1
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Celegen K, Celegen M. A Retrospective Analysis of Risk Factors and Impact of Acute Kidney Injury in Critically Ill Children. KLINISCHE PADIATRIE 2024; 236:229-239. [PMID: 36848938 DOI: 10.1055/a-1996-1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a serious clinical condition in critically ill children and is associated with worse outcomes. A few pediatric studies focused on the risk factors of AKI. We aimed to identify the incidence, risk factors, and outcomes of AKI in the pediatric intensive care unit (PICU). PATIENTS AND METHODS All the patients admitted to PICU over a period of 20 months were included. We compared both groups the risk factors between AKI and non-AKI. RESULTS A total of 63 patients (17.5%) of the 360 patients developed AKI during PICU stay. The presence of comorbidity, diagnosis of sepsis, increased PRISM III score, and positive renal angina index were found to be risk factors for AKI on admission. Thrombocytopenia, multiple organ failure syndrome, the requirement of mechanical ventilation, use of inotropic drugs, intravenous iodinated contrast media, and exposure to an increased number of nephrotoxic drugs were independent risk factors during the hospital stay. The patients with AKI had a lower renal function on discharge and had worse overall survival. CONCLUSIONS AKI is prevalent and multifactorial in critically sick children. The risk factors of AKI may be present on admission and during the hospital stay. AKI is related to prolonged mechanical ventilation days, longer PICU stays, and a higher mortality rate. Based on the presented results early prediction of AKI and consequent modification of nephrotoxic medication may generate positive effects on the outcome of critically ill children.
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Affiliation(s)
- Kubra Celegen
- Division of Pediatric Nephrology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
- Pediatric Nephrology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Mehmet Celegen
- Pediatric Intensive Care, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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2
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Kumar A, Epler K, DeWolf S, Barnes L, Hepokoski M. Bidirectional pressure: a mini review of ventilator-lung-kidney interactions. Front Physiol 2024; 15:1428177. [PMID: 38966229 PMCID: PMC11222611 DOI: 10.3389/fphys.2024.1428177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 06/03/2024] [Indexed: 07/06/2024] Open
Abstract
Acute kidney injury and respiratory failure that requires mechanical ventilation are both common complications of critical illnesses. Failure of either of these organ systems also increases the risk of failure to the other. As a result, there is a high incidence of patients with concomitant acute kidney injury and the need for mechanical ventilation, which has a devasting impact on intensive care unit outcomes, including mortality. Despite decades of research into the mechanisms of ventilator-lung-kidney interactions, several gaps in knowledge remain and current treatment strategies are primarily supportive. In this review, we outline our current understanding of the mechanisms of acute kidney injury due to mechanical ventilation including a discussion of; 1) The impact of mechanical ventilation on renal perfusion, 2) activation of neurohormonal pathways by positive pressure ventilation, and 3) the role of inflammatory mediators released during ventilator induced lung injury. We also provide a review of the mechanisms by which acute kidney injury increases the risk of respiratory failure. Next, we outline a summary of the current therapeutic approach to preventing lung and kidney injury in the critically ill, including fluid and vasopressor management, ventilator strategies, and treatment of acute kidney injury. Finally, we conclude with a discussion outlining opportunities for novel investigations that may provide a rationale for new treatment approaches.
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Affiliation(s)
- Avnee Kumar
- VA San Diego Healthcare System, San Diego, CA, United States
- Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, United States
| | - Katie Epler
- VA San Diego Healthcare System, San Diego, CA, United States
- Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, United States
| | - Sean DeWolf
- VA San Diego Healthcare System, San Diego, CA, United States
- Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, United States
| | - Laura Barnes
- VA San Diego Healthcare System, San Diego, CA, United States
- Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, United States
| | - Mark Hepokoski
- VA San Diego Healthcare System, San Diego, CA, United States
- Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, San Diego, CA, United States
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3
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Sharieff S, Rafai W, Manzoor A, Idrees A, Ahmad B, Ghulam M, Shabbir MU. Experience of Sustained Low-Efficiency Dialysis (SLED) in an Intensive Care Unit of a Quaternary Care Hospital. Cureus 2024; 16:e54376. [PMID: 38505436 PMCID: PMC10950314 DOI: 10.7759/cureus.54376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In critically ill patients, sustained low-efficiency dialysis (SLED) has become a viable option for treating acute kidney injury (AKI) instead of continuous renal replacement therapy (CRRT). This study aimed to evaluate clinical outcomes in critically ill patients receiving SLED. MATERIAL AND METHODS In our ICU, we performed a retrospective cohort study on hemodynamically unstable patients requiring dialysis in the form of SLED. Demographics, clinical, and biochemical variables were analyzed. RESULTS A total of 58 patients were enrolled in the study. The mean age was 48.58 ± 15 with a male-to-female ratio of 3:1. Higher APACHE II score, high international normalized ratio, thrombocytopenia, and septic shock were found to be poor prognostic markers, with an overall observed mortality of 56.9%. CONCLUSION SLED can be considered as an alternative to CCRT for selected hemodynamically unstable patients requiring renal replacement therapy.
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Affiliation(s)
- Saleem Sharieff
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
- Critical Care Medicine, Grand River Hospital, Kitchener, CAN
| | - Wajid Rafai
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Adil Manzoor
- Nephrology, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Asim Idrees
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Burhan Ahmad
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Madiha Ghulam
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
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4
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Komaru Y, Bai YZ, Kreisel D, Herrlich A. Interorgan communication networks in the kidney-lung axis. Nat Rev Nephrol 2024; 20:120-136. [PMID: 37667081 DOI: 10.1038/s41581-023-00760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/06/2023]
Abstract
The homeostasis and health of an organism depend on the coordinated interaction of specialized organs, which is regulated by interorgan communication networks of circulating soluble molecules and neuronal connections. Many diseases that seemingly affect one primary organ are really multiorgan diseases, with substantial secondary remote organ complications that underlie a large part of their morbidity and mortality. Acute kidney injury (AKI) frequently occurs in critically ill patients with multiorgan failure and is associated with high mortality, particularly when it occurs together with respiratory failure. Inflammatory lung lesions in patients with kidney failure that could be distinguished from pulmonary oedema due to volume overload were first reported in the 1930s, but have been largely overlooked in clinical settings. A series of studies over the past two decades have elucidated acute and chronic kidney-lung and lung-kidney interorgan communication networks involving various circulating inflammatory cytokines and chemokines, metabolites, uraemic toxins, immune cells and neuro-immune pathways. Further investigations are warranted to understand these clinical entities of high morbidity and mortality, and to develop effective treatments.
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Affiliation(s)
- Yohei Komaru
- Department of Medicine, Division of Nephrology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Yun Zhu Bai
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Daniel Kreisel
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Department of Pathology & Immunology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Andreas Herrlich
- Department of Medicine, Division of Nephrology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
- VA Saint Louis Health Care System, John Cochran Division, St. Louis, MO, USA.
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5
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Ramírez-Guerrero G, Husain-Syed F, Ponce D, Torres-Cifuentes V, Ronco C. Peritoneal dialysis and acute kidney injury in acute brain injury patients. Semin Dial 2023; 36:448-453. [PMID: 36913952 DOI: 10.1111/sdi.13151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/21/2023] [Accepted: 02/18/2023] [Indexed: 03/14/2023]
Abstract
Acute kidney injury (AKI) is a heterogeneous syndrome with multiple etiologies. It occurs frequently in the neurocritical intensive care unit and is associated with greater morbidity and mortality. In this scenario, AKI alters the kidney-brain axis, exposing patients who receive habitual dialytic management to greater injury. Various therapies have been designed to mitigate this risk. Priority has been placed by KDIGO guidelines on the use of continuous over intermittent acute kidney replacement therapies (AKRT). On this background, continuous therapies have a pathophysiological rationale in patients with acute brain injury. A low-efficiency therapy such as PD and CRRT could achieve optimal clearance control and potentially reduce the risk of secondary brain injury. Therefore, this work will review the evidence on peritoneal dialysis as a continuous AKRT in neurocritical patients, describing its benefits and risks so it may be considered as an option when deciding among available therapeutic options.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Faeq Husain-Syed
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Daniela Ponce
- Department of Internal Medicine, University Hospital, Botucatu School of Medicine, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Vicente Torres-Cifuentes
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza, Vicenza, Italy
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6
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Li X, Yuan F, Zhou L. Organ Crosstalk in Acute Kidney Injury: Evidence and Mechanisms. J Clin Med 2022; 11:jcm11226637. [PMID: 36431113 PMCID: PMC9693488 DOI: 10.3390/jcm11226637] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Abstract
Acute kidney injury (AKI) is becoming a public health problem worldwide. AKI is usually considered a complication of lung, heart, liver, gut, and brain disease, but recent findings have supported that injured kidney can also cause dysfunction of other organs, suggesting organ crosstalk existence in AKI. However, the organ crosstalk in AKI and the underlying mechanisms have not been broadly reviewed or fully investigated. In this review, we summarize recent clinical and laboratory findings of organ crosstalk in AKI and highlight the related molecular mechanisms. Moreover, their crosstalk involves inflammatory and immune responses, hemodynamic change, fluid homeostasis, hormone secretion, nerve reflex regulation, uremic toxin, and oxidative stress. Our review provides important clues for the intervention for AKI and investigates important therapeutic potential from a new perspective.
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7
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In-hospital mortality of critically Ill patients with interactions of acute kidney injury and acute respiratory failure in the resource-limited settings: Results from SEA-AKI study. J Crit Care 2022; 71:154103. [PMID: 35779395 DOI: 10.1016/j.jcrc.2022.154103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/31/2022] [Accepted: 06/11/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Our goal was to describe clinical outcomes and explore the physiological interactions between acute kidney injury (AKI) and acute respiratory failure (ARF) in critically ill patients. MATERIALS AND METHODS Data were retrieved from the SEA-AKI study, a multinational multicenter database of adult ICUs from Thailand, Laos, and Indonesia. AKI was defined using KDIGO criteria stage 2-3. ARF was defined by being mechanically ventilated. Patients were assigned into 6 patterns based on AKI and ARF sequence: "no AKI/ARF", "ARF alone", "AKI alone", "ARF first", "AKI first", and "Concurrent AKI-ARF". The primary outcome was in-hospital mortality of each pattern. RESULTS A final cohort of 5468 patients were eligible for the analysis. The "Concurrent AKI-ARF" had the highest in-hospital mortality of 69.6%. The "AKI first" and the "ARF first" had in-hospital mortality of 54.4% and 53%, respectively. Among patients with single organ failure, in-hospital mortality was 14.6% and 31.5% in the "AKI alone" and the "ARF alone", accordingly. In-hospital mortality was 12.4% in patients without AKI and ARF. CONCLUSION Critically ill patients with ARF and AKI are at higher risk of in-hospital death. Different patterns of AKI and ARF interaction result in unique clinical outcomes as well as risk factors.
