Diarrhoea, vomiting and ACE inhibitors: – an important cause of acute renal failure

Stirling, CM; Houston, J. Graeme; Robertson, Sue; Boyle, J.; Allan, A.; Norrie, John; Isles, Christopher

doi:10.1038/sj.jhh.1001571

Cited by 44 publications

(30 citation statements)

References 18 publications

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“…Various explanations for the increased incidence and decreased mortality of AKI include but are not limited to change in sensitivity and specificity of ICD-9 codes over time (although in AKI needing RRT, change in coding may not be a significant factor as compared to patients not on dialysis), initiation of RRT for less severe forms of AKI, change in the spectrum of AKI including its etiology and co-morbidities, and finally improved general and supportive care. [22,[34][35][36] The strength of this study is its large sample size, use of multiple years, and use of data from across the United States. There are also numerous limitations to this study.…”

Section: Discussionmentioning

confidence: 99%

“…However, the elderly constitute the segment of the population with the greatest incidence of AKI. Additionally, it has been demonstrated by others [22,[34][35][36] ] that coding practices for AKI may have changed over time. Although a sensitivity of coding for AKI as low as 15% [21] has been argued to contributed in underestimation of the incidence of AKI and overestimation of the outcome, this argument may not be equally relevant in patients who underwent RRT, because it is unlikely that a physician would bill for a procedure not provided (Medicare fraud) or not bill for a procedure that is provided (economic incentive to bill appropriately).…”

Section: Discussionmentioning

confidence: 99%

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Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Afshinnia

Straight

Li³

et al. 2009

Renal Failure

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Backgrounds. There are no national level data on types of dialysis in use for acute kidney injury (AKI). We aimed to assess trends in dialysis modality for AKI and mortality associated with each modality from 1998 to 2005. Methods. Using data from the 5% Medicare cohort, we identified individuals with AKI requiring dialysis. Individuals with preexisting end-stage renal disease were excluded. Intermittent hemodialysis (IHD), daily intermittent hemodialysis, and continuous renal replacement therapy (CRRT) were defined using Current Procedure Terminology codes. Mortality was defined as death during 30 days after the first dialysis session. Results. Between 1998 and 2005, there were a total of 18,249 patients identified with AKI requiring renal replacement therapy. CRRT was increasingly used for AKI, with 9.9% of patients in 1998 to 18.3% by 2005. Proportion of daily dialysis decreased during this period, while use of IHD remained stable at approximately 68%. Overall 30-day mortality declined from 44.4% in 1998 to 40.2% in 2005.Crude mortality for CRRT was highest in all years (51.0-61.8%), followed by daily (38.2-49.9%) and IHD groups (35.8-43.4%). Multinomial logistic regression analysis showed that white race, presence of sepsis, atherosclerotic heart diseases, peripheral vascular diseases, dysrhythmia, gastrointestinal and liver diseases, and any year after 2000 were independently associated with higher odds of using CRRT after adjusting for other variables. Conclusion. The proportion of patients using CRRT has increased over time. Mortality associated with IHD has decreased from 1998 to 2005. Mortality associated with different dialysis modalities is likely the result of severity of illness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Afshinnia

Straight

Li³

et al. 2009

Renal Failure

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“…Renin-angiotensin-aldosterone system (RAAS) blockers have cardioprotective and renoprotective effects in many clinical settings, and this renoprotective effect is attributable to reduced intraglomerular pressure by efferent arteriolar dilatation. In settings where glomerular filtration is maintained by efferent arteriolar constriction, such as in cases of diabetes, CHF, diarrhea, and vomiting, its vasodilatory action can induce acute kidney injury [9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

