Predictors of Acute Kidney Injury in Septic Shock Patients

Plataki, Maria; Kashani, Kianoush; Cabello-Garza, Javier; Maldonado, Fabien; Kashyap, Rahul; Kor, Daryl J.; Gajic, Ognjen; Cartin‐Ceba, Rodrigo

doi:10.2215/cjn.05480610

Cited by 158 publications

(113 citation statements)

References 55 publications

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“…Our findings regarding the prognostic utility of angiotensinogen as a biomarker of AKI suggest that the RAS could be mechanistically involved in AKI. This is supported by observational studies that have noted an association between pharmacologic inhibition of the RAS and risk of developing AKI, although there are conflicting reports in the literature (31)(32)(33)(34). The ACE II genotype has been associated with increased risk of AKI in the ICU (35).…”

Section: Discussionmentioning

confidence: 85%

Urinary Angiotensinogen and Risk of Severe AKI

Alge

Karakala

Neely

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground Biomarkers of AKI that can predict which patients will develop severe renal disease at the time of diagnosis will facilitate timely intervention in populations at risk of adverse outcomes.Design, setting, participants, & measurements Liquid chromatography/tandem mass spectrometry was used to identify 30 potential prognostic urinary biomarkers of severe AKI in a group of patients that developed AKI after cardiac surgery. Angiotensinogen had the best discriminative characteristics. Urinary angiotensinogen was subsequently measured by ELISA and its prognostic predictive power was verified in 97 patients who underwent cardiac surgery between August 1, 2008 and October 6, 2011.Results The urine angiotensinogen/creatinine ratio (uAnCR) predicted worsening of AKI, Acute Kidney Injury Network (AKIN) stage 3, need for renal replacement therapy, discharge .7 days from sample collection, and composite outcomes of AKIN stage 2 or 3, AKIN stage 3 or death, and renal replacement therapy or death. The prognostic predictive power of uAnCR was improved when only patients classified as AKIN stage 1 at the time of urine sample collection (n=79) were used in the analysis, among whom it predicted development of stage 3 AKI or death with an area under the curve of 0.81. Finally, category free net reclassification improvement showed that the addition of uAnCR to a clinical model to predict worsening of AKI improved the predictive power.Conclusions Elevated uAnCR is associated with adverse outcomes in patients with AKI. These data are the first to demonstrate the utility of angiotensinogen as a prognostic biomarker of AKI after cardiac surgery.

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Section: Discussionmentioning

confidence: 85%

Urinary Angiotensinogen and Risk of Severe AKI

Alge

Karakala

Neely

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Blood transfusions have increasingly been implicated with postoperative morbidity and mortality, and blood transfusions in septic patients were associated with increased rates of AKI. 31 Anemic patients undergoing cardiac surgery who received blood transfusions are at increased risk for AKI; [32][33][34] however, whether reduction of the rate of blood transfusion lowers the incidence of AKI following orthopedic surgery requires further study. 35 The rate of perioperative NSAID administration was greater among our controls than the cases.…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury following total joint arthroplasty: retrospective analysis

Weingarten

Gurrieri

Jarett

et al. 2012

Can J Anesth/J Can Anesth

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Introduction Postoperative acute kidney injury (AKI) following arthroplasty has not been well studied. Our aim was to identify factors associated with increased risk of AKI. Methods The medical records for adult patients who underwent elective total joint arthroplasty during June 1, 2007 to May 31, 2010 at the Mayo Clinic were reviewed to identify patients with normal preoperative kidney function who experienced perioperative AKI, defined as an increase in serum creatinine (sCr) by 26.4 lmolÁL -1 . For each AKI case, two controls were identified and matched for age, sex, and type of operation. Medical records were abstracted for demographics, comorbid conditions, and preoperative, intraoperative, and postoperative variables. Conditional logistic regression analyses were performed to identify risk factors for AKI. Results Of the 9,171 patients who underwent joint replacement operations, 167 with normal preoperative renal function developed AKI with a median [25 th , 75 th ] increase in sCr of 35.4 [26.4, 44.2] lmolÁL -1 . No patient required dialysis. A higher than normal body mass index, diabetes mellitus, the number of baseline antihypertensive medications, cerebral or peripheral vascular disease, use of general anesthesia, and perioperative blood transfusions were independently associated with risk for AKI. Hospital length of stay and intensive care admissions were greater in AKI patients, and in 12.0% of patients, sCr remained at least 26.4 lmolÁL -1 higher than preoperative baseline at least three months after surgery. Conclusion In this case-control investigation, we identified several factors associated with the development of postoperative AKI. Recognition of these risk factors could allow for the adoption of perioperative renal protective strategies in patients undergoing arthroplasty.

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“…Our findings are consistent with the previous studies performed in ICU in younger populations that have reported that AKI is more frequently observed in severe and septic patients. 1,2,17,18 There are few studies on AKI in elderly patients admitted to ICU from developing countries. In India, researchers also found that underlying chronic illness, presence of cardiac failure, and sepsis were associated with AKI and poor outcome among the elderly population in a hospital-based study.…”

Section: Yokota Et Almentioning

confidence: 99%

Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome

Yokota¹,

Sampaio²,

Rocha³

et al. 2017

IJNRD

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Aim:The elderly are at high risk of acute kidney injury (AKI) because of structural and functional degeneration over time and with the aging of the population, the demand for intensive care unit (ICU) admission for older patients has risen recently. However, data from developing countries are scarce. This study aimed to describe the incidence of AKI in elderly patients admitted to ICU from a developing country, to determine the most frequent etiologies for renal impairment and identify its risk factors and outcome. Methods: All patients admitted to the ICU at a Brazilian teaching hospital for 12 consecutive months were followed prospectively from the time of admission until ICU discharge. Elderly was defined as aged >60 years and AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 criteria. Multivariable logistic regression was used to adjust confounding and selection bias. Results: Two hundred elderly patients were included in the study. AKI incidence was 27% and the main etiology was sepsis (48.1%). At logistic regression, baseline creatinine (odds ratio [OR]=5.17, p<0.0001), Acute Physiology and Chronic Health Evaluation (APACHE) II (OR=1.20, p<0.0001), sepsis (OR=2.96, p<0.0001), and longer ICU stay (OR=1.68, p<0.0001) were associated with AKI in elderly patients. Baseline creatinine (OR=1.97, p=0.018), APACHE II (OR=1.29, p<0.0001), sepsis (OR=1.87, p<0.0001), and AKI severity (OR=2.57, p=0.027) were identified as predictors of death. Conclusion: AKI was frequent in elderly patients admitted to ICU from a developing country, and it was identified as a risk factor for death. Sepsis was an important risk factor for both AKI and mortality, similar to developed countries and in younger populations.

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Predictors of Acute Kidney Injury in Septic Shock Patients

Cited by 158 publications

References 55 publications

Urinary Angiotensinogen and Risk of Severe AKI

Urinary Angiotensinogen and Risk of Severe AKI

Acute kidney injury following total joint arthroplasty: retrospective analysis

Acute kidney injury in elderly intensive care patients from a developing country: clinical features and outcome

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