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8
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Hepokoski M, Singh P. Mitochondria as mediators of systemic inflammation and organ cross talk in acute kidney injury. Am J Physiol Renal Physiol 2022; 322:F589-F596. [PMID: 35379000 PMCID: PMC9054254 DOI: 10.1152/ajprenal.00372.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI) is a systemic inflammatory disease that contributes to remote organ failures. Multiple organ failure is the leading cause of death due to AKI, and lack of understanding of the mechanisms involved has precluded the development of novel therapies. Mitochondrial injury in AKI leads to mitochondrial fragmentation and release of damage-associated molecular patterns, which are known to active innate immune pathways and systemic inflammation. This review presents current evidence suggesting that extracellular mitochondrial damage-associated molecular patterns are mediators of remote organ failures during AKI that have the potential to be modifiable.
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Affiliation(s)
- Mark Hepokoski
- 1Veterans Affairs San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care Medicine, University of California, San Diego, California
| | - Prabhleen Singh
- 1Veterans Affairs San Diego Healthcare System, San Diego, California,3Division of Nephrology and Hypertension, University of California, San Diego, California
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9
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Goto D, Nagata S, Naito Y, Isobe S, Iwakura T, Fujikura T, Ohashi N, Kato A, Miyajima H, Sugimoto K, Yasuda H. Nicotinic acetylcholine receptor agonist reduces acute lung injury after renal ischemia-reperfusion injury by acting on splenic macrophages in mice. Am J Physiol Renal Physiol 2022; 322:F540-F552. [PMID: 35311383 DOI: 10.1152/ajprenal.00334.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Acute kidney injury (AKI) contributes to development of acute lung injury (ALI) via proinflammatory responses. We hypothesized that activation of a nicotinic acetylcholine receptor (nAChR), which exerts cholinergic anti-inflammatory effects on macrophages, could reduce ALI after AKI. We aimed to determine: 1) whether nAChR agonists could reduce ALI after AKI and 2) which macrophages in the lung or spleen contribute to the improvement of ALI by nAChR agonists. We induced AKI in C57BL/6 male mice by unilateral ischemia-reperfusion injury (IRI) with contralateral nephrectomy and administered nAChR agonists in three experimental settings: 1) splenectomy, 2) splenic macrophage deletion via intravenous administration of clodronate liposomes, and 3) alveolar macrophage deletion via intratracheal administration of clodronate liposomes. Treatment with GTS-21, anα7nAChR selective agonist, significantly reduced the levels of circulating IL-6, a key proinflammatory cytokine and lung CXCL1 and CXCL2 and neutrophil infiltration and Evans blue dye vascular leakage increased after renal IRI. In splenectomized mice, GTS-21 did not reduce circulating IL-6 and lung CXCL1 and CXCL2levels and neutrophil infiltration, and Evans blue dye vascular leakage increased after renal IRI. In mice depleted of splenic macrophages, GTS-21 treatment did not reduce lung neutrophil infiltration, and Evans blue dye vascular leakage increased after renal IRI. In mice depleted of alveolar macrophages, GTS-21 treatment significantly reduced lung neutrophil infiltration, and Evans blue dye vascular leakage increased after renal IRI. Our findings show that nAChR agonist reduces circulating IL-6 levels and acute lung injury after renal IRI by acting on splenic macrophages.
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Affiliation(s)
- Daiki Goto
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Soichiro Nagata
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yoshitaka Naito
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Shinsuke Isobe
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takamasa Iwakura
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Tomoyuki Fujikura
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Naro Ohashi
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Akihiko Kato
- Division of Blood Purification, Hamamatsu University Hospital, Hamamatsu, Shizuoka, Japan
| | - Hiroaki Miyajima
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Ken Sugimoto
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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10
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Murata I, Sugai T, Murakawa Y, Miyamoto Y, Kobayashi J, Inoue Y, Kanamoto I. Salvianolic acid B improves the survival rate, acute kidney dysfunction, inflammation and NETosis‑mediated antibacterial action in a crush syndrome rat model. Exp Ther Med 2022; 23:320. [DOI: 10.3892/etm.2022.11249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/21/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Tsugumi Sugai
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yumiko Murakawa
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yoshiaki Miyamoto
- Laboratory of Pharmacotherapeutics and Neuropsychopharmacology, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Jun Kobayashi
- Laboratory of Pathophysiology, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Sakado, Saitama 350‑0295, Japan
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11
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Ramírez-Guerrero G, Baghetti-Hernández R, Ronco C. Acute Kidney Injury at the Neurocritical Care Unit. Neurocrit Care 2021; 36:640-649. [PMID: 34518967 DOI: 10.1007/s12028-021-01345-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022]
Abstract
Neurocritical care has advanced substantially in recent decades, allowing doctors to treat patients with more complicated conditions who require a multidisciplinary approach to achieve better clinical outcomes. In neurocritical patients, nonneurological complications such as acute kidney injury (AKI) are independent predictors of worse clinical outcomes. Different research groups have reported an AKI incidence of 11.6% and an incidence of stage 3 AKI, according to the Kidney Disease: Improving Global Outcomes, that requires dialysis of 3% to 12% in neurocritical patients. These patients tend to be younger, have less comorbidity, and have a different risk profile, given the diagnostic and therapeutic procedures they undergo. Trauma-induced AKI, sepsis, sympathetic overstimulation, tubular epitheliopathy, hyperchloremia, use of nephrotoxic drugs, and renal hypoperfusion are some of the causes of AKI in neurocritical patients. AKI is the result of a sum of events, although the mechanisms underlying many of them remain uncertain; however, two important causes that merit mention are direct alteration of the physiological brain-kidney connection and exposure to injury as a result of the specific medical management and well-established therapies that neurocritical patients are subjected to. This review will focus on AKI in neurocritical care patients. Specifically, it will discuss its epidemiology, causes, associated mechanisms, and relationship to the brain-kidney axis. Additionally, the use and risks of extracorporeal therapies in this group of patients will be reviewed.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
- Dialysis and Renal Transplant Unit, Carlos Van Buren Hospital, Valparaíso, Chile.
- Deparment of Medicine, Universidad de Valparaíso, Valparaíso, Chile.
| | - Romyna Baghetti-Hernández
- Critical Care Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Deparment of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Claudio Ronco
- Department of Medicine, Università di Padova, Padua, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
- International Renal Research Institute of Vicenza, Vicenza, Italy
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12
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Van Herreweghe I, Texiwala S, Pinto R, Wald R, Adhikari NKJ. Predictors of early mortality in critically ill patients with acute kidney injury necessitating renal replacement therapy: A cohort study. J Crit Care 2021; 66:96-101. [PMID: 34507080 DOI: 10.1016/j.jcrc.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Reliable prediction of early mortality after initiation of renal replacement therapy (RRT) in critically ill patients may inform decision-making regarding this treatment. Our primary objective was to identify predictors of mortality within 2 days of starting RRT. MATERIALS AND METHODS Patients with acute kidney injury (AKI), receiving RRT, and admitted to intensive care units of one hospital were included. Associations between baseline risk factors and mortality at 2 days and at hospital discharge were analyzed using logistic regression. Discrimination of both models was assessed. RESULTS We included 626 patients, treated initially with intermittent RRT (n = 300, 47.9%), continuous RRT (n = 211, 33.7%), or sustained low-efficiency dialysis (n = 115, 18.4%). Two-day mortality after starting RRT was 12.9% (n = 81), and hospital mortality was 50.5% (n = 316). Independent predictors of 2-day mortality included primary diagnostic category (p = 0.004) and sepsis-related organ failure assessment (SOFA) score (odds ratio [OR] 1.36 per point, 95% confidence interval [CI] 1.24-1.50). Independent predictors of hospital mortality included SOFA (1.29, 95%CI 1.21-1.37), Charlson score (1.20, 95%CI 1.18-1.43), and interhospital transfer (OR 0.55, 0.38-0.81). C-statistics were 0.81 (2-day mortality) and 0.80 (hospital mortality). CONCLUSIONS Higher SOFA was associated with 2-day mortality after RRT initiation and with hospital mortality. Discrimination in both models was modest.
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Affiliation(s)
- Imré Van Herreweghe
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sikander Texiwala
- Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Third Floor, Toronto, ON, M5S 3H2, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Ron Wald
- Division of Nephrology, Department of Medicine, St. Michael's Hospital and University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Neill K J Adhikari
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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13
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Hepokoski M, Wang J, Li K, Li Y, Gupta P, Mai T, Moshensky A, Alotaibi M, Crotty Alexander LE, Malhotra A, Singh P. Altered lung metabolism and mitochondrial DAMPs in lung injury due to acute kidney injury. Am J Physiol Lung Cell Mol Physiol 2021; 320:L821-L831. [PMID: 33565357 PMCID: PMC8174821 DOI: 10.1152/ajplung.00578.2020] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a common cause of mortality in patients with acute kidney injury (AKI). Inflammatory crosstalk from the kidney to the lung has been shown to contribute to lung injury after AKI, but anti-inflammatory therapies have not been proven beneficial in human studies. Recently, AKI was shown to alter mitochondria and related metabolic pathways in the heart, but the impact of AKI on lung metabolism has not been investigated to our knowledge. In this study, we evaluated the metabolomic profile of the lung following renal ischemia and reperfusion to identify novel pathways that may be modifiable. We randomized C57BL/6 mice to 20 minutes of bilateral renal arterial clamping or sham operation under ketamine/xylazine anesthesia. At 4 hours after reperfusion, we found a significant increase in markers of lung injury, as well as significant metabolomic changes across lung, kidney, plasma and bronchoalveolar lavage fluid (BALF) compared to shams. Comparative analyses revealed that the fatty acid oxidation pathway was the most significantly altered metabolic pathway, a finding which is consistent with mitochondrial dysfunction systemically and in the lung. These metabolomic changes correlated with the extracellular accumulation of the mitochondrial damage associated molecular patterns (mtDAMPs), mitochondrial DNA (mtDNA) and transcription factor A, mitochondria (TFAM). Finally, we found that intraperitoneal injection of renal mtDAMPs caused metabolomic changes consistent with mitochondrial dysfunction in the lung in vivo. Mitochondrial function and mtDAMPs warrant further investigation as potential therapeutic targets in preventing lung injury because of AKI.
