Acute kidney injury-epidemiology, outcomes and economics

The blood urea nitrogen-to-creatinine ratio is associated with acute kidney injury among COVID-19 patients

INTRODUCTION

To explore the associations between the blood urea nitrogen-to-creatinine ratio (BCR), acute kidney injury (AKI), and in-hospital mortality in coronavirus disease 2019 (COVID-19) patients.

METHODS

COVID-19 patients from Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine were enrolled in this study. Clinical data and laboratory parameters were collected. AKI was defined using two serum creatinine tests according to KDIGO guidelines. Cox regression and receiver operating characteristic (ROC) curve analyses were performed.

RESULTS

Five hundred and sixty-seven COVID-19 patients were enrolled, 44.1% of whom were male. The mean age was 75 years. Among all patients, 17 patients developed AKI, and 30 patients died during hospitalization. Compared to non-AKI patients, the BCR in AKI patients was significantly greater. BCR was significantly associated with AKI (unadjusted HR 1.04, 95% CI: 1.02-1.05, p < 0.001; adjusted HR 1.06, 95% CI 1.02-1.10, p = 0.001). BCR was also a risk factor of in-hospital mortality (unadjusted HR 1.03, 95% CI: 1.02-1.05, p < 0.001; adjusted HR 1.04, 95% CI: 1.01-1.08, p = 0.019). The BCR threshold was 38.9, with 70.6% sensitivity and 87.1% specificity for predicting AKI, while a threshold of 33.0 predicted mortality. Subgroup analysis revealed that BCR could predict AKI and mortality in different subgroups according to sex, age, diabetes mellitus, and estimated glomerular filtration rate.

CONCLUSIONS

The BCR, a simple index, is associated with AKI onset and mortality in COVID-19 patients. The BCR possesses certain specificity for AKI screening, which indicates an effective clinical indicator for screening patients at high risk of AKI.

Toward the standardization of big datasets of urine output for AKI analysis: a multicenter validation study

Acute kidney injury (AKI) is a prevalent condition in ICU patients. However, inconsistencies in urine charting and guideline interpretations hinder accurate diagnosis and research. This study aimed to derive and validate a standardization for the processing of big urine output datasets to improve consistency in AKI diagnosis and staging. Using a derivation cohort from 14 ICUs at Beth Israel Deaconess Medical Center (2008-2019) and a validation cohort from an academic center in Amsterdam (2003-2016), we developed and validated an algorithm for computing hourly urine output rates and identifying oliguric AKI across its definitions. Peak AKI stages computed using the method were significantly associated with all clinical outcomes, including severity scores, serum creatinine levels, ICU and hospital lengths of stay, renal replacement therapy requirements, and hospital mortality (all p < 0.001). Adjusted 30-day mortality odds ratios for AKI stages 1-3 were 1.58, 2.93, and 5.24 in the derivation cohort and 2.91, 5.16, and 13.59 in the validation cohort (all p < 0.001). Tested on over 85,000 multinational ICU admissions, this approach demonstrated robust performance and consistent results across diverse settings; it has the potential to enhance clinical practice through e-alerts and support future AKI and fluid balance research, including ML model training and inference. Supported by open-source code, the proposed method advances the standardization of AKI diagnostic criteria and can be applied to other EHR-based databases.

Partial versus Complete Sternotomy for Aortic Valve Replacement-Multicenter Study

BACKGROUND

 The benefits of minimally invasive techniques in cardiac surgery remain poorly defined. We evaluated the short- and mid-term outcomes after surgical aortic valve replacement through partial upper versus complete median sternotomy (MS) in a large, German multicenter cohort.

METHODS

 A total of 2,929 patients underwent isolated surgical aortic valve replacement via partial upper sternotomy (PUS, n = 1,764) or MS (n = 1,165) at nine participating heart centers between 2016 and 2020. After propensity-score matching, 1,990 patients were eligible for analysis. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), a composite of death, myocardial infarction, and stroke at 30 days and in follow-up, up to 5 years. Secondary end points were acute kidney injury, length of hospital stay, transfusions, deep sternal wound infection, Dressler's syndrome, rehospitalization, and conversion to sternotomy.

