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BACKGROUND: Several cases of renal complications, including acute kidney injury (AKI), after influenza vaccination have been reported, but the association remains unproven. We evaluated the association between influenza vaccination and AKI occurrence among the Korean elderly in the 2018-2019 and 2019-2020 seasons. METHODS: We used a large database combining vaccination registration data from the Korea Disease Control and Prevention Agency and claims data from the National Health Insurance Service. The study subjects were patients hospitalized with AKI for the first-time following vaccination among those who received one influenza vaccine in the 2018-2019 or 2019-2020 season. Only those aged 65 or older at the date of vaccination were included. We performed a self-controlled case series study, designating the risk period as 1 to 28 days post-vaccination and the observation period as each influenza season. The adjusted incidence rate ratio (aIRR) was calculated by adjusting for nephrotoxic drug use and influenza infection that may influence AKI occurrence using a conditional Poisson regression model. RESULTS: A total of 16 713 and 16 272 AKI events were identified during the 2018-2019 and 2019-2020 seasons, respectively. The aIRR for AKI was 0.83 (95% confidence interval [CI] = 0.79-0.87) in the 2018-2019 season. The aIRR for the 2019-2020 influenza season was similar to the 2018-2019 season (aIRR = 0.86; 95% CI = 0.82-0.90). CONCLUSIONS: Influenza vaccination is associated with a lower risk of AKI in the elderly over 65. This evidence supports the recommendation of annual influenza vaccination for the elderly. Further studies are needed to determine the biological mechanisms linking the influenza vaccine and AKI.

Asunto(s)

Lesión Renal Aguda , Vacunas contra la Influenza , Gripe Humana , Humanos , Vacunas contra la Influenza/efectos adversos , Vacunas contra la Influenza/administración & dosificación , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/etiología , Anciano , Masculino , Femenino , Gripe Humana/prevención & control , Gripe Humana/epidemiología , República de Corea/epidemiología , Anciano de 80 o más Años , Incidencia , Vacunación/efectos adversos , Vacunación/estadística & datos numéricos , Bases de Datos Factuales , Hospitalización/estadística & datos numéricos , Estaciones del Año , Factores de Riesgo

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OBJECTIVES: Growing evidence has highlighted the substantial effects of COVID-19 on kidneys, ranging from mild proteinuria to severe acute kidney injury. However, comprehensive assessments of histopathological features in renal allograft biopsies are lacking. MATERIALS AND METHODS: Seventeen kidney transplant recipients with COVID-19 between March 2020 and November 2022 were evaluated. Clinical characteristics, pathological findings, and outcomes were studied. RESULTS: Six kidney transplant recipients (35.3%) developed acute kidney injury, leading to the requirement for hemodialysis. COVID-19 severity, as indicated by pneumonia (P = .028) and hospitalization (P = .002), was significantly associated with development of acute kidney injury. Most patients with COVID-19 (82.4%) showed considerably increased proteinuria levels (82.4%), along with presence of new-onset microscopic hematuria (35.3%) and nephrotic syndrome (58.8%). Tubular viral inclusionlike changes were detected in 47.1% of cases and were associated with a higher risk of graft loss (75%). Thrombotic microangiopathy and endothelial cell swelling in glomeruli were prevalent, highlighting extensive endothelial cell injury. Most recipients (88.2%) experienced rejection after COVID-19, with graft loss occurring in 46.7% of these cases. Biopsies revealed collapsing (n = 5), noncollapsing (n = 3), and recurrent (n = 2) focal segmental glomerulosclerosis, as well as acute tubulointerstitial nephritis (n = 3), crescentic glomerulonephritis with immunoglobulin A nephropathy (n = 1), and membranoproliferative glomerulonephritis (n = 1), in 129.7 ± 33 days. Eight patients experienced graft loss (8.2 ± 2 mo posttransplant). Hospitalization (P = .044) and viralinclusion-like nuclear changes in tubules (P = .044) significantly influenced graft survival. Collapsing (60%) and noncollapsing (66.7%) focal segmental glomerulosclerosis increased the risk of graft loss. CONCLUSIONS: COVID-19 has had a multifaceted and enduring effect on renal allografts, urging the need for meticulous monitoring and tailored management strategies to mitigate the risk of severe kidney-related complications and graft loss in this vulnerable population.

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Lesión Renal Aguda , COVID-19 , Trasplante de Riñón , Humanos , COVID-19/epidemiología , Trasplante de Riñón/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Adulto , Factores de Riesgo , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Biopsia , Rechazo de Injerto/inmunología , Aloinjertos , Resultado del Tratamiento , Riñón/patología , Riñón/virología , Estudios Retrospectivos , Supervivencia de Injerto , Anciano , Medición de Riesgo

