W. Bartlett ◽  
Jessica Gillon ◽  
Jennifer Hale ◽  
Natalia Jimenez-Truque ◽  
Ritu Banerjee
Keyword(s):  
Acute Kidney Injury ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Baseline Characteristics ◽  
Clinically Significant ◽  
Gestational Age At Birth ◽  
Age At Birth

OBJECTIVES To determine whether combination therapy with vancomycin and TZP is associated with a higher incidence of acute kidney injury (AKI) compared with vancomycin with cefepime in infants admitted to the NICU. METHODS This retrospective cohort study included infants in the NICU who received vancomycin/cefepime or vancomycin/TZP for at least 48 hours. The primary outcome was incidence of AKI, which was defined by the neonatal modified Kidney Disease Improving Global Outcomes AKI criteria. RESULTS Forty-two infants who received vancomycin with cefepime and 58 infants who received vancomycin with TZP were included in the analysis. The median gestational age at birth, birth weight, and dosing weight were lower in the TZP group, but other baseline characteristics were comparable, including corrected gestational age. Two patients (3%) receiving vancomycin/TZP versus 2 patients (5%) receiving vancomycin/cefepime met criteria for AKI during their antibiotic course (p = 1.00). There were no clinically significant changes in serum creatinine or urine output from baseline to the end of combination antibiotic treatment in either group. CONCLUSIONS Among infants admitted to our NICU, AKI incidence associated with vancomycin and either TZP or cefepime therapy was low and did not differ by antibiotic combination.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Incidence of Acute Kidney Injury in Critically Ill Patients Receiving Vancomycin with Concomitant Piperacillin-Tazobactam, Cefepime, or Meropenem

2019 ◽  
Vol 63 (5) ◽  
Author(s):  
Adam M. Blevins ◽  
Jennifer N. Lashinsky ◽  
Craig McCammon ◽  
Marin Kollef ◽  
Scott Micek ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Independent Predictor ◽  
Kidney Injury ◽  
University Hospital ◽  
Increased Risk ◽  
Kdigo Guidelines

ABSTRACT Critically ill patients are frequently treated with empirical antibiotic therapy, including vancomycin and β-lactams. Recent evidence suggests an increased risk of acute kidney injury (AKI) in patients who received a combination of vancomycin and piperacillin-tazobactam (VPT) compared with patients who received vancomycin alone or vancomycin in combination with cefepime (VC) or meropenem (VM), but most studies were conducted predominately in the non-critically ill population. A retrospective cohort study that included 2,492 patients was conducted in the intensive care units of a large university hospital with the primary outcome being the development of any AKI. The rates of any AKI, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, were 39.3% for VPT patients, 24.2% for VC patients, and 23.5% for VM patients (P < 0.0001 for both comparisons). Similarly, the incidences of stage 2 and stage 3 AKI were also significantly higher for VPT patients than for the patients in the other groups. The rates of stage 2 and stage 3 AKI, respectively, were 15% and 6.6% for VPT patients, 5.8% and 1.8% for VC patients, and 6.6% and 1.3% for VM patients (P < 0.0001 for both comparisons). In multivariate analysis, the use of vancomycin in combination with piperacillin-tazobactam was found to be an independent predictor of AKI (odds ratio [OR], 2.161; 95% confidence interval [CI], 1.620 to 2.883). In conclusion, critically ill patients receiving the combination of VPT had the highest incidence of AKI compared to critically ill patients receiving either VC or VM.

scholarly journals FC 050THE PREDICTIVE ABILITY OF URINARY BIOMARKERS FOR PROGRESSION OF ACUTE KIDNEY INJURY IN CRITICAL ILLNESS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Stephen Duff ◽  
Ruairi Irwin ◽  
Jean Maxime Cote ◽  
Peter Doran ◽  
Patrick Murray
Keyword(s):  
Acute Kidney Injury ◽  
Roc Analysis ◽  
Primary Outcome ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Urinary Biomarkers ◽  
High Morbidity ◽  
Odds Ratios ◽  
Clinical Model ◽  
Icu Admission