RESULTS

 Unadjusted MACCE rates were significantly lower in the PUS group both at 30 days (p = 0.02) and in 5-year follow-up (p = 0.01). However, after propensity-score matching, differences between the groups were no more statistically significant: MACCE rates were 3.9% (PUS) versus 5.4% (MS, p = 0.14) at 30 days, and 9.9 versus 11.3% in 5-year follow-up (p = 0.36). In the minimally invasive group, length of intensive care unit (ICU) stay was shorter (p = 0.03), Dressler's syndrome occurred less frequently (p = 0.006), and the rate of rehospitalization was reduced significantly (p < 0.001). There were 3.8% conversions to full sternotomy.

CONCLUSION

 In a large, German multicenter cohort, MACCE rates were comparable in surgical aortic valve replacement through partial upper and complete sternotomies. Shorter ICU stay and lower rates of Dressler's syndrome and rehospitalization were in favor of the partial sternotomy group.

Clinical Assessment of Fluid Status in Adults With Acute Kidney Injury: A Scoping Review

BACKGROUND

Acute kidney injury refers to sudden, potentially reversible, reduction in kidney function. Hypovolaemia is commonly the major risk factor. When acute kidney injury is established, fluid can accumulate leading to fluid overload. Undertaking a rigorous fluid assessment is vital in the management of a patient in hospital with acute kidney injury, as insufficient or excessive fluid can lead to increased morbidity and mortality.

OBJECTIVES

The aim of this scoping review is to identify which clinical assessments are useful when undertaking fluid assessment in a patient with acute kidney injury, and to identify signs and symptoms of fluid overload or dehydration in patients in hospital with acute kidney injury.

DESIGN

The JBI methodology for scoping reviews was followed and reported using the PRISMA-ScR checklist. PubMed, CINAHL Plus and SCOPUS were searched for research papers relating to the signs and symptoms or fluid assessments in patients with acute kidney injury.

RESULTS

Fifteen research papers were identified with four key areas being: Fluid balance/urine output and weight; early warning scores; clinical signs and symptoms; holistic assessment. The primary studies included in this scoping review have shown that hypovolaemia may be indicated by low blood pressure, orthostatic hypotension, low Mean Arterial Pressure, elevated heart rate, prolonged capillary refill time on the sternum (> 4.5 s) and subjectively reported cold peripheries. With clinical symptoms including dry mouth, increased thirst and dry skin. Accurate documentation of urine output and fluid balance is crucial in determining fluid status.

CONCLUSION

The assessment of fluid should be holistic and include history taking, diagnosis, blood tests and associated clinical signs and symptoms.

Early Urine Output in the Emergency Room as a Prognostic Indicator for Critically Ill Patients Undergoing Continuous Renal Replacement

OBJECTIVES

The impact of initial emergency room (ER) factors on survival and renal function in critically ill patients undergoing continuous renal replacement therapy (CRRT) remains unclear. This study aimed to evaluate whether these initial factors influence survival and renal recovery in such patients.

METHODS

This single-center, retrospective study included 190 critically ill patients admitted to the intensive care unit (ICU) via the ER for CRRT between 1 March 2018, and 31 May 2021. Clinical parameters, including urine output, estimated glomerular filtration rate (eGFR), and serum neutrophil gelatinase-associated lipocalin (NGAL), were assessed. The primary outcomes were 30-day and 90-day mortality, while secondary outcomes included 30-day and 90-day RRT-free durations.

RESULTS

Patients with low urine output (LUO, defined as the average of <0.5 mL/kg/h over 6 h) were significantly associated with higher 30-day and 90-day mortality rates. Multivariable Cox regression analysis revealed that the LUO group had an increased risk of 30-day and 90-day mortality (hazard ratios: 1.935 and 2.141, respectively) compared to the high urine output (HUO, defined as the average of ≥0.5 mL/kg/h over 6 h) group. No significant association was observed between mortality and initial eGFR or plasma NGAL levels. However, the HUO group and patients with initial eGFR ≥ 30 mL/min/1.73 m2 had longer RRT-free durations at 30 and 90 days. Plasma NGAL levels did not significantly correlate with RRT-free durations.

CONCLUSIONS

Initial 6-h urine output in the ER is a significant predictor of 30-day and 90-day mortality in critically ill patients undergoing CRRT.

