Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis

Abdel-Kader, Khaled; Girard, Timothy D.; Brummel, Nathan E.; Saunders, Christina; Blume, Jeffrey D.; Clark, Amanda J.; Vincz, Andrew J.; Ely, E. Wesley; Jackson, James C.; Bell, Susan P.; Archer, Kristin R.; İkizler, T. Alp; Pandharipande, Pratik P.; Siew, Edward D.

doi:10.1097/ccm.0000000000003003

Cited by 40 publications

(41 citation statements)

References 51 publications

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“…Authors discussed that volume overload and anemia caused by kidney dysfunction may limit mobility, physical exertion, fatigue, and decreased physical activity [20]. On the other hand, our study revealed that AKI at ICU admission was an independent factor of good physical status at ICU discharge.…”

Section: Effects Of Nutritional Management and Rehabilitation On Physmentioning

confidence: 36%

“…The secondary analysis of a prospective study revealed that AKI in survivors of critical illness is a predictor of worse frailty status at 3 and 12 months after hospital discharge [20]. Authors discussed that volume overload and anemia caused by kidney dysfunction may limit mobility, physical exertion, fatigue, and decreased physical activity [20].…”

Section: Effects Of Nutritional Management and Rehabilitation On Physmentioning

confidence: 99%

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Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

et al. 2018

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Background: There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. Methods: The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals. The primary outcomes were caloric and protein intake in ICU on days 3 and 7, and at ICU discharge. The secondary outcome was the impact of nutritional management and rehabilitation on physical status at ICU discharge. We defined good physical status as more than end sitting and poor physical status as bed rest and sitting. We divided the participants into 2 groups, namely, the good physical status group (Good group) and poor physical status group (Poor group) for analysis of the secondary outcome. Data were expressed as median (interquartile range). Results: The median amount of caloric intake on days 3 and 7, and at ICU discharge via enteral and parenteral routes were 8.4 (3.1–15.6), 14.9 (7.5–22.0), and 11.2 (2.5–19.1) kcal/kg/day, respectively. The median amount of protein intake on days 3 and 7, and at ICU discharge were 0.2 (0–0.5), 0.4 (0.1–0.8), and 0.3 (0–0.7) g/kg/day, respectively. The amount of caloric intake on day 3 in the Poor group was significantly higher than that of the Good group (10.1 [5.8, 16.2] vs. 5.2 [1.9, 12.4] kcal/kg/day, p < 0.001). The proportion of patients who were received rehabilitation in ICU in the Good group was significantly higher than that of the Poor group (92 vs. 63%, p < 0.001). The multivariate analysis revealed that caloric intake on day 3 and rehabilitation in ICU were considered independent factors that affect physical status (OR 1.19; 95% CI 1.05–1.34; p = 0.005 and OR 0.07; 95% CI 0.01–0.34; p = 0.001). Conclusions: The caloric and protein intakes in Japanese ICUs were 15 kcal/kg/day and 0.4 g/kg/day, respectively. In addition, critically ill patients might benefit from low caloric intake (less than 10 kcal/kg/day) until day 3 and rehabilitation during ICU stay.

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Section: Effects Of Nutritional Management and Rehabilitation On Physmentioning

confidence: 36%

Section: Effects Of Nutritional Management and Rehabilitation On Physmentioning

confidence: 99%

Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

et al. 2018

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“…Regarding the non-elderly, middle-aged population, the terms frailty, sarcopenia and their association with survival in the literature are indeed scarce. Some authors searched for the impact of frailty in sub-populations included in the realm of the general internal medicine: Uchmanowicz and co. investigated the frailty syndrome and its association and impact on arterial hypertension [ 3 ]; Abdel-Kader and co. investigated the frailty following acute kidney injury [ 4 ], Abel and Klepin proposed frailty assessment to replace the patients’ age as a predictor of responses to therapy in various hematologic malignancies [ 5 ]. Nevertheless, none has questioned the value of frailty and sarcopenia assessment within the internal medicine departments themselves.…”

