Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient

Birkelo, Bethany C.; Pannu, Neesh; Siew, Edward D.

doi:10.2215/cjn.14181021

Cited by 24 publications

(19 citation statements)

References 124 publications

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“…14,18,19,21,54,55 Incomplete recovery after AKI results in renal fibrosis, the pathological accumulation of extracellular matrix (ECM) proteins, mainly collagens in the kidney. 56,57 We then explored the protein levels of α-smooth muscle actin (α-SMA) and collagen I (Col I) by Western blotting and immunofluorescence staining (Figure 4D,E,F,G). The expression levels of α-SMA and Col I were greatly increased after I/R injury but were significantly We selected 6−8 weeks male C57 mice, separated both kidneys, and clamped the bilateral kidney pedicle for 30 min to induce ischemia.…”

Section: Resultsmentioning

confidence: 99%

“…Previous studies have reported that mitochondrial dysfunction and ATP reduction are intently relevant to CKD development and progression. ,,,,, Incomplete recovery after AKI results in renal fibrosis, the pathological accumulation of extracellular matrix (ECM) proteins, mainly collagens in the kidney. , We then explored the protein levels of α-smooth muscle actin (α-SMA) and collagen I (Col I) by Western blotting and immunofluorescence staining (Figure D,E,F,G). The expression levels of α-SMA and Col I were greatly increased after I/R injury but were significantly decreased after I/R injured cells were incubated with tFNAs, Typ, and TTC.…”

Section: Resultsmentioning

confidence: 99%

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Typhaneoside-Tetrahedral Framework Nucleic Acids System: Mitochondrial Recovery and Antioxidation for Acute Kidney Injury treatment

Yan

Cui

et al. 2023

ACS Nano

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Acute kidney injury (AKI) is not only a worldwide problem with a cruel hospital mortality rate but also an independent risk factor for chronic kidney disease and a promoting factor for its progression. Despite supportive therapeutic measures, there is no effective treatment for AKI. This study employs tetrahedral framework nucleic acid (tFNA) as a vehicle and combines typhaneoside (Typ) to develop the tFNA-Typ complex (TTC) for treating AKI. With the precise targeting ability on mitochondria and renal tubule, increased antiapoptotic and antioxidative effect, and promoted mitochondria and kidney function restoration, the TTC represents a promising nanomedicine for AKI treatment. Overall, this study has developed a dual-targeted nanoparticle with enhanced therapeutic effects on AKI and could have critical clinical applications in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Typhaneoside-Tetrahedral Framework Nucleic Acids System: Mitochondrial Recovery and Antioxidation for Acute Kidney Injury treatment

Yan

Cui

et al. 2023

ACS Nano

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“…These barriers speak to the intrinsic challenges of this type of pragmatic EHR-based research and underscore the need to develop valid heuristics to identify diagnoses, syndromes, and interventions automatically from extant data in the EHR ( 20 , 33 ). Similarly, the inability to estimate baseline creatinine from many patients’ structured EHR data hampers efforts to scale dynamic renal failure models ( 34 , 35 ); in this example, we intentionally performed relevant sensitivity analyses to check the reliability of our baseline assumptions.…”

Section: Discussionmentioning

confidence: 99%

Multistate Modeling of Clinical Trajectories and Outcomes in the ICU: A Proof-of-Concept Evaluation of Acute Kidney Injury Among Critically Ill Patients With COVID-19