Abstract Background and Aims Acute Kidney Injury (AKI) is a common hospital complication associated with high morbidity, mortality and the risk of progression to CKD. Despite globally increasing rates of AKI and a shortage of critical care beds, clinicians currently lack the tools to predict progression of early AKI. The Dublin Acute Biomarker Group Evaluation (DAMAGE) Study is a prospective multi-center observational study with a heterogenous cohort of critically ill patients (n= 717). We hypothesised that a panel of 14 novel urinary biomarkers would predict progression of AKI. Method Biomarker values were measured daily for 7 days from ICU admission, including on the day of Stage 1-2 AKI diagnoses occurring within 48 hours of ICU admission. The primary outcome was progression to the composite outcome of increased AKI KDIGO Stage, Renal Replacement Therapy (RRT) or Death within 7 days of ICU admission. AUC-ROC values and adjusted Odds Ratios were calculated using multivariate logistic regression, and the additional value of biomarkers over the clinical model (serum creatinine and urine output at time of diagnosis) was assessed. In a secondary analysis,all AKI events within 7 days (including those diagnosed at Stage 3, and/or on days 3-7) were included, with the endpoint of progression to RRT/Death within 30 days of ICU admission. Results AKI developed in 268 patients (37%) within 7 days of ICU admission. 95 patients were diagnosed with AKI at Stage 1or2 AKI within 48 hours, of whom 32 (33.7%) progressed to the primary outcome. Adjusted odds ratios for the prediction of AKI progression were significantly higher for the highest tertile, versus the lowest, of eight biomarkers including uCystatin C (OR 5.2, 95% CI; 1.3-23.6), uAlbumin (OR 4.9, 95% CI; 1.5-18.3), uNGAL (OR 4.6, 95% CI; 1.4-17.9) and uIGFBP-7 (OR 4.7, 95% CI; 1.2-21.5). LFABP-1, KIM-1, IL-18 and Alpha-1-M also significantly improved prediction (Table 1). In ROC analysis of the primary outcome, uCystatin C (AUC 0.75, 95% CI; 0.63-0.87), uNGAL (AUC 0.72, 95% CI;0.61-0.84), uAlbumin (AUC 0.70, 95% CI; 0.59-0.82) and IL-18 (AUC 0.70, 95% CI; 0.58-0.82) had moderate accuracy; the others did not. Conclusion In this cohort study of AKI progression within 7 days of ICU admission, eight novel urinary biomarkers improved the prediction of AKI progression after multivariate adjustment. Similarly, ROC analysis found that several biomarkers had moderate accuracy for the prediction of AKI progression in the ICU.

Short Versus Extended Duration Vancomycin and Piperacillin/Tazobactam and the Incidence of Acute Kidney Injury in Noncritically Ill Patients

2020 ◽  
pp. 089719002093348
Author(s):  
Alfredo Traversa ◽  
Drayton A. Hammond ◽  
Gary D. Peksa ◽  
Joshua M. DeMott
Keyword(s):  
Acute Kidney Injury ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Continuous Data ◽  
Nominal Data ◽  
Short Course ◽  
Extended Duration ◽  
Short Courses ◽  
Extended Course

