Identifying critically ill patients at high risk for developing acute renal failure: A pilot study

Chawla, Lakhmir S.; Abell, Lynn M.; Mazhari, Ramin; Egan, Melinda; Kadambi, Navin; Burke, Harry B.; Junker, Christopher; Seneff, Michael G.; Kimmel, Paul L.

doi:10.1111/j.1523-1755.2005.00686.x

Cited by 87 publications

(65 citation statements)

References 46 publications

(46 reference statements)

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“…Therefore, patients who died without AKI are used for the period of their survival to evaluate risk factors for AKI, but after their death date, they are no longer used as either AKI or non-AKI events. No patients in the cohort were lost to follow-up at 28 d. Variables included generally were the same as those to predict mortality in the article by Ely et al (21), with the additional variables of baseline PF ratio (partial pressure of arterial oxygen divided by the fraction of inspired oxygen), baseline serum albumin, and history of malignancy (Table 3) (22). There were no significant deviations from the proportional hazards assumptions.…”

Section: Statistical Analysesmentioning

confidence: 99%

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

Chawla¹,

Seneff²,

Nelson³

et al. 2007

Clinical Journal of the American Society of Nephrology

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170

103

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Acute kidney injury (AKI) is common in critically ill patients with severe sepsis (SS), and the predictors of AKI in this population have not been well characterized. The study group was the placebo group of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) data set. PROWESS is a prospective, randomized, controlled study of the use of drotrecogin ␣ (activated) for the treatment of SS. Placebo patients who had an admission renal sepsis organ failure score of 2 or more were excluded. AKI was defined as an increase in serum creatinine of 25% or 0.3 mg/dl during the first week postbaseline. The incidence of relevant parameters was then compared in patients with and without AKI. Half of the patients were randomly assigned to a model-building data set, and multivariable Cox regression was used to determine risk factors. Factors that remained significant in the remaining "model validation" data set were considered significant. Of the 840 patients in the placebo group, 547 met inclusion criteria. Of the 547 patients, 127 (23.2%) patients met criteria for AKI. The mean age of the 547 patients was 59.8 ؎ 17.0, and 43.3% of the cohort were female. The ethnicity breakdown was as follows: White 83.2%, black 5.9%, and other 11%. Univariate analyses indicated that patients with AKI had a higher incidence of a dependence on the basis of activity of daily living scale (38.6 versus 26.7%; P ‫؍‬ 0.01), a lower baseline platelet count (193,000 versus 222,000; P ‫؍‬ 0.02), a higher baseline respiratory Sepsis Organ Failure Assessment score (2.9 versus 2.7; P ‫؍‬ 0.02), higher preinfusion Acute Physiology and Chronic Health Evaluation II (APACHE II) score (24.8 versus 22.0; P ‫؍‬ 0.0002), older age (63.7 versus 58.7 yr; P ‫؍‬ 0.008), and higher log IL-6 (6.6 versus 5.8; P ‫؍‬ 0.0006). In a multivariable Cox regression, the predictors of AKI were log IL-6 (P < 0.0001) and APACHE II (P ‫؍‬ 0.0008). Increased log IL-6 and APACHE II score are significant risk factors of AKI in patients with SS. IL-6 data and the absence of correlation with measures of hypotension (e.g., mean arterial pressure, dosage of vasopressors) support the notion that inflammation is a significant component of AKI in SS.

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Section: Statistical Analysesmentioning

confidence: 99%

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

Chawla¹,

Seneff²,

Nelson³

et al. 2007

Clinical Journal of the American Society of Nephrology

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170

103

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“…Because patients who develop AKI and CKD also tend to have risk factors for cardiovascular disease (e.g., diabetes mellitus, hypertension, and hypercholesterolemia), some authors have suggested that the increased cardiovascular events and excess mortality outcomes seen in patients with kidney disease (both AKI and CKD) are largely an epiphenomenon due to shared risk factors (7,(17)(18)(19)(20)(21). AKI is associated with the development of CKD, and CKD is also a robust risk factor for major adverse cardiovascular events (MACE) (22).…”