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INTRODUCTION: Southern Hemisphere countries have been underrepresented in epidemiological studies on acute kidney injury (AKI). The objectives of this study were to determine the frequency, risk factors, and outcomes of AKI in adult hospitalized patients from the emergency department of a public high-complexity teaching hospital in the city of São Paulo, Brazil. METHODS: Observational and prospective study. AKI was defined by the KDIGO guidelines (Kidney Disease: Improving Global Outcomes) using only serum creatinine. RESULTS: Among the 731 patients studied (age: median 61 years, IQR 47-72 years; 55% male), 48% had hypertension and 28% had diabetes as comorbidities. The frequency of AKI was 52.1% (25.9% community-based AKI [C-AKI] and 26.3% hospital-acquired AKI [H-AKI]). Dehydration, hypotension, and edema were found in 29%, 15%, and 15% of participants, respectively, at hospital admission. The in-hospital and 12-month mortality rates of patients with vs. without AKI were 25.2% vs. 11.1% (p<0.001) and 36.7% vs. 12.9% (p<0.001), respectively. The independent risk factors for C-AKI were chronic kidney disease (CKD), chronic liver disease, age, and hospitalization for cardiovascular disease. Those for H-AKI were CKD, heart failure as comorbidities, hypotension, and edema at hospital admission. H-AKI was an independent risk factor for death in the hospital, but not at 12 months. C-AKI was not a risk factor for death. CONCLUSIONS: AKI occurred in more than half of the admissions to the clinical emergency department of the hospital and was equally distributed between C-AKI and H-AKI. Many patients had correctable risk factors for AKI, such as dehydration and arterial hypotension (44%) at admission. The only independent risk factor for both C-AKI and H-AKI was CKD as comorbidity.

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Lesión Renal Aguda , Servicio de Urgencia en Hospital , Hospitales Universitarios , Humanos , Persona de Mediana Edad , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Brasil/epidemiología , Masculino , Femenino , Anciano , Estudios Prospectivos , Factores de Riesgo , Servicio de Urgencia en Hospital/estadística & datos numéricos , Mortalidad Hospitalaria , Adulto , Hospitalización/estadística & datos numéricos , Comorbilidad

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BACKGROUND: The potential preventive effect of fenofibrate on lower extremity amputation (LEA) and peripheral arterial disease (PAD) in patients with type 2 diabetes (T2D) is not fully elucidated. METHODS: We selected adult patients ≥ 20 years of age with T2D from the Korean National Health Insurance Service Database (2009-2012). The fenofibrate users were matched in a 1:4 ratio with non-users using propensity scores (PS). The outcome variables were a composite of LEA and PAD and the individual components. The risks of outcomes were implemented as hazard ratio (HR) with 95% confidence intervals (CI). For safety issues, the risks of acute kidney injury, rhabdomyolysis and resulting hospitalization were analyzed. RESULTS: A total of 114,920 patients was included in the analysis with a median follow-up duration of 7.6 years (22,984 and 91,936 patients for the fenofibrate user and non-user groups, respectively). After PS matching, both groups were well balanced. The fenofibrate group was associated with significantly lower risks of composite outcome of LEA and PAD (HR 0.81; 95% CI 0.70-0.94), LEA (HR 0.76; 95% CI 0.60-0.96), and PAD (HR 0.81; 95% CI 0.68-0.96). The risk of acute kidney injury, rhabdomyolysis, or hospitalization for these events showed no significant difference between the two groups. Subgroup analyses revealed consistent benefits across age groups, genders, and baseline lipid profiles. CONCLUSIONS: This nationwide population-based retrospective observational study suggests that fenofibrate can prevent LEA and PAD in patients with T2D who are on statin therapy.

Asunto(s)

Amputación Quirúrgica , Diabetes Mellitus Tipo 2 , Fenofibrato , Hipolipemiantes , Enfermedad Arterial Periférica , Humanos , Fenofibrato/uso terapéutico , Fenofibrato/efectos adversos , Masculino , Femenino , Amputación Quirúrgica/efectos adversos , Persona de Mediana Edad , Anciano , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Enfermedad Arterial Periférica/cirugía , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Hipolipemiantes/uso terapéutico , Hipolipemiantes/efectos adversos , Factores de Riesgo , Resultado del Tratamiento , República de Corea/epidemiología , Estudios Retrospectivos , Rabdomiólisis/diagnóstico , Rabdomiólisis/epidemiología , Rabdomiólisis/inducido químicamente , Bases de Datos Factuales , Factores de Tiempo , Lesión Renal Aguda/prevención & control , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/diagnóstico , Adulto , Angiopatías Diabéticas/diagnóstico , Angiopatías Diabéticas/prevención & control , Angiopatías Diabéticas/epidemiología

