scholarly journals COVID-19-associated acute kidney injury patients treated with renal replacement therapy in the intensive care unit: A multicenter study in São Paulo, Brazil

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261958
Author(s):  
Farid Samaan ◽  
Elisa Carneiro de Paula ◽  
Fabrizzio Batista Guimarães de Lima Souza ◽  
Luiz Fernando Cardoso Mendes ◽  
Paula Regina Gan Rossi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Sao Paulo ◽  
São Paulo ◽  
Factors Associated ◽  
Organ Dysfunctions

Introduction Multicenter studies involving patients with acute kidney injury (AKI) associated with the disease caused by the new coronavirus (COVID-19) and treated with renal replacement therapy (RRT) in developing countries are scarce. The objectives of this study were to evaluate the demographic profile, clinical picture, risk factors for mortality, and outcomes of critically ill patients with AKI requiring dialysis (AKI-RRT) and with COVID-19 in the megalopolis of São Paulo, Brazil. Methods This multicenter, retrospective, observational study was conducted in the intensive care units of 13 public and private hospitals in the metropolitan region of the municipality of São Paulo. Patients hospitalized in an intensive care unit, aged ≥ 18 years, and treated with RRT due to COVID-19-associated AKI were included. Results The study group consisted of 375 patients (age 64.1 years, 68.8% male). Most (62.1%) had two or more comorbidities: 68.8%, arterial hypertension; 45.3%, diabetes; 36.3%, anemia; 30.9%, obesity; 18.7%, chronic kidney disease; 15.7%, coronary artery disease; 10.4%, heart failure; and 8.5%, chronic obstructive pulmonary disease. Death occurred in 72.5% of the study population (272 patients). Among the 103 survivors, 22.3% (23 patients) were discharged on RRT. In a multiple regression analysis, the independent factors associated with death were the number of organ dysfunctions at admission and RRT efficiency. Conclusion AKI-RRT associated with COVID-19 occurred in patients with an elevated burden of comorbidities and was associated with high mortality (72.5%). The number of organ dysfunctions during hospitalization and RRT efficiency were independent factors associated with mortality. A meaningful portion of survivors was discharged while dependent on RRT (22.3%).

Acute kidney injury

2021 ◽  
pp. 895-911
Author(s):  
Sofie A Gevaert ◽  
Eric Hoste ◽  
John A Kellum
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Cardiac Output ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Cardiac Care ◽  
Syndrome Type

Acute kidney injury is a serious condition, occurring in up to two-thirds of intensive care unit patients, and 8.8-55% of patients with acute cardiac conditions. Renal replacement therapy is used in about 1.5-15% of intensive care unit patients. The term cardiorenal syndrome refers to combined heart and kidney failure; three types of acute cardiorenal syndrome have been described: acute cardiorenal syndrome or cardiorenal syndrome type 1, acute renocardiac syndrome or cardiorenal syndrome type 3, and acute cardiorenal syndrome type 5 (cardiac and renal injury secondary to a third entity such as sepsis). Acute kidney injury replaced the previously used term 'acute renal failure' and comprises the entire spectrum of the disease, from small changes in function to the requirement of renal replacement therapy. Not only failure, but also minor and less severe decreases, in kidney function are of clinical significance both in the short and long-term. The most recent definition for acute kidney injury is proposed by the Kidney Disease: Improving Global Outcomes clinical practice guidelines workgroup. This definition is a modification of the RIFLE and AKIN definitions and staging criteria, and it stages patients according to changes in the urine output and serum creatinine (see Tables 68.1 and 68.2). Acute kidney injury is a heterogeneous syndrome with different and multiple aetiologies, often with several insults occurring in the same individual. The underlying processes include nephrotoxicity, and neurohormonal, haemodynamic, autoimmune, and inflammatory abnormalities. The most frequent cause for acute kidney injury in intensive cardiac care patients are low cardiac output with an impaired kidney perfusion (cardiogenic shock) and/or a marked increase in venous pressure (acute decompensated heart failure). Predictors for acute kidney injury in these patients include: baseline renal dysfunction, diabetes, anaemia, and hypertension, as well as the administration of high doses of diuretics. In the intensive cardiac care unit, attention must be paid to the prevention of acute kidney injury: monitoring of high-risk patients, prompt resuscitation, maintenance of an adequate mean arterial pressure, cardiac output, and intravascular volume (avoidance of both fluid overload and hypovolaemia), as well as the avoidance or protection against nephrotoxic agents. The treatment of acute kidney injury focuses on the treatment of the underlying aetiology, supportive care, and avoiding further injury from nephrotoxic agents. More specific therapies have not yet demonstrated efficacy. Renal replacement therapy is indicated in life-threatening changes in fluid, electrolyte, and acid-base balance, but there are also arguments for more early initiation.

scholarly journals Incidence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

scholarly journals Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

2020 ◽  
Author(s):  
Jonny Jonny ◽  
Moch Hasyim ◽  
Vedora Angelia ◽  
Ayu Nursantisuryani Jahya ◽  
Lydia Permata Hilman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Southeast Asia ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Apache Ii Score ◽  
Icu Patients ◽  
Three Stages

Abstract Background : Currently, there is limited data of large databases of acute kidney injury (AKI) epidemiology from Southeast Asia, especially in Indonesia, the biggest countries in. Therefore, we aimed to provide demographic data of intensive care unit (ICU) patients with AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : We collected demographic and clinical data from 952 ICU patients. Patients were classified into AKI and non-AKI. AKI was classified according to the Kidney Disease Improving Global Outcome (KDIGO) criteria in three stages. We then assess the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI patients. RRT modalities were listed down by the number of procedures conducted. Results : Overall incidence of AKI was 43%, distributed among three stages: 18.5 % stage 1, 33% stage 2, 48.5 % stage 3. Patients developing AKI need mechanical ventilation more often in comparison with non-AKI. Patients with AKI have an average APACHE score of 16.5, while non-AKI patients have an average score of 9.9. Among AKI patients, 24.6% requires RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions: This study showed that AKI is a common problem in Indonesian ICU with containing a high mortality rate. We strongly believe that identification the risk factor of AKI will provide the opportunity to develop the predictability score for AKI prevention and finally improve AKI outcome.

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