Academic literature on the topic 'Cohort studies, electrolyte disorders, acute kidney injury, mortality'

Continuous renal replacement therapy (CRRT) is a broadly-accepted treatment for critically ill patients with acute kidney injury to optimize fluid and electrolyte management. Despite intensive dialysis care, there is a high mortality rate among these patients. There is uncertainty regarding the factors associated with in-hospital mortality among patients requiring CRRT. This review evaluates how various risk factors influence the in-hospital mortality of critically ill patients who require CRRT. Five databases were surveyed to gather relevant publications up to 30 June 2020. We identified 752 works, of which we retrieved 38 in full text. Finally, six cohort studies that evaluated 1190 patients were eligible. The in-hospital mortality rate in these studies ranged from 38.6 to 62.4%. Our meta-analysis results showed that older age, lower body mass index, higher APACHE II and SOFA scores, lower systolic and diastolic blood pressure, decreased serum creatinine level, and increased serum sodium level were significantly associated with increased in-hospital mortality in critically ill patients who received CRRT. These results suggest that there are multiple modifiable factors that influence the risk of in-hospital mortality in critically ill patients undergoing CRRT. Further, healthcare professionals should take more care when CRRT is performed on older adults.

Abstract BACKGROUND AND AIMS Acute kidney injury (AKI) accounts for 13.3 million cases per year worldwide and further responsible for 1.7 million deaths per year [1]. Increasing incidence of AKI, progression toward CKD or end-stage renal disease (ESRD), affect on long term health, high mortality, morbidity and high costs are all accountable for the need to analyze AKI at a closer level [2]. Rhabdomyolysis (RM) accounting for 10% of AKI cases is due to damage of the skeletal muscle causing a release of muscle cell contents like myoglobin and toxins into the bloodstream leading to AKI, renal failure and possibly death. RM-induced AKI (RIAKI) occurs due to a variety of causes like fall risk, exposure to drugs, infections, muscle hypoxia, infections, body-temperature changes and metabolic and electrolyte disorders [3]. The immune system has been reported to play a role in the pathogenesis of AKI through inflammatory pathways. Macrophages are known to be involved in AKI to CKD transition [4]. Macrophages play an important role in the pathogenesis of RIAKI. While macrophage subtypes (inflammatory type) have been reported to drive RIAKI lesions and prognosis [5], the role of the other immune cells needs to be explored. The aim of this study was to analyze the recruitment of the whole immune system during RIAKI through single-cell RNA sequencing. METHOD Two month old C57BL/6J male mice were used for this study. Mice were administered saline (control) or glycerol i.m (7.5 mL/kg 50% glycerol diluted in saline) for induction of RM. Mouse tail vein blood was collected at 6, 24 and 48 h and serum was obtained after centrifugation (5 min at 2000 rpm). Biochemical analysis tests were used to evaluate RM intensity (creatinine phosphokinase, CPK) and renal function (blood urea nitrogen, BUN) using a Pentra 400 analyzer. To analyze the immune cell recruitment in kidney, kidneys from control and glycerol treated mice were decapsulated, minced and incubated with collagenase and DNase. The dissociated cells were then incubated in red cell lysis buffer and passed through a 40 µm filter. The dissociated cells were further incubated with CD45 antibodies and a viability marker. Kidney CD45 live cells were sorted using BD Influx cell sorter. Preparation of single cell libraries was done and single-cell RNA sequencing was performed according to 10× Genomics protocol. RESULTS Eight clusters (macrophages, monocytes, endothelial cells, neutrophils, natural killer T cells, B cells, T cells and dendritic cells) were revealed after single-cell RNA sequencing of CD45+ renal cells. Recruitment of macrophages, monocytes and neutrophils were revealed to be modified by RIAKI. As expected, NF-kB signaling pathway was the major pathway upregulated in multiple clusters. Pathway analysis in T cell cluster showcased T cell selection and differentiation and T cell receptor signaling pathway. AA467197 (a long non-coding RNA which has been reported in renal ischemia–reperfusion) was upregulated through differential expression analysis in multiple clusters. Macrophage subclustering revealed a high macrophage diversity in the seven macrophage subclusters that shared markers for macrophage subtypes (M1, M2) and pro-inflammatory markers. KLf9 was upregulated in cluster 7, which has been reported to be a stress-responsive gene associated having pro-inflammatory effect. NF-kB and IL-2 STAT5 signaling pathways were the major pathways upregulated in multiple clusters. Drug repositioning studies with connectivity map showcased SRC inhibitions as potent pharmacological intervention strategy. CONCLUSION This study revealed the immune landscaping and pathways associated in RIAKI. Single-cell approach illustrated macrophages diversity in pathological context and suggested candidates for further therapeutic approaches.