RESUMEN

BACKGROUND: Critically ill patients in the intensive care unit (ICU) often experience dysglycaemia. However, studies investigating the link between acute kidney injury (AKI) and dysglycaemia, especially in those with and without diabetes mellitus (DM), are limited. METHODS: We used the Medical Information Mart for Intensive Care IV database to investigate the association between AKI within 7 days of admission and subsequent dysglycaemia. The primary outcome was the occurrence of dysglycaemia (both hypoglycemia and hyperglycemia) after 7 days of ICU admission. Logistic regression analyzed the relationship between AKI and dysglycaemia, while a Cox proportional hazards model estimated the long-term mortality risk linked to the AKI combined with dysglycaemia. RESULTS: A cohort of 20,008 critically ill patients were included. The AKI group demonstrated a higher prevalence of dysglycaemia, compared to the non-AKI group. AKI patients had an increased risk of dysglycaemia (adjusted odds ratio [aOR] 1.53, 95% confidence interval [CI] 1.41-1.65), hypoglycemia (aOR 1.56, 95% CI 1.41-1.73), and hyperglycemia (aOR 1.53, 95% CI 1.41-1.66). In subgroup analysis, compared to DM patients, AKI showed higher risk of dysglycaemia in non-DM patients (aOR: 1.93 vs. 1.33, Pint<0.01). Additionally, the AKI with dysglycaemia group exhibited a higher risk of long-term mortality compared to the non-AKI without dysglycaemia group. Dysglycaemia also mediated the relationship between AKI and long-term mortality. CONCLUSION: AKI was associated with a higher risk of dysglycaemia, especially in non-DM patients, and the combination of AKI and dysglycaemia was linked to higher long-term mortality. Further research is needed to develop optimal glycemic control strategies for AKI patients.

Asunto(s)

Lesión Renal Aguda , Enfermedad Crítica , Hiperglucemia , Hipoglucemia , Unidades de Cuidados Intensivos , Humanos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Masculino , Estudios Retrospectivos , Femenino , Enfermedad Crítica/mortalidad , Persona de Mediana Edad , Anciano , Hiperglucemia/complicaciones , Hiperglucemia/sangre , Hiperglucemia/epidemiología , Hipoglucemia/complicaciones , Hipoglucemia/sangre , Hipoglucemia/epidemiología , Hipoglucemia/mortalidad , Unidades de Cuidados Intensivos/estadística & datos numéricos , Diabetes Mellitus/epidemiología , Factores de Riesgo , Modelos Logísticos , Modelos de Riesgos Proporcionales , Glucemia/análisis , Prevalencia

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Acute kidney injury (AKI) due to vitamin D therapy for osteoporosis is encountered in clinical practice, but epidemiological studies are scarce. We aimed to determine the association between AKI and vitamin D therapy and to identify risk factors for AKI using the Japanese Adverse Drug Event Report database. We used reporting odds ratios (RORs) to detect signals and evaluate risk factors using multiple logistic regression analysis. Among 298,891 reports from April 2004 to September 2023, 1071 implicated active vitamin D3 analogs as suspect drugs for adverse events. There was a significant association between AKI and active vitamin D3 analogs (ROR [95% confidence interval {CI}], eldecalcitol: 16.75 [14.23-19.72], P < 0.001; alfacalcidol: 5.29 [4.07-6.87], P < 0.001; calcitriol: 4.46 [1.88-10.59], P < 0.001). The median duration of administration before AKI onset was 15.4 weeks. Multiple logistic regression analysis showed a significant association between AKI and age ≥ 70 years (odds ratio [95% CI], 1.47 [1.04-2.07]; P = 0.028), weight < 50 kg (1.55 [1.12-2.13]; P = 0.007), hypertension (1.90 [1.42-2.54]; P < 0.001), and concomitant use of nonsteroidal anti-inflammatory drugs (1.58 [1.10-2.25], P = 0.012) and magnesium oxide (1.96 [1.38-2.78]; P < 0.001). Our results suggest that active vitamin D3 analogs are associated with AKI development. Physicians prescribing these medications to patients with risk factors should consider the possibility of AKI, especially during the first 6 months.

Asunto(s)

Lesión Renal Aguda , Sistemas de Registro de Reacción Adversa a Medicamentos , Colecalciferol , Bases de Datos Factuales , Farmacovigilancia , Humanos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Femenino , Masculino , Anciano , Japón/epidemiología , Persona de Mediana Edad , Colecalciferol/efectos adversos , Factores de Riesgo , Anciano de 80 o más Años , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Adulto , Hidroxicolecalciferoles/efectos adversos , Hidroxicolecalciferoles/uso terapéutico , Pueblos del Este de Asia , Vitamina D/análogos & derivados

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BACKGROUND: To date, the relationship between the Transesophageal Echocardiography (TEE) monitoring indicator tricuspid annular plane systolic excursion (TAPSE) and the incidence of postoperative acute kidney injury (AKI) in Coronary Artery Bypass Grafting(CABG) patients remains unknown. The main objective of this study was to explore the relationship between the TAPSE and the incidence of AKI in CABG patients. METHODS: This was a multicenter prospective cohort study was conducted between September 2021 and July 2022. Among 266 patients aged at least 18 years who underwent elective CABG, 140 were included. RESULTS: We measured TAPSE via M-mode TEE via the mid-esophageal (ME) right ventricle(RV) inflow-outflow view (60°). All echocardiographic measurements were performed three separate times at each time point: T0 (before the start of CABG), T2 (approximately 5 ∼ 10 min after neutralization of protamine) and T3 (before leaving the operating room), and then averaged. Serum creatinine was measured 1 day before and within 7 days after CABG. There was no statistically significant association between the TEE-monitoring indicator TAPSE and the incidence of postoperative AKI in patients who underwent CABG. CONCLUSIONS: The TAPSE was not significantly correlated with postoperative AKI incidence and could not predict the early occurrence of postoperative AKI in CABG patients. TEE needs more evaluation for clinical efficacy of predicting the early occurrence of postoperative AKI in isolated CABG.

