AKI in the ICU: definition, epidemiology, risk stratification, and outcomes

Singbartl, Kai; Kellum, John A.

doi:10.1038/ki.2011.339

Cited by 460 publications

(334 citation statements)

References 66 publications

(86 reference statements)

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“…The in-hospital mortality related to AKI varies from 20 to 50 % according to the stage or class of AKI [24,25].…”

Section: Rri and Akimentioning

confidence: 99%

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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Doppler ultrasound has been extensively used in detecting reno-vascular diseases, showing to be a noninvasive, safe, low cost and repeatable tool. The Renal Resistive Index (RRI) [(peak systolic velocity -end diastolic velocity)/peak systolic velocity] is a semi-quantitative index derived by Doppler evaluation of renal vascular bed. Normally RRI is in the range of 0.47-0.70, it increases with aging and, usually, it shows a difference between the two kidneys less than 5-8 %. RRI is an important prognostic marker in chronic kidney diseases (CKD), both in diabetic and non-diabetic kidney diseases, because, in longitudinal prospective studies, it significantly correlated with hemodynamic (ABPM, SBP, DBP, pulse pressure) and histopathological parameters (glomerular sclerosis, arteriolosclerosis, interstitial fibrosis/tubular atrophy, interstitial infiltration). In acute kidney injury (AKI) RI is a valid tool in differentiating between pre-renal and renal failure and in predicting renal response to vasoactive agents. In addition a RRI[0.74 can predict the onset of AKI in septic patients. Renal Resistive Index is a useful marker in allograft diseases because it has been widely showed a correlation with histological lesions during worsening of renal function, both in acute rejection and in chronic allograft nephropathy. Recent studies suggest its role in the risk of new onset diabetes after transplantation and it could be one of the parameters to evaluate to shift or withdrawal immunological and/or hypertensive therapy.Keywords Renal resistive index Á Diabetic nephropathy Á Acute kidney injury Á Renal transplantation Á Chronic kidney diseaseRiassunto La Metodica Color Doppler è stata diffusamente utilizzata per evidenziare patologie nefrovascolari in relazione alle caratteristiche di non invasività, sicurezza, basso costo e ripetibilità della stessa. L'indice di resistenza renale (RRI) [(Picco di velocità sistolica -Velocità telediastolica)/ Picco di velocità sistolica] è un indice semiquantitativo derivato dalla valutazione Doppler del letto vascolare renale. Normalmente il valore del RRI è nel range di 0,47-0,70, aumentando con l'età, e usualmente, è presente una differenza tra i due reni inferiore al 5-8%. RRI è un importante marker prognostico nelle patologie renali croniche (CKD), sia diabetiche che non-diabetiche, poichè, in studi prospettici longitudinali, esso correla significativamente con parametri emodinamici (ABPM, Pressione Sistolica, pressione Diastolica, Pressione di Polso) e istopatologici (glomerulosclerosi, arteriolosclerosi, fibrosi interstiziale/ atrofia tubulare e infiltrato interstiziale). Nel Danno Renale Acuto (AKI) RI è un valido strumento nel distinguere l'insufficienza acuta pre-renale da quella renale e nel predire la risposta renale agli agenti vasoattivi. Inoltre un valore di RRI [0,74 può predire la comparsa di AKI nei pazienti affetti da sepsi. RRI è un marker utile nelle patologie del rene trapiantato, perchè è stata ampiamente dimostrata una correlazione con lesioni istologiche...

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“…The in-hospital mortality related to AKI varies from 20 to 50 % according to the stage or class of AKI [24,25].…”

Section: Rri and Akimentioning

confidence: 99%

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Spatola

Andrulli

2016

J Ultrasound

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“…AKI is now recognized as a major public health problem, affecting millions of patients worldwide (1). Critically ill patients are at high risk of developing AKI, with its incidence during intensive care unit (ICU) stay varying from 36% to 67% using the recent AKI definition (2,3).…”

