Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery

Skarupskienė, Inga; Adukauskienė, Dalia; Kuzminskienė, Jurgita; Rimkutė, Laima; Balčiuvienė, Vilma; Žiginskienė, Edita; Kuzminskis, Vytautas; Adukauskaitė, Agnė; Pentiokinienė, Daiva; Bumblytė, Inga Arūnė

doi:10.1016/j.medici.2017.06.003

Cited by 13 publications

(19 citation statements)

References 24 publications

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“…When we compared the ventilated non-AKI participants to the ventilated AKI participants, the ventilated AKI participants had a higher APACHE score and three days SOFA score. This finding confirmed that AKI in ICU is a prominent risk factor that can worsen the patients' health conditions, more specifically in low-risk AKI-RRT patients [22]. In addition, Vieira, et al, showed that renal dysfunction had a serious consequence during the use of mechanical ventilation and weaning from mechanical ventilation.…”

Section: Discussionmentioning

confidence: 58%

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Prevalence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

Jonny

Hasyim

Angelia

et al. 2020

Preprint

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Background : Currently, there is limited epidemiology data on acute kidney injury (AKI) from Southeast Asia, especially from Indonesia which is one of the biggest countries in Southeast Asia. Therefore, we assessed the prevalence of AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : Demographic and clinical data were collected from 952 ICU participants. The participants were categorized into AKI and non-AKI groups. The participants were further classified according to the 3 different stages of AKI as per the Kidney Disease Improving Global Outcome (KDIGO) criteria. We then assessed the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI participants. RRT modalities were listed according to the number of times the procedures were carried out. Results : Overall incidence of AKI was 43%. The participants were divided into three groups based on the AKI stages: 18.5 % had stage 1, 33% had stage 2, and 48.5 % had stage 3. The use of mechanical ventilation was higher among the participants with AKI compared to the non-AKI participants. Also, AKI participants had higher average APACHE score compared to the non-AKI participants (16.5 vs 9.9). Among the AKI participants, 24.6% required RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low-efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions : This study showed that AKI is a common problem in the Indonesian ICU and had a high mortality rate. We strongly believe that identification of the risk factors associated with AKI will help us to develop a predictability score for AKI so we can prevent and improve AKI outcome in the future.

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Section: Discussionmentioning

confidence: 58%

“…In order to reach the acceptable gas exchange level, therefore mechanical ventilation is needed to increase the intrathoracic pressure to compensate for these negative changes. If mechanical ventilation is not used, then the AKI patients can progress to renal dysfunction such as renal tubular apoptosis [22].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

Jonny

Hasyim

Angelia

et al. 2020

Preprint

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“…There are a few reports concerning blood pressure related to mortality among AKI requiring RRT [17,31], and instead of renal prognosis, some reports disclose better prognosis with higher MAP among AKI. Among patients with postgastrointestinal surgery, the MAP comparing 80-95 mmHg with 65-79 mmHg is reported to have less incidence of AKI [38], and among patients with AKI requiring RRT after cardiac surgery, the lower MAP is associated with poor mortality [39]. As our results showed, the higher MAP would not be optimal rather than sole target of MAP ≥ 65 mmHg.…”

Section: Discussionmentioning

confidence: 59%

Predictors of withdrawal from renal replacement therapy among patients with acute kidney injury requiring renal replacement therapy

2019

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Background Although recovery of renal function after an episode of acute kidney injury (AKI) is an important clinical measure of morbidity, predictors of withdrawal from renal replacement therapy (RRT) among AKI patients remain unclear. Methods In this single-center retrospective cohort study, we examined the clinical records of AKI patients requiring RRT who were hospitalized in the ICU or general wards at our hospital from January 2010 to December 2013. A priori-determined covariates of age, sex, cardiovascular disease, chronic kidney disease (CKD), mean arterial pressure (MAP), sepsis, nephrotoxic agents, and hypoalbuminemia were assessed in Cox hazard models to estimate hazard ratio (HR). Results A total of 334 patients were enrolled (median age, 68 years; interquartile range [IQR], 57-77 years; male, 71.6%). During follow-up 157 (47.0%) patients achieved RRT withdrawal. Multivariable Cox regression analysis revealed that CKD, MAP between 95 and 105 mmHg and MAP ≥ 105 mmHg, compared with MAP between 65 and 75 mmHg, ventilator use and hypoalbuminemia, were significantly associated with RRT withdrawal. Conclusion Among patients with AKI requiring RRT, CKD, ventilator use, hypoalbuminemia, and high MAP were associated with RRT withdrawal. Furthermore, keeping a higher MAP at RRT initiation can potentially lead to dependence on RRT.

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“…This will eventually result in renal dysfunction such as renal tubular apoptosis. (22) There are 92 patients (24.6%) AKI patients required RRT(AKI-RRT), this result might validate the importance of RRT in ICU settings, despite certain challenges such as availability of modalities and understaffing of nephrologist. (24) It is important to remember that AKI is a case with a staggering amount of mortality rates, especially for critically ill patients in ICU setting.…”

Section: Discussionmentioning

confidence: 82%

“…This study result might support current view that AKI in ICU is a prominent risk factor contributes to the worsening of patients' health conditions, more specifically in low-risk AKI-RRT patients. (22) Based on the study conducted by Vieira, et al shows that renal dysfunction has serious consequence in the duration of mechanical ventilation and weaning from mechanical ventilation. The median duration of mechanical ventilation use in AKI patients was 3 days longer than non-AKI patients (10 vs 7 days).…”

Section: Discussionmentioning

confidence: 99%

Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

Jonny¹,

Hasyim²,

Angelia³

et al. 2020

Preprint

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Background : Currently, there is limited data of large databases of acute kidney injury (AKI) epidemiology from Southeast Asia, especially in Indonesia, the biggest countries in. Therefore, we aimed to provide demographic data of intensive care unit (ICU) patients with AKI and the utilization of renal replacement therapy (RRT) in Indonesia. Methods : We collected demographic and clinical data from 952 ICU patients. Patients were classified into AKI and non-AKI. AKI was classified according to the Kidney Disease Improving Global Outcome (KDIGO) criteria in three stages. We then assess the Acute Physiology and Chronic Health Evaluation (APACHE) II score of AKI and non-AKI patients. RRT modalities were listed down by the number of procedures conducted. Results : Overall incidence of AKI was 43%, distributed among three stages: 18.5 % stage 1, 33% stage 2, 48.5 % stage 3. Patients developing AKI need mechanical ventilation more often in comparison with non-AKI. Patients with AKI have an average APACHE score of 16.5, while non-AKI patients have an average score of 9.9. Among AKI patients, 24.6% requires RRT. The most common RRT modalities were intermittent hemodialysis (69.4%), followed by slow low efficiency dialysis (22.1%), continuous renal replacement therapy (4.2%), and peritoneal dialysis (1.1%). Conclusions: This study showed that AKI is a common problem in Indonesian ICU with containing a high mortality rate. We strongly believe that identification the risk factor of AKI will provide the opportunity to develop the predictability score for AKI prevention and finally improve AKI outcome.

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Mortality prediction in patients with acute kidney injury requiring renal replacement therapy after cardiac surgery

Cited by 13 publications

References 24 publications

Prevalence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

Prevalence of acute kidney injury and use of renal replacement therapy in intensive care unit patients in Indonesia

Predictors of withdrawal from renal replacement therapy among patients with acute kidney injury requiring renal replacement therapy

Acute kidney injury incidence and acute renal replacement modality in intensive care unit patients in Indonesia: A result from Southeast Asia-Acute Kidney Injury Study

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