Asunto(s)

Lesión Renal Aguda , Puente de Arteria Coronaria , Ecocardiografía Transesofágica , Complicaciones Posoperatorias , Válvula Tricúspide , Humanos , Puente de Arteria Coronaria/efectos adversos , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Estudios Prospectivos , Femenino , Masculino , Incidencia , Ecocardiografía Transesofágica/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Anciano , Persona de Mediana Edad , Válvula Tricúspide/diagnóstico por imagen , Estudios de Cohortes

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OBJECTIVE: This cohort study was to assess the association between serum calcium levels and the risk of acute kidney injury (AKI) in acute myocardial infarction (AMI) patients. METHODS: This study was analyzed using data of 1286 AMI patients aged ≥18 years who stayed in ICU more than 24 h in Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Univariable logistic regression model was established to identify potential covariates. Univariate and multivariable logistic regression models were used to analyze the association between serum calcium and the risk of AKI in patients with AMI. The association between serum calcium and the risk of AKI in patients with AMI was also shown by restricted cubic spline (RCS) plot. Odds ratio (OR) and 95% confidence interval (CI) were calculated. RESULTS: The median follow-up time was 1.61 (1.23, 2.30) days, and 436 (33.90%) participants had AKI at the end of follow-up. After adjusting for covariates, elevated level of serum calcium level was related to reduced risk of AKI in AMI patients (OR = 0.88, 95%CI: 0.80-0.98). Decreased risk of AKI was found in AMI patients with serum calcium level of 8.40-8.90 mg/dL (OR = 0.54, 95%CI: 0.34-0.86) or ≥8.90 mg/dL (OR = 0.60, 95%CI: 0.37-0.99). The RCS plot depicted that serum calcium level was negatively correlated with the risk of AKI in patients with AMI. CONCLUSIONS: AMI patients with AKI had lower serum calcium levels compared with those without AKI. Increased serum calcium level was associated with decreased risk of AKI in patients with AMI.

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Lesión Renal Aguda , Calcio , Bases de Datos Factuales , Infarto del Miocardio , Humanos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Masculino , Femenino , Infarto del Miocardio/sangre , Infarto del Miocardio/complicaciones , Infarto del Miocardio/epidemiología , Persona de Mediana Edad , Calcio/sangre , Anciano , Factores de Riesgo , Modelos Logísticos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios de Cohortes , Oportunidad Relativa , Estudios Retrospectivos

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OBJECTIVE: To describe cases of acute kidney injury (AKI) in children diagnosed with COVID-19, associated risk factors, clinical aspects and outcome of cases. METHODS: Retrospective study, carried out in a pediatric hospital between March 2020 and September 2021, with patients with COVID-19 who were diagnosed with AKI, studying information present in medical records such as comorbidities, age, gender and use of nephrotoxic medications. RESULTS: We studied 40 cases, and male individuals were significantly more affected (62.5%; p=0.025). AKI was a severe complication of COVID-19 infection, with 100% of the sample requiring admission to the Intensive Care Unit and 22.5% dying. The most prevalent comorbidities analyzed in this study were epilepsy, cerebral palsy and heart disease. Most patients were classified according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria as KDIGO 1 (42.5%), and required orotracheal intubation (67.5%). The frequency of use of nephrotoxic medications and need for dialysis was low, with percentages of 35 and 17.5%, respectively. Among the children who died, 70.4% had some comorbidity and 88.8% received invasive ventilation. CONCLUSIONS: AKI in children with COVID-19 infection is associated with severe conditions. Despite the severity, most patients were discharged alive from the hospital.

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Lesión Renal Aguda , COVID-19 , Humanos , COVID-19/complicaciones , COVID-19/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Masculino , Femenino , Niño , Estudios Retrospectivos , Adolescente , Preescolar , Factores de Riesgo , Lactante , Comorbilidad , SARS-CoV-2

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PURPOSE: Infection by carbapenem-resistant Klebsiella pneumoniae (CRKP) has high mortality. There is no clear optimal therapeutic choice for pneumonia caused by CRKP. The aim of this study was to compare the clinical outcomes and safety of the standard doses of polymyxin B-based regimens vs tigecycline-based regimens and to identify risk factors for mortality. METHODS: This retrospective cohort study included patients with pneumonia caused by CRKP between January 1, 2020 and December 31, 2022. The primary outcomes were 7-day bacterial eradication rate and 14- and 28-day all-cause mortality. The secondary outcome was incidence of acute kidney injury. RESULTS: Seventy-three patients were included in this study, 29 in the polymyxin B-based combination therapy group and 44 in tigecycline-based combination therapy group. There were no significant differences between the two groups in terms of the 7-day bacterial eradication rate (31.03% vs 20.45%, p = 0.409), the 14-day all-cause mortality (37.93% vs 22.73%, p = 0.160), and the incidence of acute kidney injury (14.29% vs 6.82%, p = 0.526). The 28-day all-cause mortality in the polymyxin B-based therapy group was higher than in the tigecycline-based group (75.86% vs 45.45%, p = 0.010). Binary logistic regression analysis revealed that male and previous use of carbapenems were independent factors associated with 28-day all-cause mortality for patients treated with polymyxin B (p < 0.05). CONCLUSIONS: Polymyxin B-based combination therapy at the standard dose should be used with caution for patients with CRKP-induced pneumonia, especially for men who used carbapenems prior to CRKP detection.

