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1.
Adv Gerontol ; 32(4): 633-638, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800194

RESUMO

The aim of the study was to determin the incidence, severity and prognostic significance of acute kidney injury (AKI) in elderly patients with community-acquired pneumonia (CAP). 122 older patients (≥60 years) with community-acquired pneumonia were examined. Acute kidney injury was diagnosed in 49 (40,2%) patients including 47 (95,9%) patients with AKI occurring prehospital. In patients with community-acquired pneumonia associated with acute kidney injury the clinical picture of AKI was harder. Also disturbance of consciousness, dyspnea, leg swelling, tachycardia, abnormal liver function tests such as hyperbilirubinemia and hypertransaminasemia were diagnosed more frequently in this group of patients. With the development of AKI increased in-hospital mortality: odds ratio of death among patients with CAP associated with AKI was 8,3 (95% CI 2,75-25,28). So, the development of AKI in elderly patients with CAP is an actual health problem requiring the development of preventive measures and drug therapy in patients with CAP and also mandatory monitoring of patients who have had acute kidney injury.


Assuntos
Infecções Comunitárias Adquiridas , Pneumonia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/patologia , Idoso , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/patologia , Humanos , Incidência , Pneumonia/complicações , Pneumonia/epidemiologia , Pneumonia/patologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Hu Li Za Zhi ; 66(6): 66-73, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31802456

RESUMO

Neonatal acute kidney injury is a common clinical condition encountered in neonatal intensive care units. Acute kidney injury in newborns is associated with a poor prognosis and significantly increased risks of mortality and chronic kidney disease. Neonatal kidney function changes with gestation and neonatal extra-uterine adaptation affects the transformation and regulation of renal functions. In particular, premature infants are more likely to develop acute kidney injury due to incomplete kidney development, which increases the difficulty of care. It is necessary to understand the definition and risk factors of acute kidney injury in neonates as well as treatment options, which include maintai­ning body fluid and water balance, stabilizing electrolyte levels, and implementing renal replacement therapy. Healthcare providers must carefully evaluate a newborn's physiological changes after birth and use relevant biological indicators to detect acute kidney injury as early as possible in order to prevent or reduce the risk of acute kidney injury and provide appropriate care to improve the quality of newborn care.


Assuntos
Lesão Renal Aguda/epidemiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Fatores de Risco
3.
Ther Adv Cardiovasc Dis ; 13: 1753944719894509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854243

RESUMO

BACKGROUND: It is known that once heart failure occurs in older patients with diabetes, the overall prognosis is extremely poor. We investigated whether early initiation of SGLT2 inhibitor therapy after admission was beneficial for diabetic patients requiring inpatient treatment for acute heart failure. METHODS: We retrospectively assessed consecutive patients with comorbid diabetes who were admitted to the Department of Cardiology in Tosei General Hospital for treatment of acute heart failure. Patients were divided into two groups: those who initiated SGLT2 inhibitor therapy (SGLT2 inhibitor group; mean age: 73 ± 9 years) and those who did not receive the inhibitors during hospitalization (conventional treatment group; mean age: 75 ± 10 years). RESULTS: No intergroup differences were observed in the distribution of either the severity or classes of heart failure on admission. Glycosylated hemoglobin levels were significantly higher in the SGLT2 inhibitor group (HbA1c: 8.1% ± 0.8%) than in the conventional treatment group (HbA1c: 7.1% ± 0.8%) (p = 0.003). After admission, patients in both groups recovered equally well, and in almost the same period of time, before discharge. The rate of diuretics use at the time of discharge in the SGLT2 inhibitor group (n = 8, 67%) was significantly lower than that in the conventional treatment group (n = 19, 100%) (p = 0.016). In particular, the dose of loop diuretics in the conventional treatment group was 34 ± 4 mg/day while that in the SGLT2 inhibitor group was significantly lower at 13 ± 5 mg/day (p = 0.008). During hospitalization, the incidence of acute kidney injury was significantly higher in the conventional treatment group (n = 11, 58%) than in the SGLT2 inhibitor group (n = 2, 16%) (p = 0.031). CONCLUSIONS: For the treatment and management of heart failure in patients with diabetes, early initiation of SGLT2 inhibitor therapy appears to be effective.