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Affiliation(s)
- Mark Hepokoski
- 1VA San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Jing Wang
- 2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California,5Department of Critical Care Medicine, Yantai Yuhuangding Hospital, Affiliated with Medical College of Qingdao University, Yantai, Shangdong, China
| | - Kefeng Li
- 4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Ying Li
- 1VA San Diego Healthcare System, San Diego, California,3Division of Nephrology and Hypertension, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Purva Gupta
- 1VA San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Tina Mai
- 1VA San Diego Healthcare System, San Diego, California
| | - Alex Moshensky
- 1VA San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Mona Alotaibi
- 1VA San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Laura E. Crotty Alexander
- 1VA San Diego Healthcare System, San Diego, California,2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Atul Malhotra
- 2Division of Pulmonary and Critical Care and Sleep Medicine, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
| | - Prabhleen Singh
- 1VA San Diego Healthcare System, San Diego, California,3Division of Nephrology and Hypertension, University of California San Diego, California,4Department of Medicine, School of Medicine, University of California, San Diego, California
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14
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Watanabe H, Fujimura R, Hiramoto Y, Murata R, Nishida K, Bi J, Imafuku T, Komori H, Maeda H, Mukunoki A, Takeo T, Nakagata N, Tanaka M, Matsushita K, Fukagawa M, Maruyama T. An acute phase protein α 1-acid glycoprotein mitigates AKI and its progression to CKD through its anti-inflammatory action. Sci Rep 2021; 11:7953. [PMID: 33846468 PMCID: PMC8041882 DOI: 10.1038/s41598-021-87217-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
The molecular mechanism for acute kidney injury (AKI) and its progression to chronic kidney disease (CKD) continues to be unclear. In this study, we investigated the pathophysiological role of the acute phase protein α1-acid glycoprotein (AGP) in AKI and its progression to CKD using AGP KO mice. Plasma AGP levels in WT mice were increased by about 3.5-fold on day 1-2 after renal ischemia-reperfusion (IR), and these values then gradually decreased to the level before renal IR on day 7-14. On day 1 after renal IR, the AGP KO showed higher renal dysfunction, tubular injury and renal inflammation as compared with WT. On day 14, renal function, tubular injury and renal inflammation in WT had recovered, but the recovery was delayed, and renal fibrosis continued to progress in AGP KO. These results obtained from AGP KO were rescued by the administration of human-derived AGP (hAGP) simultaneously with renal IR. In vitro experiments using RAW264.7 cells showed hAGP treatment suppressed the LPS-induced macrophage inflammatory response. These data suggest that endogenously induced AGP in early renal IR functions as a renoprotective molecule via its anti-inflammatory action. Thus, AGP represents a potential target molecule for therapeutic development in AKI and its progression CKD.
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Affiliation(s)
- Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
| | - Rui Fujimura
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
- Program for Leading Graduate Schools "HIGO (Health Life Science: Interdisciplinary and Glocal Oriented) Program", Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Yuto Hiramoto
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Ryota Murata
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Kento Nishida
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Jing Bi
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
- Program for Leading Graduate Schools "HIGO (Health Life Science: Interdisciplinary and Glocal Oriented) Program", Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Tadashi Imafuku
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
- Program for Leading Graduate Schools "HIGO (Health Life Science: Interdisciplinary and Glocal Oriented) Program", Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Hisakazu Komori
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Hitoshi Maeda
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Ayumi Mukunoki
- Division of Reproductive Engineering, Center for Animal Resources and Development (CARD), Kumamoto University, Kumamoto, Japan
| | - Toru Takeo
- Division of Reproductive Engineering, Center for Animal Resources and Development (CARD), Kumamoto University, Kumamoto, Japan
| | - Naomi Nakagata
- Division of Reproductive Engineering, Center for Animal Resources and Development (CARD), Kumamoto University, Kumamoto, Japan
| | - Motoko Tanaka
- Department of Nephrology, Akebono Clinic, 1-1 Shirafuji 5 Chome, Minami-ku, Kumamoto, 861-4112, Japan
| | - Kazutaka Matsushita
- Department of Nephrology, Akebono Clinic, 1-1 Shirafuji 5 Chome, Minami-ku, Kumamoto, 861-4112, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, 143 Shimo-Kasuya, Isehara, 259-1193, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-Honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
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15
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Bonavia A, Stiles N. Renohepatic crosstalk: a review of the effects of acute kidney injury on the liver. Nephrol Dial Transplant 2021; 37:1218-1228. [PMID: 33527986 DOI: 10.1093/ndt/gfaa297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Indexed: 12/13/2022] Open
Abstract
Several theories regarding acute kidney injury (AKI)-related mortality have been entertained, although mounting evidence supports the paradigm that impaired kidney function directly and adversely affects the function of several remote organs. The kidneys and liver are fundamental to human metabolism and detoxification, and it is therefore hardly surprising that critical illness complicated by hepatorenal dysfunction portends a poor prognosis. Several diseases can simultaneously impact the proper functioning of the liver and kidneys, although this review will address the impact of AKI on liver function. While evidence for this relationship in humans remains sparse, we present supportive studies and then discuss the most likely mechanisms by which AKI can cause liver dysfunction. These include 'traditional' complications of AKI (uremia, volume overload and acute metabolic acidosis, among others) as well as systemic inflammation, hepatic leukocyte infiltration, cytokine-mediated liver injury and hepatic oxidative stress. We conclude by addressing the therapeutic implications of these findings to clinical medicine.
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Affiliation(s)
- Anthony Bonavia
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.,Department of Pharmacology, Penn State College of Medicine, Hershey, PA, USA
| | - Nicholas Stiles
- Department of Anesthesiology and Perioperative Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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16
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Nishida K, Watanabe H, Miyahisa M, Hiramoto Y, Nosaki H, Fujimura R, Maeda H, Otagiri M, Maruyama T. Systemic and sustained thioredoxin analogue prevents acute kidney injury and its-associated distant organ damage in renal ischemia reperfusion injury mice. Sci Rep 2020; 10:20635. [PMID: 33244034 PMCID: PMC7691343 DOI: 10.1038/s41598-020-75025-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/27/2019] [Indexed: 12/19/2022] Open
Abstract
The mortality of patients with acute kidney injury (AKI) remains high due to AKI associated-lung injury. An effective strategy for preventing both AKI and AKI-associated lung injury is urgently needed. Thioredoxin-1 (Trx) is a redox-active protein that possesses anti-oxidative, anti-apoptotic and anti-inflammatory properties including modulation of macrophage migration inhibitory factor (MIF), but its short half-life limits its clinical application. Therefore, we examined the preventive effect of a long-acting Trx, which is a fusion protein of albumin and Trx (HSA-Trx), against AKI and AKI-associated lung injury. Recombinant HSA-Trx was expressed using a Pichia expression system. AKI-induced lung injury mice were generated by bilateral renal ischemia reperfusion injury (IRI). HSA-Trx administration attenuated renal IRI and its-associated lung injury. Both renal and pulmonary oxidative stress were suppressed by HSA-Trx. Moreover, HSA-Trx inhibited elevations of plasma IL-6 and TNF-α level, and suppressed IL-6-CXCL1/2-mediated neutrophil infiltration into lung and TNF-α-mediated pulmonary apoptosis. Additionally, HSA-Trx suppressed renal IRI-induced MIF expression in kidney and lung. Administration of HSA-Trx resulted in a significant increase in the survival rate of renal IRI mice. Collectively, HSA-Trx could have therapeutic utility in preventing both AKI and AKI-associated lung injury as a consequence of its systemic and sustained multiple biological action.
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Affiliation(s)
- Kento Nishida
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Hiroshi Watanabe
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
| | - Masako Miyahisa
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Yuto Hiramoto
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Hiroto Nosaki
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Rui Fujimura
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Hitoshi Maeda
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan
| | - Masaki Otagiri
- Faculty of Pharmaceutical Sciences, Sojo University, 4-22-1 Ikeda, Kumamoto, 860-0082, Japan
| | - Toru Maruyama
- Department of Biopharmaceutics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
- Center for Clinical Pharmaceutical Sciences, School of Pharmacy, Kumamoto University, 5-1, Oe-honmachi, Chuo-ku, Kumamoto, 862-0973, Japan.
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17
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Recombinant thrombomodulin prevents acute lung injury induced by renal ischemia-reperfusion injury. Sci Rep 2020; 10:289. [PMID: 31937858 PMCID: PMC6959219 DOI: 10.1038/s41598-019-57205-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/23/2019] [Indexed: 01/06/2023] Open
Abstract
Acute kidney injury (AKI) complicated by acute lung injury has a detrimental effect on mortality among critically ill patients. Recently, a renal ischemia-reperfusion (IR) model suggested the involvement of histones and neutrophil extracellular traps (NETs) in the development of distant lung injury after renal IR. Given that recombinant thrombomodulin (rTM) has anti-inflammatory roles by binding to circulating histones, we aimed to clarify its effect on distant lung injury induced by AKI in a murine bilateral renal IR model. Both pretreatment and delayed treatment with rTM significantly decreased pulmonary myeloperoxidase activity, but they did not affect renal dysfunction at 24 h after renal IR. Additionally, rTM mitigated the renal IR-augmented expression of proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and keratinocyte-derived chemokine), and vascular leakage, as well as the degree of lung damage. Intense histone accumulation and active NET formation occurred in both the kidneys and the lungs; however, rTM significantly decreased the histone and NET accumulation only in the lungs. Administration of rTM may have protective impact on the lungs after renal IR by blocking histone and NET accumulation in the lungs, although no protection was observed in the kidneys. Treatment with rTM may be an adjuvant strategy to attenuate distant lung injury complicating AKI.
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18
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Bamoulid J, Philippot H, Kazory A, Yannaraki M, Crepin T, Vivet B, Devillard N, Roubiou C, Bresson-Vautrin C, Chalopin JM, Courivaud C, Ducloux D. Acute kidney injury in non-critical care setting: elaboration and validation of an in-hospital death prognosis score. BMC Nephrol 2019; 20:419. [PMID: 31752723 PMCID: PMC6868787 DOI: 10.1186/s12882-019-1610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/29/2019] [Indexed: 01/05/2023] Open
Abstract
Background Acute kidney injury (AKI) is still characterized by a high mortality rate. While most patients with AKI are admitted in conventional medical units, current available data are still obtained from studies designed for patients admitted in intensive care units (ICU). Our study aimed to elaborate and validate an in-hospital death prognosis score for AKI admitted in conventional medical care units. Methods We included two prospective cohorts of consecutive patients with AKI admitted between 2001 and 2004 (elaboration cohort (EC)) and between 2010 and 2014 (validation cohort (VC)). We developed a scoring system from clinical and biological parameters recorded at admission from the EC to predict in-hospital mortality. This score was then tested for validation in the VC. Results Three-hundred and twenty-three and 534 patients were included in the EC and VC cohorts, respectively. The proportion of in-hospital death were 15.5% (EC) and 8.9% (VC), mainly due to sepsis. The parameters independently associated with the in-hospital death in the EC were Glasgow score, oxygen requirement, fluid overload, blood diastolic pressure, multiple myeloma and prothrombin time. The in-hospital death prognosis score AUC was 0.845 +/− 0.297 (p < 0.001) after validation in the VC. Conclusions Our in-hospital death prognosis score is the first to be prospectively developed and validated for AKI admitted in a conventional medical care unit. Based on current parameters, easily collected at time of admission, this score could be a useful tool for physicians and nephrologists to determine the in-hospital death prognosis of this AKI population.
