A Knowledge-based and Data-driven Approach for Predicting Acute Kidney Injury in Patients with Heart Failure.

Although hypoalbuminemia at admission is a risk for acute kidney injury (AKI) and mortality in patients with acute decompensated heart failure (ADHF), the clinical significance of decreased serum albumin levels (DAL) during ADHF therapy has not been elucidated. This study aimed to evaluate whether DAL was associated with AKI, and whether intravenous atrial natriuretic peptide (ANP) administration, which provides an effective treatment for ADHF but promotes albumin extravasation, was associated with DAL and AKI. A total of 231 consecutive patients with ADHF were enrolled. AKI was defined as ≥0.3mg/dl absolute or 1.5-fold increase in serum creatinine levels within 48h. AKI occurred in 73 (32%) of the 231 patients during ADHF therapy. The median value of decreases in serum albumin levels was 0.3g/dl at 7days after admission. When DAL was defined as ≥0.3g/dl decrease in serum albumin levels, DAL occurred in 113 patients, and was independently associated with AKI. Of the 231 patients, 73 (32%) were treated with intravenous ANP. DAL occurred more frequently in patients receiving ANP than in those not receiving ANP (77 vs. 36%, p < 0.001), and ANP was independently associated with DAL. The incidence of AKI was higher in patients receiving ANP than in those not receiving ANP (48 vs. 24%, p < 0.001). ANP was independently associated with AKI. In conclusion, DAL is associated with AKI. Intravenous ANP administration may be one of the promoting factors of DAL, which leads to AKI, indicating a possible novel mechanism of AKI.

This multi-institute retrospective cohort study investigated the association between preoperative anemia and postoperative acute kidney injury (AKI) in patients undergoing metabolic and bariatric surgery (MBS). Using the TriNetX research network, we identified adult patients who underwent MBS between January 2010 and December 2024. Patients were categorized as anemic or non-anemic based on preoperative hemoglobin levels (hemoglobin < 12 g/dL for females and < 13 g/dL for males). Propensity score matching was performed to balance the baseline characteristics. The primary outcome was AKI within 30 days of MBS. The secondary outcomes included infections, intensive care unit admission, surgical complications, and deep vein thrombosis. Analyses were conducted separately for female and male patients, with additional sensitivity analyses for the female subgroups. After propensity score matching, preoperative anemia was significantly associated with an increased risk of postoperative AKI in females (1.51% vs. 0.71%, odds ratio (OR) 2.14, 95% confidence interval (CI) 1.53-2.98, p < 0.0001) (n = 7144 pairs). This association persisted in all sensitivity analyses. Even mild anemia (hemoglobin 10-12 g/dL) was associated with a higher AKI risk (OR 1.62, p = 0.004) in female patients. In males (n = 971 pairs), anemia similarly increased the AKI risk (4.94% vs. 2.68%, OR 1.89, 95% CI 1.16-3.07, p = 0.009). No significant differences were observed in secondary outcomes for either sex. Preoperative anemia is independently associated with an increased risk of postoperative AKI in both female and male patients undergoing MBS, suggesting that preoperative anemia screening and management could be important for reducing postoperative kidney complications in this population.

Background and purposeWe conducted a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in patients undergoing CT angiography (CTA) and CT perfusion (CTP) for acute...

Risk factors associated with acute kidney injury in patients with traumatic brain injury: A systematic review and meta-analysis.

Guidelines recommend withholding sofosbuvir (SOF) in patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min. To assess the risk of acute kidney injury (AKI) in patients with no renal contraindications for SOF-based treatment. This multicenter retrospective observational study included all consecutive patients that were treated with SOF-based or telaprevir/boceprevir (TVR/BOC)-based regimens at two tertiary university centers in North America. AKI was defined as an increase of ≥0.3 mg/dL (≥26.5 μmol/L) in serum creatinine level. Multivariable logistic regression analysis was used to identify risk factors for the occurrence of AKI. In total, 426 patients were included and treated with a SOF-based regimen (n=233, 54.7%) or TVR/BOC-based regimen (n=193, 45.3%). Among patients treated with a TVR/BOC-based regimen 34 (18%) of 193 patients experienced AKI compared to 26 (11%) of 233 patients treated with SOF-based regimens (P=.056). Multivariable logistic regression analysis showed that the presence of ascites (OR: 4.44, 95%CI: 1.46-13.54, P=.009) and the use of NSAIDs (OR: 4.47, 95%CI: 1.32-15.19, P=.016) were associated with a risk of AKI during SOF-based antiviral therapy. Creatinine levels returned to normal at end of follow-up in 23 (88%) of the 26 patients who experienced AKI with a SOF-based regimen and had a creatinine level available during follow-up. Although the risk for AKI was lower than for patients treated with TVR/BOC-based regimens, AKI was seen during 11% of SOF-based regimens and was mostly reversible. Patients with ascites and patients using NSAIDs have an increased risk for AKI during SOF-based antiviral therapy.

