Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study

Cely, Javier Enrique; Mendoza, Elkin José; Díaz, John Jaime Sprockel; Pérez, Luis; Mateus, Janeth Marcela; Maldonado, Sebastián; Diaztagle, Juan José

doi:10.1159/000506502

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…Few recent studies focus on CA-AKI as opposed to hospital-acquired AKI, which has been explored in diverse clinical settings such as heart surgery and intensive care units [7][8][9][10][11][12][13]. [14][15][16][17][18][19][20]. We found a high prevalence of CA-AKI (19.6%), which could be motivated by the advanced age and multiple comorbidities of our population.…”

Section: Discussionmentioning

confidence: 78%

“…Most studies exploring AKI outcomes have considered either hospital acquired AKI requiring dialysis or homogenous patient populations such as those exposed to radiocontrast agents, cardiac surgery, or intensive care and examined outcomes such as short-term mortality and costs [7][8][9][10][11][12][13]. Few studies have examined the impact of CA-AKI in long-term outcomes after hospital discharge, such as mortality, the progression of preexisting chronic kidney disease (CKD), and the development of new-onset CKD [14][15][16][17][18][19][20]. Rather than distinct entities, AKI and CKD are now recognized as interconnected syndromes because AKI is a risk factor for CKD progression, and CKD is a risk factor for new episodes of AKI [21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After?

et al. 2021

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Community-acquired acute kidney injury is a frequent diagnosis at hospital admission in developed countries. Due to the multiple comorbidities, patients admitted to internal medicine departments have a higher susceptibility to acute kidney injury.To determine the prevalence, risk factors, and impact of community-acquired acute kidney injury, we developed a retrospective observational case-control study in an internal medicine ward at a tertiary hospital comparing patients admitted with community-acquired acute kidney injury with patients without acute kidney injury at hospital admission. Patients who needed dialysis were excluded.Community-acquired acute kidney injury was present in 19.6% of patients, mostly prerenal acute kidney injury (68.8%) and Kidney Disease Improving Global Outcomes classification stage 1 (51.9%). Dementia (OR 3.3, [0.2-0.6]) and loop diuretics as outpatient medication (OR 2.2, [0.2-0.9]) were risk factors for community-acquired acute kidney injury. These patients presented higher mortality after hospital discharge (p=0.003), and 35.1% of deaths occurred in the first 90 days. At one-year follow-up, chronic kidney disease progression was more frequent in the community-acquired acute kidney injury group (24.6% versus 2.6%, p=0.002); otherwise, new-onset chronic kidney disease was similar between groups.The long-term consequences of community-acquired acute kidney injury can be severe, including renal disease progression and mortality after hospital discharge (mostly in the first 90 days); thus, it is important to implement programs to provide early evaluation for these patients. Patients taking diuretics are at increased risk of acute kidney injury. Also, patient and caregiver education on hydration of demented patients could prevent communityacquired acute kidney injury.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After?

et al. 2021

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“…One of the challenges in assessing the nephrotoxic nature of medicines is that the medicines implicated, such as medicines affecting the renin angiotensin system, are frequently used to treat morbidities that make people more at risk of acute kidney injury, such as diabetes and heart failure; thus, confounding by indication can be a factor affecting associations. Patient-related precipitating factors, such as infection, dehydration or exacerbation of an illness such as heart failure, may also have confounded the results observed [33,34]. However, we included SSA as a method to control for patient-specific confounding, which suggests the addition of the medicine was a contributor independent of the disease.…”

Section: Discussionmentioning

confidence: 99%

Medicine-Induced Acute Kidney Injury Findings from Spontaneous Reporting Systems, Sequence Symmetry Analysis and a Case–Control Study with a Focus on Medicines Used in Primary Care

