Admission calcium levels and risk of acute kidney injury in hospitalised patients

Cheungpasitporn, Wisit; Mao, Michael A; Sakhuja, Ankit; Erickson, Stephen B.

doi:10.1111/ijcp.13057

Cited by 32 publications

(23 citation statements)

References 41 publications

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“…An increase in serum calcium is associated with incident heart failure [33] and possible hypercalcemia-induced neuronal injury among patients with acute ischemic stroke [34]. Moreover, an increase in serum calcium may result in AKI via renal vasoconstriction and nephrogenic diabetes insipidus-induced volume depletion [35][36][37][38][39][40]. In our current study, we also adjusted AKI during hospitalization in our multivariable logistic regression analysis, and we found that the upward trend of serum calcium change of >1.0 mg/dL was significantly associated with increased in-hospital mortality, while the highest mortality (6.3-fold increased mortality) was observed in patients with an absolute increase in serum calcium level ≥2.0 mg/dL.…”

Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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Background and objectives: Calcium concentration is strictly regulated at both the cellular and systemic level, and changes in serum calcium levels can alter various physiological functions in various organs. This study aimed to assess the association between changes in calcium levels during hospitalization and mortality. Materials and Methods: We searched our patient database to identify all adult patients admitted to our hospital from January 1st, 2009 to December 31st, 2013. Patients with ≥2 serum calcium measurements during the hospitalization were included. The serum calcium changes during the hospitalization, defined as the absolute difference between the maximum and the minimum calcium levels, were categorized into five groups: 0–0.4, 0.5–0.9, 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL. Multivariable logistic regression was performed to assess the independent association between calcium changes and in-hospital mortality, using the change in calcium category of 0–0.4 mg/dL as the reference group. Results: Of 9868 patients included in analysis, 540 (5.4%) died during hospitalization. The in-hospital mortality progressively increased with higher calcium changes, from 3.4% in the group of 0–0.4 mg/dL to 14.5% in the group of ≥2.0 mg/dL (p < 0.001). When adjusted for age, sex, race, principal diagnosis, comorbidity, kidney function, acute kidney injury, number of measurements of serum calcium, and hospital length of stay, the serum calcium changes of 1.0–1.4, 1.5–1.9, and ≥2.0 mg/dL were significantly associated with increased in-hospital mortality with odds ratio (OR) of 1.55 (95% confidence interval (CI) 1.15–2.10), 1.90 (95% CI 1.32–2.74), and 3.23 (95% CI 2.39–4.38), respectively. The association remained statistically significant when further adjusted for either the lowest or highest serum calcium. Conclusion: Larger serum calcium changes in hospitalized patients were progressively associated with increased in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

et al. 2020

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“…Those needs that are classified as unmet require provision of some ample spaces for the purpose of imagination in relation to leveraging the strength associated with big data, as well as relevant artificial intelligence (AI) to improve the overall status of patients with kidney diseases [25]. In this article, we discuss the big data concepts in nephrology, describe the potential use of AI in nephrology and transplantation, and also encourage researchers and clinicians to submit their invaluable research, including original clinical research studies [26][27][28][29][30], database studies from registries [31][32][33], meta-analyses [34][35][36][37][38][39][40][41][42][43][44], and artificial intelligence research [25,[45][46][47][48] in nephrology and transplantation. Table 1 demonstrates known and commonly used databases that have provided big data in nephrology and transplantation [49][50][51].…”

Section: Introductionmentioning

confidence: 99%

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

Thongprayoon

Kaewput

Kovvuru

et al. 2020

JCM

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Kidney diseases form part of the major health burdens experienced all over the world. Kidney diseases are linked to high economic burden, deaths, and morbidity rates. The great importance of collecting a large quantity of health-related data among human cohorts, what scholars refer to as “big data”, has increasingly been identified, with the establishment of a large group of cohorts and the usage of electronic health records (EHRs) in nephrology and transplantation. These data are valuable, and can potentially be utilized by researchers to advance knowledge in the field. Furthermore, progress in big data is stimulating the flourishing of artificial intelligence (AI), which is an excellent tool for handling, and subsequently processing, a great amount of data and may be applied to highlight more information on the effectiveness of medicine in kidney-related complications for the purpose of more precise phenotype and outcome prediction. In this article, we discuss the advances and challenges in big data, the use of EHRs and AI, with great emphasis on the usage of nephrology and transplantation.