Background: Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used empiric combination of antimicrobials. Recently, studies have demonstrated an increase in acute kidney injury (AKI) associated with combination therapy of VPT. However, the majority of studies required patients to be on VPT for a minimum of 48 to 72 hours to be considered for inclusion and had extended treatment durations longer than most empiric, short course regimens. Objective: To assess the incidence of AKI in noncritically ill patients being treated with VPT for short-courses (24 to 60 hours) compared to patients receiving extended-courses (72 hours to 7 days). Methods: This was a retrospective cohort study comparing the incidence of AKI in noncritically ill patients receiving VPT for short and extended durations between January 2016 and August 2018. Fishers exact tests were used for differences in nominal data between groups and Mann-Whitney U tests were used for continuous data. Results: Of the 2567 screened, 154 patients were included in the short-course group and 106 were included in the extended-course group. The incidence of AKI for patients in the short-course group was 12% (19/154) versus 26% (28/106) in the extended-course group (odds ratio: 2.55, 95% CI: 1.33-4.87; P = .004). Conclusion: In noncritically ill patients, a short-course of VPT experienced less AKI compared to an extended-course. Clinicians should continue to practice strict antimicrobial stewardship for VPT therapies expected to continue beyond 72 hours.

scholarly journals Genetic polymorphisms of heme-oxygenase 1 (HO-1) may impact on acute kidney injury, bronchopulmonary dysplasia, and mortality in premature infants

2015 ◽  
Vol 77 (6) ◽  
pp. 793-798 ◽  
Author(s):  
David J. Askenazi ◽  
Brian Halloran ◽  
Neha Patil ◽  
Susan Keeling ◽  
Behtash Saeidi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Genetic Polymorphisms ◽  
Bronchopulmonary Dysplasia ◽  
Heme Oxygenase ◽  
Premature Infants ◽  
Kidney Injury ◽  
Heme Oxygenase 1

scholarly journals Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants

2015 ◽  
Vol 30 (9) ◽  
pp. 1511-1518 ◽  
Author(s):  
David Askenazi ◽  
Neha R. Patil ◽  
Namasivayam Ambalavanan ◽  
Jessica Balena-Borneman ◽  
David J. Lozano ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Bronchopulmonary Dysplasia ◽  
Premature Infants ◽  
Kidney Injury

scholarly journals Association between recovered acute kidney injury within 48hours and mortality in patients following coronary angiography: a cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Q Li ◽  
S Q Chen ◽  
H Z Huang ◽  
L W Liu ◽  
W H Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Odds Ratio ◽  
Baseline Level ◽  
Primary Outcome ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Funding Sources ◽  
All Cause Mortality ◽  
The Impact

Abstract Background The association of recovered acute kidney injury (AKI) with mortality was controversial. Our study aims to investigate the impact of recovered AKI on mortality in patients following coronary angiography (CAG). Methods Our study retrospectively enrolled 3,970 patients with pre-operative serum p creatinine (Scr) and twice measurements within 48hours after procedure. Recovered AKI defined as the diagnosis of AKI (Scr &gt;0.3 mg/dL or &gt;50% from the baseline level) on day 1 when Scr failed to meet the criteria for AKI on the day 2. Maintained AKI was defined as AKI not meeting the definition for recovered AKI. The primary outcome was 1-year all-cause mortality. Multivariable logistic regression was used to assess the association between recovered AKI and 1-year mortality. Results Among 3,970 participants, 861 (21.7%) occurred AKI, of whom 128 (14.9%) was recovered AKI and 733 (85.1%) was maintained AKI. 312 (7.9%) patients died within 1-year after admission. After multivariable analysis, recovered AKI was not associated with higher 1-year mortality (adjusted odds ratio [aOR], 1.37; CI, 0.68–2.51) compared without AKI. Among AKI patients, Recovered AKI was associated with a 52% lower 1-year mortality compared with maintained AKI. Additionally, maintained AKI was significantly associated with higher 1-year mortality (aOR, 2.67; CI, 2.05–3.47). Conclusions Our data suggested that recovered AKI within 48h was a common subtype of AKI following CAG, without increasing mortality. More attention need to be paid to the patients suffering from maintained AKI following CAG. FUNDunding Acknowledgement Type of funding sources: None. Association of AKI and mortality Subgroups analysis

Association of Intraoperative Hypotension with Acute Kidney Injury after Elective Noncardiac Surgery

