Association between metformin use on admission and outcomes in intensive care unit patients with acute kidney injury and type 2 diabetes: A retrospective cohort study

Zheng, Jiezhao; Wen, Deliang; Chen, Xiaohua; Chen, Weiyan; Chen, Weixiao; Xiong, Xuming; Zhang, Zhenhui

doi:10.1016/j.jcrc.2020.12.007

Cited by 15 publications

(15 citation statements)

References 25 publications

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“…Recent metformin use appeared as a risk factor for AKD but then as a strong protective factor in our sensitivity analysis when considering non-recovery at day 90. The latter is consistent with previous work reporting improved short-term survival following incident AKI in those exposed to metformin [ 38 , 39 ].…”

Section: Discussionsupporting

confidence: 93%

Patient outcomes following AKI and AKD: a population-based cohort study

Wang

Lambourg

Guthrie

et al. 2022

BMC Med

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Background Acute kidney injury (AKI) is common and associated with adverse outcomes as well as important healthcare costs. However, evidence examining the epidemiology of acute kidney disease (AKD)—recently defined as AKI persisting between 7 and 90 days—remains limited. The aims of this study were to establish the rates of early AKI recovery, progression to AKD and non-recovery; examine risk factors associated with non-recovery and investigate the association between recovery timing and adverse outcomes, in a population-based cohort. Methods All adult residents of Tayside & Fife, Scotland, UK, with at least one episode of community or hospital-managed AKI using KDIGO creatinine-based definition during the period 1 January 2010 to 31 December 2018 were identified. Logistic regression was used to examine factors associated with non-recovery, and Cox modelling was used to establish associations between AKI recovery timing and risks of mortality and development of de novo CKD. Results Over 9 years, 56,906 patients with at least one AKI episode were identified with 18,773 (33%) of these progressing to AKD. Of those progressing to AKD, 5059 (27%) had still not recovered at day 90 post AKI diagnosis. Risk factors for AKD included: increasing AKI severity, pre-existing cancer or chronic heart failure and recent use of loop diuretics. Compared with early AKI recovery, progression to AKD was associated with increased hazard of 1-year mortality and de novo CKD (HR = 1.20, 95% CI 1.13 to 1.26 and HR = 2.21, 95% CI 1.91 to 2.57 respectively). Conclusions These findings highlight the importance of early AKI recognition and management to avoid progression to AKD and long-term adverse outcomes.

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Section: Discussionsupporting

confidence: 93%

Patient outcomes following AKI and AKD: a population-based cohort study

Wang

Lambourg

Guthrie

et al. 2022

BMC Med

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“…SMD<0.1 is considered an acceptable result. 9 Data were described as mean ± standard deviation, median (25th-75th percentile), or number (percentage), depending on the type and distribution of the variable. Kruskal Wallis and Chi-square (or Fisher's exact) tests were used to compare among the categorical covariates.…”

Section: Discussionmentioning

confidence: 99%

“… 4 Medications classified as ACEIs were benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, quinapril, and ramipril, and ARBs included candesartan, irbesartan, losartan, telmisartan and valsartan. 9 We included ARB in the ACEI category for the analysis in this study due to the small number of subjects using this class of medications. Other medications are also taken from “Medications on admission”.…”

