Long‐term outcome of severe acute kidney injury survivors followed by nephrologists in a developing country

Ponce, Daniela; Dias, Dayana Bitencourt; Nascimento, Ginivaldo Ribeiro; Silveira, Liciana Vaz de Arruda; Balbi, André Luís

doi:10.1111/nep.12593

Cited by 9 publications

(4 citation statements)

References 65 publications

(269 reference statements)

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“…We found that the age-related non-renal CCI independently predicted both long-term chronic dialysis and death, which is supported by other findings (15). Patients with previous CKD may already have an impaired renal reserve, and an AKI insult may accelerate tissue damage, thus increasing the need for chronic dialysis (15,24,25). Similarly, in-hospital MODS may result in longterm organ failure sequelae and predict long-term mortality, which is consistent with the findings of Lone and Walsh (26).…”

Section: Discussionsupporting

confidence: 84%

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

et al. 2017

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The specific timing for discontinuing renal replacement therapy (RRT) in acute kidney injury (AKI) patients is debatable. The predictive abilities of variables at the time of discontinuation of RRT for the long-term prognoses of patients have not been explored. This study aimed to explore the prognostic factors upon discontinuation of RRT for long-term chronic dialysis and death of patients with acute RRT-requiring AKI, thus improving decision making regarding the discontinuation of RRT and the follow-up of patients thereafter. A cohort of 302 AKI patients who required acute RRT and remained alive and free of dialysis for at least 30 days after discharge from January 2009 to December 2012 were followed up. The predictive abilities of general characteristics, RRT details, and variables upon discontinuation of RRT for long-term chronic dialysis and all-cause death were evaluated using Cox proportional hazards models. Kaplan-Meier analysis with a log-rank test was used to compare the survival curves between the strata of levels of good predictors upon discontinuation of RRT. After a median follow-up time of 4.1 years, 20 (6.6%) patients initiated chronic dialysis and 56 (18.5%) patients died. A higher CysC level upon discontinuation of RRT (HR 1.520, 95% CI 1.082-2.135; P = 0.016), comorbid chronic kidney disease, and a higher non-renal Charlson comorbidity index (CCI) were independently predictive for chronic dialysis. The hemoglobin level upon discontinuation of RRT was inversely predictive of death (HR 0.986, 95% CI 0.973-0.999; P = 0.035), and comorbid malignancy, the presence of multiple organ dysfunction syndrome, and a higher non-renal CCI also predicted death. Urine output upon discontinuation of RRT was marginally inversely predictive of death (HR 0.997, 95% CI 0.994-1.000; P = 0.056). Patients who discontinued RRT with CysC levels <2.97 mg/L, hemoglobin levels >85 g/L, and urine output >1130 mL/24 h showed significantly higher non-chronic dialysis and survival rates according to a log-rank test. Our study suggested that upon discontinuation of RRT, higher serum CysC levels had the most promising predictive value for long-term chronic dialysis, and lower hemoglobin levels predicted long-term death; lower urine output also marginally predicted long-term death. Based on the remission of the comprehensive condition, lower CysC levels and higher hemoglobin levels and urine output should be considered in the decision to stop RRT. Patients showing worse levels of these indices upon discontinuation of RRT should undergo stricter follow-up and treatment to improve long-term outcomes.

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Section: Discussionsupporting

confidence: 84%

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

et al. 2017

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“…As AKI could result in high mortality, it is important to take back to homeostasis by a suitable way [4] . The CD11b + /Ly6C int population is identified as wound healing population, which carries membrane receptors and chemokines associated with inflammation at the same time [14] .…”

