Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Nie, Sasa; Feng, Zhe; Li, Tang; Wang, Xiaolong; He, Yong; Fang, Jingai; Li, Suhua; Yang, Yibin; Mao, Huijuan; Jiao, Jundong; Liu, Wenhu; Cao, Ning; Wang, Wenge; Sun, Jin; Shao, Fengmin; Li, Wenge; He, Qiang; Jiang, Hongli; Lin, Hongli; Fu, Ping; Zhang, Xinzhou; Liu, Yanping; Wu, Yuangang; Xi, Chunsheng; Meng, Linghui; Qu, Zhijie; Zhu, Jihe; Zheng, Yali; Yu, Na; Liu, Ying; Li, Wei; Cai, Guangyan; Chen, Xiangmei

doi:10.1159/000484234

Cited by 20 publications

(13 citation statements)

References 36 publications

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“…But there were no significant difference between AKI and non-AKI in terms of the infection site and underlying disease in our study. However, young age and female gender have been reported to be 2 protective factors in AKI [40-43]. Older patients (>75 years) have significantly higher in-hospital ICU mortality than younger patients with sepsis [20].…”

Section: Discussionmentioning

confidence: 99%

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Zhan

et al. 2021

Blood Purif

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Objective: The objective of this study was to assess the relationship between serum procalcitonin (PCT) and acute kidney injury (AKI) induced by bacterial septic shock. Methods: A retrospective study was designed which included patients who were admitted to the ICU from January 2015 to October 2018. Multiple logistic regression and receiver operating characteristic (ROC) as well as smooth curve fitting analysis were used to assess the relationship between the PCT level and AKI. Results: Of the 1,631 patients screened, 157 patients were included in the primary analysis in which 84 (53.5%) patients were with AKI. Multiple logistic regression results showed that PCT (odds ratio [OR] = 1.017, 95% confidence interval [CI] 1.009–1.025, p < 0.001) was associated with AKI induced by septic shock. The ROC analysis showed that the cutoff point for PCT to predict AKI development was 14 ng/mL, with a sensitivity of 63% and specificity 67%. Specifically, in multivariate piecewise linear regression, the occurrence of AKI decreased with the elevation of PCT when PCT was between 25 ng/mL and 120 ng/mL (OR 0.963, 95% CI 0.929–0.999; p = 0.042). The AKI increased with the elevation of PCT when PCT was either <25 ng/mL (OR 1.077, 95% CI 1.022–1.136; p = 0.006) or >120 ng/mL (OR 1.042, 95% CI 1.009–1.076; p = 0.013). Moreover, the PCT level was significantly higher in the AKI group only in female patients aged ≤75 years (p = 0.001). Conclusions: Our data revealed a nonlinear relationship between PCT and AKI in septic shock patients, and PCT could be used as a potential biomarker of AKI in female patients younger than 75 years with bacterial septic shock.

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Section: Discussionmentioning

confidence: 99%

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Zhan

et al. 2021

Blood Purif

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“…The unadjusted cohort consisted of 68 studies which included 232,586,252 patients (130,605,382 women and 101,970,870 men (Figs. 3 and 4 ) [ 29 , 31 – 34 , 36 , 38 , 42 , 43 , 45 , 47 , 57 – 112 ]. Studies could be divided into 7 distinct categories.…”

Section: Resultsmentioning

confidence: 99%

Female sex reduces the risk of hospital-associated acute kidney injury: a meta-analysis

Neugarten

Golestaneh

2018

BMC Nephrol

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BackgroundFemale sex has been included as a risk factor in models developed to predict the development of AKI. In addition, the commentary to the Kidney Disease Improving Global Outcomes Clinical Practice Guideline for AKI concludes that female sex is a risk factor for hospital-acquired AKI. In contrast, a protective effect of female sex has been demonstrated in animal models of ischemic AKI.MethodsTo further explore this issue, we performed a meta-analysis of AKI studies published between January, 1978 and April, 2018 and identified 83 studies reporting sex-stratified data on the incidence of hospital-associated AKI among nearly 240,000,000 patients.ResultsTwenty-eight studies (6,758,124 patients) utilized multivariate analysis to assess risk factors for hospital-associated AKI and provided sex-stratified ORs. Meta-analysis of this cohort showed that the risk of developing hospital-associated AKI was significantly greater in men than in women (OR 1.23 (1.11,1.36). Since AKI is not a single disease but instead represents a heterogeneous group of disorders characterized by an acute reduction in renal function, we performed subgroup meta-analyses. The association of male sex with AKI was strongest among studies of patients who underwent non-cardiac surgery. Male sex was also associated with AKI in studies which included unselected hospitalized patients and in studies of critically ill patients who received care in an intensive care unit. In contrast, cardiac surgery-associated AKI and radiocontrast-induced AKI showed no sexual dimorphism.ConclusionsOur meta-analysis contradicts the established belief that female sex confers a greater risk of AKI and instead suggests a protective role.

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“…Due to dysregulation of transporters across the blood–brain barrier, AKI causes an imbalance of excitatory and inhibitory neurotransmitters [ 51 ]. According to the evidence from the clinical study, it could be assumed that AKI is an independent risk factor for CKD development and is associated with multiple organ dysfunction [ 52 ]. The kidneys and the brain share similar vascoregulatory and anatomic pathways [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis

Hussain

Singh

Antony

et al. 2021

JCM

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Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle–Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort (n = 3) and case–control (n = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52–2.43), p ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09–1.11), p < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62–3.28), p = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20–3.70), p = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association.

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Risk Factor Analysis for AKI Including Laboratory Indicators: a Nationwide Multicenter Study of Hospitalized Patients

Cited by 20 publications

References 36 publications

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Association between Procalcitonin and Acute Kidney Injury in Patients with Bacterial Septic Shock

Female sex reduces the risk of hospital-associated acute kidney injury: a meta-analysis

Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis

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