Section: Methodsmentioning

confidence: 99%

The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Ruan¹,

Li²,

Hu³

et al. 2022

COPD

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Background Acute respiratory failure (ARF) is a common cause of admission to the intensive care unit (ICU) for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). There is still a lack of effective interventions and treatments. ACE inhibitors (ACEI)/ angiotensin II receptor blockers (ARB) were effective in COPD patients. We aimed to study the effect of ACEI/ARB use on AECOPD combined with ARF and evaluate the effect of in-hospital continuation of medication. Methods We included patients with AECOPD and ARF from the Medical Information Bank for Intensive Care (MIMIC-III) database. MIMIC III is a large cohort database from Boston, USA. Patients were divided into two groups according to the use of ACEI/ARB before admission. Propensity score matching (PSM) was used to reduce potential bias between the two groups. Cox regression and Kaplan-Meier curves compared 30-day mortality in ACEI/ARB users and non-users. We also defined and analyzed the use of in-hospital ACEI/ARB. Multiple models were used to ensure the robustness of the findings. Subgroup analysis was used to analyze the variability between groups. Results A total of 544 patients were included in the original study. After PSM, 256 patients were included in the matched cohort. Multivariate Cox regression showed 30-day mortality was significantly lower in ACEI/ARB users compared with controls (HR = 0.50, 95% CI: 0.29–0.86, p = 0.013). In PSM and inverse probability-weighted models, the results are stable Continued in-hospital use of ACEI/ARB remains effective (HR 0.40, 95% CI 0.22–0.74, p = 0.003). Kaplan-Meier showed a significant difference in survival between the two groups. Conclusion This study found that pre-hospital ACEI/ARB use was associated with reduced mortality in patients with AECOPD and ARF.

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“…Adults (older than 18 years) who fulfilled the definition of AKI within 7 days after ICU admission in MIMIC-IV were eligible for our study. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria as previously reported ( 14 , 15 ). Even though some patients were recurrently admitted to ICU, we considered only the first hospital and first ICU admission.…”

Section: Methodsmentioning

confidence: 99%

Association Between Wait Time of Central Venous Pressure Measurement and Outcomes in Critical Patients With Acute Kidney Injury: A Retrospective Cohort Study

Chen

Wen

Zheng

et al. 2022

Front. Public Health

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BackgroundHemodynamic management is of paramount importance in patients with acute kidney injury (AKI). Central venous pressure (CVP) has been used to assess volume status. We intended to identify the optimal time window in which to obtain CVP to avoid the incidence of adverse outcomes in patients with AKI.MethodsThe study was based on the Medical Information Mart for Intensive Care (MIMIC) IV database. The primary outcome was in-hospital mortality. Secondary outcomes included the number of ICU-free days and norepinephrine-free days at 28 days after ICU admission, and total fluid input and fluid balance during the first and second day. A time–dose–response relationship between wait time of CVP measurement and in-hospital mortality was implemented to find an inflection point for grouping, followed by propensity-score matching (PSM), which was used to compare the outcomes between the two groups.ResultsTwenty Nine Thousand and Three Hundred Thirty Six patients with AKI were enrolled, and the risk of in-hospital mortality increased when the CVP acquisition time was >9 h in the Cox proportional hazards regression model. Compared with 8,071 patients (27.5%) who underwent CVP measurement within 9 h and were assigned to the early group, 21,265 patients (72.5%) who delayed or did not monitor CVP had a significantly higher in-hospital mortality in univariate and multivariate Cox regression analyses. After adjusting for potential confounders by PSM and adjusting for propensity score, pairwise algorithmic, overlap weight, and doubly robust analysis, the results were still stable. The HRs were 0.58–0.72, all p < 0.001. E-value analysis suggested robustness to unmeasured confounding.ConclusionsAmong adults with AKI in ICU, increased CVP wait time was associated with a greater risk of in-hospital mortality. In addition, early CVP monitoring perhaps contributed to shortening the length of ICU stays and days of norepinephrine use, as well as better fluid management.

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Association between metformin use on admission and outcomes in intensive care unit patients with acute kidney injury and type 2 diabetes: A retrospective cohort study

Cited by 15 publications

References 25 publications

Patient outcomes following AKI and AKD: a population-based cohort study

Patient outcomes following AKI and AKD: a population-based cohort study

The Association of Renin-Angiotensin System Blockades and Mortality in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Acute Respiratory Failure: A Retrospective Cohort Study

Association Between Wait Time of Central Venous Pressure Measurement and Outcomes in Critical Patients With Acute Kidney Injury: A Retrospective Cohort Study

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