Asunto(s)

Antibacterianos , Quimioterapia Combinada , Infecciones por Klebsiella , Klebsiella pneumoniae , Polimixina B , Tigeciclina , Humanos , Polimixina B/administración & dosificación , Polimixina B/uso terapéutico , Polimixina B/efectos adversos , Masculino , Estudios Retrospectivos , Tigeciclina/administración & dosificación , Tigeciclina/uso terapéutico , Tigeciclina/efectos adversos , Femenino , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/mortalidad , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Anciano , Klebsiella pneumoniae/efectos de los fármacos , Persona de Mediana Edad , Carbapenémicos/uso terapéutico , Carbapenémicos/efectos adversos , Carbapenémicos/administración & dosificación , Resultado del Tratamiento , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Neumonía Bacteriana/mortalidad

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Importance: Kidney disease is common in infants admitted to the neonatal intensive care unit (NICU). Despite the risk of chronic kidney disease (CKD) in infants discharged from the NICU, neither evidence- nor expert-based recommendations exist to guide clinical care after discharge. Objective: To develop recommendations for risk stratification and kidney health monitoring among infants after discharge from the NICU. Evidence Review: At the National Institute of Health-supported Consensus Workshop to Address Kidney Health in Neonatal Intensive Care Unit Graduates meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on 3 at-risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury (AKI), and (3) infants with critical cardiac disease. Using established modified Delphi processes, workgroups derived consensus recommendations. Findings: In this modified Delphi consensus statement, the panel developed 10 consensus recommendations, identified gaps in knowledge, and prioritized areas of future research. Principal suggestions include risk stratification at time of hospital discharge, family and clinician education and counseling for subsequent kidney health follow-up, and blood pressure assessment as part of outpatient care. Conclusions and Relevance: Preterm infants, critically ill infants with AKI, and infants with critical cardiac disease are at increased risk of CKD. We recommend (1) risk assessment at the time of discharge, (2) clinician and family education, and (3) kidney health assessments based on the degree of risk. Future work should focus on improved risk stratification, identification of early kidney dysfunction, and development of interventions to improve long-term kidney health.

Asunto(s)

Consenso , Técnica Delphi , Unidades de Cuidado Intensivo Neonatal , Humanos , Recién Nacido , Lesión Renal Aguda/diagnóstico , Lesión Renal Aguda/epidemiología , Recien Nacido Prematuro , Enfermedad Crítica , Medición de Riesgo/métodos , Insuficiencia Renal Crónica

RESUMEN

Acute kidney injury (AKI) is related to adverse clinical outcomes. Therefore, identifying patients at increased risk of postoperative AKI and proactively providing appropriate care is crucial. However, only a limited number of modifiable risk factors have been recognized to mitigate AKI risk. We retrospectively analyzed adult patients who underwent endotracheal intubation and mechanical ventilation of more than 2 h during non-cardiac surgery at Seoul National University Hospital from January 2011 to November 2022. Patients were grouped into low- or high-tidal volume groups based on their intraoperative tidal volume relative to their predicted body weight (PBW) of 8 ml/kg. The association between intraoperative tidal volume and postoperative AKI was evaluated using inverse probability of treatment weighting (IPTW), adjusting for various preoperative confounders. Among the 37,726 patients included, the incidence of postoperative AKI was 4.1%. The odds of postoperative AKI risk were significantly higher in the high-tidal volume group than in the low-tidal volume group before and after IPTW (odds ratio [OR] 1.20, 95% confidence interval [CI] 1.08-1.32, P = 0.001 and OR: 1.10, 95% CI 1.02-1.19, P = 0.010, respectively). In the multivariable logistic regression analysis after IPTW, a high tidal volume was independently associated with an increased risk of postoperative AKI (OR: 1.21, 95% CI 1.12-1.30, P < 0.001). In this propensity score-weighted analysis, an intraoperative high tidal volume of more than 8 ml/kg PBW was significantly associated with an increased risk of postoperative AKI after IPTW in non-cardiac surgical patients. Intraoperative tidal volume showed potential as a modifiable risk factor for preventing postoperative AKI.