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Affiliation(s)
- Jamal Bamoulid
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France. .,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France. .,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France. .,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France.
| | - Hélène Philippot
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.
| | - Amir Kazory
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maria Yannaraki
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Thomas Crepin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Bérengère Vivet
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Nadège Devillard
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Caroline Roubiou
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Catherine Bresson-Vautrin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France
| | - Jean-Marc Chalopin
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Cécile Courivaud
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
| | - Didier Ducloux
- CHU Besançon, Department of Nephrology, Dialysis, and Renal Transplantation, F-25030, Besançon, France.,UMR1098, Federation hospitalo-universitaire INCREASE, F-25020, Besançon, France.,Faculté de Médecine et de Pharmacie, Université de Franche-Comté, F-25020, Besançon, France.,Structure Fédérative de Recherche, SFR FED4234, F-25000, Besançon, France
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19
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Zhao H, Chen Q, Huang H, Suen KC, Alam A, Cui J, Ciechanowicz S, Ning J, Lu K, Takata M, Gu J, Ma D. Osteopontin mediates necroptosis in lung injury after transplantation of ischaemic renal allografts in rats. Br J Anaesth 2019; 123:519-530. [DOI: 10.1016/j.bja.2019.05.041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/15/2022] Open
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20
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Renal Decapsulation Prevents Intrinsic Renal Compartment Syndrome in Ischemia-Reperfusion-Induced Acute Kidney Injury: A Physiologic Approach. Crit Care Med 2019; 46:216-222. [PMID: 29341964 DOI: 10.1097/ccm.0000000000002830] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Acute kidney injury is a serious complication with unacceptably high mortality that lacks of specific curative treatment. Therapies focusing on the hydraulic behavior have shown promising results in preventing structural and functional renal impairment, but the underlying mechanisms remain understudied. Our goal is to assess the effects of renal decapsulation on regional hemodynamics, oxygenation, and perfusion in an ischemic acute kidney injury experimental model. METHODS In piglets, intra renal pressure, renal tissue oxygen pressure, and dysoxia markers were measured in an ischemia-reperfusion group with intact kidney, an ischemia-reperfusion group where the kidney capsule was removed, and in a sham group. RESULTS Decapsulated kidneys displayed an effective reduction of intra renal pressure, an increment of renal tissue oxygen pressure, and a better performance in the regional delivery, consumption, and extraction of oxygen after reperfusion, resulting in a marked attenuation of acute kidney injury progression due to reduced structural damage and improved renal function. CONCLUSIONS Our results strongly suggest that renal decapsulation prevents the onset of an intrinsic renal compartment syndrome after ischemic acute kidney injury.
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21
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Lee BJ, Hsu CY, Parikh R, McCulloch CE, Tan TC, Liu KD, Hsu RK, Pravoverov L, Zheng S, Go AS. Predicting Renal Recovery After Dialysis-Requiring Acute Kidney Injury. Kidney Int Rep 2019; 4:571-581. [PMID: 30993232 PMCID: PMC6451155 DOI: 10.1016/j.ekir.2019.01.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION After dialysis-requiring acute kidney injury (AKI-D), recovery of sufficient kidney function to discontinue dialysis is an important clinical and patient-oriented outcome. Predicting the probability of recovery in individual patients is a common dilemma. METHODS This cohort study examined all adult members of Kaiser Permanente Northern California who experienced AKI-D between January 2009 and September 2015 and had predicted inpatient mortality of <20%. Candidate predictors included demographic characteristics, comorbidities, laboratory values, and medication use. We used logistic regression and classification and regression tree (CART) approaches to develop and cross-validate prediction models for recovery. RESULTS Among 2214 patients with AKI-D, mean age was 67.1 years, 40.8% were women, and 54.0% were white; 40.9% of patients recovered. Patients who recovered were younger, had higher baseline estimated glomerular filtration rates (eGFR) and preadmission hemoglobin levels, and were less likely to have prior heart failure or chronic liver disease. Stepwise logistic regression applied to bootstrapped samples identified baseline eGFR, preadmission hemoglobin level, chronic liver disease, and age as the predictors most commonly associated with coming off dialysis within 90 days. Our final logistic regression model including these predictors had a correlation coefficient between observed and predicted probabilities of 0.97, with a c-index of 0.64. An alternate CART approach did not outperform the logistic regression model (c-index 0.61). CONCLUSION We developed and cross-validated a parsimonious prediction model for recovery after AKI-D with excellent calibration using routinely available clinical data. However, the model's modest discrimination limits its clinical utility. Further research is needed to develop better prediction tools.
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Affiliation(s)
- Benjamin J. Lee
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Houston Kidney Consultants, Houston, Texas, USA
- Houston Methodist Institute for Academic Medicine, Houston, Texas, USA
| | - Chi-yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Rishi Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Thida C. Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Kathleen D. Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Critical Care, Department of Anesthesia, University of California, San Francisco, San Francisco, California, USA
| | - Raymond K. Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Leonid Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Sijie Zheng
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Alan S. Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
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22
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Srivastava A, Palsson R, Leaf DE, Higuera A, Chen ME, Palacios P, Baron RM, Sabbisetti V, Hoofnagle AN, Vaingankar SM, Palevsky PM, Waikar SS. Uric Acid and Acute Kidney Injury in the Critically Ill. Kidney Med 2019; 1:21-30. [PMID: 32734180 PMCID: PMC7380422 DOI: 10.1016/j.xkme.2019.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Rationale & Objective Uric acid is excreted by the kidney and accumulates in acute kidney injury (AKI). Whether higher plasma uric acid level predisposes to AKI or its complications is not known. Study Design Prospective observational cohort study. Setting & Participants 2 independent cohorts of critically ill patients: (1) 208 patients without AKI admitted to the intensive care unit (ICU) at Brigham & Women's Hospital between October 2008 and December 2016; and (2) 250 participants with AKI requiring renal replacement therapy (RRT) who had not yet initiated RRT enrolled in the Acute Renal Failure Trial Network (ATN) Study. Exposure Plasma uric acid level upon ICU admission and before RRT initiation in the ICU and ATN Study cohorts, respectively. Outcomes Incident AKI and 60-day mortality in the ICU and ATN Study cohorts, respectively. Analytical Approach Logistic regression models were used to test the association of plasma uric acid level with incident AKI and 60-day mortality. Results In the ICU cohort, median plasma uric acid level was 4.7 (interquartile range [IQR], 3.6-6.4) mg/dL, and 40 patients (19.2%) developed AKI. Higher plasma uric acid levels associated with incident AKI, but this association was confounded by serum creatinine level and was not significant after multivariable adjustment (adjusted OR per doubling of uric acid, 1.50; 95% CI, 0.80-2.81). In the ATN Study cohort, median plasma uric acid level was 11.1 (IQR, 8.6-14.2) mg/dL, and 125 participants (50.0%) died within 60 days. There was no statistically significant association between plasma uric acid levels and 60-day mortality in either unadjusted models or after multivariable adjustment for demographic, severity-of-illness, and kidney-specific covariates (adjusted OR per doubling of uric acid, 1.15; 95% CI, 0.71-1.86). Limitations Heterogeneity of ICU patients. Conclusions Plasma uric acid levels upon ICU admission or before RRT initiation are not independently associated with adverse clinical outcomes in critically ill patients.
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Affiliation(s)
- Anand Srivastava
- Division of Nephrology and Hypertension, Center for Translational Metabolism and Health, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.,Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Ragnar Palsson
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - David E Leaf
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Angelica Higuera
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Margaret E Chen
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Polly Palacios
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rebecca M Baron
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | | | - Andrew N Hoofnagle
- Department of Laboratory Medicine, University of Washington, Seattle, WA
| | | | - Paul M Palevsky
- Renal Section, Veterans Affairs Pittsburgh Healthcare System and Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sushrut S Waikar
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA
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23
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Teixeira JP, Ambruso S, Griffin BR, Faubel S. Pulmonary Consequences of Acute Kidney Injury. Semin Nephrol 2019; 39:3-16. [DOI: 10.1016/j.semnephrol.2018.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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24
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Krishnappa V, Hein W, DelloStritto D, Gupta M, Raina R. Palliative care for acute kidney injury patients in the intensive care unit. World J Nephrol 2018; 7:148-154. [PMID: 30596033 PMCID: PMC6305526 DOI: 10.5527/wjn.v7.i8.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/25/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Patients with acute kidney injury (AKI) in the intensive care unit (ICU) are often suitable for palliative care due to the high symptom burden. The role of palliative medicine in this patient population is not well defined and there is a lack of established guidelines to address this issue. Because of this, patients in the ICU with AKI deprived of the most comprehensive or appropriate care. The reasons for this are multifactorial including lack of palliative care training among nephrologists. However, palliative care in these patients can help alleviate symptoms, improve quality of life, and decrease suffering. Palliative care physicians can determine the appropriateness and model of palliative care. In addition to shared decision-making, advance directives should be established with patients early on, with specific instructions regarding dialysis, and those advance directives should be respected.
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Affiliation(s)
- Vinod Krishnappa
- Northeast Ohio Medical University, Rootstown, OH 44272, United States
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates, Akron, OH 44302, United States
| | - William Hein
- Northeast Ohio Medical University, Rootstown, OH 44272, United States
| | | | - Mona Gupta
- Department of Hospice and Palliative Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, United States
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General/Akron Nephrology Associates and Akron Children's Hospital, Akron, OH 44307, United States
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25
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Lee SA, Cozzi M, Bush EL, Rabb H. Distant Organ Dysfunction in Acute Kidney Injury: A Review. Am J Kidney Dis 2018; 72:846-856. [PMID: 29866457 DOI: 10.1053/j.ajkd.2018.03.028] [Citation(s) in RCA: 151] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/25/2018] [Indexed: 01/09/2023]
Abstract
Acute kidney injury (AKI) is common in critically ill patients and is associated with increased morbidity and mortality. Dysfunction of other organs is an important cause of poor outcomes from AKI. Ample clinical and epidemiologic data show that AKI is associated with distant organ dysfunction in lung, heart, brain, and liver. Recent advancements in basic and clinical research have demonstrated physiologic and molecular mechanisms of distant organ interactions in AKI, including leukocyte activation and infiltration, generation of soluble factors such as inflammatory cytokines/chemokines, and endothelial injury. Oxidative stress and production of reactive oxygen species, as well as dysregulation of cell death in distant organs, are also important mechanism of AKI-induced distant organ dysfunction. This review updates recent clinical and experimental findings on organ crosstalk in AKI and highlights potential molecular mechanisms and therapeutic targets to improve clinical outcomes during AKI.
