Risk Factors for Development of Acute Kidney Injury in Critically Ill Patients: A Systematic Review and Meta-Analysis of Observational Studies

Abstract

Background. Acute kidney injury (AKI) is a frequent complication of critically ill patients. The impact of different risk factors associated with this entity in the ICU setting is unknown. Objectives. The purpose of this research was to assess the risk factors associated with the development of AKI in critically ill patients by meta-analyses of observational studies. Data Extraction. Two reviewers independently and in duplicate used a standardized form to collect data from published reports. Authors were contacted for missing data. The Newcastle-Ottawa scale assessed study quality. Data Synthesis. Data from 31 diverse studies that enrolled 504,535 critically ill individuals from a wide variety of ICUs were included. Separate random-effects meta-analyses demonstrated a significantly increased risk of AKI with older age, diabetes, hypertension, higher baseline creatinine, heart failure, sepsis/systemic inflammatory response syndrome, use of nephrotoxic drugs, higher severity of disease scores, use of vasopressors/inotropes, high risk surgery, emergency surgery, use of intra-aortic balloon pump, and longer time in cardiopulmonary bypass pump. Conclusion. The best available evidence suggests an association of AKI with 13 different risk factors in subjects admitted to the ICU. Predictive models for identification of high risk individuals for developing AKI in all types of ICU are required.

AKI in Low-Risk versus High-Risk Patients in Intensive Care

“…We reviewed the literature to identify risk factors for AKI and a recent meta-analysis of 31 observational studies in critically ill patients was used as a source of data on susceptibilities and exposures (14). We considered the following susceptibilities: age, sex, race, body mass index, comorbid conditions (i.e., diabetes, cardiac disease, chronic renal disease, hypertension), and eGFR; and exposures within 24 hours of ICU admission, including admission type (medical versus surgical), APS-III score, hypotension, suspected sepsis, and nephrotoxic drug use.…”

Risk factors of acute kidney injury requiring renal replacement therapy based on regional registry data

“…These results are understandable considering the pathophysiology and natural course of this group of diseases; in most cases neurologic diseases are not associated with impaired kidney function. The additional risk factors selected in our study may result from the specificity of the population studied [13]. The diagnostic accuracy of the statistical model we used is very good as 16 variables enabled a prediction of the end-point in more than 80% of cases.…”

“…In the KDIGO guidelines, cardiogenic shock is one of the cardinal determinants of AKI [12]. Both the use of catecholamines and intra-aortic counterpulsation balloons are considered risk factors for AKI [13]. Moreover, according to the guidelines mentioned above [12] and in other studies [14], an extensive surgical procedure is an AKI-inducing factor.…”

Iatrogenic AKI and Agranulocytosis: a Cautious Tale of Medication Use in Elderly Patients

“…advanced age, chronic kidney disease and other preexisting chronic medical conditions) and other predisposing factors (e.g. sepsis and surgery) [10]. AKI is strongly associated with advanced age, and the recent increase in AKI incidence is linked to the growing size of the elderly population.…”