scholarly journals Intravenous contrast use and acute kidney injury: a retrospective study of 1,238 inpatients undergoing computed tomography

2021 ◽  
Vol 54 (2) ◽  
pp. 77-82
Author(s):  
Thyago A. Coser ◽  
Juliana S. V. Leitão ◽  
Betina M. Beltrame ◽  
Luciano S. Selistre ◽  
Leandro Tasso
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Primary Outcome ◽  
Kidney Injury ◽  
Primary Outcome Measure ◽  
Relative Increase ◽  
Contrast Administration ◽  
Intravenous Contrast

Abstract Objective: To determine the incidence of nephropathy induced by intravenous contrast in hospitalized patients undergoing computed tomography (CT). Materials and Methods: This was a retrospective cohort study involving 1,238 patients who underwent CT with or without intravenous administration of a contrast agent (iopromide). The primary outcome measure was acute kidney injury (AKI), as defined by the traditional criteria-an absolute or relative increase in serum creatinine (SCr) ≥ 0.5 mg/dL or ≥ 25% over baseline, respectively, at 2-3 days after contrast administration-and the newer, Kidney Disease: Improving Global Outcomes (KDIGO) criteria-an absolute or relative increase in SCr ≥ 0.3 mg/dL or ≥ 50% over baseline, respectively, at 2-7 days after contrast administration. Results: The overall incidence of AKI was 11.52% when the KDIGO criteria were applied. Univariate logistic regression demonstrated a significant association between an absolute post-CT increase in SCr ≥ 0.5 mg/dL and AKI, although that association did not retain significance in the multivariate analysis. Multivariate logistic regression initially found an association between an absolute post-CT increase in SCr ≥ 0.3 mg/dL and advanced age, although that association was not maintained after correction. We found no association between AKI and the risk factors evaluated. Conclusion: We identified no criteria for contrast-induced nephropathy after CT; nor did we find AKI to be associated with the classical risk factors.

scholarly journals Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

2020 ◽  
pp. 102490792091339
Author(s):  
Seda Dağar ◽  
Emine Emektar ◽  
Hüseyin Uzunosmanoğlu ◽  
Şeref Kerem Çorbacıoğlu ◽  
Özge Öztekin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Contrast Media ◽  
Kidney Injury ◽  
Intravenous Contrast ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

scholarly journals 1244. Evaluation of Intraoperative Topical Vancomycin and the Incidence of Acute Kidney Injury

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S448-S448
Author(s):  
Alison L Blackman ◽  
Sabeen Ali ◽  
Xin Gao ◽  
Rosina Mesumbe ◽  
Carly Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Serum Creatinine ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Kidney Injury ◽  
Topical Formulation ◽  
Multivariable Logistic Regression Model ◽  
Multivariable Logistic Regression

Abstract Background The use of intraoperative topical vancomycin (VAN) is a strategy aimed to prevent surgical site infections (SSI). Although there is evidence to support its efficacy in SSI prevention following orthopedic spine surgeries, data describing its safety, specifically acute kidney injury (AKI) risk, is limited. The purpose of this study was to determine the AKI incidence associated with intraoperative topical VAN. Methods This is a retrospective cohort study reviewing patient encounters where intraoperative topical VAN was administered from February 2018 to July 2018. All adult patients ( ≥18 years) that received topical VAN in the form of powder, beads, rods, paste, cement spacers, or unspecified topical routes were included. Patient encounters were excluded for AKI or renal replacement therapy (RRT) at baseline, ≤ 2 serum creatinine values drawn after surgery, and/or if irrigation was the only topical formulation given. The primary outcome was the percentage of patients who developed AKI after intraoperative topical VAN administration. AKI was defined as an increase in serum creatinine (SCr) ≥50% from baseline, an increase in SCr >0.5 from baseline, or0 if RRT was initiated after topical VAN was given. Secondary outcomes included analysis of AKI risk factors and SSI incidence. AKI risk factors were analyzed using a multivariable logistic regression model. Results A total of 589 patient encounters met study criteria. VAN powder was the most common formulation (40.9%), followed by unspecified topical routes (30.7%) and beads (9.9%%). Nonspinal orthopedic surgeries were the most common procedure performed 46.7%. The incidence of AKI was 8.7%. In a multivariable logistic regression model, AKI was associated with concomitant systemic VAN (OR 3.39, [3.39–6.22]) and total topical VAN dose. Each doubling of the topical dose was associated with increased odds of developing AKI (OR = 1.42, [1.08–1.86]). The incidence of SSI was 5.3%. Conclusion AKI rates associated with intraoperative topical VAN are comparable to that of systemic VAN. Total topical vancomycin dose and concomitant systemic VAN was associated with an increased AKI risk. Additional analysis is warranted to compare these patients to a similar population that did not receive topical VAN. Disclosures All authors: No reported disclosures.