Assuntos
Glicemia/efeitos dos fármacos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Insuficiência Cardíaca/tratamento farmacológico , Inibidores de Simportadores de Cloreto de Sódio e Potássio/administração & dosagem , Inibidores do Transportador 2 de Sódio-Glicose/administração & dosagem , Doença Aguda , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Glicemia/metabolismo , Comorbidade , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Hemoglobina A Glicada/metabolismo , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Intervalo Livre de Progressão , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Inibidores de Simportadores de Cloreto de Sódio e Potássio/efeitos adversos , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Fatores de Tempo
4.
Nephrol Nurs J ; 46(6): 629-640, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31872993

RESUMO

Reducing the growing burden of acute kidney injury (AKI) is a real challenge. This article explores admissions and emergency visits of patients with AKI in California between 2005 and 2015. Data were drawn from California's Office of Statewide Health Planning and Development (OSHPD) hospital dataset. Trend analyses, including comorbidities and spatiotemporal analysis, were conducted. AKI hospital episodes almost doubled between 2005 and 2015 (25,495 vs. 48,845, respectively); the growing trend was largely attributable to an increasing number of patients with co-existing CKD and diabetes or hypertension (2,511 vs. 25,098 in 2005 and 2015, respectively). We also found an increasingly positive spatiotemporal correlation between diabetes prevalence and AKI hospitalization rate over time. Based on results of this study, we identified modifiable targets to reduce the growing number of AKI episodes and the potential escalating health care costs.


Assuntos
Lesão Renal Aguda , Complicações do Diabetes , Diabetes Mellitus , Hospitalização , Lesão Renal Aguda/complicações , Lesão Renal Aguda/epidemiologia , California/epidemiologia , Complicações do Diabetes/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Fatores de Risco
5.
Methodist Debakey Cardiovasc J ; 15(3): 228-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687105

RESUMO

This column is supplied by Amita Jain, MD, and Juan Jose Olivero, MD. Dr. Jain completed an internal medicine residency at Houston Methodist Hospital in Houston, Texas, and recently joined a primary care practice in Delaware. She earned a Bachelor of Medicine and Surgery (MBBS) degree, with a distinction in microbiology, from Terna Medical College at the Maharashtra University of Health Sciences in Navi Mumbai, India. Before coming to Houston, Dr. Jain completed residency training in internal medicine and allied subspecialties at the Dr. Babasaheb Ambedkar Memorial Hospital in Byculla, Mumbai. Dr. Olivero is a nephrologist at Houston Methodist Hospital and a member of the hospital's Nephrology Training Program. He obtained his medical degree from the University of San Carlos School of Medicine in Guatemala, Central America, and completed his residency and nephrology fellowship at Baylor College of Medicine in Houston, Texas.


Assuntos
Lesão Renal Aguda/induzido quimicamente , Ácidos Aristolóquicos/efeitos adversos , Suplementos Nutricionais/efeitos adversos , Medicamentos de Ervas Chinesas/efeitos adversos , Falência Renal Crônica/induzido quimicamente , Rim/efeitos dos fármacos , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Progressão da Doença , Interações Ervas-Drogas , Humanos , Rim/fisiopatologia , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/fisiopatologia , Falência Renal Crônica/terapia , Prognóstico , Medição de Risco , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fatores de Tempo
6.
Lancet ; 394(10212): 1949-1964, 2019 11 23.
Artigo em Inglês | MEDLINE | ID: mdl-31777389

RESUMO

Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine, decrease in urine output, or both. AKI occurs in approximately 10-15% of patients admitted to hospital, while its incidence in intensive care has been reported in more than 50% of patients. Kidney dysfunction or damage can occur over a longer period or follow AKI in a continuum with acute and chronic kidney disease. Biomarkers of kidney injury or stress are new tools for risk assessment and could possibly guide therapy. AKI is not a single disease but rather a loose collection of syndromes as diverse as sepsis, cardiorenal syndrome, and urinary tract obstruction. The approach to a patient with AKI depends on the clinical context and can also vary by resource availability. Although the effectiveness of several widely applied treatments is still controversial, evidence for several interventions, especially when used together, has increased over the past decade.


