Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Bolanos, Jonathan A.; Yuan, Christina M.; Little, Dustin J.; Oliver, David K.; Howard, Steven R.; Abbott, Kevin C.; Olson, Stephen W.

doi:10.2215/cjn.00890115

Cited by 24 publications

(28 citation statements)

References 40 publications

(68 reference statements)

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“…In addition to a decreased eGFR, a diagnosis of CKD can be made on the basis of proteinuria. While we did not have access to data on proteinuria, it has been observed in a population of combat injured service-members [22]. In this study of 51 casualties that required renal replacement therapy, the majority of whom (72%) had rhabdomyolysis, proteinuria was observed in 25% of subjects [22].…”

Section: Discussionmentioning

confidence: 66%

“…While we did not have access to data on proteinuria, it has been observed in a population of combat injured service-members [22]. In this study of 51 casualties that required renal replacement therapy, the majority of whom (72%) had rhabdomyolysis, proteinuria was observed in 25% of subjects [22]. Therefore, while we cannot exclude the possibility of decreased renal function or CKD in these patients, given the limitations of creatinine and lack of data on proteinuria, our results imply that renal function is not grossly abnormal after an episode of rhabdomyolysis.…”

Section: Discussionmentioning

confidence: 99%

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Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

Faulk

Walker

Howard³

et al. 2018

Am J Nephrol

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Background: Although rhabdomyolysis has been associated with acute kidney injury and mortality in the short term, the long-term consequences of an episode of rhabdomyolysis remain unknown. We sought to identify the long-term outcomes of rhabdomyolysis, including mortality, renal function, and incidence of hypertension (HTN), among service members initially admitted to the intensive care unit after sustaining a combat injury in Iraq or Afghanistan between February 1, 2002 and February 1, 2011. Methods: Information on age, sex, injury severity score, mechanism of injury, serum creatinine, burn injury, presenting mean arterial pressure, and creatine kinase were retrospectively collected and analyzed for 2,208 patients. Standard descriptive tests were used to compare characteristics of patients with and without rhabdomyolysis. Competing risk Cox proportional hazards models were performed to assess the associated risk of rhabdomyolysis with both HTN and poor renal function. Results: While rhabdomyolysis was associated with HTN on univariate analysis (hazard ratio [HR] 1.30, 95% CI 1.03–1.64; p = 0.029), this difference did not persist on multivariable analysis (HR 1.27, 95% CI 0.99–1.62; p = 0.058). The median estimated glomerular filtration rate (eGFR) was 119 (interquartile range [IQR] 103–128) among those with rhabdomyolysis, compared with 108 (IQR 94–121) in the group without rhabdomyolysis (p < 0.001). Conclusion: After adjustment, patients with rhabdomyolysis were not at an increased risk of HTN compared to patients without rhabdomyolysis. eGFR was paradoxically higher in patients with rhabdomyolysis. There was no association found between rhabdomyolysis and mortality.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

Faulk

Walker

Howard³

et al. 2018

Am J Nephrol

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“…Rates of cardiovascular disease, cardiovascular mortality, and overall mortality are increased following traumatic amputation [6,7,8,9,10,11]. Undiagnosed CKD due to overestimation of GFR by SCr-based equations could be one explanation, since high rates of proteinuria have been reported following apparent recovery from battle injury-associated post-traumatic acute kidney injury (AKI) [12], traumatic amputation can cause significant loss of creatinine-producing skeletal muscle, and CKD patients suffer from increased rates of cardiovascular disease and mortality [13,14]. …”

Section: Introductionmentioning

confidence: 99%

Effects of Traumatic Amputation on β-Trace Protein and β2-Microglobulin Concentrations in Male Soldiers