et al. 2022

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Introduction Primary care provides an opportunity to prevent community acquired, medicine or drug-induced acute kidney injury. One of the barriers to proactive prevention of medicine-induced kidney injury in primary care is the lack of a list of nephrotoxic medicines that are most problematic in primary care, particularly one that provides a comparison of risks across medicines. Objective The aim of this study was to consolidate evidence on the risks associated with medicines and acute kidney injury, with a focus on medicines used in primary care. Method We searched the MEDLINE and EMBASE databases to identify published studies of all medicines associated with acute kidney injury identified from spontaneous report data. For each medicine positively associated with acute kidney injury, as identified from spontaneous reports, we implemented a sequence symmetry analysis (SSA) and a case-control design to determine the association between the medicine and hospital admission with a primary diagnosis of acute kidney injury (representing community-acquired acute kidney injury). Administrative claims data held by the Australian Government Department of Veterans' Affairs for the study period 2005-2019 were used. ResultsWe identified 89 medicines suspected of causing acute kidney injury based on spontaneous report data and a reporting odds ratio above 2, from Japan, France and the US. Spironolactone had risk estimates of 3 or more based on spontaneous reports, SSA and case-control methods, while furosemide and trimethoprim with sulfamethoxazole had risk estimates of 1.5 or more. Positive association with SSA and spontaneous reports, but not case control, showed zoledronic acid had risk estimates above 2, while candesartan telmisartan, simvastatin, naproxen and ibuprofen all had risk estimates in SSA between 1.5 and 2. Positive associations with case-control and spontaneous reports, but not SSA, were found for amphotericin B, omeprazole, metformin, amlodipine, ramipril, olmesartan, ciprofloxacin, valaciclovir, mycophenolate and diclofenac. All with the exception of metformin and omeprazole had risk estimates above 2. Conclusion This research highlights a number of medicines that may contribute to acute injury; however, we had an insufficient sample to confirm associations of some medicines. Spironolactone, furosemide, and trimethoprim with sulfamethoxazole are medicines that, in particular, need to be used carefully and monitored closely in patients in the community at risk of acute kidney injury.

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“…In addition, some empiric antibiotics on which patients are started can also cause a nephrotoxic effect. Difficulties in diagnosis, delays in initiation of treatment, and inappropriately initiated empiric therapies can lead to an increase in length of hospital stay and mortality in patients with CKD, while there is an increased risk of irreversible renal damage and mortality in patients with AKI [12,13].…”

Section: Introductionmentioning

confidence: 99%

The place of infectious markers in predicting culture positivity in patients with renal failure hospitalized with suspected infection

et al. 2021

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Infectious diseases are an important cause of mortality in patients with renal failure. The markers used to diagnose infection in patients with renal failure have various limitations. Culture positivity is an objective guide in that context. The purpose of this study was to examine the effectiveness of frequently used markers of bacterial infection in predicting culture positivity in renal failure patients with renal failure hospitalized with suspected bacterial infection over an approximately 1.5-year period were included in this prospective observational study. Patients' demographic and laboratory findings were recorded.Demographic and laboratory findings and mortality were compared between patients with and without culture-positivity. Parameters affecting culture positivity were also analyzed. Four hundred twenty-six patients (median age 67.50, 45.5% female) were included in the study. Culture positivity was determined in 54.5% of patients. Hospital stay was longer (p < 0.001) and leukocyte (p < 0.001), neutrophil percentage (p < 0.05) and CRP (p < 0.001) values were significantly higher in culture-positive patients. Mortality was also significantly higher in culture-positive patients than in culture-negative patients (p < 0.05). CRP was determined as a predictor of culture positivity at logistic regression analysis (p = 0.000, exp ß [1.004]). Culture positivity was determined in more than half of the patients hospitalized with suspected bacterial infection. CRP, a longstanding marker, was identified as a parameter predicting culture positivity.We think that the determination in further studies of a cut-off point for CRP in determining culture positivity may be a useful diagnostic guide.

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Risk Factors for Community-Acquired Acute Kidney Injury in Medical Patients: A Nested Case-Control Study

Cited by 3 publications

References 20 publications

Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After?

Community-Acquired Acute Kidney Injury at Hospital Admission: What Happens One Year After?

Medicine-Induced Acute Kidney Injury Findings from Spontaneous Reporting Systems, Sequence Symmetry Analysis and a Case–Control Study with a Focus on Medicines Used in Primary Care

The place of infectious markers in predicting culture positivity in patients with renal failure hospitalized with suspected infection

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