Assuntos
Lesão Renal Aguda , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/fisiopatologia , Lesão Renal Aguda/terapia , Biomarcadores/sangue , Creatinina/sangue , Humanos , Incidência , Medição de Risco , Sepse/complicações
7.
Br J Nurs ; 28(21): 1358-1364, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31778327

RESUMO

This article describes the development of a scoring system for general surgical patients to highlight those at greater risk of developing acute kidney injury (AKI). Following a search of the literature on current practice, a list of common variables was composed. Hospital Episode Statistics (HES) data from two random hospital trusts was used. With the help of a risk analysis system (CRAB Medical module, CRAB Clinical Informatics Ltd) it was possible to examine the relationship between potential risk factors and the incidence of AKI. Using Analyse-it for Excel a binary logistic model was created, which led to the development of a logistic regression equation and consequently a scoring system. The sensitivity and specificity of the model was tested using the receiver operating characteristic (ROC) curve. There was good correlation across the whole risk spectrum with an area under ROC curve of 0.806 (95% confidence intervals 0.787-0.825). The scoring system was developed into an admission checklist for general surgical patients to highlight a patient's risk of developing AKI. In a ward setting a checklist that immediately assesses the patient and produces a rapid indication as to whether the patient is at high risk or low risk would seem to be the ideal tool.


Assuntos
Lesão Renal Aguda/epidemiologia , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Humanos
8.
Pan Afr Med J ; 34: 2, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762871

RESUMO

In Ivory Coast, the prevalence of human immunodeficiency virus (HIV) infection is high. Any organ can be affected, in particular the kidney. Some studies conducted in Ivory Coast highlighted that opportunistic infections are a poor prognostic factors for acute renal failure (ARF). The purpose of this study was to investigate the other possible factors associated with ARF outcome among subjects with HIV infection. We conducted a retrospective analytical study, at the University Hospital Center of Yopougon over the period January 2014-December 2017. All patients over the age of 18 years with HIV infection associated with ARF were enrolled. The study included 73 patients, reflecting a rate of 24%. The average age of patients was 39.32 ± 10.50 years, ranging from 18 to 65 years. Sex ratio of 1.6 favoured women. Obesity (p=0.047; OR=8.72; CI (95%)=1.07-39.21) and CD4 count < 200/mm3 (p=0.000; OR=58.50; IC (95%)=10.31-55.12) were associated with poor prognosis of ARF. In Ivory Coast, the hospital prevalence of ARF in patients with HIV is high. Unfavorable outcome included death or chronicity. In addition to deep immunosuppression already known as a poor prognostic factor, this study showed that obesity is associated with unfavorable outcome of ARF in subjects with HIV.


Assuntos
Lesão Renal Aguda/epidemiologia , Contagem de Linfócito CD4 , Infecções por HIV/complicações , Obesidade/epidemiologia , Lesão Renal Aguda/virologia , Adolescente , Adulto , Idoso , Costa do Marfim/epidemiologia , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Adulto Jovem
9.
Medicine (Baltimore) ; 98(43): e16989, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651833

RESUMO

Periprocedural myocardial injury (PMI) and contrast-induced nephropathy (CIN) are frequent complications of percutaneous coronary intervention (PCI) associated with early and late major adverse cardiovascular events. Both conditions are associated with similar risk factors, which could imply their possible association. The aim of our study was to assess the correlation of PMI and early postprocedural creatinine shift (ECS) as a marker of renal injury.A total of 209 hospitalized patients with stable coronary artery disease (CAD) were enrolled, who underwent an elective PCI in a period of 12 months. All patients had their serum high-sensitivity troponin I (hsTnI) measured at baseline and 16 hours after the PCI. PMI was defined according to the elevation of postprocedural hsTnI using criteria provided by both the most recent consensus documents as well as evidence-based data. Renal injury was evaluated using the ECS concept. Serum creatinine (SCr) was also measured at baseline and at 16 hours. ECS was defined as SCr >5% at 16 hours compared to baseline.Although incidence of both PMI (77.5%) and ECS (44.5%) were high, no association of these 2 conditions could be found. Further analyses of our data showed that diabetes is associated with a higher incidence of ECS, while patients on beta-blocker therapy had a lower incidence of ECS.In our study, no association between PMI and ECS was found. Additional studies with a larger number of patients and longer patient observation are needed to assess the correlation between PMI and CIN as well as to validate the attractive, but controversial, concept of ECS as an early marker of CIN.