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Lesión Renal Aguda , Complicaciones Posoperatorias , Puntaje de Propensión , Volumen de Ventilación Pulmonar , Humanos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/fisiopatología , Masculino , Femenino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Anciano , Factores de Riesgo , Respiración Artificial/efectos adversos , Incidencia , Adulto

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BACKGROUND: Acute kidney failure is a serious consequence of coronavirus disease 2019 (COVID-19). OBJECTIVES: To identify the prevalence of COVID-19, kidney failure, frequency of death, and associated factors in patients receiving intensive care. DESIGN AND SETTING: Analytical cross-sectional study conducted in the intensive care unit (ICU) of a medium-sized philanthropic general hospital in center-west Minas Gerais. METHODS: Adults and older individuals who underwent real-time polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were evaluated by the nephrology team. RESULTS: Among the 176 patients, the prevalence of COVID-19 and acute kidney injury (AKI) were 103 (58.5%) and 132 (75%), respectively, and 44 (25%) had chronic kidney disease (CKD) and 16 (15,5%) were positive for SARS-CoV-2. In the Charlson index classification, which estimates the risk of death, a statistically significant difference was identified in the percentages of groups with and without COVID-19 for indices 0, 1, and 2. There was a significant association between kidney disease and ICU mortality (P < 0.05). Patients with CKD had fewer fatal outcomes (13/97, 13.4%) than those with AKI (85/97, 87.6%). CONCLUSIONS: COVID-19 rates remained high long after diagnosis and prevention of SARS-CoV-2 infection. In addition, a higher death rate among patients who developed AKI, whose prevalence was also greater than that in the national literature, regardless of the presence of COVID-19, revealed a worrying scenario and corroborated the need for early and judicious approaches to preserve the lives of patients with AKI admitted to intensive care units.

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Lesión Renal Aguda , COVID-19 , Unidades de Cuidados Intensivos , Humanos , COVID-19/mortalidad , COVID-19/epidemiología , Lesión Renal Aguda/mortalidad , Lesión Renal Aguda/epidemiología , Estudios Transversales , Masculino , Femenino , Unidades de Cuidados Intensivos/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Brasil/epidemiología , Prevalencia , Adulto , SARS-CoV-2 , Mortalidad Hospitalaria , Factores de Riesgo , Anciano de 80 o más Años , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/epidemiología

RESUMEN

Postoperative acute kidney injury (AKI) is a common complication that is associated with chronic kidney disease, early postsurgical mortality, and prolonged hospital stays. Preterm neonates who undergo surgery are at risk factors for AKI due to underdeveloped kidneys. To date, little is known about the incidence and perioperative risk factors for AKI in preterm neonates undergoing noncardiac surgery. Preterm neonates who underwent noncardiac surgery between January May 1, 2020, and February 28, 2023, were enrolled in the trial according to the inclusion criteria. Both multivariable and logistic regression analyses were used to analyze the associations between characteristic data and AKI. In total, 106 preterm neonates met the inclusion criteria, and 25 preterm neonates (23.6%) developed postoperative AKI. Multivariate analysis revealed that the factors associated with AKI were gestational age < 32 weeks [OR: 4.88; 95% CI (1.23-19.42)], preoperative sepsis [OR: 3.98; 95% CI (1.29-12.28)], and intraoperative hypotension [OR: 3.75; 95% CI (1.26-11.15)]. Preterm neonates who developed AKI were more likely to have longer hospital length of stays (38 [18,69] days vs. 21[12,46]) and higher medical costs (93,181.6 [620450.0,173,219.0] ï¿¥ vs. 58,134.6 [31015.1,97,224,1) ï¿¥ than neonates who did not develop AKI. Preterm neonates who underwent noncardiac surgery had a high incidence of AKI. Independent risk factors for AKI in preterm neonates who underwent noncardiac surgery were low gestational age, preoperative sepsis, and intraoperative hypotension. Preterm neonates who developed AKI were more likely to have longer hospital stays and higher medical costs.

Asunto(s)

Lesión Renal Aguda , Recien Nacido Prematuro , Tiempo de Internación , Complicaciones Posoperatorias , Humanos , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Recién Nacido , Factores de Riesgo , Masculino , Femenino , Estudios Retrospectivos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Edad Gestacional , Incidencia , Sepsis/epidemiología , Sepsis/etiología , Sepsis/complicaciones , Procedimientos Quirúrgicos Operativos/efectos adversos

RESUMEN

Although community-acquired acute kidney injury (CA-AKI) represents a significant subset of all AKI incidence, evidence is limited due to the lack of comprehensive data prior to diagnosis. Here, we examined the risk of drug use for CA-AKI by using exhaustive pre-diagnostic prescription data. We included 78,754 working-age healthy individuals who underwent an annual health checkup program. We conducted a cohort study to assess the association between prevalent drug use and subsequent CA-AKI incidence using the Cox proportional hazard model. Subsequently, we conducted a case-crossover study to compare the new drug use in the case period directly before the CA-AKI incidence (- 3 to 0 months) with that in the control period far before the CA-AKI incidence (- 15 to - 12 months and - 9 to - 6 months) using the conditional Poisson regression model. The prevalent use of renin-angiotensin-aldosterone system (RAAS) inhibitors was associated with an increased CA-AKI incidence, but the new use was not. The new use of diuretics, anti-infectious drugs, and contrast medium was also associated with an increased CA-AKI incidence. These results suggest we need to pay attention for the incidence of AKI among the general population taking those common drugs.

