Epidemiology of acute kidney injury in surgical intensive care at University Hospital in Egypt. A prospective observational study

Mohamed, Hossam; Mukhtar, Ahmed; Mostafa, Shereen; Wageh, Sama; Eladawy, Ahmed; Zaghlol, Ahmed; Hasanin, Ahmed; Hosni, Mostafa; Farrag, Mohammad A.; Botros, M. M.; Farok, Sara; Lotfi, A.

doi:10.1016/j.egja.2013.03.003

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…Bivariate analysis highlighted the relevant risk factors for AKI that have been investigated individually or in combination by other observational studies (Mataloun et al, 2006;Prakash et al, 2006;Taber & Mueller, 2006;Bagshaw et al, 2008;Perazella, 2012;Wahrhaftig, Correa & de Souza, 2012;Wang et al, 2012;Herrera-Gutiérrez et al, 2013;Mohamed et al, 2013). We found that typical risk factors were associated with AKI in the studied patients, including advanced age, higher APACHE II score at admission to ICU, sedation, mechanical ventilation, and infection.…”

Section: Discussionsupporting

confidence: 56%

“…Two studies found incidences of 25.5% (Ponce et al, 2011) and 39.3% (Nisula et al, 2013) using AKIN classification. Other authors reported an incidence range of 35.7-47.0% by using the Risk/Injury/Failure/Loss/End-stage (RIFLE) system (Bagshaw et al, 2008;Wahrhaftig, Correa & de Souza, 2012;Mohamed et al, 2013). In a prospective study including 29,269 patients hospitalized at 54 ICUs from 23 countries, Uchino et al (2005) found 1738 patients (5.7%; 95% CI 5.5%-6.0%) who had AKI some time during their ICU stay, with a frequency ranging from 1.4-25.9% of all patients.…”

Section: Discussionmentioning

confidence: 99%

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Peer Review #1 of "Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study (v0.2)"

Silva¹

2018

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Background: Acute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital. Methods: This is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (S Cr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression. Results: Overall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ=29.0-69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0±9.4. The number of potentially nephrotoxic drugs ranged from 2-24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI 1.05-1.27) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity. Discussion: Intensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Peer Review #1 of "Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study (v0.2)"

Silva¹

2018

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“…The incidence of RF in our study remains relatively low (9.3%) in comparison with the one described in the literature among critically ill patients and which varies according to the used definitions and the populations researched in the different studies: from 5 to 40%. 2,[5][6][7][8][9][10][11][12][13] According to the studies, RF requires an ERE technique in 20 to 70% of the cases. 7,14 All these studies are about the ERE performed within the ICU unlike our study in which the off-site IDH involved 28,7% of the patients.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of intermittent hemodialysis conducted off-site on patients with renal insufficiency admitted in the intensive care unit of a developing country

et al. 2019

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Background: In most developing countries, the renal replacement therapy (RRT) in ICU is not performed locally. We designed this study to assess the intermittent hemodialysis (IHD) offsite intakes on survival in critically ill patients admitted with renal failure.Methods: We prospectively analyzed all patients admitted to medical ICU with Acute Renal Failure (AKF) or Chronic Renal Failure (CKF) from February 2011 to September 2013. Patients were divided into two groups: those that received IHD in Hemodialysis Unit (IHD+) and those who did not (IHD-). Every patient IHD+ was matched to a patient IHD - using propensity score.Results: 202 patients were included: 151 with ARF and 51 with CRF. 116 patients were matched (age: 48±18 years; 46F/70M; median serum creatinine: 51mg/l; IQR: 32-90 mg/l). The total number of dialysis sessions was 112 for 58 patients (1.8±1.4 session/patient). The median delay to initiate IHD was 5.5h (IQR: 2-8h) and median duration of transportation was 10 min (IQR: 10-15min) with 23.6% transportation incidents. Significant hypotension with tachycardia were reported during IHD. ICU mortality rate was the same in the both groups (58.6%). In multivariate analysis, CRF (RR=2.69; p=0.006), serum creatinine >50mg/l (RR=3.54; p=0.007) and requirement for vasopressors infusion (RR=1.8; p=0.041) were independent predictive factors for receiving IHD.Conclusions: Our study doesn’t show an improvement in survival in ICU patients who receive IHD offsite. The probability to require IHD offsite increases with CRF and the use of vasopressors.

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“…Two studies found incidences of 25.5% ( Ponce et al., 2011 ) and 39.3% ( Nisula et al., 2013 ) using AKIN classification. Other authors reported an incidence range of 35.7–47.0% by using the Risk/Injury/Failure/Loss/End-stage (RIFLE) system ( Bagshaw et al., 2008 ; Wahrhaftig, Correia & De Souza, 2012 ; Mohamed et al., 2013 ). In a prospective study including 29,269 patients hospitalized at 54 ICUs from 23 countries, Uchino et al.…”

Section: Discussionmentioning

confidence: 99%

Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study

Soares

Mambrini

Botelho

et al. 2018

PeerJ

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BackgroundAcute kidney injury (AKI) is associated with a significant increase in morbidity, mortality, and health care costs. In intensive care units (ICU), AKI is commonly multifactorial and frequently involves diverse factors, such as hypovolemia, sepsis, and the use of nephrotoxic drugs. We aimed to investigate drug therapy and other factors associated with the development of AKI in a Brazilian public hospital.MethodsThis is a cross-sectional study involving critically ill patients at an ICU of a tertiary hospital. All data on sequential serum creatinine (SCr) level, glomerular filtration rate (GFR), and urine output were collected during ICU stay. The primary outcome was the occurrence of AKI assessed by the Acute Kidney Injury Network (AKIN) criterion. Sociodemographics, clinical data and drug therapy were considered as covariates. Factors associated with AKI were assessed using logistic regression.ResultsOverall, 122 participants were included in the study. Median age was 46.0 (interquartile range, IQ = 29.0–69.0) years, with a predominance of men (58.2%). Mean number of prescribed drugs throughout ICU stay was 22.0 ± 9.4. The number of potentially nephrotoxic drugs ranged from two to 24 per patient. A total of 29 (23.8%) ICU patients developed AKI. In the AKI-group, patients were older and showed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores at admission, higher rates of sedation, mechanical ventilation, and infection. More drugs in general and specifically more vasoactive drugs were prescribed for AKI group. Patients who developed AKI tended to have extended stays in the ICU and a lower probability of being discharged alive than patients with no AKI development. Model adjustments of logistic regression showed that the number of medications (OR 1.15; 95% CI [1.05–1.27]) was the only factor associated with AKI in this study. This association was independent of drug nephrotoxicity.DiscussionIntensive care is characterized by its complexity that combines unstable patients, severe diseases, high density of medical interventions, and drug use. We found that typical risk factors for AKI showed statistical association on bivariate analysis. The contribution of drug therapy in the occurrence of AKI in medical ICUs reinforces the need for prevention strategies focused on early recognition of renal dysfunction and interventions in drug therapy. These actions would help improve the quality of patient care and ensure progress towards medication safety.

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Epidemiology of acute kidney injury in surgical intensive care at University Hospital in Egypt. A prospective observational study

Cited by 6 publications

References 12 publications

Peer Review #1 of "Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study (v0.2)"

Peer Review #1 of "Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study (v0.2)"

Evaluation of intermittent hemodialysis conducted off-site on patients with renal insufficiency admitted in the intensive care unit of a developing country

Drug therapy and other factors associated with the development of acute kidney injury in critically ill patients: a cross-sectional study

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