Assuntos
Lesão Renal Aguda/epidemiologia , Meios de Contraste/efeitos adversos , Traumatismos Cardíacos/epidemiologia , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Lesão Renal Aguda/sangue , Lesão Renal Aguda/induzido quimicamente , Idoso , Biomarcadores/sangue , Doença da Artéria Coronariana/cirurgia , Creatinina/sangue , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Traumatismos Cardíacos/sangue , Traumatismos Cardíacos/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Fatores de Risco , Troponina I/sangue
10.
Isr Med Assoc J ; 21(10): 692-695, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31599513

RESUMO

BACKGROUND: Data suggest that subclinical hypothyroidism (SCH) is associated with progression of chronic renal disease; however, no study to date has assessed the possible relation between SCH and acute deterioration of renal function. OBJECTIVES: To investigate the possible relation between SCH and acute kidney injury (AKI) in a large cohort of patients with ST-elevation myocardial infarction (STEMI) treated with primary coronary intervention (PCI). METHODS: We evaluated thyroid stimulating hormone (TSH) and free T4 levels of 1591 STEMI patients with no known history of hypothyroidism or thyroid replacement treatment who were admitted to the coronary care unit (October 2007-August 2017). The presence of SCH was defined as TSH levels ≥ 5 mU/ml in the presence of normal free T4 levels. Patients were assessed for development of AKI ( 0.3 mg/dl increase in serum creatinine, according to the KDIGO criteria). RESULTS: The presence of SCH was demonstrated in 68/1593 (4.2%) STEMI patients. Patients presenting with SCH had more AKI complications during the course of STEMI (20.6% vs. 9.6 %; P = 0.003) and had significantly higher serum creatinine change throughout hospitalization (0.19 mg/dl vs. 0.08 mg/dl, P = 0.04). No significant difference was present in groups regarding baseline renal function and the amount of contrast volume delivered during coronary angiography. In multivariate logistic regression model, SCH was independently associated with AKI (odds ratio = 2.19, 95% confidence interval 1.05-4.54, P =0.04). CONCLUSIONS: Among STEMI patients treated with PCI, the presence of SCH is common and may serve as a significant marker for AKI.


Assuntos
Lesão Renal Aguda/epidemiologia , Hipotireoidismo/epidemiologia , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Lesão Renal Aguda/fisiopatologia , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hipotireoidismo/fisiopatologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia
11.
Hypertension ; 74(5): 1144-1151, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31564161

RESUMO

Preeclampsia is a common cause of acute kidney injury (AKI) in low- and middle-income countries, but AKI incidence in preeclampsia, its risk factors, and renal outcomes are unknown. A prospective observational multicenter study of women admitted with preeclampsia in South Africa was conducted. Creatinine concentrations were extracted from national laboratory databases for women with maximum creatinine of ≥90 µmol/L (≥1.02 mg/dL). Renal injury and recovery were defined by Kidney Disease Improving Global Outcomes creatinine criteria. Predefined risk factors, maternal outcomes, and neonatal outcomes were compared between AKI stages. Of 1547 women admitted with preeclampsia 237 (15.3%) met AKI criteria: 6.9% (n=107) stage 1, 4.3% (n=67) stage 2, and 4.1% (n=63) stage 3. There was a higher risk of maternal death (n=7; relative risk, 4.3; 95% CI, 1.6-11.4) and stillbirth (n=80; relative risk, 2.2; 95% CI, 1.8-2.8) in women with AKI compared with those without. Perinatal mortality was also increased (89 of 240; 37.1%). Hypertension in a previous pregnancy was the strongest predictor of AKI stage 2 or 3 (odds ratio, 2.24; 95% CI, 1.21-4.17). Renal recovery rate reduced with increasing AKI stage. A third of surviving women (76 of 230 [33.0%]) had not recovered baseline renal function by discharge. Approximately half (39 of 76; 51.3%) of these women had no further creatinine testing post-discharge. In summary, AKI was common in women with preeclampsia and had high rates of associated maternal and perinatal mortality. Only two-thirds of women had confirmed renal recovery. History of a previous hypertensive pregnancy was an important risk factor.