Asunto(s)

Lesión Renal Aguda , Estudios Cruzados , Humanos , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/inducido químicamente , Femenino , Masculino , Incidencia , Adulto , Persona de Mediana Edad , Estudios de Cohortes , Diuréticos/efectos adversos , Diuréticos/uso terapéutico , Medios de Contraste/efectos adversos , Prevalencia

RESUMEN

BACKGROUND: Acute kidney injury (AKI) is a severe postoperative complication in patients undergoing major surgery. Proton pump inhibitors (PPIs) are used preoperatively as prophylaxis for postoperative gastrointestinal bleeding. Whether preoperative PPI use is associated with an increased risk of postoperative AKI remains uncertain. METHODS: This retrospective cohort study used electronic medical records from the clinical data warehouse of Peking University First Hospital to screen all adult hospitalizations undergoing major surgery between 1 January 2018 and 31 December 2020. Exposure was preoperative PPI use, defined as PPI use within 7 days before major surgery. The primary outcome was postoperative AKI, defined as AKI occurring within 7 days after major surgery; secondary outcomes included in-hospital AKI and in-hospital mortality. RESULTS: A total of 21,533 patients were included in the study (mean [SD] age, 57.8 [15.0] years; 51.2% male), of which 944 (4.4%) were prescribed PPI within 7 days before major surgery (PPI users). Overall, 72 PPI users (7.6%) and 356 non-users (1.7%) developed postoperative AKI. After adjustment, preoperative PPI use was associated with an increased risk of postoperative AKI (adjusted OR, 1.47; 95% CI, 1.04-2.07) and in-hospital AKI (adjusted OR, 1.41; 95% CI, 1.03-1.94). Moreover, subgroup analyses showed that the risk of PPI on postoperative AKI was amplified by the concomitant use of non-steroidal anti-inflammatory drugs or diuretics. No significant difference was observed between preoperative PPI use and in-hospital mortality in the fully adjusted model (adjusted OR 1.63; 95% CI, 0.55-4.85). CONCLUSIONS: Preoperative PPI use was associated with an increased risk of AKI in patients undergoing major surgery. This risk may be enhanced by the concomitant use of other nephrotoxic drugs. Clinicians should weigh the pros and cons before initiating PPI prophylaxis.

Asunto(s)

Lesión Renal Aguda , Mortalidad Hospitalaria , Complicaciones Posoperatorias , Inhibidores de la Bomba de Protones , Humanos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/epidemiología , Inhibidores de la Bomba de Protones/efectos adversos , Inhibidores de la Bomba de Protones/administración & dosificación , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Adulto , Factores de Riesgo , Cuidados Preoperatorios/métodos , China/epidemiología

RESUMEN

BACKGROUND: In various disease contexts, magnesium abnormalities are associated with acute kidney injury (AKI) incidence. However, this association remains unclear and has not been systematically investigated in patients with cirrhosis. Hence, we aimed to elucidate the association between admission serum magnesium levels and AKI incidence in intensive care unit (ICU)-admitted cirrhotic patients. METHODS: A retrospective cohort study was conducted using MIMIC-IV2.2 data, focusing on critically ill patients with cirrhosis. We employed univariable and multivariable logistic regression and restricted cubic spline analyses to robustly address our research objectives. To further substantiate the findings, subgroup and sensitivity analyses were also conducted. RESULTS: Among the 3,228 enrolled ICU-admitted cirrhotic patients, 34.4% were female, and the overall AKI incidence was 68.6% (2,213/3,228). Multivariable logistic regression analysis revealed an independent relationship between elevated serum magnesium levels and increased AKI risk (OR = 1.55 [95% CI = 1.15-2.09], p = 0.004). Compared with individuals with serum magnesium levels < 1.6 mg/dL, individuals with serum magnesium levels in Q2 (1.6-2.6 mg/dL) and Q3 (≥2.6 mg/dL) had adjusted ORs for AKI of 1.89 (95% CI = 1.34-2.65, p < 0.001) and 2.19 (95% CI = 1.27-3.75, p = 0.005), respectively. The restricted cubic spline analysis revealed that AKI risk increased linearly with increasing serum magnesium levels. Subgroup analysis revealed that the association between serum magnesium levels and AKI incidence was remarkably stable in subgroup analysis (all Pinteraction >0.05). CONCLUSIONS: High serum magnesium concentrations were significantly associated with an increased AKI risk in ICU-admitted patients with cirrhosis. Further randomized trials are needed to confirm this association.