Section: Introductionmentioning

confidence: 99%

Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

Gringauz

Refaela

Brom

et al. 2018

JCM

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Background: Low blood ALT, Alanine aminotransferase activity and high FRAIL (Fatigue, Resistance, Ambulation, Illnesses and Loss of Weight) questionnaire scores were previously shown to be associated with frailty and increased risk of mortality. We aimed to correlate these tools with mortality and each other in patients hospitalized in an internal medicine department. Methods: This is a prospective study in a large tertiary hospital. We assessed the predictive value for clinical outcomes of both low ALT blood activity and the pre-frail and frail categories of the “FRAIL” questionnaire. Results: During a 15 months study, 179 consecutive patients were recruited, of whom 20 died. When all study participants were divided to three groups according to admission ALT levels (below 10 IU/L, 11 to 19 IU/L and above 20 IU/L) we found a statistically significant difference in the rate of mortality: 4 patients died within the group of ALT < 10 IU/L, 14 patients died in the group of 10 IU/L < ALT < 19 IU/L and in the group of patients with ALT > 20 IU/L, only 2 patients died (p = 0.042). A higher score on the FRAIL questionnaire was associated, with statistical significance, with higher risk of mortality (p = 0.029). There was a significant correlation (p = 0.038) between blood ALT activity and the pre-frailty and frailty classifications by the FRAIL Questionnaire. Conclusions: Both the FRAIL questionnaire and blood ALT activity are simple and practical tools for frailty assessment and risk stratification of patients hospitalized in the internal medicine department. Both tool’s results also correlate with each other.

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“…In the elderly population, the incidence of electrolyte imbalance is expected to be higher because of organ decline, decreased physiologic reserves, frailty, and the higher prevalence of disability and functional impairment. [18][19][20] Kidneys are responsible for maintaining water homeostasis, and AKI could magnify the effect of dysnatremia on the clinical consequences. Normal ranges of serum sodium levels within 135.0-145.0 mmol/L used in clinical settings are determined mainly based on healthy subjects, and whether these values are applicable to elderly patients with complex comorbidities is still unknown.…”

Section: Discussionmentioning

confidence: 99%

Associations of serum sodium levels with mortality in very elderly acute kidney injury patients

Liang

Mao

et al. 2020

Preprint

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Background: Patients suffering from acute kidney injury (AKI) have been associated with impaired sodium. However, studies on the association of dysnatremia with all-cause mortality risk in AKI patients are particularly lacking. We examined the relationship between different levels of serum sodium and mortality among very elderly patients with AKI. Methods: We retrospectively enrolled very elderly patients (≥ 75 years) from Chinese PLA General Hospital from 2007, to 2018. All-cause mortality was examined according to eight predefined sodium levels: <130.0 mmol/L, 130.0–134.9 mmol/L, 135.0–137.9 mmol/L, 138.0–141.9 mmol/L, 142.0–144.9 mmol/L, 145.0–147.9 mmol/L, 148.0–151.9 mmol/L, and ≥152.0 mmol/L. We estimated the risk of all-cause mortality using a multivariable adjusted Cox proportional hazard model, with a normal serum potassium level of 135.0–137.9 mmol/L as a reference. Results: In total, 744 geriatric patients were suitable for the final evaluation. Among them, 260 (34.9%) died within 90 days; during the 1-year follow-up, 5 patients were lost to follow-up, and 383 (51.8%) died. After 90 days, the mortality rates in the eight strata were 36.1, 27.8, 19.6, 24.4, 30.7, 48.6, 52.8, and 57.7%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L [hazard ratio (HR): 2.247; 95% confidence interval (CI): 1.117–4.521], from 142.0 to 144.9 mmol/L (HR: 1.964; 95% CI: 1.100–3.508), from 145.0 to 147.9 mmol/L (HR: 2.942; 95% CI: 1.693–5.114), from 148.0 to 151.9 mmol/L (HR: 3.455; 95% CI: 2.009–5.944), and ≥152.0 mmol/L (HR: 3.587; 95% CI: 2.151–5.983) had an increased risk of all-cause mortality. After 1 year, the mortality rates in the eight strata were 58.3, 47.8, 33.7, 38.9, 45.5, 64.3, 69.4, and 78.4%, respectively. In the multivariable adjusted analysis, patients with sodium levels <130.0 mmol/L (HR: 1.944; 95% CI: 1.125–3.360), from 142.0 to 144.9 mmol/L (HR: 1.681; 95% CI: 1.062–2.660), from 145.0 to 147.9 mmol/L (HR: 2.631; 95% CI: 1.683–4.112), from 148.0 to 151.9 mmol/L (HR: 2.411; 95% CI: 1.552–3.744), and ≥152.0 mmol/L (HR: 3.037; 95% CI: 2.021–4.563) had an increased risk of all-cause mortality. Conclusion: Sodium levels outside the interval of 130.0–141.9 mmol/L were associated with increased risks of 90-day mortality and 1-year mortality in very elderly AKI patients.

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Acute Kidney Injury and Subsequent Frailty Status in Survivors of Critical Illness: A Secondary Analysis

Cited by 40 publications

References 51 publications

Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

Influence of Nutritional Management and Rehabilitation on Physical Outcome in Japanese Intensive Care Unit Patients: A Multicenter Observational Study

Low Blood ALT Activity and High FRAIL Questionnaire Scores Correlate with Increased Mortality and with Each Other. A Prospective Study in the Internal Medicine Department

Associations of serum sodium levels with mortality in very elderly acute kidney injury patients

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