Assuntos
Lesão Renal Aguda/epidemiologia , Morte Materna/tendências , Morte Perinatal , Pré-Eclâmpsia/epidemiologia , Natimorto/epidemiologia , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Adolescente , Adulto , Comorbidade , Intervalos de Confiança , Creatinina/sangue , Países em Desenvolvimento , Feminino , Seguimentos , Hospitalização/estatística & dados numéricos , Humanos , Recém-Nascido , Testes de Função Renal , Razão de Chances , Pobreza , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Gravidez , Prevalência , Estudos Prospectivos , Medição de Risco , Índice de Gravidade de Doença , África do Sul , Análise de Sobrevida
12.
Acute Med ; 18(3): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31536053

RESUMO

We sought to assess the impact of renal impairment on acute medical admissions and to identify potential contributory factors to admissions involving renal impairment at presentation. In a prospective cohort study, 29.5% of all acute medical emergency admissions had an eGFR <60ml/min/1.73m2 at presentation. Of these, 19.9% had definite chronic kidney disease and 8.4% had definite acute kidney injury. Detailed analysis of a random subset of patients with an eGFR <60ml/min/1.73m2 at presentation demonstrated that the major reasons for admission included falls, dehydration and fluid overload. 46% were on diuretics and 53% were on an ACEI or ARB or both. Gastrointestinal disturbance and recent medication changes were common and diuretic use persisted even with diarrhoea or vomiting.


Assuntos
Lesão Renal Aguda , Inibidores da Enzima Conversora de Angiotensina , Estado Terminal , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/epidemiologia , Serviço Hospitalar de Emergência , Hospitalização , Humanos , Incidência , Estudos Prospectivos
13.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 1004-1007, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537228

RESUMO

OBJECTIVE: To investigate the risk factors and prognosis of acute kidney injury (AKI) in children with sepsis in pediatric intensive care unit (PICU). METHODS: A retrospective analysis of clinical data of PICU sepsis children in Anhui Children's Hospital from May 2015 to May 2018 was performed. The children were divided into AKI group and non-AKI group according to whether AKI occurred within 48 hours of PICU [referring to the diagnostic criteria for Kidney Disease: Improving Global Outcomes (KDIGO)]. The general data, physiological data and clinical outcomes of the two groups were compared; Logistic regression analysis was used to analyze the risk factors of AKI in children with sepsis and the prognostic factors. RESULTS: AKI occurred in 55 of 127 children with sepsis, the incidence of AKI was 43.3%, and the overall mortality was 28.3% (36/127), with 41.8% (23/55) in AKI group and 18.1% (13/72) in non-AKI group. (1) Compared with non-AKI group, oxygenation index, albumin, the pediatric critical illness case score (PCIS) and urine volume in AKI group were significantly decreased, while cystatin C, procalcitonin (PCT), prothrombin time (PT), activated partial thromboplastin time (APTT), pediatric multiple organ dysfunction score (P-MODS), the proportions of mechanical ventilation, vasoactive drug use, shock, septic shock and mortality were significantly increased, while there was no difference in age, gender, mean arterial pressure (MAP), white blood cell count (WBC) and C-reactive protein (CRP) between the two groups. Multivariate Logistic regression analysis showed that low serum albumin [odds ratio (OR) = 0.627, 95% confidence interval (95%CI) = 0.495-0.794, P = 0.000] and homocystatin C (OR = 2.641, 95%CI = 1.157-6.032, P = 0.021) were risk factors for AKI in children with sepsis. (2) Compared with the survival group of children with sepsis AKI, the proportion of mechanical ventilation, septic shock, vasoactive drug use, positive balance ratio of liquid for 72 hours, 6-hour lactate clearance rate < 10%, and AKI 3-stage patients in the death group of children with sepsis AKI were significantly increased. Multivariate Logistic regression analysis showed that 72-hour positive liquid balance (OR = 8.542, 95%CI = 1.956-37.307, P = 0.004) and 6-hour lactate clearance rate < 10% (OR = 5.980, 95%CI = 1.393-25.676, P = 0.016) were risk factors for the death of children with sepsis AKI. CONCLUSIONS: Serum albumin and cystatin C should be closely monitored in children with sepsis. Early detection and intervention of positive fluid balance and low lactate clearance rate can reduce the mortality of AKI in children with sepsis.


Assuntos
Lesão Renal Aguda/diagnóstico , Sepse/diagnóstico , Lesão Renal Aguda/epidemiologia , Criança , Humanos , Unidades de Terapia Intensiva Pediátrica , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia
14.
Rev Assoc Med Bras (1992) ; 65(8): 1094-1101, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531608