Section: Introductionmentioning

confidence: 99%

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Leite

Macedo

Martins

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Propofol has been shown to provide protection against renal ischemia/reperfusion injury experimentally, but clinical evidence is limited to patients undergoing cardiac surgery. There are no data about its association with oliguria and AKI in critically ill patients.Design, setting, participants, & measurements We obtained data from the Multiparameter Intelligent Monitoring in Intensive Care II database (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008). Patient selection criteria included adult patients in their first intensive care unit (ICU) admission, need for mechanical ventilation, and treatment with propofol or midazolam. Propensity score analysis (1:1) was used and renal-related outcomes (AKI, oliguria, cumulative fluid balance, and need for RRT) were evaluated during the first 7 days of ICU stay.Results There were 1396 propofol/midazolam-matched patients. AKI in the first 7-day ICU time period was statistically lower in propofol-treated patients compared with midazolam-treated patients (55.0% versus 67.3%, P,0.001). Propofol was associated with lower AKI incidence using both urine output (45.0% versus 55.7%, P,0.001) and serum creatinine criteria (28.8% versus 37.2%, P=0.001). Patients receiving propofol had oliguria (,400 ml/d) less frequently (12.4% versus 19.6%, P=0.001) and had diuretics prescribed less often (8.5% versus 14.3%, P=0.001). In addition, during the first 7 days of ICU stay, patients receiving propofol less frequently achieved cumulative fluid balance .5% of body weight (50.1% versus 58.3%, P=0.01). The need for RRT in the first 7 days of ICU stay was also less frequent in propofol-treated patients (3.4% versus 5.9%, P=0.03). ICU mortality was lower in propofol-treated patients (14.6% versus 29.7%, P,0.001). ConclusionsIn this large, propensity-matched ICU population, patients treated with propofol had a lower risk of AKI, fluid-related complications, and need for RRT.

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“…AKI is a major clinical problem among hospital patients (1). Definitions of AKI based on changes in serum creatinine and urine output within each time frame have now been developed and are widely accepted and used (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Subacute Kidney Injury in Hospitalized Patients

Fujii

Uchino

Takinami

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The epidemiology of AKI and CKD has been described. However, the epidemiology of progressively worsening kidney function (subacute kidney injury [s-AKI]) developing over a longer time frame than defined for AKI (7 days), but shorter than defined for CKD (90 days), is completely unknown.Design, setting, participants, & measurements This retrospective study used a hospital laboratory and admission database. Adult patients admitted to a teaching hospital in Tokyo, Japan, between April 1, 2008, and October 31, 2011, were included. s-AKI was classified into three grades of severity (mild, moderate, severe) in accordance with the Risk, Injury, and Failure categories of the Risk, Injury, Failure, Risk, Loss, and ESRD classification, but did not use its time frame. Kidney injury (AKI and s-AKI) occurring during each hospital stay was identified, and logistic regression analysis was performed to assess their effect on hospital mortality. ResultsOf 56,567 patients admitted to the hospital during the study period, 49,518 were included. Of these, 87.8% had no evidence of kidney dysfunction, 11.0% had AKI, and 1.1% had s-AKI. Patients with s-AKI had mild renal dysfunction in 82.7% of cases, moderate in 12.1%, and severe in 5.0%. Worsening s-AKI category was linearly correlated with hospital mortality, as previously described for AKI (no injury: 1.2%, mild: 6.5%, moderate: 12.9%, severe: 20.7%). Although mortality (8.0% versus 17.5%) and need for renal replacement therapy (0.2% versus 2.2%) were lower in patients with s-AKI than in those with AKI, multivariable regression analysis confirmed that s-AKI was an independent risk factor for hospital mortality (odds ratio (OR), 5.44; 95% confidence interval [95% CI], 3.89 to 7.44); the OR with AKI was 14.8 (95% CI, 13.2 to 16.7).Conclusions Close to 1% of hospitalized patients develop s-AKI. This condition is independently associated with increased hospital mortality, and the risk for death increases with s-AKI severity. Patients with s-AKI had a better outcome and were less likely to require renal replacement therapy than patients with AKI.

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AKI in the ICU: definition, epidemiology, risk stratification, and outcomes

Cited by 460 publications

References 66 publications

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Doppler ultrasound in kidney diseases: a key parameter in clinical long-term follow-up

Renal Outcomes in Critically Ill Patients Receiving Propofol or Midazolam

Subacute Kidney Injury in Hospitalized Patients

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