Asunto(s)

Lesión Renal Aguda , Unidades de Cuidados Intensivos , Cirrosis Hepática , Magnesio , Humanos , Lesión Renal Aguda/sangre , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Femenino , Magnesio/sangre , Estudios Retrospectivos , Masculino , Persona de Mediana Edad , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Unidades de Cuidados Intensivos/estadística & datos numéricos , Incidencia , Anciano , Factores de Riesgo , Enfermedad Crítica , Modelos Logísticos , Bases de Datos Factuales , Adulto

RESUMEN

This retrospective study was conducted at the Izmir Tepecik Training and Research Hospital from January 2020 to December 2021. It aimed to determine acute kidney injury (AKI) frequency and associated factors in critically ill COVID-19 patients. Out of 177 patients, 49.7% developed AKI, with an average onset of 7.63 days. AKI stages varied, and progression occurred in 27 patients within 48 hours. ICU and hospital mortality rates were significantly higher in AKI patients (86.4% and 92%, respectively) compared to non-AKI patients (19.1% and 22.5%). The study highlights age, sequential organ failure assessment (SOFA) score, and nephrotoxic agent presence as significant factors influencing AKI development in COVID-19 patients. Key Words: Critical care unit, COVID-19, Acute kidney failure.

Asunto(s)

Lesión Renal Aguda , COVID-19 , Mortalidad Hospitalaria , Unidades de Cuidados Intensivos , SARS-CoV-2 , Humanos , COVID-19/complicaciones , COVID-19/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Anciano , Puntuaciones en la Disfunción de Órganos , Factores de Riesgo , Adulto , Enfermedad Crítica , Turquía/epidemiología

RESUMEN

Acute kidney injury (AKI) is an important feature of thrombotic microangiopathy (TMA). This present study aimed to describe and analyze the characterization, prevalence, and prognosis in TMA patients with AKI. This study was an observational, retrospective patient cohort study in which patients were classified as AKI and non-AKI groups. An analysis of the relationship between the risk factors and AKI and in-hospital mortality was conducted using logistic regression. Kaplan-Meier curves were adopted to obtain the link between AKI and in-hospital mortality. There were 27 and 51 patients in the AKI and non-AKI groups, respectively, and the morbidity and mortality of AKI were 34.62% and 40.74%, respectively. AKI was associated with an older age (P = .033) and higher infection rates (P < .001). In comparison with the non-AKI group, the AKI group had tremendously intrarenal manifestations: hematuria (P < .001), proteinuria (P < .001). The AKI group received all continuous renal replacement therapy treatment (P < .001), but fewer glucocorticoids were used (P = .045). In-hospital mortality (P = .045) were higher in the AKI group. The risk factors for AKI (P = .037) were age. In addition, higher total bilirubin (P = .011) and age (P = .022) were significantly correlated with increasing risk of in-hospital mortality. Survival analysis by Kaplan-Meier revealed a significantly poor prognosis predicted by the AKI group (P = .045). Acute kidney injury could be commonly seen in TMA pneumonia and was related to a higher mortality rate.

Asunto(s)

Lesión Renal Aguda , Mortalidad Hospitalaria , Microangiopatías Trombóticas , Humanos , Microangiopatías Trombóticas/epidemiología , Microangiopatías Trombóticas/etiología , Femenino , Masculino , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Pronóstico , Prevalencia , Factores de Riesgo , Anciano , Adulto , Estimación de Kaplan-Meier , Factores de Edad , Terapia de Reemplazo Renal

RESUMEN

OBJECTIVES: Cardiac surgery associated-acute kidney injury is a common and serious postoperative complication of cardiac surgery, which is associated with increased postoperative morbidity and mortality. This study aimed to explore the association between cardiopulmonary bypass (CPB) blood flow rate (BFR), and major adverse kidney events (MAKEs) at day 30. DESIGN: Retrospective single-center before-after observational study. Patients were divided in 2 groups according to CPB flow rates: a first group with an institutional protocol targeting a CPB-BFR of >2.2 L/min/m² (low CPB-BFR group), and a second group with a modified institutional protocol targeting a CPB-BFR of >2.4 L/min/m² (high CPB-BFR group). The primary outcome was MAKE at 30 days, defined as the composite of death, renal replacement therapy or persistent renal dysfunction. SETTING: The data were collected from clinical routines in university hospital. PARTICIPANTS: Adult patients who underwent elective and urgent cardiac surgery without severe chronic renal failure, for whom CPB duration was ≥90 minutes. INTERVENTIONS: We included 533 patients (low CPB-BFR group, n = 270; high CPB-BFR group, n = 263). MEASUREMENTS AND MAIN RESULTS: A significant decrease in MAKE at 30 days was observed in the high CPB-BFR group (3% v 8%; odds ratio [OR], 0.779; 95% confidence interval [CI], 0.661-0.919; p < 0.001) mainly mediated by a lower 30-day mortality in the high CPB-BFR group (1% v 5%; OR, 0.697; 95% CI, 0.595-0.817; p = 0.001), as was renal replacement therapy (1% v 4%; OR, 0.739; 95% CI, 0.604-0.904; p = 0.016). CONCLUSIONS: In patients undergoing cardiac surgery, increased CPB-BFR was associated with a decrease in MAKE at 30 days including mortality and renal replacement therapy.

Asunto(s)

Lesión Renal Aguda , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Complicaciones Posoperatorias , Puntaje de Propensión , Humanos , Puente Cardiopulmonar/efectos adversos , Masculino , Femenino , Estudios Retrospectivos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Anciano , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/diagnóstico , Velocidad del Flujo Sanguíneo/fisiología