Identification of Risk Factors in High-Dose Methotrexate-Induced Acute Kidney Injury in Childhood Acute Lymphoblastic Leukemia

Chemotherapy ◽  
2018 ◽  
Vol 63 (2) ◽  
pp. 100-106 ◽  
Author(s):  
Dao-Hai Cheng ◽  
Hua Lu ◽  
Tao-Tao Liu ◽  
Xiao-Qin Zou ◽  
Hui-Mei Pang
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Lymphoblastic Leukemia ◽  
Kidney Injury ◽  
High Dose ◽  
High Dose Methotrexate ◽  
Baseline Serum ◽  
Childhood All ◽  
Dose Methotrexate

Aims: Although high-dose methotrexate (HDMTX) is an effective means for the treatment of acute lymphoblastic leukemia (ALL), the development of renal dysfunction remains a significant management challenge. This study aimed to identify the key factors in HDMTX-induced acute kidney injury (AKI) in childhood ALL. Methods: We retrospectively analyzed the clinical data in 1,329 courses of HDMTX treatment in 336 Chinese ALL children at the First Affiliated Hospital of Guangxi Medical University from September 2012 to November 2016. The clinical data were compared between the groups of children with development of AKI and those without. Risk factors were identified by multiple logistic regression analysis, and the diagnostic performance of plasma MTX concentration was evaluated by receiver operating characteristic (ROC) curve analysis. Results: AKI was observed in 88 patients (26.2%) and 104 courses (7.8%). Binary logistic regression revealed that age (OR 1.349; p = 0.005), first HDMTX course (OR 1.767; p = 0.013), MTX dose per body surface area (BSA; OR 1.944; p = 0.015), and baseline serum total protein (OR 0.929; p = 0.021) significantly correlated with AKI. The area under the ROC for 48-h plasma MTX concentration was 0.890 (95% CI 0.850–0.930), and sensitivity and specificity values of the cut-off value were 78.8 and 90.4%, respectively. Conclusion: Increasing age, higher MTX dose per BSA, lower baseline serum protein, and first HDMTX course were significant risk factors for developing HDMTX-induced AKI in childhood ALL. The threshold of 48-h MTX plasma concentration is valuable for the prediction of HDMTX-induced AKI.

scholarly journals Risk factors for acute kidney injury and mortality in high risk patients undergoing cardiac surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0252209
Author(s):  
Giuseppe Filiberto Serraino ◽  
Michele Provenzano ◽  
Federica Jiritano ◽  
Ashour Michael ◽  
Nicola Ielapi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Blood Glucose ◽  
Kidney Injury ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Risk Patients

Background Acute Kidney Injury (AKI) represents a clinical condition with poor prognosis. The incidence of AKI in hospitalized patients was about 22–57%. Patients undergoing cardiac surgery (CS) are particularly exposed to AKI because of the related oxidative stress, inflammation and ischemia-reperfusion damage. Hence, the risk profile of patients undergoing CS who develop AKI and who are consequently at increased mortality risk deserves further investigation. Methods We designed a retrospective study examining consecutive patients undergoing any type of open-heart surgery from January to December 2018. Patients with a history of AKI were excluded. AKI was diagnosed according to KDIGO criteria. Univariate associations between clinical variables and AKI were tested using logistic regression analysis. Variable thresholds maximizing the association with AKI were measured with the Youden index. Multivariable logistic regression analysis was performed to assess predictors of AKI through backward selection. Mortality risk factors were assessed through the Cox proportional hazard model. Results We studied 158 patients (mean age 51.2±9.7 years) of which 74.7% were males. Types of procedures performed were: isolated coronary artery bypass (CABG, 50.6%), valve (28.5%), aortic (3.2%) and combined (17.7%) surgery. Overall, incidence of AKI was 34.2%. At multivariable analysis, young age (p = 0.016), low blood glucose levels (p = 0.028), estimated Glomerular Filtration Rate (p = 0.007), pH (p = 0.008), type of intervention (p = 0.031), prolonged extracorporeal circulation (ECC, p = 0.028) and cross-clamp (p = 0.021) times were associated with AKI. The threshold for detecting AKI were 91 and 51 minutes for ECC and cross-clamp times, respectively. At survival analysis, the presence of AKI, prolonged ECC and cross-clamp times, and low blood glucose levels forecasted mortality. Conclusions AKI is common among CS patients and associates with shortened life-expectancy. Several pre-operative and intra-operative predictors are associated with AKI and future mortality. Future studies, aiming at improving prognosis in high-risk patients, by a stricter control of these factors, are awaited.