Little

Yuan²,

Thurlow³

et al. 2015

Am J Nephrol

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Background: Serum creatinine (SCr) levels are decreased following traumatic amputation, leading to the overestimation of glomerular filtration rate (GFR). β-Trace protein (BTP) and β₂-microglobulin (B2M) strongly correlate with measured GFR and have not been studied following amputation. We hypothesized that BTP and B2M would be unaffected by traumatic amputation. Methods: We used the Department of Defense Serum Repository to compare pre- and post-traumatic amputation serum BTP and B2M levels in 33 male soldiers, via the N Latex BTP and B2M nephelometric assays (Siemens Diagnostics, Tarrytown, N.Y., USA). Osterkamp estimation using DEXA scan measurements was used to establish percent estimated body weight loss (%EBWL). Results were analyzed for small (3-5.9% EBWL), medium (6-13.5%), and large (>13.5%) amputation subgroups; and for a control group matched 1:1 to the 12 large amputation subjects. Paired Student's t test was used for comparisons. Results: Mean serum BTP levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. BTP appeared to decrease following large %EBWL amputation (p = 0.05). Mean serum B2M levels were unchanged in controls, all amputees, and the small and medium amputation subgroups. B2M appeared to increase following large %EBWL amputation (p = 0.05). Conclusions: BTP and B2M levels are less affected than SCr by amputation, and should be considered for future study of GFR estimation. BTP and B2M changes following large %EBWL amputation require validation and may offer insight into non-GFR BTP and B2M determinants as well as increased cardiovascular disease and mortality following amputation. This is a work of the US Government and is not subject to copyright protection in the USA. Foreign copyrights may apply. Published by S. Karger AG, Basel

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“…One of the few other studies examining long term-outcomes after traumatic AKI examined 40 soldiers who survived traumatic AKI-RRT in that study there was a lower incidence of ESKD (2.5% vs 10.6%) and a lower long-term mortality (2.5% vs 25%) rate over a median follow-up of 2.7 years than in our cohort. [24] These differences might be attributed to low incidence rates, younger age (26 ± 6 years), and fewer baseline comorbidities in the military study. [24] Follow-up strategy in patients of AKI-RRT AKI-RRT has been shown to be associated with an increased incidence of ESKD, mortality, [25] coronary events, [13] stroke, [26] and bone fracture [14] among those who survived to hospital discharge.…”

Section: Aki-rrtmentioning

confidence: 92%

“…[24] These differences might be attributed to low incidence rates, younger age (26 ± 6 years), and fewer baseline comorbidities in the military study. [24] Follow-up strategy in patients of AKI-RRT AKI-RRT has been shown to be associated with an increased incidence of ESKD, mortality, [25] coronary events, [13] stroke, [26] and bone fracture [14] among those who survived to hospital discharge. Although guidelines published by Kidney Disease:…”

Section: Aki-rrtmentioning

confidence: 92%

Long-term outcomes following vehicle trauma related acute kidney injury requiring renal replacement therapy: A nationwide population study

Chan

Prowle

2020

Preprint

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Background Acute kidney injury (AKI) is a frequent complication of traumatic injury; however, long-term outcomes such as mortality and end-stage kidney disease (ESKD) have been rarely reported in this important patient population. We compared the long-term outcome of traumatic and non-traumatic AKI requiring renal replacement therapy (AKI-RRT). Methods This nationwide cohort study used data from the Taiwan National Health Insurance Research Database. Vehicle-trauma patients developing AKI-RRT during hospitalization were identified, and matching non-traumatic AKI-RRT patients were identified between 2000 and 2010. The incidences of end-stage kidney disease (ESKD), 30-day, and long-term mortality were evaluated, and clinical and demographic associations with these outcomes were identified using Cox proportional hazards regression models. Results 546 traumatic AKI-RRT patients, median age 47.6 years (interquartile range: 29.0-64.3) and 76.4% male, were identified. Compared to non-traumatic AKI-RRT, traumatic AKI-RRT patients had longer length of stay in hospital [median (IQR):15 (5-34) days vs 6 (3-11) days; p < 0.001). After propensity matching with non-traumatic AKI-RRT cases with similar demographic and clinical characteristics. Traumatic AKI-RRT patients had lower rates of long-term mortality (adjusted hazard ratio (HR), 0.488; 95% CI, 0.405-0.588; p < 0.001), but similar rates of ESKD (HR, 1.075; 95% CI, 0.767–1.509; p = 0.674) and short-term risk of death (HR, 1.165; 95% CI, 0.920-1.476; p = 0.205) as non-traumatic AKI-RRT patients. Conclusions Despite severe injuries, traumatic AKI-RRT patients had better long-term survival than non-traumatic AKI-RRT patients, but a similar risk of ESKD. Our results provide a better understanding of long-term outcomes after traumatic AKI-RRT.

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Outcomes After Post-Traumatic AKI Requiring RRT in United States Military Service Members

Cited by 24 publications

References 40 publications

Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

Rhabdomyolysis among Critically Ill Combat Casualties: Long-Term Outcomes

Effects of Traumatic Amputation on β-Trace Protein and β2-Microglobulin Concentrations in Male Soldiers

Long-term outcomes following vehicle trauma related acute kidney injury requiring renal replacement therapy: A nationwide population study

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