Acute Kidney Injury: Controversies Revisited

Yong, Kenneth; Dogra, Gursharan; Boudville, Neil; Pinder, Mary; Lim, Wai H.

doi:10.4061/2011/762634

Cited by 30 publications

(36 citation statements)

References 141 publications

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“…Peritoneal dialysis was not used, consistent with previous experience (37). The most common RRT indication was hyperkalemia (69%), followed by azotemia (51%), volume overload (49%), and acidosis (45%).…”

Section: Discussionsupporting

confidence: 65%

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos

Yuan

Little

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Mortality and CKD risk have not been described in military casualties with posttraumatic AKI requiring RRT suffered in the Iraq and Afghanistan wars.Design, setting, participants, & measurements This is a retrospective case series of post-traumatic AKI requiring RRT in 51 military health care beneficiaries (October 7, 2001-December 1, 2013, evacuated to the National Capital Region, documenting in-hospital mortality and subsequent CKD. Participants were identified using electronic medical and procedure records.Results Age at injury was 2666 years; of the participants, 50 were men, 16% were black, 67% were white, and 88% of injuries were caused by blast or projectiles. Presumed AKI cause was acute tubular necrosis in 98%, with rhabdomyolysis in 72%. Sixty-day all-cause mortality was 22% (95% confidence interval [95% CI], 12% to 35%), significantly less than the 50% predicted historical mortality (P,0.001). The VA/NIH Acute Renal Failure Trial Network AKI integer score predicted 60-day mortality risk was 33% (range, 6%-96%) (n=49). Of these, nine died (mortality, 18%; 95% CI, 10% to 32%), with predicted risks significantly miscalibrated (P,0.001). The area under the receiver operator characteristic curve for the AKI integer score was 0.72 (95% CI, 0.56 to 0.88), not significantly different than the AKI integer score model cohort (P=0.27). Of the 40 survivors, one had ESRD caused by cortical necrosis. Of the remaining 39, median time to last follow-up serum creatinine was 1158 days (range, 99-3316 days), serum creatinine was 0.8560.24 mg/dl, and eGFR was 118623 ml/min per 1.73 m 2 . No eGFR was ,60 ml/min per 1.73 m 2 , but it may be overestimated because of large/medium amputations in 54%. Twenty-five percent (n=36) had proteinuria; one was diagnosed with CKD stage 2.Conclusions Despite severe injuries, participants had better in-hospital survival than predicted historically and by AKI integer score. No patient who recovered renal function had an eGFR,60 ml/min per 1.73 m 2 at last follow-up, but 23% had proteinuria, suggesting CKD burden.

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Section: Discussionsupporting

confidence: 65%

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos

Yuan

Little

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…1 The use of CM has risen in recent years due to an increase in radiographic procedures, and this coupled with an aging population already suffering from diabetes and cardiovascular/renal diseases (including chronic kidney disease, hypertension, hypotension, advanced congestive heart failure, and compromised left ventricular performance) has led to an increase in the incidence of CI-AKI. [2][3][4][5][6][7][8] CI-AKI…”

Section: Introductionmentioning

confidence: 99%

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Andreucci¹,

Faga²,

Riccio³

et al. 2016

IJNRD

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Contrast-induced acute kidney injury (CI-AKI) is a problem associated with the use of iodinated contrast media, causing kidney dysfunction in patients with preexisting renal failure. It accounts for 12% of all hospital-acquired kidney failure and increases the length of hospitalization, a situation that is worsening with increasing numbers of patients with comorbidities, including those requiring cardiovascular interventional procedures. So far, its diagnosis has relied upon the rise in creatinine levels, which is a late marker of kidney damage and is believed to be inadequate. Therefore, there is an urgent need for biomarkers that can detect CI-AKI sooner and more reliably. In recent years, many new biomarkers have been characterized for AKI, and these are discussed particularly with their use in known CI-AKI models and studies and include neutrophil gelatinase-associated lipocalin, cystatin C (Cys-C), kidney injury molecule-1, interleukin-18, N-acetyl-β-d-glucosaminidase, and L-type fatty acid-binding protein (L-FABP). The potential of miRNA and metabolomic technology is also mentioned. Early detection of CI-AKI may lead to early intervention and therefore improve patient outcome, and in future any one or a combination of several of these markers together with development in technology for their analysis may prove effective in this respect.

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“…These are important factors in resource-poor areas where reliable power sources, access to clean water and water treatment plants might not be widely available 7. PD also carries a low bleeding risk and may be more suitable for some patients in terms of cardiovascular stability 3. Another advantage of PD is the absence of an extracorporeal circuit, which for our case was a key factor in view of our patient's religious beliefs.…”

Section: Discussionmentioning

confidence: 87%

“…The prospective multinational study carried out by Uchino et al 4 revealed that 5–6% of AKI on ICU required RRT, and this figure was consistent across the 23 participating countries. In the developed world, extracorporeal modes of dialysis, namely continuous RRT and intermittent haemodialysis, are the most commonly used forms of RRT in AKI, while acute PD is often overlooked 2 3. On the other hand, in the developing world, use of acute PD is more widespread 5 6.…”

Section: Discussionmentioning

confidence: 99%

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Acute peritoneal dialysis in a Jehovah's Witness post laparotomy

Appalsawmy

Akbani

2016

BMJ Case Reports

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A 56-year-old man who was a Jehovah's Witness with an advanced directive against autologous procedures developed acute kidney injury needing renal replacement therapy while he was intubated and ventilated on the intensive care unit. He was being treated for hyperosmolar hyperglycaemic state. He also had a healing laparotomy wound, having undergone a splenectomy less than a month ago following a road traffic accident. His hyperkalaemia and metabolic acidosis were refractory to medical treatment. As he became oligoanuric, decision was taken to carry out acute peritoneal dialysis (PD) by inserting a Tenckhoff catheter in his abdomen using peritoneoscopic technique. The patient was started on automated PD without any complications. His urine output gradually improved, and his renal function eventually recovered. On discharge from hospital, his renal function was within normal range, and he had no abdominal complications from the acute PD.

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Acute Kidney Injury: Controversies Revisited

Cited by 30 publications

References 141 publications

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

The potential use of biomarkers in predicting contrast-induced acute kidney injury

Acute peritoneal dialysis in a Jehovah's Witness post laparotomy

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