Sp222performance of Urinary Monocyte Chemoattractant Protein-1 (Mcp-1) to Diagnose Acute Kidney Injury in Snakebite Envenomation Due to Bothrops

Abstract

INTRODUCTION AND AIMS:The incidence of acute kidney injury (AKI) has increased and with significant mortality risk. We aim to evaluate our single-center outcomes after AKI. METHODS: Electronic medical records and clinical data were prospectively collected for patients diagnosed with AKI by KDIGO criteria from 15 th July to 22 nd October 2016, excluding patients with baseline estimated GFR (eGFR) of <15ml/min. Patients were followed up till 12 months after AKI diagnosis. RESULTS: Among the 404 patients (mean age 65.8 6 14.1), 276 (68%) survived 365 days from AKI episode. Majority of patients were male (58%) of Chinese ethnicity (68.8%) with a mean eGFR (CKD-EPI) of 50.2 6 27.7mL/min. Three hundred ten (76.7%) patients had single etiology of AKI with the 3 most common etiologies of AKI being pre-renal (27.7%) followed by sepsis-associated (25.5%) and ischemic acute tubular necrosis (15.3%). One hundred two (27.7%) patients received renal replacement therapy (RRT). At 3 months post-AKI, 27.1% had complete recovery (serum creatinine fell below or to the baseline level), 28.9% had partial recovery (serum creatinine decreased by 25% from peak level but remained above baseline level) and 44% had non-recovery of renal function (dialysis-dependent or serum creatinine decreased by <25% from serum creatinine at RRT initiation). At 12 months, 19.6%, 31.4% and 49% had complete, partial and non-recovery, respectively. On survival analysis, patients with KDIGO Stage 1 and 2 AKI had significantly better survival than stage 3 AKI. CONCLUSIONS: AKI is associated with significant 6-month mortality and development of renal partial or non-recovery. The association of better survival with early AKI stages suggests a strong need for early AKI detection. INTRODUCTION AND AIMS:Renal functional assessment at 3 months after continuous renal replacement therapy (CRRT) initiation can be useful in predicting longterm mortality and progression to ESRD. METHODS:We investigated the association between fluid balance before and after CRRT initiation and long-term outcomes after acute kidney injury (AKI) episode requiring CRRT. Among 1764 adult AKI patients started on CRRT from 2009 to 2013 in intensive care units in four tertiary academic hospitals in Korea, 331 survivors at 3 months after CRRT initiation were enrolled. Chronic kidney disease (CKD) progression was defined as a worsening renal status assessed at 3 months after CRRT initiation, comprising RRT continuation, an increase in serum creatinine of more than 50%, and a decrease in the estimated glomerular filtration rate of 35% or more than the baseline values. RESULTS: Cumulative fluid balance during 5 days after CRRT initiation was not associated with CKD progression. However, a positive fluid balance during 24 hours before CRRT initiation had the protective effect for CKD progression [Odds ratio 0.46 (0.23-0.91); P ¼ 0.026]. This result was significant after adjustment for gender, age, and baseline serum creatinine. During the median 20.4 (7.5-39.7) months of follow-up, fluid balance w...