RESUMO

INTRODUCTION: Acute kidney injury (AKI) is a frequent event among critically ill patients hospitalized in intensive care units (ICU) and represents a global public health problem, being imperative an interdisciplinary approach. OBJECTIV: To investigate, through literature review, the AKI epidemiology in ICUs. METHODS: Online research in Medline, Scientific Electronic Library Online, and Latin American and Caribbean Literature in Health Sciences databases, with analysis of the most relevant 47 studies published between 2010 and 2017. RESULTS: Data of the 67,033 patients from more than 300 ICUs from different regions of the world were analyzed. The overall incidence of AKI ranged from 2.5% to 92.2%, and the mortality from 5% to 80%. The length of ICU stay ranged from five to twenty-one days, and the need for renal replacement therapy from 0.8% to 59.2%. AKI patients had substantially higher mortality rates and longer hospital stays than patients without AKI. CONCLUSION: AKI incidence presented high variability among the studies. One of the reasons for that were the different criteria used to define the cases. Availability of local resources, renal replacement therapy needs, serum creatinine at ICU admission, volume overload, and sepsis, among others, influence mortality rates in AKI patients.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/terapia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação , Fatores de Risco
15.
Zhonghua Er Ke Za Zhi ; 57(9): 669-673, 2019 Sep 02.
Artigo em Chinês | MEDLINE | ID: mdl-31530351

RESUMO

Objective: To analyze diagnosis rate of chronic kidney disease (CKD) in hospitalized pediatric patients in a single center and understand pediatricians' awareness of CKD. Methods: This was a cross-sectional study. Children who were admitted to the Division of Pediatric Nephrology, Peking University First Hospital from January 1, 2008 to December 31, 2017 and met the diagnostic criteria of CKD (kidney disease: improving global outcomes 2012 guideline) were recruited. A total of 4 472 cases were enrolled. Original CKD diagnosis was collected from the home page of medical records. Actual CKD diagnosis was validated and corrected by reviewing medical records and recalculating glomerular filtration rate. The diagnosis rate and influencing factors of pediatric CKD, the distribution and etiology of actual CKD were analyzed. The comparison between groups were performed with χ(2) test. Results: In 4 472 cases, there were 3 470 cases in actual CKD stage 1, among which only 24 cases were in original CKD stage 1. There were 543 cases in actual CKD stage 2-3, among which only 181 cases were in original CKD stage 2-3. Three hundred and one cases were in actual CKD stage 4-5, including 290 cases in original CKD stage 4-5. In addition, there were 43 cases with unknown CKD stage and 115 cases with acute kidney injury. Compared to original CKD diagnosis, the diagnosis rates of CKD stage 1-5 were 0.7% (24/3 470), 16.7% (58/348), 63.1% (123/195), 90.7% (78/86) and 98.6% (212/215), respectively. The proportions of actual CKD stage 1-5 were 80.4% (3 470/4 314), 8.1% (348/4 314), 4.5% (195/4 314), 2.0% (86/4 314) and 5.0% (215/4 314). The etiology of actual CKD included primary glomerular disease (62.2%, 2 686/4 314), secondary glomerular disease (19.7%, 849/4 314), hereditary kidney disease (9.1%, 391/4 314), congenital abnormalities of the kidney and urinary tract (CAKUT) (3.1%, 135/4 314), tubulointerstitial disease (2.2%, 94/4 314) and etiology uncertain (2.1%, 89/4 314). The leading cause of end stage renal disease was etiology uncertain (31.1%, 67/215), followed by hereditary kidney disease (24.2%, 52/215), CAKUT (16.3%, 35/215) and primary glomerular disease (16.3%, 35/215). Conclusions: Among actual CKD hospitalized pediatric patients, the diagnosis rate of CKD given by physicians at discharge was relatively low, especially patients in earlier CKD stages, which reflected serious lack of physicians' awareness of CKD.


Assuntos
Rim/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/epidemiologia , Criança , Estudos Transversais , Taxa de Filtração Glomerular , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Fatores de Risco
16.
Int Heart J ; 60(5): 1022-1029, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484858