Lyons

Mody

Bewley

et al. 2022

Critical Care Explorations

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IMPORTANCE:Multistate models yield high-fidelity analyses of the dynamic state transition and temporal dimensions of a clinical condition's natural history, offering superiority over aggregate modeling techniques for addressing these types of problems. OBJECTIVES:To demonstrate the utility of these models in critical care, we examined acute kidney injury (AKI) development, progression, and outcomes in COVID-19 critical illness through multistate analyses. DESIGN, SETTING, AND PARTICIPANTS:Retrospective cohort study at an urban tertiary-care academic hospital in the United States. All patients greater than or equal to 18 years in an ICU with COVID-19 in 2020, excluding patients with preexisting end-stage renal disease. MAIN OUTCOMES AND MEASURES:Using electronic health record data, we determined AKI presence/stage in discrete 12-hour time windows and fit multistate models to determine longitudinal transitions and outcomes. RESULTS:Of 367 encounters, 241 (66%) experienced AKI (maximal stages: 88 stage-1, 49 stage-2, 104 stage-3 AKI [51 received renal replacement therapy (RRT), 53 did not]). Patients receiving RRT overwhelmingly received invasive mechanical ventilation (IMV) (n = 60, 95%) compared with the AKI-without-RRT (n = 98, 53%) and no-AKI groups (n = 39, 32%; p < 0.001), with similar mortality patterns (RRT: n = 36, 57%; AKI: n = 74, 40%; non-AKI: n = 23, 19%; p < 0.001). After 24 hours in the ICU, almost half the cohort had AKI (44.9%; 95% CI, 41.6-48.2%). At 7 days after stage-1 AKI, 74.0% (63.6-84.4) were AKI-free or discharged. By contrast, fewer patients experiencing stage-3 AKI were recovered (30.0% [24.1-35.8%]) or discharged (7.9% [5.2-10.7%]) after 7 days. Early AKI occurred with similar frequency in patients receiving and not receiving IMV: after 24 hours in the ICU, 20.9% of patients (18.3-23.6%) had AKI and IMV, while 23.4% (20.6-26.2%) had AKI without IMV. CONCLUSIONS AND RELEVANCE:In a multistate analysis of critically ill patients with COVID-19, AKI occurred early and heterogeneously in the course of critical illness. Multistate methods are useful and underused in ICU care delivery science as tools for understanding trajectories, prognoses, and resource needs.

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“…Acute kidney injury (AKI) is a common condition in critically ill children affecting 24%–41% of children admitted to the paediatric intensive care unit (PICU) 1–4. It is now recognised as an independent predictor of PICU mortality1 2 5 and can lead to hypertension and chronic kidney disease (CKD) among survivors 6 7. In fact, AKI and CKD are now viewed as a continuum instead of two separate entities 7…”

Section: Introductionmentioning

confidence: 99%

Pattern and prognostic factors for kidney function progression in survivors of children with acute kidney injury: a cohort study

Hui,

Chan,

Cheung

et al. 2024

Arch Dis Child

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ObjectiveTo examine the pattern of kidney function progression after acute kidney injury (AKI) and identify the associated risk factors.DesignA prospective cohort study was conducted from June 2020 to June 2021 on children aged 1 month to <18 years admitted to the paediatric intensive care unit (PICU). Acute kidney disease (AKD) was defined as AKI persisting from 7 to 90 days after diagnosis. The natural history and prognostic factors of kidney function progression were determined.ResultsAmong the 253 admissions with a median (IQR) age of 4.9 (9.7) years, the AKI and AKD incidence was 41.9% and 52.2% respectively. The incidence of estimated glomerular filtration rate (eGFR) <90 mL/min/1.73 m2was 6.7% at 90 days and 11.9% at latest follow-up. Severe and prolonged AKI and higher degree of nephrotoxic medication exposure were associated with AKD development. The severity and duration of AKI and AKD significantly predicted kidney function non-recovery. Children with both entities exhibited a higher peak-to-baseline serum creatinine level ratio at 90 days (1.6 vs 1.0, p<0.001), and a more pronounced decline in eGFR (21% vs 19%, p=0.028) during the follow-up period compared with those without AKI/AKD. They also had an increased risk of having eGFR <90 mL/min/1.73 m2at 90 days (HR 14.9 (95% CI 1.8 to 124.0)) and latest follow-up (HR 3.8 (95% CI 1.1 to 13.1)).ConclusionsAKI and AKD are prevalent among critically ill children and pose substantial risk for non-recovery of kidney function among PICU survivors. A structural follow-up visit for AKI survivors to monitor kidney function progression is advocated.

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Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient

Cited by 24 publications

References 124 publications

Typhaneoside-Tetrahedral Framework Nucleic Acids System: Mitochondrial Recovery and Antioxidation for Acute Kidney Injury treatment

Typhaneoside-Tetrahedral Framework Nucleic Acids System: Mitochondrial Recovery and Antioxidation for Acute Kidney Injury treatment

Multistate Modeling of Clinical Trajectories and Outcomes in the ICU: A Proof-of-Concept Evaluation of Acute Kidney Injury Among Critically Ill Patients With COVID-19

Pattern and prognostic factors for kidney function progression in survivors of children with acute kidney injury: a cohort study

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