111 Background: Androgen deprivation therapy (ADT) has been associated with cardiovascular risk in prostate cancer patients. Thus, we performed a systematic review and meta-analysis to assess the incidence of acute kidney injury (AKI) in prostate cancer patients under ADT. Methods: PubMed, Embase, and Cochrane Library were searched from inception to October 2024. A random-effects model was employed to compute mean differences for continuous endpoints. Heterogeneity was evaluated by prediction interval and I-squared statistics. All statistical analysis was conducted using R software 4.4.1. GRADE approach rated the certainty of the evidence and the results were reported following the PRISMA statement guidelines. Results: Four studies involving 72,980 patients with a mean age of 73.5 years were included. Over a mean follow-up of 6.7 years, ADT was associated with an increase in the AKI incidence in prostate cancer patients compared to patients not receiving ADT (RR 1.34; 95% CI 1.13-1.58; p&lt;0.001). Among patients who developed AKI while receiving ADT, the use of GnRH agonists was not associated with AKI incidence (RR 4.32; 95% CI 0.60-30.97; p=0.146). Similarly, when comparing AKI risk between patients on GnRH agonists alone and those without ADT, no statistically significant difference was found (RR 1.24; 95% CI 0.73-2.11; p=0.424). Orchiectomized patients had a lower AKI incidence than GnRH agonist users (RR 1.16; 95% CI 1.04-1.3; p=0.009). All studies were limited by retrospective designs, introducing potential selection and therapeutic bias. Conclusions: In this meta-analysis, ADT was associated with an increased risk of AKI. No statistical association was found between GnRH agonist use and AKI. Orchiectomy presented a lower AKI risk compared to GnRH agonists. Further investigations, including post hoc analysis of randomized controlled trials, are warranted to confirm these findings. Characteristics of the included studies. Study Sample size (n) Mean age (years) ADT modality Control group AKI incidence (ADT) AKI incidence (control) Hazard ratio for GnRH use (95% CI) – sensitivity analyses Follow-up (years) Gandaglia 2014 31,408 78.6 GnRH agonist and Bilateral orchiectomy No ADT 30.7% 24.9% 1.73 (1.62-1.85) 10 Cardwell 2021 10,751 69.2 GnRH agonists, GnRH antagonist, oral antiandrogens, estrogens and orchiectomy No ADT 6.1% 5.2% 1.09 (0.88-1.34) 3.9 Sherer 2021 27,868 66 GnRH agonists, oral antiandrogens, and GnRH antagonist No ADT +Radiotherapy 10.5% 7.9% 1.25 (1.13-1.37) a 8.8 Lapi 2013 2,953 80.2 GnRH agonists, oral antiandrogens, GnRH agonists + oral antiandrogens, bilateral orchiectomy, estrogens, other combinations No ADT 9.2% 4.5% ≈ 1.54 (1.17-2.15) b / ≈ 1.04 (1.27-1.46) c 4.1 a Sensitivity analysis of all ADT modalities. b Adjusted analysis of current ADT modalities. c Adjusted analysis of past ADT modalities.

The Addition of a Nonsteroidal Anti-inflammatory Drug in Local Infiltration Analgesia During Total Knee Arthroplasty Increases the Risk of Acute Kidney Injury in Patients Who Have Renal Impairment: A Propensity-Matched Retrospective Cohort Study

Preoperative Renal Resistive Index Predicts Risk of Acute Kidney Injury in Patients Undergoing Cardiac Surgery

Aims/patients & methods: To evaluate the risk of acute kidney injury (AKI) in patients with HIV receiving proton pump inhibitors (PPI) a cohort study was conducted utilizing the Veterans Affairs Informatics and Computing Infrastructure (VINCI) database. Patients were followed from the index date until the earliest date of AKI, 120 days or end of study period, or death. Statistical analyses utilized a Cox proportional hazards model. Results: A total of 21,643 patients (6000 PPI and 15,643 non-PPI) met all study criteria. The PPI cohort had twice the risk of AKI compared with controls (2.12, hazard ratio: 1.46-3.1). Conclusion: A nationwide cohort study supported the relationship of an increased risk of AKI in patients receiving PPIs.