2015 ◽  
Vol 123 (3) ◽  
pp. 515-523 ◽  
Author(s):  
Louise Y. Sun ◽  
Duminda N. Wijeysundera ◽  
Gordon A. Tait ◽  
W. Scott Beattie
Keyword(s):  
Acute Kidney Injury ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Intraoperative Hypotension ◽  
Outcome Relationship ◽  
Surgical Duration ◽  
Postoperative Aki

Abstract Background: Intraoperative hypotension (IOH) may be associated with postoperative acute kidney injury (AKI), but the duration of hypotension for triggering harm is unclear. The authors investigated the association between varying periods of IOH with mean arterial pressure (MAP) less than 55, less than 60, and less than 65 mmHg with AKI. Methods: The authors conducted a retrospective cohort study of 5,127 patients undergoing noncardiac surgery (2009 to 2012) with invasive MAP monitoring and length of stay of 1 or more days. Exclusion criteria were preoperative MAP less than 65 mmHg, dialysis dependence, urologic surgery, and surgical duration less than 30 min. The primary exposure was IOH. The primary outcome was AKI (50% or 0.3 mg/dl increase in creatinine) during the first 2 postoperative days. Multivariable logistic regression was used to model the exposure–outcome relationship. Results: AKI occurred in 324 (6.3%) patients and was associated with MAP less than 60 mmHg for 11 to 20 min and MAP less than 55 mmHg for more than 10 min in a graded fashion. The adjusted odds ratio of AKI for MAP less than 55 mmHg was 2.34 (1.35 to 4.05) for 11- to 20-min exposure and 3.53 (1.51 to 8.25) for more than 20 min. For MAP less than 60 mmHg, the adjusted odds ratio for AKI was 1.84 (1.11 to 3.06) for 11- to 20-min exposure. Conclusions: In this analysis, postoperative AKI is associated with sustained intraoperative periods of MAP less than 55 and less than 60 mmHg. This study provides an impetus for clinical trials to determine whether interventions that promptly treat IOH and are tailored to individual patient physiology could help reduce the risk of AKI.

scholarly journals Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational Age

2019 ◽  
Vol 37 (02) ◽  
pp. 231-240 ◽  
Author(s):  
Michelle C. Starr ◽  
Louis Boohaker ◽  
Laurie C. Eldredge ◽  
Shina Menon ◽  
Russell Griffin ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Gestational Age ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Respiratory Support ◽  
Composite Outcome ◽  
Count Ratio ◽  
Multiple Gestations ◽  
Support Count ◽  
Ischemic Encephalopathy

Abstract Objective This study aimed to evaluate the association between acute kidney injury (AKI) and lung outcomes in infants born ≥32 weeks of gestational age (GA). Study Design Secondary analysis of infants ≥32 weeks of GA in the assessment of worldwide acute kidney injury epidemiology in neonates (AWAKEN) retrospective cohort (n = 1,348). We used logistic regression to assess association between AKI and a composite outcome of chronic lung disease (CLD) or death at 28 days of age and linear regression to evaluate association between AKI and duration of respiratory support. Results CLD occurred in 82/1,348 (6.1%) infants, while death occurred in 22/1,348 (1.6%); the composite of CLD/death occurred in 104/1,348 (7.7%). Infants with AKI had an almost five-fold increased odds of CLD/death, which remained after controlling for GA, maternal polyhydramnios, multiple gestations, 5-minute Apgar's score, intubation, and hypoxic–ischemic encephalopathy (adjusted odds ratio [OR] = 4.9, 95% confidence interval [CI]: 3.2–7.4; p < 0.0001). Infants with AKI required longer duration of respiratory support (count ratio = 1.59, 95% CI: 1.14–2.23, p = 0.003) and oxygen (count ratio = 1.43, 95% CI: 1.22–1.68, p < 0.0001) compared with those without AKI. Conclusion AKI is associated with CLD/death and longer duration of respiratory support in infants born at ≥32 weeks of GA. Further prospective studies are needed to elucidate the pathophysiologic relationship.

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