Section: Introductionmentioning

confidence: 99%

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Chawla

Amdur

Shaw

et al. 2014

Clinical Journal of the American Society of Nephrology

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272

228

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Background and objectives AKI is associated with major adverse kidney events (MAKE): death, new dialysis, and worsened renal function. CKD (arising from worsened renal function) is associated with a higher risk of major adverse cardiac events (MACE): myocardial infarction (MI), stroke, and heart failure. Therefore, the study hypothesis was that veterans who develop AKI during hospitalization for an MI would be at higher risk of subsequent MACE and MAKE.Design, setting, participants, & measurements Patients in the Veterans Affairs (VA) database who had a discharge diagnosis with International Classification of Diseases, Ninth Revision, code of 584.xx (AKI) or 410.xx (MI) and were admitted to a VA facility from October 1999 through December 2005 were selected for analysis. Three groups of patients were created on the basis of the index admission diagnosis and serum creatinine values: AKI, MI, or MI with AKI. Patients with mean baseline estimated GFR,45 ml/min per 1.73 m 2 were excluded. The primary outcomes assessed were mortality, MAKE, and MACE during the study period (maximum of 6 years). The combination of MAKE and MACE-major adverse renocardiovascular events (MARCE)-was also assessed.Results A total of 36,980 patients were available for analysis. Mean age6SD was 66.8611.4 years. The most deaths occurred in the MI+AKI group (57.5%), and the fewest (32.3%) occurred in patients with an uncomplicated MI admission. In both the unadjusted and adjusted time-to-event analyses, patients with AKI and AKI+MI had worse MARCE outcomes than those who had MI alone (adjusted hazard ratios, 1.37 [95% confidence interval, 1.32 to 1.42] and 1.92 [1.86 to 1.99], respectively).Conclusions Veterans who develop AKI in the setting of MI have worse long-term outcomes than those with AKI or MI alone. Veterans with AKI alone have worse outcomes than those diagnosed with an MI in the absence of AKI.

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“…Chronic risk factors include age, chronic kidney disease (CKD), diabetes, and congestive heart failure (8,9). However, models using these traditional risk factors remain inadequate (5,6,(10)(11)(12). Two patients with identical clinical risk factors often react differently to the same insult; one may suffer no harm while the other may require RRT.…”

mentioning

confidence: 99%

“…Acute risk factors include volume depletion, exposure to nephrotoxic agents, surgery, and sepsis (5)(6)(7)(8). Chronic risk factors include age, chronic kidney disease (CKD), diabetes, and congestive heart failure (8,9).…”

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confidence: 99%

Searching for Genes That Matter in Acute Kidney Injury

Coca

Patel

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and Objectives: Identifying patients who may develop acute kidney injury (AKI) remains challenging, asclinical determinants explain only a portion of individual risk. Another factor that likely affects risk is intrinsic genetic variability. Therefore, a systematic review of studies was performed that related the development or prognosis of AKI to genetic variation.Design, setting, participants, and measurements: MEDLINE, EMBASE, HuGEnet, SCOPUS, and Web of Science were searched for articles from 1950 to Dec 2007. Two independent researchers screened articles using predetermined criteria. Studies were assessed for methodological quality via an aggregate scoring system. Results: The 16 included studies were of cohort or case-cohort design and investigated 35 polymorphisms in 21 genes in association with AKI. Fifteen gene-gene interactions were also investigated in four separate studies. Study populations were primarily premature infants or adults who were critically ill or postcardiac bypass patients. Among the studies, five different definitions of AKI were used. Only one polymorphism, APO E e2/e3/e4, had greater than one study showing a significant impact (P < 0.05) on AKI incidence. The mean quality score of 5.8/10 (range four to nine), heterogeneity in the studies, and the dearth of studies precluded additional meta-analysis of the results.Conclusions: Current association studies are unable to provide definitive evidence linking genetic variation to AKI. Future success will require a narrow consensus definition of AKI, rigorous epidemiologic techniques, and a shift from a priori hypothesis-driven to genome-wide association studies.

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Identifying critically ill patients at high risk for developing acute renal failure: A pilot study

Abstract: Decreased levels of serum albumin concentration, increased A-a gradient, and presence of active cancer predict which patients who are admitted to the ICU will develop ARF.

Cited by 87 publications

References 46 publications

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

Elevated Plasma Concentrations of IL-6 and Elevated APACHE II Score Predict Acute Kidney Injury in Patients with Severe Sepsis

Association between AKI and Long-Term Renal and Cardiovascular Outcomes in United States Veterans

Searching for Genes That Matter in Acute Kidney Injury

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