Introduction: Occurrence of Acute Kidney Injury (AKI) is high in hospitalised and critically ill patients. Most of the cases reported by the developed countries are Hospital Acquired Acute Kidney Injury (HA-AKI). AKI is a major medical complication in the developing world also and is due to predominantly community acquired causes, where the epidemiology differs from that in developed countries. Many studies have reported that Community Acquired Acute Kidney Injury (CA-AKI) and HA-AKI differ in mortality, need for renal replacement and residual renal injury. Aim: To know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Materials and Methods: A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional Ethical Clearance by comparing 50 cases of CA-AKI and 50 cases of HA-AKI admitted by the General Medicine Department as per the inclusion and exclusion criteria. Serum Creatinine (S.Cr) at admission, after 48 hours and at the time of discharge were measured. Serial urine output measurements were done. Need for dialysis was noted in both the groups. Both groups were compared based on need for dialysis, difference in mortality and residual renal injury at the time of discharge. Chi-square and student t-tests were applied respectively and p-value ≤0.05 was considered as significant. Statistical Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results: the CA-AKI and HA-AKI groups were comparable in age and gender but differed in some co-morbidities. CA-AKI group had underlying hepatobiliary disorders and Non steroidal Anti-Inflammatory Drug (NSAID) abuse more often than HA- AKI group. There was a significant reduction in S.Cr over the duration of hospital stay in CA-AKI (mean S.Cr at admission was 4.85 mg/dL, at 48 hours 2.05 mg/dL and at discharge 1.20 mg/dL). S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI but did not reach baseline in many patients in comparison to CA-AKI group (mean S.Cr at admission was 1.10 mg/dL, at 48 hours 2.38 mg/dL, at discharge 1.57 mg/dL). The highest stage of AKI was stage 3 in CA-AKI group (22 vs 11 of HA-AKI). HA-AKI group had more number of patients in stage 2 AKI (26 vs 18 of CA-AKI). There was no significant difference in mortality and requirement of haemodialysis between CA-AKI and HA-AKI groups. Conclusion: There was no difference between the two groups in terms of mortality and need for renal replacement therapy but there was significant residual renal injury in HA-AKI group.

Abstract Background and Aims Some decades ago, patients with cancer were not submitted to invasive procedures because of their short life expectancy. This is one of the main reasons why data about kidney histology in oncological patients with kidney impairment is very scarce: kidney biopsies were not performed in this population. However, renal biopsy is an especially useful diagnostic and prognostic tool in these patients when they develop kidney injury. The aim of our study is to study clinical and histological characteristics of patients with active solid organ malignancy that underwent kidney biopsy in a multicenter cohort. Method We performed a multicenter collaborative retrospective study. Clinical, demographical, and histological data from patients with an active neoplasia or in active cancer treatment who underwent kidney biopsy were collected. Statistics: Quantitative variables are expressed as mean+/-SD (normal distribution) or median (IQ 25-75) (non-normal distribution).Qualitative variables are expressed as percentage. Actuarial survival curves were performed using Kaplan-Meier. Results 94 patients with cancer who underwent a kidney biopsy during the study period, from 9 hospitals were included.63.8% men, 36.2% woman and mean age 66 (SD +/- 10,95) years old. The indications for biopsy were acute renal failure (63.8%), proteinuria (17%), and exacerbation of chronic kidney disease (11.7%). At the time of the renal biopsy, 27.7% patients presented diabetes, 60.6% high blood pressure, 10.6% were on non-steroidal anti-inflammatory drugs treatment, and 74.5% were receiving renin angiotensin system blockers. Malignances were lung (31.9%), intestinal (13.8%) and prostate (8.5%), with 43.6% metastatic cancer. As oncospecific treatment, 33% received chemotherapy, 30.8% immunotherapy (of which 37.93% received more than 1 checkpoint inhibitor (CPI) and 24.13% had immune-related adverse events), 22.4 % specific therapies, 17 % surgery, and 3.2% conservative treatment. Previously to kidney injury, 51.06% presented Cr> 1 mg / dL. At the time of kidney biopsy, median creatinine was 2,63mg/dL [1,75-3,9 (IQ 25-75)], median urine protein/creatinine ratio 795 mg/g [221-3182(IQ 25-75)]; 51.1% presented haematuria and 22.3% nephrotic range proteinuria; 8.5% eosinophiluria and 7.44% hemolytic anemia and /or low platelet. At the time of renal biopsy, 8.5% presented ANCA and 5.31% decrease in C3 / C4 serum levels. The renal biopsy diagnosis was: 40.4% acute interstitial nephritis, followed by acute tubular necrosis (9.6%), thrombotic microangiopathy (6.4%), membranous nephropathy (5.3%) and IgA nephropathy (6.4%). 62.8% received corticosteroids (28.81% pulses) for an average of 5.8 months [3.7-9.1(IQ 25-75)]. 12.8% required kidney replacement therapy. 43.6% showed complete recovery of kidney function at the end of follow-up. Average follow-up 22.59 months. 40.2% of patients died at the end of follow-up and 72.34 % presented chronic kidney disease. As expected, and maybe related to the heterogeneous cancer disease studied, the only factor associated with mortality was the presence of the metastasis at the moment of kidney biopsy (p=0.028). Conclusion Histological kidney diagnosis in patients with active cancer involves various renal disorders, such as acute interstitial nephritis, thrombotic microangiopathy, membranous nephropathy and IgA nephropathy. Renal biopsy in this group of patients provides valuable diagnostic and prognostic information. More studies are needed to expand the consensus in the diagnosis and treatment of oncological patients with renal injury.

