Acute kidney injury with renal replacement therapy in trauma patients

Beitland, Sigrid; Moen, H; Os, Ingrid

doi:10.1111/j.1399-6576.2010.02253.x

Cited by 18 publications

(23 citation statements)

References 34 publications

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“…Renal recovery was similar to that previously reported in military casualties (1)(2)(3)5,(7)(8)(9). In civilian series, .90% of patients recover renal function before discharge, even though many had comorbidities that increased ESRD risk (10)(11)(12)14,29,30).…”

Section: Discussionsupporting

confidence: 84%

“…Observed mortality is approximately 40%-80% in civilian trauma series (10)(11)(12)29,30). Preexisting chronic conditions and increasing age have been associated with higher mortality in some series (10,12), However, Machemehl et al reported mortality was independent of age, albeit in an older population with comorbidities (13). Among children in the Prospective Pediatric CRRT registry, mortality was 42%, but PTAKI was not a reported cause of AKI (31).…”

Section: Discussionmentioning

confidence: 99%

“…AKI integer score-estimated mortality risk for those who died within 60 days versus those who survived was compared using the Wilcoxon rank-sum test (STATA 12.1; StataCorp, College Station, TX). Observed 60-day mortality was compared with expected historical mortality of 50% (the lower range of historical reports for military casualties with PTAKI requiring dialysis, and the weighted average mortality observed in more recent civilian case series [10][11][12][13]) (binomial distribution; QuickCalcs). It was also compared with AKI integer score-estimated mortality risk using the Hosmer-Lemeshow goodness of fit test in the 49 participants who had sufficient information to calculate the score (programmed in R by S. R.H.; available at: http://www.r-project.org, using the Resource Selection package from CRAN, for five subgroups and tested for stability from three to ten subgroups [Supplemental Material 1]) (21).…”

Section: Methodsmentioning

confidence: 99%

“…Although mortality is unchanged, casualties are increasingly severe, associated with improved resuscitation, surgical, and evacuation capabilities (3)(4)(5)(6)(7)(8)(9). Civilian mortality is similar at 36%-73% (10)(11)(12)(13). In Korea and Vietnam, survivors were reported to recover fully, but followup was sparse, and quantification of renal function not available.…”

Section: Introductionmentioning

confidence: 99%

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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: 84%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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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“…[3561219] We found that median (IQR) LOS was 5.5 (1-53) days ( P = 0.001) in the control group as compared to 9 (1, 83) days in the renal failure group. Also ISS was found to be higher in control group (20.4 ± 8.5) than in the non-renal failure groups (13.3 ± 6.0) with P value < 0.001.…”

Section: Discussionmentioning

confidence: 95%

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Medha

Subramanian

Pandey

et al. 2013

J Emerg Trauma Shock

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Context:There is a need for identifying risk factors aggravating development of acute renal failure after attaining trauma and defining new parameters for better assessment and management. Aim of the study was to determine the incidence of acute renal failure among trauma patients, and its correlation with various laboratory and clinical parameters recorded at the time of admission and in-hospital mortality.Subjects and Methods:The retrospective cohort study included admitted 208 trauma patients over a period of one year. 135 trauma patients at the serum creatinine level >2.0 mg/dL were enrolled in under the group of acute renal failure. 73 patients who had normal creatinine level made the control group. They were further assessed with clinical details and laboratory investigations.Results:Incidence of acute renal failure was 3.1%. There were 118 (87.4%) males and average length of stay was 9 (1, 83) days. Severity of injury (ISS, GCS) was relatively more among the renal failure group. Renal failure was transient in 35 (25.9%) patients. They had higher incidence of bone fracture (54.0%) (P= 0.04). Statistically significant association was observed between patients with head trauma and mortality 72 (59.0%) (P= 0.001). Prevalence of septic 24 (59.7%) and hemorrhagic 9 (7.4%) shock affected the renal failure group.Conclusion:Trauma patients at the urea level >50 mg/dL, ISS >24 on the first day of admission had 23 times and 7 times the risk of developing renal failure. Similarly, patients with hepatic dysfunction and pulmonary dysfunction were 12 times and 6 times. Patients who developed cardiovascular dysfunction, hematological dysfunction and post-trauma renal failure during the hospital stay had risk for mortality 29, 7 and 8 times, respectively. The final prognostic score obtained was: 14*hepatic dysfunction + 11*cISS + 18*cUrea + 12*cGlucose + 10*pulmonary dysfunction. Optimal score cut-off for prediction of renal failure was found to be ≥25 with specificity, sensitivity and positive likelihood ratio to be 84.9%, 78.4% and 3.9, respectively.

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Obese trauma patients have increased need for dialysis

Farhat

Grigorian

Nguyen

et al. 2019

Eur J Trauma Emerg Surg

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Acute kidney injury with renal replacement therapy in trauma patients

Abstract: AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT.

Cited by 18 publications

References 34 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

Incidence, clinical predictors and outcome of acute renal failure among North Indian trauma patients

Obese trauma patients have increased need for dialysis

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