Acute Renal Failure in Hospitalized Patients: Part II

Pruchnicki, Maria C.; Dasta, Joseph F.

doi:10.1345/aph.1a340

Cited by 13 publications

(8 citation statements)

References 82 publications

(66 reference statements)

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“…The likelihood ratio of a positive test result [sensitivity/(1-specificity)] was 1.413, and the likelihood ratio of a negative test result [(1-sensitivity)/specificity] was 0.687. Using the 36~67% prevalence of AKI in critically ill patients from previous reports 2–4 , we estimated the probabilities of AKI to be 44~74% following a positive test result (PCT >0.315 ng/ml) and 28~58% following a negative test result (PCT ≤ 0.315 ng/ml). Interactive graphical presentation was illustrated by the Clinical Accuracy and Utility tool by Allen et al .…”

Section: Resultsmentioning

confidence: 99%

“…Acute kidney injury (AKI) occurs in 5 to 7% of all hospitalized patients 1 . With a frequency of 36 to 67%, however, AKI occurs more frequently in critically ill patients 2–4 . The development of AKI in patients in the intensive care unit (ICU) varies depending on their underlying etiology (e.g., sepsis, trauma, major surgery, or exposure to contrast medium), but once AKI occurs, the results are associated with significant morbidity and high mortality 4 .…”

Section: Introductionmentioning

confidence: 99%

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Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Chun

Chung

Kim

et al. 2019

Sci Rep

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Procalcitonin (PCT) is a useful marker for the diagnosis of systemic inflammatory response syndrome. In addition, PCT is affected by renal function. However, few studies have investigated the relationship between PCT and the development of acute kidney injury (AKI). Hence, we investigated whether serum PCT levels at the time of admission were associated with the development of AKI and clinical outcomes. A total of 790 patients in whom PCT was measured on admission to the intensive care unit (ICU) were analyzed retrospectively. We attempted to investigate whether serum PCT levels measured at the time of admission could be used as a risk factor for the development of AKI in septic and nonseptic patients or as a risk factor for all-cause mortality, and diagnostic usefulness of PCT was further assessed. Serum PCT levels were significantly higher in patients with AKI than in those without AKI (P < 0.001). After multivariable adjustment for clinical factors, laboratory findings, and comorbidities, PCT as a continuous variable showed a significant association with AKI (OR 1.006, 95% CI [1.000–1.011]; P = 0.035). However, PCT was not effective in predicting mortality. The cut-off value of PCT for the prediction of AKI incidence was calculated to be 0.315 ng/ml, with sensitivity and specificity of 60.9% and 56.9%, respectively. The odds ratios (ORs) from an equation adjusted for optimum thresholds of PCT levels for developing AKI with and without sepsis were 2.422 (1.222–4.802, P = 0.011) and 1.798 (1.101–2.937, P = 0.019), respectively. However, there were no absolute differences between the pre- and posttest probabilities after including the PCT value for AKI development. This study suggests that the PCT value was higher in AKI patients than in non-AKI patients, but PCT measurement at the time of admission did not improve the prediction model for AKI.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Chun

Chung

Kim

et al. 2019

Sci Rep

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“…Clearly, medication dosing errors are occurring in these patients, increasing the risk of adverse drug reactions 19. Elderly patients with renal impairment are also at increased risk of ARF while hospitalized 9, 10. Recognition of CKD by inpatient physicians identifies those patients who require preventive measures including maintenance of adequate hydration and avoidance of hypotension and nephrotoxic agents.…”

Section: Discussionmentioning

confidence: 99%

“…Early recognition, intervention, and management of patients with CKD by physicians has been shown to slow progression of disease and decrease complications 5–7. In the hospital setting, patients with CKD are at increased risk of medication dosing errors and acute renal failure (ARF) 8–10…”

mentioning

confidence: 99%

Reporting of estimated glomerular filtration rate: Effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients

Quartarolo

Thoelke

Schafers

2007

Journal of Hospital Medicine

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BACKGROUNDPhysician recognition of chronic kidney disease (CKD) in elderly patients has been noted to be poor. These patients are at increased risk of medication dosing errors and acute renal failure.OBJECTIVETo investigate the effect of reporting estimated glomerular filtration rate (GFR) of elderly hospitalized patients on physician recognition of CKD and physician prescribing behaviors.DESIGNA retrospective combined with a prospective medical record review project.SETTINGA large academic medical center.PATIENTSPatients included were 65 years of age or older and had creatinine values within the normal laboratory range (< 1.6 mg/dL).INTERVENTIONReporting a calculated estimate of GFR to physicians.MEASUREMENTSRates of recognition of CKD were examined before and after the intervention. The effects of the intervention on prescription of renal‐dosed antibiotics and nonsteroidal anti‐inflammatory drugs (NSAIDS) and cyclooxygenase‐ 2 inhibitors (COX‐2) at hospital discharge were assessed.RESULTSA total of 260 and 198 patients were included before and after the intervention, respectively. Recognition of chronic kidney disease was low in both groups but demonstrated a significant increase following reporting of estimated GFR (3.9% to 12.6%, P < .001). Reporting of GFR was not associated with a significant decrease in prescription of NSAID/COX‐2 medications or increased rates of correct dosing of antibiotics (P = .10 and P = .81, respectively).CONCLUSIONSAlthough reporting of estimated GFR was associated with improved physician recognition of CKD in elderly hospitalized patients, it did not lead to a change in physician prescribing. More extensive interventions are necessary to increase recognition and decrease medication dosing errors. Journal of Hospital Medicine 2007;2:74–78. © 2007 of Hospital Medicine.

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“…Unfortunately, radiocontrast administration is the third leading cause of hospitalacquired acute renal failure, which is associated with high morbidity and mortality. [1][2][3][4] Radiocontrast-induced nephropathy (RIN) is defined as an abrupt deterioration in renal function in the absence of other identifiable causes. 4 The clinical course of RIN can range from transient elevations in serum creatinine (SCr) to permanent renal failure requiring dialysis.…”

Section: Introductionmentioning

confidence: 99%

N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?

Chong

Zed

2004

CJEM

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Objective: To systematically review the efficacy and safety of N-acetylcysteine (NAC) for the prevention of radiocontrast-induced nephropathy (RIN), and to discuss its potential role in the emergency department. Methodology: We conducted a search of MEDLINE (from 1966 to December 2003), PubMed (1966 to December 2003) and EMBASE (1988 to December 2003) for English-language, prospective, randomized, controlled trials in humans using the search terms N-acetylcysteine, acetylcysteine, radiopharmaceuticals, contrast media, and kidney failure (acute). Results: Five trials support and 4 trials refute the hypothesis that NAC helps prevent RIN. In 7 of 9 trials, oral NAC was administered twice daily for 2 days, on the day before and on the day of the radiocontrast study — a regime not feasible for emergent situations. More recent trials suggest that adequate hydration and lower volumes of radiocontrast, rather than NAC, are more effective ways to prevent RIN. Conclusion: Although further study may be indicated, current evidence does not suggest that NAC has a role in the emergency prevention of RIN.

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Acute Renal Failure in Hospitalized Patients: Part II

Cited by 13 publications

References 82 publications

Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Association between acute kidney injury and serum procalcitonin levels and their diagnostic usefulness in critically ill patients

Reporting of estimated glomerular filtration rate: Effect on physician recognition of chronic kidney disease and prescribing practices for elderly hospitalized patients

N-acetylcysteine for radiocontrast-induced nephropathy: Potential role in the emergency department?

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