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Affiliation(s)
- Sul A Lee
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Yonsei University College of Medicine, Seoul, South Korea
| | - Martina Cozzi
- Department of Nephrology and Dialysis, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Errol L Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hamid Rabb
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
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26
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Choi YJ, Zhou D, Barbosa ACS, Niu Y, Guan X, Xu M, Ren S, Nolin TD, Liu Y, Xie W. Activation of Constitutive Androstane Receptor Ameliorates Renal Ischemia-Reperfusion-Induced Kidney and Liver Injury. Mol Pharmacol 2018; 93:239-250. [PMID: 29351922 PMCID: PMC5801556 DOI: 10.1124/mol.117.111146] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/05/2018] [Indexed: 02/05/2023] Open
Abstract
Acute kidney injury (AKI) is associate with high mortality. Despite evidence of AKI-induced distant organ injury, a relationship between AKI and liver injury has not been clearly established. The goal of this study is to investigate whether renal ischemia-reperfusion (IR) can affect liver pathophysiology. We showed that renal IR in mice induced fatty liver and compromised liver function through the downregulation of constitutive androstane receptor (CAR; -90.4%) and inhibition of hepatic very-low-density lipoprotein triglyceride (VLDL-TG) secretion (-28.4%). Treatment of mice with the CAR agonist 1,4-bis[2-(3,5 dichloropyridyloxy)] benzene (TCPOBOP) prevented the development of AKI-induced fatty liver and liver injury, which was associated with the attenuation of AKI-induced inhibition of VLDL-TG secretion. The hepatoprotective effect of TCPOBOP was abolished in CAR-/- mice. Interestingly, alleviation of fatty liver by TCPOBOP also improved the kidney function, whereas CAR ablation sensitized mice to AKI-induced kidney injury and lethality. The serum concentrations of interleukin-6 (IL-6) were elevated by 27-fold after renal IR, but were normalized in TCPOBOP-treated AKI mice, suggesting that the increased release of IL-6 from the kidney may have mediated the AKI responsive liver injury. Taken together, our results revealed an interesting kidney-liver organ cross-talk in response to AKI. Given the importance of CAR in the pathogenesis of renal IR-induced fatty liver and impaired kidney function, fatty liver can be considered as an important risk factor for kidney injury, and a timely management of hepatic steatosis by CAR activation may help to restore kidney function in patients with AKI or kidney transplant.
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Affiliation(s)
- You-Jin Choi
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Dong Zhou
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Anne Caroline S Barbosa
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Yongdong Niu
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Xiudong Guan
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Meishu Xu
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Songrong Ren
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Thomas D Nolin
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Youhua Liu
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
| | - Wen Xie
- Center for Pharmacogenetics and Department of Pharmaceutical Sciences (Y.-J.C., A.C.S.B., Y.N, M.X., S.R., W.X.), Department of Pathology, School of Medicine (D.Z., Y.L.), Center for Clinical Pharmaceutical Sciences, Department of Pharmacy and Therapeutics, School of Pharmacy (T.D.N), and Department of Pharmacology and Chemical Biology (W.X.), University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Pharmacology, Shantou University Medical College, Shantou, Guangdong, China (Y.N.); and Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China (X.G.)
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27
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Affiliation(s)
- H. Schiffl
- Medizinische Klinik, Klinikum Innenstadt der Universität München, München - Germany
| | - S.M. Lang
- Medizinische Klinik, Klinikum Innenstadt der Universität München, München - Germany
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28
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Mehrotra P, Collett JA, Gunst SJ, Basile DP. Th17 cells contribute to pulmonary fibrosis and inflammation during chronic kidney disease progression after acute ischemia. Am J Physiol Regul Integr Comp Physiol 2018; 314:R265-R273. [PMID: 29118018 PMCID: PMC5867669 DOI: 10.1152/ajpregu.00147.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022]
Abstract
Acute kidney injury (AKI) is associated with high mortality rates and predisposes development of chronic kidney disease (CKD). Distant organ damage, particularly in the lung, may contribute to mortality in AKI patients. Animal models of AKI demonstrate an increase in pulmonary infiltration of lymphocytes and reveal an acute compromise of lung function, but the chronic effects of AKI on pulmonary inflammation are unknown. We hypothesized that in response to renal ischemia/reperfusion (I/R), there is a persistent systemic increase in Th17 cells with potential effects on pulmonary structure and function. Renal I/R injury was performed on rats, and CKD progression was hastened by unilateral nephrectomy and exposure to 4.0% sodium diet between 35 and 63 days post-I/R. Th17 cells in peripheral blood showed a progressive increase up to 63 days after recovery from I/R injury. Infiltration of leukocytes including Th17 cells was also elevated in bronchiolar lavage (BAL) fluid 7 days after I/R and remained elevated for up to 63 days. Lung histology demonstrated an increase in alveolar cellularity and a significant increase in picrosirius red staining. Suppression of lymphocytes with mycophenolate mofetil (MMF) or an IL-17 antagonist significantly reduced Th17 cell infiltration and fibrosis in lung. In addition, tracheal smooth muscle contraction to acetylcholine was significantly enhanced 63-days after I/R relative to sham-operated controls. These data suggest that AKI is associated with a persistent increase in circulating and lung Th17 cells which may promote pulmonary fibrosis and the potential alteration in airway contractility.
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MESH Headings
- Acute Kidney Injury/complications
- Acute Kidney Injury/immunology
- Acute Kidney Injury/pathology
- Animals
- Disease Models, Animal
- Disease Progression
- Immunosuppressive Agents/pharmacology
- Lung/drug effects
- Lung/immunology
- Lung/pathology
- Lung/physiopathology
- Male
- Muscle Contraction
- Muscle, Smooth/immunology
- Muscle, Smooth/pathology
- Muscle, Smooth/physiopathology
- Phenotype
- Pneumonia/etiology
- Pneumonia/immunology
- Pneumonia/pathology
- Pneumonia/physiopathology
- Pulmonary Fibrosis/etiology
- Pulmonary Fibrosis/immunology
- Pulmonary Fibrosis/pathology
- Pulmonary Fibrosis/physiopathology
- Rats, Nude
- Rats, Sprague-Dawley
- Rats, Transgenic
- Renal Insufficiency, Chronic/etiology
- Renal Insufficiency, Chronic/immunology
- Renal Insufficiency, Chronic/pathology
- Risk Factors
- Sodium, Dietary/toxicity
- Th17 Cells/drug effects
- Th17 Cells/immunology
- Time Factors
- Trachea/immunology
- Trachea/pathology
- Trachea/physiopathology
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Affiliation(s)
- Purvi Mehrotra
- Department of Cellular and Integrative Physiology, Indiana University , Indianapolis, Indiana
| | - Jason A Collett
- Department of Cellular and Integrative Physiology, Indiana University , Indianapolis, Indiana
| | - Susan J Gunst
- Department of Cellular and Integrative Physiology, Indiana University , Indianapolis, Indiana
| | - David P Basile
- Department of Cellular and Integrative Physiology, Indiana University , Indianapolis, Indiana
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29
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Abstract
Acute renal failure (ARF) in the ICU patient usually occurs as part of a wider multiple organ dysfunction, and is associated with mortality rates of around 50%. Differences in definitions make comparing study populations difficult and moves are being made to improve uniformity, and to recognize that ARF is not a single event but a continuous process from mild renal dysfunction through to complete organ failure requiring renal replacement therapy. In this review we will discuss the epidemiology of ARF within the limitations imposed by comparing studies that use different definitions and focus on different patient populations.
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Affiliation(s)
- J L Vincent
- Department of Intensive Care, Erasme University Hospital, Bruxelles, Belgium.
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30
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Lee BJ, Go AS, Parikh R, Leong TK, Tan TC, Walia S, Hsu RK, Liu KD, Hsu CY. Pre-admission proteinuria impacts risk of non-recovery after dialysis-requiring acute kidney injury. Kidney Int 2018; 93:968-976. [PMID: 29352593 DOI: 10.1016/j.kint.2017.10.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/30/2017] [Accepted: 10/05/2017] [Indexed: 01/22/2023]
Abstract
Renal recovery after dialysis-requiring acute kidney injury (AKI-D) is an important clinical and patient-centered outcome. Here we examined whether the pre-admission proteinuria level independently influences risk for non-recovery after AKI-D in a community-based population. All adult members of Kaiser Permanente Northern California who experienced AKI-D between January 1, 2009 and September 30, 2015 were included. Pre-admission proteinuria levels were determined by dipstick up to four years before the AKI-D hospitalization and the outcome was renal recovery (survival and dialysis-independence four weeks and more) at 90 days after initiation of renal replacement therapy. We used multivariable logistic regression to adjust for baseline estimated glomerular filtration rate (eGFR), age, sex, ethnicity, short-term predicted risk of death, comorbidities, and medication use. Among 5,347 adults with AKI-D, the mean age was 66 years, 59% were men, and 50% were white. Compared with negative/trace proteinuria, the adjusted odds ratios for non-recovery (continued dialysis-dependence or death) were 1.47 (95% confidence interval 1.19-1.82) for 1+ proteinuria and 1.92 (1.54-2.38) for 2+ or more proteinuria. Among survivors, the crude probability of recovery ranged from 83% for negative/trace proteinuria with baseline eGFR over 60 mL/min/1.73m2 to 25% for 2+ or more proteinuria with eGFR 15-29 mL/min/1.73m2. Thus, the pre-AKI-D level of proteinuria is a graded, independent risk factor for non-recovery and helps to improve short-term risk stratification for patients with AKI-D.