To examine the relationship between Neutrophil-Lymphocyte Ratio (NLR) and Acute Kidney Injury (AKI) in patients undergoing noncardiac surgery, and subgroup analysis was performed for different types of non-cardiac surgery. The present retrospective cohort study included 10,159 adult patients who underwent major noncardiac surgery at Nanfang Hospital, Southern Medical University, between 2008 and 2018. Postoperative AKI was defined as an increase in serum creatinine level of at least 0.3mg/dl within 48h, or 1.5 times higher than baseline within 7days postoperatively according to the Kidney Disease Improving Global Outcome. The correlation between preoperative NLR and postoperative AKI was determined by stepwise multivariate logistic regression analysis, and the predictive value of NLR was evaluated by the receiver operating characteristics curve (ROC) analysis. Four hundred and eighty-five (4.77%) patients developed AKI postoperatively. Preoperative NLR was independently associated with postoperative AKI in all patients undergoing non-cardiac surgery (Odds ratio [OR], 1.03; 95% confidence interval [CI], 1.00-1.06). The optimal cut-off value of NLR was 2.12 according ROC analysis. The OR and 95% CI of AKI for NLR > 2.12 was 1.48 (1.21-1.81) compared with NLR ≤ 2.12. In addition, the positive association was mainly shown in patients undergone digestive system surgery with a cut-off value of 2.12 but not in neurological and musculoskeletal system surgeries. The present study confirmed the association of preoperative NLR with postoperative AKI in digestive system surgical patients. A NLR value of 2.12 may be a useful cut-off to evaluate the risk of AKI.

Introduction: The use of polyethylene glycol-based solutions is the gold standard for bowel preparation for colonoscopy. However, polyethylene glycol use might be associated with the risk of acute kidney injury. We aim to find out acute kidney injury and risk factors associated with the development of acute kidney injury in patients using polyethylene glycol for colonoscopy.Materials and Methods: This was an observational study conducted in the Department of Nephrology and Gastroenterology, Bir hospital. Patients who underwent colonoscopy using polyethylene glycol were included in the study and assessed for acute kidney injury; its incidence, association of risk factors with acute kidney injury, and outcome (complete recovery or no recovery) of acute kidney injury by 3 months.Results: The mean age of the patients was 45.81 ± 18.60 years with the majority of the patients being male (60%). Out of 48 study participants, 4(8%) develop acute kidney injury. Multivariate regression analysis depicted that chronic kidney disease, chronic liver disease, congestive cardiac failure, and use of non-steroidal anti-inflammatory drugs, angiotensin receptor blockers, and diuretics drugs were the predictors which significantly influenced the occurrence of acute kidney injury in patients using polyethylene glycol.Conclusions: The evidence strongly suggests that in patients without preexisting renal disease, comorbidities, or use of drugs; the risk of renal impairment is low after colonoscopy using polyethylene glycol as a bowel cleansing agent. In the presence of risk factors for renal dysfunction, polyethylene glycol should be used cautiously.

To investigate serum cystatin C level as an early biomarker for predicting acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF). Fifty-six consecutive patients with hepatitis B virus-related ACLF who had normal serum creatinine (Cr) level (< 1.2 mg/dL in men, or < 1.1 mg/dL in women) were enrolled in the Liver Failure Treatment and Research Center of Beijing 302 Hospital between August 2011 and October 2012. Thirty patients with chronic hepatitis B (CHB) and 30 healthy controls in the same study period were also included. Measurement of serum cystatin C (CysC) was performed by a particle-enhanced immunonephelometry assay using the BN Prospec nephelometer system. The ACLF patients were followed during their hospitalization period. In the ACLF group, serum level of CysC was 1.1 ± 0.4 mg/L, which was significantly higher (P < 0.01) than those in the healthy controls (0.6 ± 0.3 mg/L) and CHB patients (0.7 ± 0.2 mg/L). During the hospitalization period, eight ACLF patients developed AKI. Logistic regression analysis indicated that CysC level was an independent risk factor for AKI development (odds ratio = 1.8; 95%CI: 1.4-2.3, P = 0.021). The cutoff value of serum CysC for prediction of AKI in ACLF patients was 1.21 mg/L. The baseline CysC-based estimated glomerular filtration rate (eGFR(CysC)) was significantly lower than the creatinine-based eGFR (eGFR(CG) and eGFR(MDRD)) in ACLF patients with AKI, suggesting that baseline eGFR(CysC) represented early renal function in ACLF patients while the Cr levels were still within the normal ranges. Serum CysC provides early prediction of renal dysfunction in ACLF patients with a normal serum Cr level.