scholarly journals Preprocedural Lp(a) level and ApoB/ApoA-Ι ratio and the risk for contrast-induced acute kidney injury in patients undergoing emergency PCI

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Jun Tao ◽  
Wen Dai ◽  
Chenglin Ye ◽  
Qian Yao ◽  
Man Zhou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Kidney Diseases ◽  
Kidney Injury ◽  
Cubic Spline ◽  
High Serum ◽  
Serum Lipoprotein ◽  
Creatinine Concentration ◽  
Potential Risk Factors

Abstract Background High serum Lipoprotein(a) (Lp(a)) level and Apolipoprotein B/Apolipoprotein AΙ (ApoB/ApoA-Ι) ratio are risk factors for cardiovascular disease and kidney disease and have been found to be correlated with the prevalence and prognosis of various kidney diseases. However, it is not clear whether the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI are correlated with the prevalence of contrast-induced acute kidney injury (CI-AKI). Methods A total of 931 participants undergoing emergency PCI from July 2018 to July 2020 were included. According to whether the serum creatinine concentration was higher than the baseline concentration (by ≥25% or ≥ 0.5 mg/dL) 48–72 h after contrast exposure, these participants were divided into a CI-AKI group (n = 174) and a non-CI-AKI group (n = 757). Serum Lp(a), ApoA-Ι and ApoB concentration were detected in the patients when they were admitted to hospital, and the ApoB/ApoA-Ι ratio was calculated. Logistic regression and restricted cubic spline analyses were used to explore the correlation between the Lp(a) concentration or the ApoB/ApoA-Ι ratio and the risk of CI-AKI. Results Among the 931 participants undergoing emergency PCI, 174 (18.69%) participants developed CI-AKI. Compared with the non-CI-AKI group, the Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in the CI-AKI group were significantly higher (P < 0.05). The incidence of CI-AKI was positively associated with the serum Lp(a) level and ApoB/ApoA-Ι ratio pre-PCI in each logistic regression model (P < 0.05). After adjusting for all the risk factors included in this study, restricted cubic spline analyses found that the Lp(a) level and the ApoB/ApoA-Ι ratio before PCI, within certain ranges, were positively associated with the prevalence of CI-AKI. Conclusion High Lp(a) levels and high ApoB/ApoA-Ι ratios before PCI are potential risk factors for CI-AKI.

MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Andrey Vasin ◽  
Olga Mironova ◽  
Viktor Fomin
Keyword(s):  
Computed Tomography ◽  
Acute Kidney Injury ◽  
Cardiovascular Diseases ◽  
Contrast Media ◽  
Kidney Injury ◽  
Ct Scans ◽  
Intravenous Contrast ◽  
Dosing Regimens ◽  
Intravenous Contrast Media ◽  
Contrast Media Administration

Abstract Background and Aims Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI. Method A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media. Results We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury. Conclusion Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice. ClinicalTrials.gov ID: NCT04666389

RA03.02: ACUTE KIDNEY INJURY AFTER ESOPHAGEAL CANCER SURGERY: INCIDENCE, RISK FACTORS, AND IMPACT ON ONCOLOGIC OUTCOMES

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 23-23 ◽  
Author(s):  
Conor Murphy ◽  
Talulla Dunne ◽  
Jessie Elliott ◽  
Sinead King ◽  
Narayanasamy Ravi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Esophageal Cancer ◽  
Logistic Regression ◽  
Kidney Injury ◽  
Cancer Surgery ◽  
Transthoracic Approach ◽  
Operative Trauma ◽  
Esophageal Cancer Surgery ◽  
Postoperative Aki