RESUMO

Optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) may increase contrast volume. However, the impact of OCT-guided PCI on the decline in kidney function (DKF) in actual clinical practice remains unclear.Among 1,003 consecutive patients who underwent either OCT-guided or intravascular ultrasound (IVUS)-guided PCI in our institute, we identified 202 propensity score-matched pairs adjusted by baseline factors. The incidence of DKF was compared between the OCT-guided PCI group and the IVUS-guided PCI group. DKF was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or a relative increase of ≥ 25% over baseline within 48 hours (acute DKF) or 1 month (sustained DKF) after PCI.Baseline characteristics, including the prevalence of chronic kidney disease (54% versus 46%, P = 0.09), were comparable between the OCT- and IVUS-guided PCI groups except for the age. The contrast volume was comparable between the two groups (153 ± 56 versus 144 ± 60 mL, P = 0.09), although it was significantly greater in the OCT-guided PCI group in patients with acute coronary syndrome (ACS; 175 ± 55 versus 159 ± 43 mL, P = 0.04). The incidence of acute DKF (0.5% versus 2.5%, P = 0.22) and sustained DKF (5.0% versus 10.4%, P = 0.31) was comparable between the two groups. Multivariate analysis demonstrated that ACS (odds ratio 4.74, 95% confidence interval 2.72-8.25, P < 0.001) was a predictor of sustained DKF.Compared with IVUS-guided PCI, OCT-guided PCI did not increase the incidence of DKF in actual clinical practice, although the increased contrast volume was observed in ACS cases.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Lesão Renal Aguda/induzido quimicamente , Meios de Contraste/efeitos adversos , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica/métodos , Ultrassonografia de Intervenção/métodos , Centros Médicos Acadêmicos , Síndrome Coronariana Aguda/diagnóstico por imagem , Lesão Renal Aguda/epidemiologia , Idoso , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular/fisiologia , Humanos , Incidência , Japão , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Razão de Chances , Segurança do Paciente/estatística & dados numéricos , Intervenção Coronária Percutânea/efeitos adversos , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Tomografia de Coerência Óptica/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos
17.
Rev Port Cir Cardiotorac Vasc ; 26(2): 109-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476810

RESUMO

OBJECTIVES: To study the incidence of acute kidney injury (AKI) in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with cardiopulmonary bypass (CPB), and to explore the association between the incidence of AKI and predictors related to CPB. METHODS: Observational, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. Kidney Disease: Improving Global Outcomes - Clinical Practice Guideline for Acute Kidney Injury (KDIGO) classification was used to characterize AKI. The analysis included preoperative variables (anthropometric data, cardiovascular risk factors and blood parameters), as well as the type of surgery, intraoperative variables related to CPB, and postoperative creatinine variation. Association between variables was studied with binary logistic regression. RESULTS: We have included 329 patients, of which 62 (19%), developed AKI. There were statistically significant differences between the groups in age (p<0.001; OR (95%)-1.075 (1.037-1.114)), duration of CPB (p=0.011; 1.008 (1.002-1.014)), urine output during CPB (p=0.038; 0.998 (0.996-0.999)), mannitol and furosemide administration during CPB, (respectively, p=0.032; 2.293 (1.075-4.890) and p=0.013; 2.535 (1.214-5.296)). CONCLUSIONS: A significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB, namely: age, duration of CPB, urine output during CPB, mannitol and furosemide administration during CPB.


Assuntos
Lesão Renal Aguda/etiologia , Ponte Cardiopulmonar/efeitos adversos , Lesão Renal Aguda/epidemiologia , Ponte Cardiopulmonar/estatística & dados numéricos , Estudos Transversais , Humanos , Incidência , Prognóstico , Estudos Retrospectivos , Fatores de Risco
18.
Transplant Proc ; 51(7): 2262-2264, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31400980

RESUMO

INTRODUCTION: The ideal crystalloid solution to be used during the perioperative period in patients undergoing kidney transplantation remains unclear. Normal saline (NS), the intravenous fluid commonly using during the perioperative period, contains a high chloride content, which may be associated with hyperchloremic metabolic acidosis and acute kidney injury. Balanced crystalloid (BC) solutions have a lower chloride content. The purpose of the study was to determine if a BC solution prevents the incidence of hyperchloremia and hyperkalemia during renal transplantation. METHODS: NS and BC given during kidney transplantation are compared. The primary outcome was hyperchloremia and hyperkalemia within 24 hours after surgery. Secondary outcomes were levels of serum creatinine at preoperative and within 5 days after transplantation, the incidence of acute rejection episodes, graft failure, length of stay at hospital, and mortality. RESULTS: A total of 60 patients were included in the study (30 in the BC group and 30 in the NS group). The mean postoperative chloride was 103.0 mmol/L (95% CI, 101-105) in the NS group and 100 mmol/L (95% CI, 98-102) in the BC group (P < .05). There were no significant differences in demographic characteristics, serum creatinine values within 5 days, short-term outcomes, and graft survival rates at 28 days postoperatively between groups (P > .05). CONCLUSIONS: Our results suggest that a moderate volume (approximately 1500.0 mL) of NS infusion causes hyperchloremia rather than adverse clinical outcomes. A moderate amount of NS infusion can be used safely during uncomplicated living-donor kidney transplantations.