Abstract Introduction Gender disparity in the management of a variety of cardiovascular disorders has been well established. Studies have shown that women are less likely to undergo surgical aortic valve replacement (SAVR), and have higher mortality and health care cost in the management of aortic stenosis (AS). The impact of transcatheter aortic valve replacement (TAVR) on this gender disparity has not been well established. Purpose We sought to examine the impact of gender on outcomes following aortic valve replacement for AS in the era of routine transcatheter valve replacement. Methods We used the National Inpatient Sample (2009–18), a representative probability sample of the United States, to study visits for all aortic valve replacements and in-hospital outcomes as a function of gender. Survey estimation commands were used to provide national estimates. Results There were an estimated 431,344 SAVR and 189,137 TAVR inpatient visits during the periods of 2009–18 and 2011–18, respectively with a higher representation of women in the TAVR cohort (46.4% [95% CI, 45.9%-46.9%]) than SAVR (36.8% [95% CI, 36.4%-37.2%]). Women were slightly older with higher prevalence of uncomplicated hypertension (HTN) and pulmonary circulation disorders. However, women exhibited a lower prevalence of complicated HTN, complicated diabetes mellitus, prior percutaneous coronary intervention, prior coronary artery bypass grafting, peripheral vascular disease and renal failure. In-hospital mortality was higher in women after SAVR (3.8%±0.1 vs 2.7%±0.07, p<0.001) and TAVR (2.4%±0.1 vs 1.7%±0.1, p<0.001) compared to men. Female SAVR patients had higher rates of permanent pacemaker (PPM) implantation, stroke and significant bleeding (5.9%±0.1 vs 5%±0.1, 2.8%±0.1 vs 2.3%±0.07, and 37.8%±0.8 vs 29.8%±0.6; p<0.001, respectively) but lower rates of acute kidney injury (AKI) (16.4%±0.3 vs 20.3%±0.3, p<0.001). In addition, women undergoing TAVR had higher rates of stroke and significant bleeding (2.4%±0.1 vs 1.6%±0.09 and 28.7%±0.6 vs 22%±0.5; p<0.001 respectively) but lower rates of PPM and AKI (9.5%±0.3 vs 10.7%±0.2 and 11.3%±0.3 vs 13.4%±0.3; p<0.001, respectively). There was a reduction in mortality, compared to the early TAVR era, for all groups during the study period, particularly in female TAVR patients (from approximately 5.2% to 1.7%). In-hospital mortality for women was lower after TAVR than SAVR, both after multivariable adjustment (OR = 0.33, 95% CI 0.24–0.45) and propensity matching (mean difference 1.28%±0.49). Conclusions TAVR appears to have narrowed the gender disparity in the management of AS. Although women continue to have a higher in-hospital mortality following both TAVR and SAVR compared to men, TAVR is associated with a lower inpatient mortality in women compared to SAVR. Thus, TAVR may represent a bridge for the gender gap in aortic valve replacement. Funding Acknowledgement Type of funding sources: None.