Abstract Background Surgery remains the cornerstone of treatment for esophageal cancer. Esophagectomy serves as an exemplar of major operative trauma, yet there is a paucity of literature regarding postoperative renal outcomes. We aimed to study the incidence of acute kidney injury (AKI) after esophageal cancer surgery, and to determine independent risk factors for postoperative renal impairment. Methods Consecutive patients undergoing potentially curative surgery for esophageal cancer from 2006–2016 were studied. AKI was defined according to AKIN criteria. Complications were recorded prospectively and comprehensive complications index (CCI) was determined. Multivariate linear and logistic regression were performed to determine factors independently predictive of postoperative AKI. Results 661 patients (72.9% male), a mean age of 63.5 ± 9.7 years, underwent surgery (2-stage esophagectomy, 307 [46.4%]; 3-stage esophagectomy, 117 [17.7%]; transhiatal esophagectomy, 112 [16.9%]; extended total gastrectomy, 122 [18.5%)], pharyngolaryngoesophagectomy, 3 [0.5%]), with a CCI of 21.3 ± 19.7 and an in-hospital mortality of 1.4%. Baseline prevalence of chronic kidney disease was 1.8%. Postoperative AKI occurred in 174 (26.3%) patients, with AKIN 1, 2 and 3 in 122 (18.5%), 41 (6.2%) and 11 (1.7%), respectively. Of these, 5 (2.9%) required renal replacement therapy during admission. Preoperatively, greater BMI (P = 0.02, OR 1.05 [95% CI 1.01–1.10]), male sex (P = 0.05, OR 1.68 [1.01–2.78]), age (P = 0.001, OR 1.04 [1.02–1.07]), hypertension (P = 0.005, OR 1.85 [1.20–2.84]), and transthoracic approach (P = 0.01, OR 1.82 [1.14–2.89]) independently predicted postoperative AKI. After surgery, while CCI was predictive of AKI on univariable analysis (P < 0.001 OR 1.03 [1.02–1.04]), atrial fibrillation (P = 0.001 OR 3.25 [1.57–6.72]) and prolonged intubation (P = 0.016 OR 3.61 [1.28–10.21]) were independently associated with AKI on multivariable logistic regression. On multivariable linear regression, neoadjuvant treatment (surgery only, 13.5 ± 35.8%; chemotherapy, 25.3 ± 42.2%; chemoradiation 18.7 ± 31.9%, P = 0.02), transthoracic approach (P = 0.006), and baseline BMI (P = 0.02) predicted postoperative %Δcreatinine. Postoperative AKI did not impact survival outcome on univariable or multivariable analysis. Conclusion Major AKI is rare after esophageal cancer surgery, with risk independently associated with increasing age, features of the metabolic syndrome, and postoperative morbidity. Disclosure All authors have declared no conflicts of interest.

scholarly journals Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients with Coronavirus Disease 2019

2020 ◽  
pp. 1-9
Author(s):  
Yichun Cheng ◽  
Nanhui Zhang ◽  
Ran Luo ◽  
Meng Zhang ◽  
Zhixiang Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
Stage 1

<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Acute kidney injury (AKI) is a common complication in patients admitted to the intensive care unit. We aimed to assess the incidence, risk factors and in-hospital outcomes of AKI in COVID-19 patients admitted to the intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective observational study in the intensive care unit of Tongji Hospital, which was assigned responsibility for the treatments of severe COVID-19 patients by the Wuhan government. AKI was defined and staged based on Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Mild AKI was defined as stage 1, and severe AKI was defined as stage 2 or stage 3. Logistic regression analysis was used to evaluate AKI risk factors, and Cox proportional hazards model was used to assess the association between AKI and in-hospital mortality. <b><i>Results:</i></b> A total of 119 patients with COVID-19 were included in our study. The median patient age was 70 years (interquartile range, 59–77) and 61.3% were male. Fifty-one (42.8%) patients developed AKI during hospitalization, corresponding to 14.3% in stage 1, 28.6% in stage 2 and 18.5% in stage 3, respectively. Compared to patients without AKI, patients with AKI had a higher proportion of mechanical ventilation mortality and higher in-hospital mortality. A total of 97.1% of patients with severe AKI received mechanical ventilation and in-hospital mortality was up to 79.4%. Severe AKI was independently associated with high in-hospital mortality (OR: 1.82; 95% CI: 1.06–3.13). Logistic regression analysis demonstrated that high serum interleukin-8 (OR: 4.21; 95% CI: 1.23–14.38), interleukin-10 (OR: 3.32; 95% CI: 1.04–10.59) and interleukin-2 receptor (OR: 4.50; 95% CI: 0.73–6.78) were risk factors for severe AKI development. <b><i>Conclusions:</i></b> Severe AKI was associated with high in-hospital mortality, and inflammatory response may play a role in AKI development in critically ill patients with COVID-19.

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