Acute Renal Failure in Critically Ill Patients&lt;SUBTITLE&gt;A Multinational, Multicenter Study&lt;/SUBTITLE&gt;

Uchino, Shigehiko

doi:10.1001/jama.294.7.813

Cited by 3,717 publications

(2,550 citation statements)

References 28 publications

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“…When supported by RRT, the observed mortality for the more severe end of the spectrum of AKI remains high in the range of 50-60%. 8,17 This observed mortality has changed little in recent decades despite advances in renal support technology; however, as previously discussed, this outcome largely reflects the transition in demographic and clinical characteristics of patients admitted to ICU. Overall, recent data have suggested there are declining mortality trends for patients with AKI.…”

Section: Mortalitymentioning

confidence: 98%

“…5 Studies focused on critically ill patients have found the incidence to range from 30-70%, 4,6,7 with approximately 5% of patients requiring acute RRT. 8 Data also indicate that the incidence is increasing significantly, while crude mortality rates have improved only marginally. [9][10][11] These data imply that the burden of illness attributable to AKI has increased, and while mortality rates are relatively stable, these figures will still translate into a greater absolute number of deaths for patients with AKI.…”

Section: Incidencementioning

confidence: 99%

“…15,16 An estimated 30% of all critically ill patients have premorbid CKD. 8,17 In patients with a superimposed episode of AKI on CKD, there is a high risk of non-recovery and accelerated progression to ESKD. 18 …”

Section: Lengths Of Staymentioning

confidence: 99%

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Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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Purpose This review provides a focused and comprehensive update on emerging evidence related to acute kidney injury (AKI).Principal findings Acute kidney injury is a significant clinical problem that increasingly complicates the course of hospitalization and portends worse clinical outcome for sick hospitalized patients. The recent introduction of consensus criteria for the diagnosis of AKI (i.e., RIFLE/AKIN classification) have greatly improved our capacity not only to standardize the diagnosis and classification of severity of AKI, but also to facilitate conducting comparative epidemiologic studies in an effort to better understand the burden of adult and pediatric AKI and its syndromes (i.e., septic, cardio-renal, hepato-renal). The characterization of several novel AKI-specific biomarkers (i.e., neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and interleukin-18) is extending our understanding of the pathophysiology of AKI. Moreover, these biomarkers appear to have clinical relevance for early detection and they provide prognostic value. These innovations are aiding in the design of epidemiologic surveys and randomized trials of therapeutic interventions. Strategies for prevention Editor's Note: This article is the first of two linked special review articles published in this issue of the Journal. The concept of these articles emerged from the scientific content of the 2010 Acute Kidney Injury (AKI) and Renal Support in Critical Illness Symposium, hosted in Edmonton, Alberta. This review (Part 1) provides a focused and comprehensive update on emerging evidence in the diagnosis and classification of AKI, on specific AKI syndromes, and on the prevention and conservative management of hospitalized patients with AKI. Abstracts presented at this meeting were selected on the basis of peer review by the Scientific Committee and were accepted for presentation at the AKI 2010 Symposium, and appear as Electronic Supplementary Material at

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Section: Mortalitymentioning

confidence: 98%

Section: Incidencementioning

confidence: 99%

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Review article: Acute kidney injury in critical illness

Bagshaw

Bellomo

Devarajan

et al. 2010

Can J Anesth/J Can Anesth

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“…AKI after cardiac surgery is the second most common cause of AKI in patients in the intensive care unit 5. Although overall morbidity and mortality after cardiac surgery have decreased during the past decade, the incidence of AKI after cardiac surgery has not changed 6.…”

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confidence: 99%

High‐Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Smith

Blume

Linton

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased short‐ and long‐term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High‐density lipoproteins (HDLs) have anti‐inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti‐inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association.Methods and ResultsWe tested our hypothesis in 391 subjects from a randomized clinical trial of perioperative atorvastatin to reduce AKI after cardiac surgery. A 2‐component latent variable mixture model was used to assess the association between preoperative HDL cholesterol concentration and postoperative change in serum creatinine, adjusted for known AKI risk factors and suspected confounders. Interaction terms were used to examine the effects of preoperative statin use, preoperative statin dose, and perioperative atorvastatin treatment on the association between preoperative HDL and AKI. A higher preoperative HDL cholesterol concentration was independently associated with a decreased postoperative serum creatinine change (P=0.02). The association between a high HDL concentration and an attenuated increase in serum creatinine was strongest in long‐term statin‐using patients (P=0.008) and was further enhanced with perioperative atorvastatin treatment (P=0.004) and increasing long‐term statin dose (P=0.003).ConclusionsA higher preoperative HDL cholesterol concentration was associated with decreased AKI after cardiac surgery. Preoperative and perioperative statin treatment enhanced this association, demonstrating that pharmacological potentiation is possible during the perioperative period.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00791648.

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“…During the previous decades, the component of AKI had been proposed instead of the WRF, and AKI has also been reported to affect the outcome of patients admitted to ICUs 29, 30, 31. The RIFLE criteria have been established as the standard method for evaluating AKI in intensive care patients 5, 6.…”

Section: Discussionmentioning

confidence: 99%

Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure

et al. 2018

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AimsWhether or not the definition of a worsening renal function (WRF) is adequate for the evaluation of acute renal failure in patients with acute heart failure is unclear.Methods and resultsOne thousand and eighty‐three patients with acute heart failure were analysed. A WRF, indicated by a change in serum creatinine ≥0.3 mg/mL during the first 5 days, occurred in 360 patients while no‐WRF, indicated by a change <0.3 mg/dL, in 723 patients. Acute kidney injury (AKI) upon admission was defined based on the ratio of the serum creatinine value recorded on admission to the baseline creatinine value and placed into groups based on the degree of AKI: no‐AKI (n = 751), Class R (risk; n = 193), Class I (injury; n = 41), or Class F (failure; n = 98). The patients were assigned to another set of four groups: no‐WRF/no‐AKI (n = 512), no‐WRF/AKI (n = 211), WRF/no‐AKI (n = 239), and WRF/AKI (n = 121). A multivariate logistic regression model found that no‐WRF/AKI and WRF/AKI were independently associated with 365 day mortality (hazard ratio: 1.916; 95% confidence interval: 1.234–2.974 and hazard ratio: 3.622; 95% confidence interval: 2.332–5.624). Kaplan–Meier survival curves showed that the rate of any‐cause death during 1 year was significantly poorer in the no‐WRF/AKI and WRF/AKI groups than in the WRF/no‐AKI and no‐WRF/no‐AKI groups and in Class I and Class F than in Class R and the no‐AKI group.ConclusionsThe presence of AKI on admission, especially Class I and Class F status, is associated with a poor prognosis despite the lack of a WRF within the first 5 days. The prognostic ability of AKI on admission may be superior to WRF within the first 5 days.

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Acute Renal Failure in Critically Ill Patients<SUBTITLE>A Multinational, Multicenter Study</SUBTITLE>

Abstract: In this multinational study, the period prevalence of ARF requiring RRT in the ICU was between 5% and 6% and was associated with a high hospital mortality rate.

Cited by 3,717 publications

References 28 publications

Review article: Acute kidney injury in critical illness

Review article: Acute kidney injury in critical illness

High‐Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Worsening renal function definition is insufficient for evaluating acute renal failure in acute heart failure

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