Acute kidney injury

Connell, Alistair; Laing, Chris

doi:10.7861/clinmedicine.15-6-581

Cited by 14 publications

(14 citation statements)

References 15 publications

(11 reference statements)

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“…Acute kidney injury (AKI), a kind of syndrome with sudden degradation of renal function, is characterized by loss of urine creatinine . With 7.0% incidence in China, AKI becomes a representative public health matter that ranges from newborns to senior citizens .…”

Section: Introductionmentioning

confidence: 99%

Circular RNA YAP1 acts as the sponge of microRNA‐21‐5p to secure HK‐2 cells from ischaemia/reperfusion‐induced injury

Huang

Cao

Wang

et al. 2020

J Cellular Molecular Medi

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Acute kidney injury (AKI), a kind of syndrome with sudden degradation of renal function, is characterized by loss of urine creatinine. 1 With 7.0% incidence in China, AKI becomes a representative public health matter that ranges from newborns to senior citizens. 2 AKI is divided into pre-kidney, intrinsic and post-kidney, of whose pathophysiology risk factors include inflammatory diseases, 3 traumatism 4 and drug overdose. 5 In addition, ischaemia/reperfusion (I/R) during kidney transplantation also is extremely likely to elicit AKI. 6,7 I/R injury, which results from the inadequate supply of oxygen and nutrients to kidney Abstract Circular RNA YAP1 (circYAP1) was reported to participate in progression of gastric cancer. However, the role of circYAP1 in acute kidney injury (AKI) remains obscure.We attempted to examine the effects of circYAP1 on ischaemia/reperfusion-stimulated renal injury. AKI model was established by treating HK-2 cells in ischaemia/ reperfusion (I/R) environment. CircYAP1 expression in blood of AKI patients and I/Rtreated HK-2 cells was evaluated via RT-qPCR. CCK-8, flow cytometry, ELISA and ROS assay were executed to test the impact of circYAP1 on cell viability, apoptosis, inflammatory cytokines and ROS generation. Bioinformatic analysis was executed to explore miRNA targets. The relativity between circYAP1 and miR-21-5p was verified by RT-qPCR and luciferase assay. The functions of miR-21-5p in I/R-triggered injury were reassessed. PI3K/AKT/mTOR pathway was detected by Western blot. Down-regulated circYAP1 was observed in AKI blood samples and I/R-treated HK-2 cells. CircYAP1 overexpression expedited cell growth and weakened secretion of inflammatory factors and ROS generation in I/R-disposed cells. Besides, we found circYAP1 could sponge to miR-21-5p. Interestingly, miR-21-5p overexpression overturned the repressive effects of circYAP1 on cell injury. Moreover, PI3K/AKT/mTOR pathway was activated by circYAP1 via inhibiting miR-21-5p. We demonstrated that circYAP1 activated PI3K/AKT/mTOR pathway and secured HK-2 cells from I/R injury via sponging miR-21-5p. K E Y W O R D S acute kidney injury, circular RNA YAP1, ischaemia/reperfusion, microRNA-21-5p, PI3K/AKT/ mTOR pathway

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Section: Introductionmentioning

confidence: 99%

Circular RNA YAP1 acts as the sponge of microRNA‐21‐5p to secure HK‐2 cells from ischaemia/reperfusion‐induced injury

Huang

Cao

Wang

et al. 2020

J Cellular Molecular Medi

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“…4,5 AKI causes fluid overload and metabolic derangement, and may adversely affect other organ systems. 6 It is associated with a need for prolonged hospitalisation, 7 renal replacement therapy 8 and high dependency care, 9 and with greater in-hospital mortality rates. 10 Lifetime risk of chronic and end-stage kidney disease is raised in AKI survivors, 11 contributing significantly to their global prevalence.…”

Section: Introductionmentioning

confidence: 99%

“…AKI management involves recognition, supportive care, therapy directed at the underlying cause, monitoring, renal replacement therapy (if required), appropriate follow-up and interventions to reduce recurrence 6 . Because prompt AKI identification might support timely and effective treatment, NHS England mandated the embedding of an AKI detection algorithm—The NHS Early Detection Algorithm (NHSEDA; Supplementary Fig.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions

et al. 2019

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We developed a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application, specialist clinical response team and care protocol. Clinical outcome data were collected from adults with AKI on emergency admission before (May 2016 to January 2017) and after (May to September 2017) deployment at the intervention site and another not receiving the intervention. Changes in primary outcome (serum creatinine recovery to ≤120% baseline at hospital discharge) and secondary outcomes (30-day survival, renal replacement therapy, renal or intensive care unit (ICU) admission, worsening AKI stage and length of stay) were measured using interrupted time-series regression. Processes of care data (time to AKI recognition, time to treatment) were extracted from casenotes, and compared over two 9-month periods before and after implementation (January to September 2016 and 2017, respectively) using pre–post analysis. There was no step change in renal recovery or any of the secondary outcomes. Trends for creatinine recovery rates (estimated odds ratio (OR) = 1.04, 95% confidence interval (95% CI): 1.00–1.08, p = 0.038) and renal or ICU admission (OR = 0.95, 95% CI: 0.90–1.00, p = 0.044) improved significantly at the intervention site. However, difference-in-difference analyses between sites for creatinine recovery (estimated OR = 0.95, 95% CI: 0.90–1.00, p = 0.053) and renal or ICU admission (OR = 1.06, 95% CI: 0.98–1.16, p = 0.140) were not significant. Among process measures, time to AKI recognition and treatment of nephrotoxicity improved significantly ( p < 0.001 and 0.047 respectively).

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“…Affecting more than 18% of hospitalized patients [2], it is associated with prolonged hospital stay, need for acute renal replacement therapy (RRT), or intensive care admission as well as the development of chronic kidney disease and the need for long-term dialysis [3-5]. Although AKI may be a marker of systemic physiological decompensation in acute illnesses (eg, sepsis, trauma, or high-risk surgery), AKI itself might directly cause additional deaths through, for instance, metabolic derangement or extracellular fluid volume overload [6]. Such impacts are expensive; AKI confers excess annual costs of £1 billion to the English National Health Service (NHS) [7].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs

Connell¹,

Raine²,

Martin³

et al. 2019

J Med Internet Res

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BackgroundThe development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response.ObjectiveWe sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients.MethodsWe developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis.ResultsThe median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P<.001), DID analysis with the comparator site was not significant (OR 1.13, 95% CI 0.63-1.99; P=.69). There was no impact on other secondary clinical outcomes. Mean health care costs per patient were reduced by £2123 (95% CI −£4024 to −£222; P=.03), not including costs of providing the technology.ConclusionsThe digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites.

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Acute kidney injury

Cited by 14 publications

References 15 publications

Circular RNA YAP1 acts as the sponge of microRNA‐21‐5p to secure HK‐2 cells from ischaemia/reperfusion‐induced injury

Circular RNA YAP1 acts as the sponge of microRNA‐21‐5p to secure HK‐2 cells from ischaemia/reperfusion‐induced injury

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions

Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs

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