et al. 2013

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McKittrick-Wheelock syndrome can be successfully treated by emergent dialysis, prescription of bicarbonate, and endoscopic submucosal dissection, which allow elderly people suffering from this syndrome to maintain their activities of daily living. In patients with this syndrome, a large colonic villous adenoma secretes excessive amounts of mucus and causes severe electrolyte depletion and dehydration. An 81-year-old man who had been suffering from chronic renal failure (creatinine 256.4 lmol/L), hypertension, and arrhythmia presented with frequent mucous diarrhea for a month. He was hospitalized for appetite loss, vomiting, general fatigue, and acute renal failure. His blood tests and blood gas analysis revealed urea nitrogen 58.9 mmol/L, creatinine 954.7 lmol/L, pH 7.13, and a base excess of -20.1 mmol/L. Although his symptoms were improved by the emergent dialysis and rehydration, he suffered a relapse only 4 days after he was discharged. At the second admission, a nearcircumferential tumor was found in the rectum by the colonoscopy, which was pathologically confirmed as a villous adenoma. Considering his age and complications, endoscopic submucosal dissection was selected, and internal use of sodium bicarbonate was prescribed. Diarrhea and appetite loss were improved by these treatments, and the creatinine level was also improved to 168.0 lmol/L.

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“…8-10 CPB itself is considered one of the main etiologic factors in the development of AKI. 11- 14 In addition, because RAS inhibitor-associated AKI is more likely to develop under certain conditions, such as hypovolemia and renal hypoperfusion, 15, 16 we hypothesized that preload augmentation before distal anastomosis and maintenance of pulsatile blood flow and pressure during surgery would mitigate the effect of RAS inhibitors on renal function after OPCAB. However, comprehensive data to support…”

Section: Editorial P 1800mentioning

confidence: 99%

Effects of Renin-Angiotensin System Inhibitors on the Occurrence of Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Grafting

Yoo

Youn

Shim

et al. 2010

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp s the indications for renin-angiotensin system (RAS) inhibitors expand for secondary prevention in patients with coronary artery disease, 1 an increasing number of patients presenting for coronary artery bypass graft surgery (CABG) have had chronic angiotensin-converting enzyme inhibitor or angiotensin receptor blocker administration. Although continued RAS inhibitor therapy is associated with improved survival and retarded progression of renal disease, 2-4 concerns about the development acute kidney injury (AKI) in situations associated with decreased glomerular filtration pressure have been raised. 2,5,6 Editorial p 1800Indeed, cardiac surgery under cardiopulmonary bypass (CPB) is significantly associated with changes in the glomerular filtration rate and volume shift. Chronic preoperative RAS inhibitor therapy reportedly resulted in 28% increased risk of AKI following cardiac surgery, suggesting withholding of these medications prior to surgery. 2 However, from the currently available evidence no definite conclusion can be drawn on withdrawing RAS inhibitors prior to CABG at the expense of losing their anti-ischemic benefits. 2,7Use of the off-pump CABG (OPCAB) technique in patients presenting with high surgical risk has increased, with preferable results. 8-10 CPB itself is considered one of the main etiologic factors in the development of AKI. 11-14 In addition, because RAS inhibitor-associated AKI is more likely to develop under certain conditions, such as hypovolemia and renal hypoperfusion, 15,16 we hypothesized that preload augmentation before distal anastomosis and maintenance of pulsatile blood flow and pressure during surgery would mitigate the effect of RAS inhibitors on renal function after OPCAB. However, comprehensive data to support Background: Despite several studies that evaluated the effects of renin-angiotensin system (RAS) inhibitors on postoperative renal function in cardiac surgery patients, no final conclusions are available. The aim of the present study was to determine the effect of RAS inhibitors on renal function following off-pump coronary artery bypass grafting (OPCAB).

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Diarrhoea, vomiting and ACE inhibitors: – an important cause of acute renal failure

Cited by 44 publications

References 18 publications

Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Trends in Dialysis Modality for Individuals with Acute Kidney Injury

Prerenal uremia induced by severe diarrhea due to colon adenoma: a case of McKittrick–Wheelock syndrome in an elderly patient

Effects of Renin-Angiotensin System Inhibitors on the Occurrence of Acute Kidney Injury Following Off-Pump Coronary Artery Bypass Grafting

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