Obesity and recovery from acute kidney injury (Ob AKI): a prospective cohort feasibility study

MacLaughlin, Helen; Blacklock, Rochelle; Wright, Kelly; Pot, Gerda K.; Jayawardene, Satish; McIntyre, Christopher W.; Macdougall, Iain C.; Selby, Nicholas M.

doi:10.1136/bmjopen-2018-024033

Cited by 8 publications

(4 citation statements)

References 35 publications

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“…Obese patients were also at higher risk of cardiovascular events. These patients are exposed to a chronic inflammatory state and high level of baseline pro-inflammatory cytokines which could contribute to higher morbidity [35][36][37]. The findings are consistent with other studies of trauma patients [3,28,38].…”

Section: Discussionsupporting

confidence: 87%

The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank from 2013 to 2016

et al. 2021

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Background The obesity paradox has been recently demonstrated in trauma patients, where improved survival was associated with overweight and obese patients compared to patients with normal weight, despite increased morbidity. Little is known whether this effect is mediated by lower injury severity. We aim to explore the association between body mass index (BMI) and renal trauma injury grade, morbidity, and in-hospital mortality. Methods A retrospective cohort of adults with renal trauma was conducted using 2013–2016 National Trauma Data Bank. Multiple regression analyses were used to assess outcomes of interest across BMI categories with normal weight as reference, while adjusting for relevant covariates including kidney injury grade. Results We analyzed 15181 renal injuries. Increasing BMI above normal progressively decreased the risk of high-grade renal trauma (HGRT). Subgroup analysis showed that this relationship was maintained in blunt injury, but there was no association in penetrating injury. Overweight (OR 1.02, CI 0.83–1.25, p = 0.841), class I (OR 0.92, CI 0.71–1.19, p = 0.524), and class II (OR 1.38, CI 0.99–1.91, p = 0.053) obesity were not protective against mortality, whereas class III obesity (OR 1.46, CI 1.03–2.06, p = 0.034) increased mortality odds. Increasing BMI by category was associated with a stepwise increase in odds of acute kidney injury, cardiovascular events, total hospital length of stay (LOS), intensive care unit LOS, and ventilator days. Conclusions Increasing BMI was associated with decreased risk of HGRT in blunt trauma. Overweight and obesity were associated with increased morbidity but not with a protective effect on mortality. The obesity paradox does not exist in kidney trauma when injury grade is accounted for.

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Section: Discussionsupporting

confidence: 87%

The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank from 2013 to 2016

et al. 2021

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“…This study explicitly examined how body mass index may modify the risk of further kidney damage after an episode of AKI. In a small feasibility study, obesity was not associated with the relative risk of CKD development or progression 12 months after AKI [ 39 ]. The present study extends the follow up time beyond 12 months, and adds to the literature on the role of BMI on CKD outcomes after AKI.…”

Section: Discussionmentioning

confidence: 99%

Body mass index and chronic kidney disease outcomes after acute kidney injury: a prospective matched cohort study

et al. 2021

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Background Acute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI. Methods This prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size. Results The cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25–29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20–24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87–3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76–2.92) and similarly, there was no detectable effect of BMI modifying this risk. Conclusions In this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.

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“… 26 However, a high BMI is associated with hypertension, diabetes, aggravated oxidative stress, causing glomerular hyperfiltration and renal injury aggravation. 27 Therefore, the relationship between recovery of renal function and BMI remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Prospective model for predicting renal recovery in cardiac surgery patients with acute kidney injury requiring renal replacement therapy

Song

Liang

et al. 2021

Nephrology

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Aim: To develop a model for predicting renal recovery in cardiac surgery patients with acute kidney injury (AKI) requiring renal replacement therapy (RRT).Methods: Data from a prospective randomized controlled trial, conducted in a tertiary hospital to compare the survival effect of two dosages of hemofiltration for continuous RRT in cardiac surgery patients between 20 March 2012 and 9 August 2015, were used to develop the model. The outcome was renal recovery defined as alive and dialysis-free 90 days after RRT initiation. Multivariate logistic regression with a stepwise backward selection of variables based on Akaike Information Criterion was applied to develop the model, which was internally validated using bootstrapping.Model discrimination, calibration and clinical value were assessed using the concordance index (C-Index), calibration plots and decision curve analysis, respectively.Results: Totally, 211 patients with AKI requiring RRT (66.8% male) with median age of 57 years were included. The incidence of renal recovery was 33.2% (n = 70). The model included six variables: body mass index stratification, baseline estimated glomerular filtration rate, hypertension, sepsis, mean arterial pressure and mechanical ventilation. The C-Index for this model was 0.807 (95% CI, 0.744-0.870). After correction by the bootstrap, the C-Index was 0.780 (95% CI, 0.720-0.845). The calibration plots indicated good consistency between actual observations and model prediction of renal recovery. Decision curve analysis demonstrated the model was clinical usefulness. Conclusion:We developed and validated a model to predict the chance of renal recovery in cardiac surgery patients with AKI requiring RRT.

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Obesity and recovery from acute kidney injury (Ob AKI): a prospective cohort feasibility study

Cited by 8 publications

References 35 publications

The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank from 2013 to 2016

The Impact of Obesity on Renal Trauma Outcome: An Analysis of the National Trauma Data Bank from 2013 to 2016

Body mass index and chronic kidney disease outcomes after acute kidney injury: a prospective matched cohort study

Prospective model for predicting renal recovery in cardiac surgery patients with acute kidney injury requiring renal replacement therapy

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