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Affiliation(s)
- Benjamin J Lee
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Rishi Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Sophia Walia
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Raymond K Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kathleen D Liu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Division of Critical Care, Department of Anesthesia, University of California, San Francisco, San Francisco, California, USA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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31
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Uchino S, Bellomo R, Kellum JA, Morimatsu H, Morgera S, Schetz MR, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Oudemans-Van Straaten HM, Ronco C. Patient and Kidney Survival by Dialysis Modality in Critically Ill Patients with Acute Kidney Injury. Int J Artif Organs 2018; 30:281-92. [PMID: 17520564 DOI: 10.1177/039139880703000402] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using a large, international cohort, we sought to determine the effect of initial technique of renal replacement therapy (RRT) on the outcome of acute renal failure (ARF) in the intensive care unit (ICU). We enrolled 1218 patients treated with continuous RRT (CRRT) or intermittent RRT (IRRT) for ARF in 54 ICUs in 23 countries. We obtained demographic, biochemical and clinical data and followed patients to either death or hospital discharge. Information was analyzed to assess the independent impact of treatment choice on survival and renal recovery. Patients treated first with CRRT (N=1006, 82.6%) required vasopressor drugs and mechanical ventilation more frequently compared to those receiving IRRT (N=212, 17.4%), (p<0.0001). Unadjusted hospital survival was lower (35.8% vs. 51.9%, p<0.0001). However, unadjusted dialysis-independence at hospital discharge was higher after CRRT (85.5% vs. 66.2%, p<0.0001). Multivariable logistic regression showed that choice of CRRT was not an independent predictor of hospital survival or dialysis-free hospital survival. However, the choice of CRRT was a predictor of dialysis independence at hospital discharge among survivors (OR: 3.333, 95% CI: 1.845 - 6.024, p<0.0001). Further adjustment using a propensity score did not significantly change these results. We conclude that worldwide, the choice of CRRT as initial therapy is not a predictor of hospital survival or dialysis-free hospital survival but is an independent predictor of renal recovery among survivors.
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Affiliation(s)
- S Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo - Japan
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32
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Cao W, Cui S, Yang L, Wu C, Liu J, Yang F, Liu Y, Bin J, Hou FF. Contrast-Enhanced Ultrasound for Assessing Renal Perfusion Impairment and Predicting Acute Kidney Injury to Chronic Kidney Disease Progression. Antioxid Redox Signal 2017; 27:1397-1411. [PMID: 28715949 DOI: 10.1089/ars.2017.7006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIMS Acute kidney injury (AKI) is increasingly recognized as a major risk factor leading to progression to chronic kidney disease (CKD). However, the diagnostic tools for predicting AKI to CKD progression are particularly lacking. Here, we tested the utility of contrast-enhanced ultrasound (CEUS) for predicting progression to CKD after AKI by using both mild (20-min) and severe (45-min) bilateral renal ischemia-reperfusion injury mice. RESULTS Renal perfusion measured by CEUS reduced to 25% ± 7% and 14% ± 6% of the pre-ischemic levels in mild and severe AKI 1 h after ischemia (p < 0.05). Renal perfusion returned to pre-ischemic levels 1 day after mild AKI followed by restoration of kidney function. However, severe AKI caused persistent renal perfusion impairment (60% ± 9% of baseline levels) accompanied by progressive renal fibrosis and sustained decrease in renal function. Renal perfusion at days 1-21 significantly correlated with tubulointerstitial fibrosis 42 days after AKI. For predicting renal fibrosis at day 42, the area under the receiver operating characteristics curve of renal perfusion impairment at day 1 was 0.84. Similar changes in the renal image of CEUS were observed in patients with AKI-CKD progression. INNOVATION This study demonstrates that CEUS enables dynamic and noninvasive detection of renal perfusion impairment after ischemic AKI and the perfusion abnormalities shown by CEUS can early predict the progression to CKD after AKI. CONCLUSIONS These results indicate that CEUS enables the evaluation of renal perfusion impairment associated with CKD after ischemic AKI and may serve as a noninvasive technique for assessing AKI-CKD progression. Antioxid. Redox Signal. 27, 1397-1411.
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Affiliation(s)
- Wei Cao
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
| | - Shuang Cui
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
| | - Li Yang
- 2 Division of Pharmacology, Nanfang Hospital , Southern Medical University, Guangzhou, P.R. China
| | - Chunyi Wu
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
| | - Jian Liu
- 3 Division of Cardiology, Nanfang Hospital , Southern Medical University, Guangzhou, P.R. China
| | - Fang Yang
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
| | - Youhua Liu
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
| | - Jianping Bin
- 3 Division of Cardiology, Nanfang Hospital , Southern Medical University, Guangzhou, P.R. China
| | - Fan Fan Hou
- 1 Division of Nephrology, State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Nanfang Hospital, Southern Medical University , Guangzhou, P.R. China
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33
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Meersch M, Küllmar M, Schmidt C, Gerss J, Weinhage T, Margraf A, Ermert T, Kellum JA, Zarbock A. Long-Term Clinical Outcomes after Early Initiation of RRT in Critically Ill Patients with AKI. J Am Soc Nephrol 2017; 29:1011-1019. [PMID: 29196304 DOI: 10.1681/asn.2017060694] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/02/2017] [Indexed: 12/12/2022] Open
Abstract
Whether earlier initiation of RRT in critically ill patients with AKI can improve outcomes remains debated. We examined follow-up data from a large clinical trial to prospectively investigate the long-term outcomes associated with the timing of RRT initiation in such patients. We extended the follow-up of patients in the Early Versus Delayed Initiation of RRT in Critically Ill Patients with AKI (ELAIN) Trial from 90 days to 1 year after randomization for 230 (99.6%) patients. The primary outcome was a composite of major adverse kidney events (persistent renal dysfunction, dialysis dependence, and mortality) at 1 year. Secondary outcomes included inflammatory markers. Overall, 72 of 111 (64.9%) and 106 of 119 (89.1%) patients met the primary outcome in the early (stage 2 AKI) and delayed (stage 3 AKI) initiation groups, respectively (odds ratio [OR] with early initiation, 0.23; 95% confidence interval [95% CI], 0.11 to 0.45; P< 0.001). The early initiation group had a 1-year all-cause mortality rate (56 of 111 [50.2%]) significantly lower than that of the delayed initiation group (83 of 119 [69.8%]; absolute difference, -19.6%; 95% CI, -32.0% to -7.2%; P<0.01). After 1 year, 16 of 55 (29.1%) and 23 of 36 (63.9%) surviving patients in the early and delayed groups, respectively, failed to recover renal function (absolute difference, -34.8%; 95% CI, -54.6% to -15.0%; P=0.001). In conclusion, early initiation of RRT in these critically ill patients with AKI significantly reduced the occurrence of major adverse kidney events, reduced mortality, and enhanced renal recovery at 1 year.
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Affiliation(s)
- Melanie Meersch
- Department of Anaesthesiology, Intensive Care and Pain Medicine and
| | - Mira Küllmar
- Department of Anaesthesiology, Intensive Care and Pain Medicine and
| | | | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University Hospital of Münster, Muenster, Germany
| | - Toni Weinhage
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Muenster, Germany; and
| | - Andreas Margraf
- Department of Anaesthesiology, Intensive Care and Pain Medicine and
| | - Thomas Ermert
- Department of Anaesthesiology, Intensive Care and Pain Medicine and
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Chong K, Silver SA, Long J, Zheng Y, Pankratz VS, Unruh ML, Chertow GM. Infrequent Provision of Palliative Care to Patients with Dialysis-Requiring AKI. Clin J Am Soc Nephrol 2017; 12:1744-1752. [PMID: 29042462 PMCID: PMC5672958 DOI: 10.2215/cjn.00270117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of palliative care in AKI is not well described. We sought to better understand palliative care practice patterns for hospitalized patients with AKI requiring dialysis in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using the 2012 National Inpatient Sample, we identified patients with AKI and palliative care encounters using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We compared palliative care encounters in patients with AKI requiring dialysis, patients with AKI not requiring dialysis, and patients without AKI. We described the provision of palliative care in patients with AKI requiring dialysis and compared the frequency of palliative care encounters for patients with AKI requiring dialysis with that for patients with other illnesses with similarly poor prognoses. We used logistic regression to determine factors associated with the provision of palliative care, adjusting for demographics, hospital-level variables, and patient comorbidities. RESULTS We identified 3,031,036 patients with AKI, of whom 91,850 (3%) received dialysis. We observed significant patient- and hospital-level differences in the provision of palliative care for patients with AKI requiring dialysis; adjusted odds were 26% (95% confidence interval, 12% to 38%) lower in blacks and 23% (95% confidence interval, 3% to 39%) lower in Hispanics relative to whites. Lower provision of palliative care was observed for rural and urban nonteaching hospitals relative to urban teaching hospitals, small and medium hospitals relative to large hospitals, and hospitals in the Northeast compared with the South. After adjusting for age and sex, there was low utilization of palliative care services for patients with AKI requiring dialysis (8%)-comparable with rates of utilization by patients with other illnesses with poor prognosis, including cardiogenic shock (9%), intracranial hemorrhage (10%), and acute respiratory distress syndrome (10%). CONCLUSIONS The provision of palliative care varied widely by patient and facility characteristics. Palliative care was infrequently used in hospitalized patients with AKI requiring dialysis, despite its poor prognosis and the regular application of life-sustaining therapy.
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Affiliation(s)
- Kelly Chong
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Samuel A. Silver
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Jin Long
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - V. Shane Pankratz
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Mark L. Unruh
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
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35
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Kinsey GR. The spleen as a bidirectional signal transducer in acute kidney injury. Kidney Int 2017; 91:1001-1003. [PMID: 28407873 DOI: 10.1016/j.kint.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 01/05/2017] [Indexed: 10/19/2022]
Abstract
In acute kidney injury models, the lung is damaged through an interleukin-6-dependent inflammatory response. Clinically, development of lung injury requiring mechanical ventilation markedly increases in-hospital acute kidney injury mortality. Andres-Hernando et al. demonstrate that the spleen coordinates interleukin-6-dependent interleukin-10 production, which lessens lung injury during experimental acute kidney injury. This study highlights the beneficial influence of the spleen on the lung, and dovetails with other recent publications, to demonstrate the integral role of the spleen in acute kidney injury.
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Affiliation(s)
- Gilbert R Kinsey
- Department of Medicine, Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia, Charlottesville, Virginia, USA.