Section: Discussionmentioning

confidence: 99%

Bioinformatics Analysis of Genes and Pathways of CD11b+/Ly6Cintermediate Macrophages after Renal Ischemia-Reperfusion Injury

et al. 2018

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Renal ischemia-reperfusion injury (IRI) is a major cause of acute kidney injury (AKI), which could induce the poor prognosis. The purpose of this study was to characterize the molecular mechanism of the functional changes of CDllb+/Ly6C macrophages after renal IRI. The gene expression profiles of CDllb+/Ly6Cintermcdiate macrophages of the sham surgery mice, and the mice 4 h, 24 h and 9 days after renal IRI were downloaded from the Gene Expression Omnibus database. Analysis of mRNA expression profiles was conducted to identify differentially expressed genes (DEGs), biological processes and pathways by the series test of cluster. Protein-protein interaction network was constructed and analysed to discover the key genes. A total of 6738 DEGs were identified and assigned to 20 model profiles. DEGs in profile 13 were one of the predominant expression profiles, which are involved in immune cell chemotaxis and proliferation. Signet analysis showed that Atp5al, Atp5o, Cox4i, Cdc42, Rac2 and Nhp2 were the key genes involved in oxidation-reduction, apoptosis, migration, M1-M2 differentiation, and proliferation of macrophages. RPS18 may be an appreciate reference gene as it was stable in macrophages. The identified DEGs and their enriched pathways investigate factors that may participate in the functional changes of CD 1lbLy6C macrophages after renal IRI. Moreover, the vital gene Nhp2 may involve the polarization of macrophages, which may be a new target to affect the process of AKI.

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“…Macedo studied 84 AKI survivors and found renal recovery occurring up to one and a half years after ICU, and 36% had creatinine-estimated GFR <60 mL/min/1.73 m 2 at 18 months [ 15 ]. Ponce discovered 43.3% of 500 Brazilian AKI grade 3 patients with CKD at 36 months [ 16 ]. Similarly, an Islandic register study of over 25,000 patients with hospital AKI reported renal recovery (return to <1.5 times the baseline creatinine) ranged from 88% to 44% in AKI grades 1–3, respectively [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors

Rimes-Stigare

Ravn

Awad

et al. 2018

Critical Care Research and Practice

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Background Renal dysfunction after acute kidney injury (AKI) is common, potentially modifiable, but poorly understood. Acute kidney disease (AKD) describes renal dysfunction 7 to 90 days after AKI and is determined by percentage change in creatinine from baseline. Chronic kidney disease (CKD) is defined as the estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 m2 persisting for more than 90 days. We compared CKD incidence using both creatinine- and cystatin C-based GFR with AKD incidence at 90 days in AKI survivors. Methods A prospective cohort study was conducted in a Swedish intensive care unit (ICU) between 2008 and 2010. We included AKI patients alive at 90 days. We excluded patients <18 and >100 years, death before follow-up, CKD prior to admission, and follow-up before 60 days or beyond 270 days. Creatinine and cystatin C were measured at 90 days and converted to eGFR (mL/min/1.73 m2). Results We included 274 patients. At 90-day follow-up, the median creatinine eGFR (MDRD) was 81.6 (IQR 58.6–106.8) and median cystatin C eGFR was 51.5 (IQR 35.8–70.7). The incidence of CKD (eGFR < 60) was 25.8% based on creatinine but 63.7% using cystatin C estimates. AKD was present in 47 patients (18.9%). Age, discharge cystatin C, creatinine at discharge, and female gender predicted creatinine-defined CKD at follow-up. Age, discharge cystatin C, CRRT on ICU, and diabetes were associated with cystatin C-based CKD. Conclusions In AKI survivors followed up at 3 months, CKD criteria were met in a quarter of patients using creatinine and in two-thirds using cystatin C eGFR. Less than one-fifth of patients fulfilled AKD criteria. The application of AKD criteria may underestimate renal dysfunction in AKI survivors.

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Long‐term outcome of severe acute kidney injury survivors followed by nephrologists in a developing country

Cited by 9 publications

References 65 publications

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

Predictive Factors Upon Discontinuation of Renal Replacement Therapy for Long‐Term Chronic Dialysis and Death in Acute Kidney Injury Patients

Bioinformatics Analysis of Genes and Pathways of CD11b+/Ly6Cintermediate Macrophages after Renal Ischemia-Reperfusion Injury

Creatinine- and Cystatin C-Based Incidence of Chronic Kidney Disease and Acute Kidney Disease in AKI Survivors

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