Assuntos
Acidose/epidemiologia , Lesão Renal Aguda/epidemiologia , Soluções Cristaloides/efeitos adversos , Hidratação/efeitos adversos , Hiperpotassemia/epidemiologia , Transplante de Rim , Solução Salina/efeitos adversos , Acidose/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Adulto , Creatinina/sangue , Feminino , Hidratação/métodos , Humanos , Hiperpotassemia/induzido quimicamente , Masculino , Pessoa de Meia-Idade , Período Perioperatório
19.
Medicine (Baltimore) ; 98(33): e16867, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415421

RESUMO

Acute kidney injury (AKI) is a complex syndrome with a variety of possible etiologies and symptoms. It is characterized by high mortality and poor recovery of renal function. The incidence and mortality rates of patients with AKI in intensive care units are extremely high. It is generally accepted that early identification and prompt treatment of AKI are essential to improve outcomes. This study aimed to develop a model based on risk stratification to identify and diagnose early stage AKI for improved prognosis in critically ill patients.This was a single-center, retrospective, observational study. Based on relevant literature, we selected 13 risk factors (age, sex, hypertension, diabetes, coronary heart disease, chronic kidney disease, total bilirubin, emergency surgery, mechanical ventilation, sepsis, heart failure, cancer, and hypoalbuminemia) for AKI assessment using the Kidney Disease Improving Global Outcomes (KDIGO) diagnostic criteria. Univariate and multivariate analyses were used to determine risk factors for eventual entry into the predictive model. The AKI predictive model was established using binary logistic regression, and the area under the receiver operating characteristic curve (AUROC or AUC) was used to evaluate the predictive ability of the model and to determine critical values.The AKI predictive model was established using binary logistic regression. The AUROC of the predictive model was 0.81, with a sensitivity of 69.8%, specificity of 83.4%, and positive likelihood ratio of 4.2.A predictive model for AKI in critically ill patients was established using 5 related risk factors: heart failure, chronic kidney disease, emergency surgery, sepsis, and total bilirubin; however, the predictive ability requires validation.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Modelos Estatísticos , Lesão Renal Aguda/diagnóstico , Adulto , Idoso , Bilirrubina/sangue , Comorbidade , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Sepse/epidemiologia
20.
Am J Health Syst Pharm ; 76(16): 1211-1217, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369116

RESUMO

PURPOSE: Results of a study to determine whether obesity is associated with acute kidney injury (AKI) among patients receiving combination therapy with piperacillin-tazobactam and vancomycin are reported. METHODS: A retrospective, single-center cohort study of patients who received combination therapy for at least 48 hours was conducted using data from the University of Kentucky Center for Clinical and Translational Science's Enterprise Data Trust. Patients with chronic kidney disease, baseline creatinine clearance of less than 30 mL/min, cystic fibrosis, or missing height or weight information were excluded. RESULTS: A total of 8,125 patients were included in the cohort. Among the variables evaluated, total body weight of 91 kg or more was the variable most predictive of AKI. Patients with a weight of 91 kg or higher were more likely than lower-weight patients to have diabetes (39% versus 21%, p < 0.00001), hypertension (64% versus 47%, p < 0.00001), and heart failure (15% versus 13%, p = 0.007). The median daily vancomcyin dose was lower in patients with a weight of less than 91 kg (2,000 mg versus 3,000 mg, p < 0.00001); however, weight-based doses were lower in patients weighing 91 kg or more (25.5 mg/kg/day versus 27.9 mg/kg/day, p < 0.00001). AKI was more common in patients weighing 91 kg or more (24% versus 18%, p < 0.00001; adjusted odds ratio, 1.46 [95% confidence interval, 1.28-1.66]). CONCLUSION: Increased total body weight increased the rate of AKI among patients concurrently treated with piperacillin-tazobactam and vancomycin independent of clinically important confounders, with an important breakpoint occurring at 91 kg.


Assuntos
Lesão Renal Aguda/epidemiologia , Antibacterianos/efeitos adversos , Obesidade/epidemiologia , Combinação Piperacilina e Tazobactam/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/induzido quimicamente , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Peso Corporal , Quimioterapia Combinada/efeitos adversos , Quimioterapia Combinada/métodos , Feminino , Humanos , Kentucky/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
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