Endpoints for Clinical Trials of Acute Kidney Injury

Palevsky, Paul M.

doi:10.1159/000493203

Cited by 15 publications

(7 citation statements)

References 18 publications

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“…The existence of AKI may result in an accumulation of metabolic products such as water, sodium and several disturbances may be observed in electrolyte concentrations. AKI is a serious factor ending up in longer hospital stays and higher patient morbidity [21]. Although most of the AKI cases recover completely with the help of supportive treatment; its prognosis is predominantly determined by its etiology and the existence of previous kidney disease or deteriorated eGFR.…”

Section: Discussionmentioning

confidence: 99%

“…Today, in-hospital mortality for patients with AKI is reported as varying between 30-50%, especially when dialysis is required. Negative prognostic factors include advanced age, oliguria, use of vasopressors, multiorgan dysfunction, need for blood transfusions and hypotension [21,22]. So far, no specific treatment is proposed for COVID-19 induced AKI.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the Frequency of Acute Kidney Injury in Hospitalized Patients with Benign Prostatic Hyperplasia Due to COVID-19 Pneumonia

Bilge¹,

Akıllı²,

Yoldemir³

et al. 2022

Grand J Urol

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Objective: Benign prostatic hyperplasia (BPH)-related acute kidney injury (AKI) occurs in male patients as a natural result of aging and androgen exposure. In our study, we investigated the frequency of BPH-related AKI and its relationship with disease severity in patients hospitalized for COVID-19 pneumonia. Materials and Methods: This is a retrospective and observational study on 869 male patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), who were diagnosed with COVID-19 by real-time PCR testing and hospitalized due to COVID-19 pneumonia. None of the patients was admitted to the intensive care unit (ICU). 55 patients out of 869 had BPH. AKI was defined according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. BPH and non-BPH groups were statistically compared with respect to the existence, frequency, hospitalization duration and in-hospital death. Results: Median age was 70 years for BPH group and BPH patients were significantly older than the non-BPH. Hypertension, coronary artery disease and heart failure were significantly more frequent in the BPH group. On admission, compared with normal serum creatinine, serum urea was significantly higher in the BPH patients. All AKI patients with BPH had three or more comorbidities. During hospitalization, AKI occurred in 7,3% of the BPH patients compared with the non-BPH (0,98%). The incidence of AKI was significantly higher in the patients with BPH (OR:7,94, 95% CI:2,31-27,25). In-hospital death occurred in 16,4% of the patients with BPH. The mortality was significantly lower in non-BPH group (8,6%) compared with the BPH. Our final analysis showed that age, arterial hypertension, prior coronary artery disease and heart failure were independent risk factors for occurred BPH-related AKI. Conclusions: Older male patients with common comorbidities showed a higher risk for mortality from COVID-19 pneumonia. Also, AKI patients with BPH had a poorer prognosis and higher mortality than the non-BPH patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Evaluation of the Frequency of Acute Kidney Injury in Hospitalized Patients with Benign Prostatic Hyperplasia Due to COVID-19 Pneumonia

Bilge¹,

Akıllı²,

Yoldemir³

et al. 2022

Grand J Urol

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“…Accurate AKI assessment is important for characterizing risk factors associated with specific outcomes, developing risk stratification and prediction tools [19,20], designing intervention trials [21], assessing inpatient costs attributable to AKI [22,23], and organizing outpatient follow-up strategies [20,24]. Assumptions about the baseline sCr have been continuing challenges for defining AKI [25][26][27]. The most recent outpatient sCr is a popular approach for defining the baseline sCr [3,16], but these analyses excluded admissions without previous outpatient sCr values and do not consider admission source [2, 3].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Static and Dynamic Baseline Creatinine Surrogates for Defining Acute Kidney Injury

Warnock

Neyra

Macedo

et al. 2021

Nephron

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Background: “Dynamic” baseline serum creatinine (sCr), based on a rolling 48-h window, and a static baseline sCr (previous outpatient sCr) were used to define acute kidney injury (AKI). Methods: Retrospective cohort study of adult admissions to the University of Alabama (UAB) Health System hospitals for years 2016–2018. Included admissions had >1- and <180-day length of stay, >2 inpatient sCr measurements, and an averaged estimated glomerular filtration rate >15 mL/min/1.73 m2. The final cohort of 62,380 patients included 100,570 admissions, 3,509 inpatient deaths, and 1,916 admissions with inpatient dialysis. AKI was defined by Kidney Disease Improving Global Outcomes (KDIGO) criteria and a static or dynamic baseline sCr. Discrimination was evaluated with area under receiver operator curves (AUC), logistic regression, and net reclassification improvement (NRI). Results: Preadmission outpatient “static” sCr values were available for 43,433 admissions. The lowest sCr value during a rolling 48-h window before each inpatient sCr defined a “dynamic” baseline sCr. Using point-wise comparisons, the dynamic baseline sCr performed better than static baseline sCr for inpatient mortality (AUC [0.819 vs. 0.741; p < 0.001] and NRI ≥0.306 [p < 0.001]) and inpatient dialysis (AUC [0.903 vs. 0.864; p < 0.001] and NRI ≥0.317 [p < 0.001]). Conclusions: The dynamic baseline sCr is available without reference to preadmission sCr values and avoids confounding associated with missing outpatient sCr values. AKI defined with the dynamic baseline sCr significantly improved discrimination of risk for inpatient mortality and dialysis compared to static baseline sCr.

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“…Nevertheless, recent research has gone against this notion based on studies conducted on individuals with reduced filtration capacities who are more prone to ESRD progression and mortality than a reversal of the condition [23,24]. These facts highlight significant clinical problems that arise from acute and chronic disorders.…”

Section: Of 22mentioning

confidence: 99%

Still Finding Ways to Augment the Existing Management of Acute and Chronic Kidney Diseases with Targeted Gene and Cell Therapies: Opportunities and Hurdles

Corridon¹

2023

Preprint

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The rising global incidence of acute and chronic kidney diseases has increased the demand for renal replacement therapy. This issue, compounded with the limited availability of viable kidneys for transplantation, has propelled the search for alternative strategies to address the growing health and economic burdens associated with these conditions. In the search for such alternatives, significant efforts have been devised to augment the current and primarily supportive management of renal injury with novel regenerative strategies. For example, gene- and cell-based approaches that utilize recombinant peptides/proteins, gene, cell, organoid, and RNAi technologies have shown promising outcomes primarily in experimental models. Supporting research has also been conducted to improve our understanding of the critical aspects that facilitate the development of efficient gene- and cell-based techniques that the complex structure of the kidney has traditionally limited. This manuscript is intended to communicate efforts that have driven the development of such therapies by identifying the vectors and delivery routes needed to drive exogenous transgene incorporation that may support the treatment of acute and chronic kidney diseases.

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Endpoints for Clinical Trials of Acute Kidney Injury

Cited by 15 publications

References 18 publications

Evaluation of the Frequency of Acute Kidney Injury in Hospitalized Patients with Benign Prostatic Hyperplasia Due to COVID-19 Pneumonia

Evaluation of the Frequency of Acute Kidney Injury in Hospitalized Patients with Benign Prostatic Hyperplasia Due to COVID-19 Pneumonia

Comparison of Static and Dynamic Baseline Creatinine Surrogates for Defining Acute Kidney Injury

Still Finding Ways to Augment the Existing Management of Acute and Chronic Kidney Diseases with Targeted Gene and Cell Therapies: Opportunities and Hurdles

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