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Murata I, Abe Y, Yaginuma Y, Yodo K, Kamakari Y, Miyazaki Y, Baba D, Shinoda Y, Iwasaki T, Takahashi K, Kobayashi J, Inoue Y, Kanamoto I. Astragaloside-IV prevents acute kidney injury and inflammation by normalizing muscular mitochondrial function associated with a nitric oxide protective mechanism in crush syndrome rats. Ann Intensive Care 2017; 7:90. [PMID: 28871521 PMCID: PMC5583140 DOI: 10.1186/s13613-017-0313-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background Crush syndrome (CS) is a serious medical condition characterized by muscle cell damage resulting from decompression after compression (i.e., ischemia/reperfusion injury). A large number of CS patients develop cardiac failure, kidney dysfunction, and systemic inflammation, even when fluid therapy is administered. We evaluated whether the administration of astragaloside-IV (AS)-containing fluid improved survival by preventing kidney and muscular mitochondrial dysfunction in a rat model of CS. Results The CS model was generated by subjecting anesthetized rats to bilateral hind limb compression with a rubber tourniquet for 5 h. Rats were then randomly divided into four groups: (1) sham; (2) CS with no treatment; (3) CS with normal saline treatment; and (4) CS with normal saline + 10 mg/kg AS. AS-containing fluid improved kidney function by improving shock and metabolic acidosis in CS rats. In addition, there was a reduction in oxidative damage. The attenuation of hyperkalemia was significantly related to improving muscle injury via preventing mitochondrial dysfunction. Moreover, this mitochondria protection mechanism was related to the nitric oxide (NO) generated by activation of endothelial nitric oxide synthase, which provided an anti-oxidative and anti-inflammatory effect. Conclusions Treatment with AS-containing fluid led to a dramatic improvement in survival following CS because of direct and indirect anti-oxidative effects in the kidney, and improvements in mitochondrial dysfunction and inflammation owing to AS acting as an NO donor in injured muscle. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0313-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isamu Murata
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan.
| | - Yuji Abe
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Yaginuma
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kayako Yodo
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuka Kamakari
- Water and Food Inspection Group, Saitama Prefectural Institute of Public Health, Saitama, Japan
| | - Yurika Miyazaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Daichi Baba
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Yuko Shinoda
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Toru Iwasaki
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Kunihiko Takahashi
- Hygiene Inspection Section, Koshigaya City Public Health Center, Saitama, Japan
| | - Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Yutaka Inoue
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
| | - Ikuo Kanamoto
- Laboratory of Drug Safety Management, Faculty of Pharmacy and Pharmaceutical Science, Josai University, Keyakidai 1-1, Sakado, Saitama, 350-0295, Japan
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Hsia CCW, Ravikumar P, Ye J. Acute lung injury complicating acute kidney injury: A model of endogenous αKlotho deficiency and distant organ dysfunction. Bone 2017; 100:100-109. [PMID: 28347910 PMCID: PMC5621379 DOI: 10.1016/j.bone.2017.03.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 12/11/2022]
Abstract
The lung interfaces with atmospheric oxygen via a large surface area and is perfused by the entire venous return bearing waste products collected from the whole body. It is logical that the lung is endowed with generous anti-oxidative capacity derived both locally and from the circulation. The single-pass pleiotropic alpha-Klotho (αKlotho) protein was discovered when its genetic disruption led to premature multi-organ degeneration and early death. The extracellular domain of αKlotho is cleaved by secretases and released into circulation as endocrine soluble αKlotho protein, exerting wide-ranging cytoprotective effects including anti-oxidation on distant organs including the lung, which exhibits high sensitivity to circulating αKlotho insufficiency. Because circulating αKlotho is derived mainly from the kidney, acute kidney injury (AKI) leads to systemic αKlotho deficiency that in turn increases the risks of pulmonary complications, i.e., edema and inflammation, culminating in the acute respiratory distress syndrome. Exogenous αKlotho increases endogenous anti-oxidative capacity partly via activation of the Nrf2 pathway to protect lungs against injury caused by direct hyperoxia exposure or AKI. This article reviews the current knowledge of αKlotho antioxidation in the lung in the setting of AKI as a model of circulating αKlotho deficiency, an under-recognized condition that weakens innate cytoprotective defenses and contributes to the dysfunction in distant organs.
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Affiliation(s)
- Connie C W Hsia
- Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9034, United States of America.
| | - Priya Ravikumar
- Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-9034, United States of America; Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9034, United States of America
| | - Jianfeng Ye
- Charles and Jane Pak Center of Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX 75390-9034, United States of America
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Reciprocal Risk of Acute Kidney Injury and Acute Respiratory Distress Syndrome in Critically Ill Burn Patients. Crit Care Med 2017; 44:e915-22. [PMID: 27340755 DOI: 10.1097/ccm.0000000000001812] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the association between acute respiratory distress syndrome and acute kidney injury with respect to their contributions to mortality in critically ill patients. DESIGN Retrospective analysis of consecutive adult burn patients requiring mechanical ventilation. SETTING A 16-bed burn ICU at tertiary military teaching hospital. PATIENTS Adult patients more than 18 years old requiring mechanical ventilation during their initial admission to our burn ICU from January 1, 2003, to December 31, 2011. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total 830 patients were included, of whom 48.2% had acute kidney injury (n = 400). These patients had a 73% increased risk of developing acute respiratory distress syndrome after controlling for age, gender, total body surface area burned, and inhalation injury (hazard ratio, 1.73; 95% CI, 1.18-2.54; p = 0.005). In a reciprocal multivariate analysis, acute respiratory distress syndrome (n = 299; 36%) demonstrated a strong trend toward developing acute kidney injury (hazard ratio, 1.39; 95% CI, 0.99-1.95; p = 0.05). There was a 24% overall in-hospital mortality (n = 198). After adjusting for the aforementioned confounders, both acute kidney injury (hazard ratio, 3.73; 95% CI, 2.39-5.82; p < 0.001) and acute respiratory distress syndrome (hazard ratio, 2.16; 95% CI, 1.58-2.94; p < 0.001) significantly contributed to mortality. Age, total body surface area burned, and inhalation injury were also significantly associated with increased mortality. CONCLUSIONS Acute kidney injury increases the risk of acute respiratory distress syndrome in mechanically ventilated burn patients, whereas acute respiratory distress syndrome similarly demonstrates a strong trend toward the development of acute kidney injury. Acute kidney injury and acute respiratory distress syndrome are both independent risks for subsequent death. Future research should look at this interplay for possible early interventions.
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Datta D, Foley RJ, Wu R, Grady J, Scalise P. Renal Function, Weaning, and Survival in Patients With Ventilator-Dependent Respiratory Failure. J Intensive Care Med 2017; 34:212-217. [PMID: 28288543 DOI: 10.1177/0885066617696849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Acute kidney injury in acute critical illness has been associated with poor weaning and survival outcomes. The relation between renal dysfunction as defined by creatinine clearance (CrCl) and weaning from prolonged mechanical ventilation (PMV) is not known. The objective of this study was to determine the relation of measured CrCl to weaning and survival in patients on PMV. METHODS We retrospectively studied 167 patients on PMV admitted to a long-term acute care facility for weaning over a 3-year period. Data obtained included age, gender, admission blood urea nitrogen (BUN), serum creatinine, CrCl, random urine creatinine (RUCr), and 24-hour urinary creatinine (24UCr). Renal dysfunction was defined as normal (CrCl > 90 mL/min), mild (CrCl 60-90 mL/min), moderate (CrCl 30-59 mL/min), and severe (CrCl < 30 mL/min). Primary outcome measured was liberation from PMV, defined as being off ventilator for >7 days. Survival, defined as being alive at discharge, time to wean, and time to discharge alive were secondary outcomes. The association between the studied parameters and outcomes was determined by unpaired t test. The predictive value of studied parameters for weaning and survival was determined by multivariate logistic regression analysis. P < .05 was statistically significant. RESULTS Mean age was 68.5 (14) years; 49% were males; 64% were liberated and 65.8% survived. Blood urea nitrogen, RUCr, 24Ucr, and CrCl had a significant association with successful weaning. These parameters (except BUN) also had a significant association with survival. A better outcome occurred with CrCl > 90 mL/min. CONCLUSION Measured CrCl has a significant relation to successful weaning and survival in patients on PMV and may be useful in prognosticating their outcome.
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Affiliation(s)
- Debapriya Datta
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Raymond J Foley
- Division of Pulmonary and Critical Care Medicine, University of Connecticut Health Center, Farmington, CT, USA
| | - Rong Wu
- Biostatistics Center, University of Connecticut Health Center, Farmington, CT, USA
| | - James Grady
- Biostatistics Center, University of Connecticut Health Center, Farmington, CT, USA
| | - Paul Scalise
- Division of Pulmonary and Critical Care Medicine, Hospital for Special Care, New Britain, CT, USA
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40
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Ohnuma T, Uchino S. Prediction Models and Their External Validation Studies for Mortality of Patients with Acute Kidney Injury: A Systematic Review. PLoS One 2017; 12:e0169341. [PMID: 28056039 PMCID: PMC5215838 DOI: 10.1371/journal.pone.0169341] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 12/15/2016] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To systematically review AKI outcome prediction models and their external validation studies, to describe the discrepancy of reported accuracy between the results of internal and external validations, and to identify variables frequently included in the prediction models. METHODS We searched the MEDLINE and Web of Science electronic databases (until January 2016). Studies were eligible if they derived a model to predict mortality of AKI patients or externally validated at least one of the prediction models, and presented area under the receiver-operator characteristic curves (AUROC) to assess model discrimination. Studies were excluded if they described only results of logistic regression without reporting a scoring system, or if a prediction model was generated from a specific cohort. RESULTS A total of 2204 potentially relevant articles were found and screened, of which 12 articles reporting original prediction models for hospital mortality in AKI patients and nine articles assessing external validation were selected. Among the 21 studies for AKI prediction models and their external validation, 12 were single-center (57%), and only three included more than 1,000 patients (14%). The definition of AKI was not uniform and none used recently published consensus criteria for AKI. Although good performance was reported in their internal validation, most of the prediction models had poor discrimination with an AUROC below 0.7 in the external validation studies. There were 10 common non-renal variables that were reported in more than three prediction models: mechanical ventilation, age, gender, hypotension, liver failure, oliguria, sepsis/septic shock, low albumin, consciousness and low platelet count. CONCLUSIONS Information in this systematic review should be useful for future prediction model derivation by providing potential candidate predictors, and for future external validation by listing up the published prediction models.
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Affiliation(s)
- Tetsu Ohnuma
- Intensive Care Unit, Department of Anesthesiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shigehiko Uchino
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
- * E-mail:
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DeBellis RJ, Smith BS, Cawley PA, Burniske GM. Drug Dosing in Critically Ill Patients with Renal Failure: A Pharmacokinetic Approach. J Intensive Care Med 2016. [DOI: 10.1177/088506660001500601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Accurate pharmacotherapy management in the intensive care unit (ICU) patient is crucial to minimize adverse drug events. Pharmacokinetic principles including absorption, distribution, metabolism, and excretion (ADME) all play an important role in determining the fate of medications used in the critical care setting. Renal failure in this setting further alters pharmacokinetic parameters, resulting in drug dosing changes. This article highlights and applies principles of drug dosing in normal patients and in the pharmacokinetically challenging environment of critically ill patients with renal failure. Specific drug dosing tables serve as a guide for the clinician to renally adjust medication doses in the critically ill patient with renal failure.
