Predictors of Acute Kidney Disease Severity in Hospitalized Patients with Acute Kidney Injury

Abstract

Acute kidney disease (AKD) forms part of the continuum of acute kidney injury (AKI) and worsens clinical outcomes. Currently, the predictors of AKD severity have yet to be established. We conducted a retrospective investigation involving 310 hospitalized patients with AKI and stratified them based on the AKD stages defined by the Acute Dialysis Quality Initiative criteria. Demographic, clinical, hematologic, and biochemical profiles, as well as 30-day outcomes, were compared between subgroups. In the analysis, the use of offending drugs (odds ratio, OR (95% confidence interval, CI), AKD stage 3 vs. non-AKD, 3.132 (1.304––7.526), p = 0.011, AKD stage 2 vs. non-AKD, 2.314 (1.049–5.107), p = 0.038), high AKI severity (OR (95% CI), AKD stage 3 vs. non-AKD, 6.214 (2.658–14.526), p < 0.001), and early dialysis requirement (OR (95% CI), AKD stage 3 vs. non-AKD, 3.366 (1.008–11.242), p = 0.049) were identified as independent predictors of AKD severity. Moreover, a higher AKD severity was associated with higher 30-day mortality and lower dialysis-independent survival rates. In conclusion, our study demonstrated that offending drug use, AKI severity, and early dialysis requirement were independent predictors of AKD severity, and high AKD severity had negative impact on post-AKI outcomes.

Update on prognosis driven classification of pediatric AKI

“…Adult studies have shown even more variability with incidence ranging from 3.8% in the general adult population of a single Canadian territory to 4.4%-74% in adults of special populations including those undergoing cardiac and non-cardiac procedure, chemotherapy, hematopoietic stem cell transplant recipients, those with AKI, heart failure, sepsis, cirrhosis, and SARS-CoV-2 infection (20). Hospitalized adults with AKI admitted to both the general floors as well as ICUs had high prevalence of AKD with most studies showing about one-fourth to half of all patients developing AKD (19,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Adults with cardiac diseases, post cardiac surgery, sepsis and cirrhosis all had high AKD prevalence suggesting hemodynamic status may play a significant role in sustained kidney injury and progression (17,18,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)48).…”

“…There have been more comprehensive studies of risk factors for AKD development in adults as outlined in Table 4. In hospitalized adults with AKI, age, gender, intrinsic kidney disease, AKI stage, oliguria, anuria, nephrotoxin exposure, early need for dialysis, BUN level, diabetes, anemia, and respiratory failure have been associated with AKD development (31)(32)(33). In adults admitted to an ICU setting age, male sex, African American race, sepsis, lower baseline eGFR and CKD, anemia, and lower ejection fraction have been shown to be risk factors for AKD (35,39,45).…”

Pharmacotherapeutic Evaluation of Covid-19 Patients Suffering from Acute Kidney Injury

“…Patients suffering from COVID-19 show various degrees of kidney damage caused by the virus. This can be evaluated based on blood urea nitrogen (BUN), creatinine levels, and other structural changes including edema or inflammation of renal parenchyma, focal fibrosis, epithelial cell necrosis with interstitial hyperemia [37,38]. Increased release of proinflammatory factors in response to the viral attack is associated with the development of COVID-19-related acute kidney injury [39].…”

Incidence of Renal Impairment in Elderly Hospitalized Patients

“…Chronic kidney disease (CKD) is a prevalent condition among the elderly, often leading to detrimental outcomes such as decreased autonomy, increased hospitalization rates, and higher mortality (1). This disease is commonly associated with chronic conditions that contribute to fraility, including hypertension, coronary artery disease, arterial fibrillation, congestive heart failure, stroke, and peripheral vascular disease (2,3). Furthermore, CKD has been identified as a predictor of disability in older adults.…”