There is limited information on the incidence of acute kidney injury (AKI) in patients with traumatic brain injury (TBI) although AKI may contribute to morbidity and mortality. We investigated the incidence of AKI in patients with moderate and severe TBI and the association of AKI with risk factors and outcomes in these patients.We studied all TBI patients over 16 years of age admitted to the two designated trauma hospitals in the state of Victoria, Australia from 1 January to 31 December 2008. Patients were included if they had head trauma and presented with a Glasgow coma scale (GCS) <13. Prospectively collected data from the hospital trauma registries, ICUs, and pathology databases were analyzed retrospectively. Risk injury failure loss end (RIFLE) criteria were used to categorize renal function.The incidence of AKI was 9.2% (19/207). Patients who developed AKI were older, had higher severity of illness scores, and a lower GCS. Overall 42.1% of these patients died in hospital compared with 18.1% in patients without AKI. In univariable linear regression analysis, age, severity of illness, and admitting hospital were associated with AKI. After multivariable logistic regression, the occurrence of AKI was associated with age (p < 0.001) and higher APACHE III scores (p = 0.016).AKI is relatively common even in patients with TBI. Its association with age and APACHE III scores helps identify patients at higher risk of AKI.

PurposeLittle is known about the incidence, risk factors, and prognostic implications of acute kidney injury (AKI) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in China. In this study, we investigated the incidence, risk factors, and short-term outcomes of AKI in these patients.Patients and MethodsWe analyzed the records of 1768 patients admitted to Nanjing First Hospital with a principal diagnosis of AECOPD. Of these, 377 patients had AKI.ResultsAKI occurred in 377 patients (21%). Independent risk factors for AKI in patients with AECOPD were advanced age, coronary artery disease, anemia, cancer, chronic kidney disease, hypercapnic encephalopathy, acute respiratory failure, and mechanical ventilation. Patients with AKI had worse prognostic implications and were more likely to require mechanical ventilation (38.7% vs 19.1%, P<0.001); non-invasive mechanical ventilation (38.2% vs 18.9%, P<0.001); invasive mechanical ventilation (18.3% vs 3.1%, P<0.001); intensive care unit (ICU) admission (33.7% vs 12.9%, P<0.001); had a longer ICU stay (9 days vs 8 days, P=0.033) and longer hospitalization (13 days vs 10 days, P<0.001); and higher in-hospital mortality (18.0% vs 2.7%, P<0.001) than those without AKI. Multivariable analysis indicated that compared to patients without AKI, those with stage 1, 2, or 3 AKI had a 1.9-fold, 2.1-fold, or 6.0-fold increased risk of in-hospital death, respectively.ConclusionAKI is common in patients with AECOPD requiring hospitalization. Patients with AKI have worse short-term outcomes. Thus, AKI may be a prognostic predictor of patient survival.

The development of acute kidney injury (AKI) in patients during hospitalization worsens the prognosis. The study aimed to estimate the prognostic value of AKI in patients with ST-segment elevation myocardial infarction (MI) in prospective follow-up study. A prospective follow-up of 12 months included 268 patients with ST-segment elevation MI who underwent percutaneous coronary intervention. The incidence of AKI was assessed and its effect on the outcome of ST-segment elevation MI during the observed period was traced. AKI was diagnosed according to Kidney Disease: Improving Global Outcomes recommendations. AKI was recorded in 20.5%. The incidence of AKI increased with decrease in the level of glomerular filtration rate on admission (P = 0.047) and an increase in the stage of acute heart failure according to Killip on admission (P = 0.006). The development of AKI was associated with an increase in-hospital mortality, increasing with a worsening stage of AKI (P<0.001), the same pattern was characteristic for death from cardiovascular causes during follow-up. AKI increases the risk of death from cardiovascular causes by four times [odds ratio 95% 4.400 (1.928-10.040), P <0.001]. The multivariate analysis revealed risk factors for the development of AKI: age >75 years (P = 0.006), female (P = 0.008), Killip >I (P = 0.045). AKI is common in patients with ST-segment elevation MI and is associated with a poor prognosis. The development of AKI is associated with an increase mortality, increasing with a worsening stage of AKI.