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Affiliation(s)
- Ronald J. DeBellis
- Massachusetts College of Pharmacy and Health Sciences, University of Massachusetts School of Medicine
| | - Brian S. Smith
- University of Massachusetts Memorial Health Care, Worcester, MA
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Hofmann RM, Mak R, Wood KE, Heisey DM, Becker BN. Serial APACHE III Scoring for Acute Renal Failure in the Intensive Care Unit. J Intensive Care Med 2016. [DOI: 10.1177/088506660101600502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severity stratification and prediction models are important tools for gauging outcomes in critically ill patients. However, most severity scoring systems are inaccurate when attempting to predict mortality in individuals with acute renal failure (ARF), including the APACHE (Acute Physiology and Chronic Health Evaluation) II scoring system. APACHE III scoring encompasses a greater array of physiologic parameters that may better correlate with outcome in ARF. We evaluated APACHE II and APACHE III scoring in 27 individuals admitted to the intensive acre unit (ICU) with ARF requiring dialysis. We also evaluated the predictive value of serial APACHE III scoring on mortality. Sixteen of the study subjects were discharged alive from the ICU. APACHE II scores for ICU survivors versus nonsurvivors were not significantly different at the outset of dialysis treatment, though they did discriminate between survivors and nonsurvivors at 48 hours (survivors 15 ± 6.2; nonsurvivors 18.1 ± 6.9; p = 0.019). However, average APACHE III scores for survivors were significantly less than those for nonsurvivors on all days of score collection, including at the outset of dialysis (day 0 survivors 94.7 ± 22.1; nonsurvivors 106.8 ± 21.7; p = 0.03). APACHE III scores on day 2 also discriminated between those who recovered renal function (83.6 ± 16.7) compared to those who did not (105.6 ± 21.4) (p = 0.05). Serial APACHE III scoring provided rapid and reproducible scoring that differentiated between survivors and nonsurvivors in a group of critically ill patients with ARF. This study suggests that further investigations are warranted to confirm whether serial APACHE III scoring should be considered as an adjunct clinical tool in caring for individuals with ARF in the ICU.
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Affiliation(s)
| | - Rosa Mak
- Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI
| | - Kenneth E. Wood
- Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI
| | | | - Bryan N. Becker
- Divisions of Nephrology, University of Wisconsin, Madison, WI.
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Abstract
Acute renal failure (ARF) is a complication frequently observed in critically ill patients. This review provides details regarding the epidemiology and overall care of the ARF patient. ARF is defined and classified based on etiology. These classifications are prerenal azotemia, ischemic ARF, and postrenal azotemia. Examples of drug-induced nephrotoxicity are also outlined. Clinical presentation and diagnostic criteria of ARF are differentiated among the major ARF classes, and management strategies are outlined. These management strategies include preventive, supportive, pharmacologic, and nonpharmacologic interventions. Current standards of practice and investigational therapies are also discussed. Pharmacokinetic monitoring and dosing regimen adjustments in ARF patients with and without renal replacement therapy are reviewed. Finally, a prognostic evaluation of ARF in critically ill patients is provided based on current knowledge of the disease state and treatment options.
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Affiliation(s)
| | - Bradley A. Boucher
- Department of Clinical Pharmacy, University of Tennessee, Memphis, Memphis, TN 38163,
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Abstract
As many as 5% of patients who need mechanical ventilation will require prolonged mechanical ventilation (PMV). The cost of their care and its associated morbidity is alarming; however, good outcomes can be achieved when their care is specialized and delivered in a programmatic manner. In this article, we review some of the common and potentially reversible reasons why patients fail successfully liberation from mechanical ventilation. We examine the outcomes of patients requiring PMV and present evidence that supports the development of specialized units where patients can be cohorted and may produce better outcomes than would be likely if these patients remained in the ICU.
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Affiliation(s)
- P J Scalise
- Hospital for Special Care, New Britain, CT 06053, USA.
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Xu J, Zhang M, Ni Y, Shi J, Gao R, Wang F, Dong Z, Zhu L, Liu Y, Xu H. Impact of low hemoglobin on the development of contrast-induced nephropathy: A retrospective cohort study. Exp Ther Med 2016; 12:603-610. [PMID: 27446250 PMCID: PMC4950745 DOI: 10.3892/etm.2016.3416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 03/31/2016] [Indexed: 12/21/2022] Open
Abstract
An increase in the use of iodinated contrast media, such as iohexol, iodixanol, iopamidol and iopromide, occasionally causes contrast-induced nephropathy (CIN) in patients undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The present study aimed to assess the effects of low levels of hemoglobin on the development of CIN in patients with normal renal function following CAG/PCI. A total of 841 consecutive patients undergoing CAG/PCI were divided into two groups: Patients with low levels of hemoglobin (male, <120 g/l; female, <110 g/l; n=156) and normal levels of hemoglobin (male, 120-160 g/l; female, 110-150 g/l; n=685). Multiple logistic regression analysis was performed to identify risk factors for CIN, which developed in 14.7% of patients with low levels of hemoglobin (relative risk, 3.07) and 5% of patients with normal levels of hemoglobin (P<0.01). Independent risk factors for developing CIN in patients with low levels of hemoglobin were a contrast media volume ≥200 ml, diuretic usage, low levels of hemoglobin and diabetes mellitus. For the patients with normal hemoglobin levels, the independent risk factors for developing CIN were a contrast media volume ≥200 ml and diuretic usage. The change in serum creatinine in patients with low levels of hemoglobin was significantly greater compared with patients with normal levels of hemoglobin (7.35±22.60 vs. 1.40±12.00; P<0.01). A similar incidence of developing CIN was observed when patients were administered each type of contrast media: Iohexol, iodixanol, iopamidol and iopromide. The optimal cut-off point at which the serum hemoglobin concentration resulted in a high probability of developing CIN was determined as 111.5 g/l in females and 115.5 g/l in males. In conclusion, low levels of hemoglobin were observed to be an independent risk factor for developing CIN. Patients with reduced hemoglobin levels should, therefore, be closely monitored prior to, and during, the administration of iodinated contrast media.
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Affiliation(s)
- Jinzhong Xu
- Department of Clinical Pharmacy, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Meiling Zhang
- Department of Pharmacy, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang 310012, P.R. China
| | - Yinghua Ni
- Department of Clinical Pharmacy, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310052, P.R. China
| | - Jiana Shi
- Department of Pharmacy, Zhejiang Province People's Hospital, Hangzhou, Zhejiang 31014, P.R. China
| | - Ranran Gao
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing 100096, P.R. China
| | - Zhibing Dong
- Department of Cardiovascular Medicine, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang 317500, P.R. China
| | - Lingjun Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Yanlong Liu
- College of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, Zhejiang 325035, P.R. China
| | - Huimin Xu
- Department of Clinical Pharmacy, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Guru PK, Singh TD, Akhoundi A, Kashani KB. Association of Thrombocytopenia and Mortality in Critically Ill Patients on Continuous Renal Replacement Therapy. Nephron Clin Pract 2016; 133:175-82. [DOI: 10.1159/000447543] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022] Open
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Abstract
The potential impact of renal replacement therapy on clinical outcomes in acute renal failure (ARF) remains a subject of ongoing investigation and controversy. This article reviews in depth the clinical trials to date that have examined the effect of dialysis-related variables on outcomes of patients with hospital-acquired ARF. In particular, the role of the dialysis modality, dialyzer characteristics, and dosing strategies are discussed. Clinical trials comparing intermittent hemodialysis (HD) to continuous renal replacement therapies (CRRT) have failed to demonstrate a survival difference when adjusting for disease severity. Similarly, studies evaluating dialyzer membrane biocompatibility and flux properties had no impact on survival. Efforts aimed at measuring dialysis adequacy in patients with ARF receiving HD using urea kinetic modeling are hindered by a lack of understanding of solute kinetics in this setting. However, dosing strategies during CRRT are promising. Finally, the application of cell therapy to the successful substitution of renal function shows promise for the future.
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Affiliation(s)
- Geoffrey S Teehan
- Division of Nephrology, Tupper Research Institute, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111, USA
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Flores S, Rhodes Proctor Short S, Basu RK. Acute kidney injury in pediatric heart transplantation and extracorporeal cardiac support therapies. PROGRESS IN PEDIATRIC CARDIOLOGY 2016. [DOI: 10.1016/j.ppedcard.2015.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Faubel S, Shah PB. Immediate Consequences of Acute Kidney Injury: The Impact of Traditional and Nontraditional Complications on Mortality in Acute Kidney Injury. Adv Chronic Kidney Dis 2016; 23:179-85. [PMID: 27113694 DOI: 10.1053/j.ackd.2016.02.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/20/2016] [Accepted: 02/23/2016] [Indexed: 01/20/2023]
Abstract
Acute kidney injury (AKI) that requires renal replacement therapy is associated with a mortality rate that exceeds 50% in the intensive care unit, which is greater than other serious illnesses such as acute lung injury and myocardial infarction. Much information is now available regarding the complications of AKI that contribute to mortality and may be usefully categorized as "traditional" and "nontraditional". Traditional complications are the long-recognized complications of AKI such as hyperkalemia, acidosis, and volume overload, which may be typically corrected with renal replacement therapy. "Nontraditional" complications include complications such as sepsis, lung injury, and heart failure that may arise due to the effects of AKI on inflammatory cytokines, immune function, and cell death pathways such as apoptosis. In this review, we discuss both traditional and nontraditional complications of AKI with a focus on factors that contribute to mortality, considering both pathophysiology and potential remedies. Because AKI is the most common inpatient consult to nephrologists, it is essential to be aware of the complications of AKI that contribute to mortality to devise appropriate treatment strategies to prevent and manage AKI complications with the ultimate goal of reducing the unacceptably high mortality rate of AKI.
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Abstract
Kidney injury, including acute kidney injury (AKI) and chronic kidney disease (CKD), has become very common in critically ill patients treated in ICUs. Many epidemiological studies have revealed significant associations of AKI and CKD with poor outcomes of high mortality and medical costs. Although many basic studies have clarified the possible mechanisms of sepsis and septic AKI, translation of the obtained findings to clinical settings has not been successful to date. No specific drug against human sepsis or AKI is currently available. Remarkable progress of dialysis techniques such as continuous renal replacement therapy (CRRT) has enabled control of “uremia” in hemodynamically unstable patients; however, dialysis-requiring septic AKI patients are still showing unacceptably high mortality of 60–80 %. Therefore, further investigations must be conducted to improve the outcome of sepsis and septic AKI. A possible target will be remote organ injury caused by AKI. Recent basic studies have identified interleukin-6 and high mobility group box 1 (HMGB1) as important mediators for acute lung injury induced by AKI. Another target is the disease pathway that is amplified by pre-existing CKD. Vascular endothelial growth factor and HMGB1 elevations in sepsis were demonstrated to be amplified by CKD in CKD-sepsis animal models. Understanding the role of kidney injury as an amplifier in sepsis and multiple organ failure might support the identification of new drug targets for sepsis and septic AKI.
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Affiliation(s)
- Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo, 113-8655 Japan
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