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“…For subgroup analysis of the risk of in-hospital severe AKI, our results suggested that ionized calcium ≤ 4.79 mg/dL or ≥ 5.20 mg/dL was significantly associated with higher risk of severe AKI. Previous studies have demonstrated the AKI risk among patients with various serum calcium levels 14,15,22 . However, total calcium measurements have considerable limitations in the identification of actual calcium abnormalities, such as its dependency on serum albumin level 10 .…”

Section: Discussionmentioning

confidence: 99%

“…Ionized calcium is an essential mineral required for many physiologic functions in the body, from cellular function, intracellular messenger transduction, hormonal activity, to cardiac function and neuronal activity [8][9][10][11] . From the kidney standpoint, AKI in the setting of hypercalcemia can arise via several mechanisms such as volume depletion from polyuria (decreased collecting duct cells response to vasopressin) and direct alterations of intravascular tone [12][13][14] . Besides, persistent hypercalcemia can lead to calcium deposits in the kidneys or nephrocalcinosis 15 .…”

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Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

Cheungpasitporn

Chewcharat

Mao

et al. 2020

Sci Rep

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this study aimed to investigate the risk of acute kidney injury (AKi) in hospitalized patients based on admission serum ionized calcium levels. this is a cohort study of all hospitalized adult patients, from January 2009 to December 2013 at a tertiary referral hospital, who had available serum ionized calcium at the time of admission. We excluded patients who had end-stage kidney disease or AKi at admission. We stratified admission serum ionized calcium into 6 groups; ≤ 4.39, 4.40-4.59, 4.60-4.79, 4.80-4.99, 5.00-5.19, and ≥ 5.20 mg/dL. We used serum creatinine criterion of KDIGO definition for diagnosis of AKi. We performed logistic regression analysis to assess the risk of in-hospital AKi occurrence based on admission serum ionized calcium, using serum ionized calcium of 5.00-5.19 mg/ dL as the reference group. We studied a total of 25,844 hospitalized patients. Of these, 3,294 (12.7%) developed AKI in hospital, and 622 (2.4%) had AKI stage 2 or 3. We observed a U-shaped association between admission serum ionized calcium and in-hospital AKi, with nadir in-hospital AKi was in serum ionized calcium of 5.00-5.19 mg/dL. After adjustment for confounders, low serum ionized calcium of 4.40-4.59, ≤ 4.39 mg/dL and elevated serum ionized calcium ≥ 5.20 mg/dL were associated with increased risk of AKI with odds ratio of 1.33 (95% CI 1.14-1.56), 1.45 (95% CI 1.21-1.74), and 1.26 (95% CI 1.04-1.54), respectively. Both hypocalcemia, and hypercalcemia at the time of admission were associated with an increased risk of hospital-acquired AKi.

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Admission calcium levels and risk of acute kidney injury in hospitalised patients

Abstract: Admission hypocalcaemia and hypercalcaemia are associated with an increased risk for hospital acquired AKI. Patients with admission hypercalcaemia (≥10 mg/dL) carry a 1.51-fold risk for AKI development during hospitalisation.

Cited by 32 publications

References 41 publications

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Impact of Changes in Serum Calcium Levels on In-Hospital Mortality

Promises of Big Data and Artificial Intelligence in Nephrology and Transplantation

Impact of admission serum ionized calcium levels on risk of acute kidney injury in hospitalized patients

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