Unlocking new frontiers: DNA nanotechnology's impact on acute kidney injury diagnosis and treatment

Acute kidney injury (AKI) serves as an independent risk factor for chronic kidney disease (CKD) and hastens its progression. However, effective early diagnosis and treatment methods for AKI are still limited in clinical practice. There is a pressing need to develop fast, effective, and noninvasive diagnostic methods for AKI, as well as treatments that reduce nephrotoxicity. DNA nanotechnology, utilizing the programmable properties of DNA to engineer nanostructures and nanodevices, has achieved significant advancements in disease diagnosis and treatment. The application of DNA nanotechnology for kidney disease, particularly AKI, has been increasingly explored. This review encompasses the advancement of rapid and highly sensitive detection methods for AKI biomarkers, alongside the development of targeted drug delivery systems to the kidneys. These innovations facilitate precise treatment while minimizing adverse drug effects. The review underscores the progress in employing DNA nanotechnology for AKI diagnosis and treatment. Initially, we examine DNA nanotechnology-based strategies for AKI diagnosis, with an emphasis on biomarker detection. Subsequently, we delve into the therapeutic applications of DNA nanotechnology in AKI, highlighting targeted drug delivery and reduced toxicity. Finally, we offer insights into the challenges and opportunities associated with the clinical application of DNA nanotechnology in AKI management.

Rosiridin prevents cisplatin-induced renal toxicity by inhibiting caspase-3/NF-κB/ Bcl-2 signaling pathways in rats and in silico study

The present investigation determines the effects of rosiridin in cisplatin (CP)-induced renal toxicity in rats. The experimental animals were used and divided into four groups. Experimental rats were randomly divided into group-I normal control, group-II CP group (8 mg/kg i.p.), group-III CP + rosiridin (10 mg/kg, p.o.) and group-IV rosiridin (10 mg/kg p.o.). Various biochemical parameters, i.e., creatinine, urea, uric acid, cholesterol, blood urea nitrogen, antioxidant levels, inflammatory markers such as interleukins-1β (IL-1β), IL-6, tumor necrosis factor-α (TNF-α), nuclear factor kappa B (NF-κB), apoptosis markers including B cell lymphoma-2 (Bcl-2), caspase-3 and histopathological investigations were evaluated. Additionally, molecular docking and dynamics were performed to assess the interaction of rosiridin with target proteins. Rosiridin significantly minimized alteration in creatinine, urea, uric acid, cholesterol, blood urea nitrogen, antioxidant levels, and inflammatory, i.e., IL-1β, IL-6, TNF-α, NF-κB, Bcl-2, and caspase-3 which CP induced in rats. The interaction of rosiridin showed a favorable docking energy. The MD simulation results showed the higher stability of the complex generated from rosiridin. The current study exhibited rosiridin having a protective effect on CP-induced renal toxicity.

Key performance indicators for acute intermittent kidney replacement therapy in critically ill patients: a protocol for a systematic review

INTRODUCTION

There have been previous initiatives to identify key performance indicators (KPIs) for continuous kidney replacement therapy. However, no formal reviews of the evidence for KPIs of intermittent kidney replacement therapy (IKRT) have been conducted. This systematic review will appraise the evidence for KPIs of IKRT in critically ill patients and is part of the DIALYZING WISELY (NCT05186636) programme which aims to improve the performance of acute renal replacement therapy in intensive care units by aligning local practices with evidence-based best practices.

METHODS AND ANALYSIS

Ovid MEDLINE, Ovid Embase, CINAHL and Cochrane Library will be searched for studies involving KPIs for IKRT. Grey literature will also be searched and include technical reports, practice guidelines and conference proceedings as well as websites of relevant organisations. We will search the Agency of Healthcare Research and National Quality Measures Clearinghouse for IKRT-related KPIs. Studies will be included if they contain KPIs, occur in critically ill patients and are associated with IKRT. We will evaluate the risk of bias using the modified Cochrane tool and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluations methodology. The analysis will be primarily descriptive. Each KPI will be evaluated for importance, scientific acceptability, usability and feasibility using the four criteria proposed by the United States Strategic Framework Board for a National Quality Measurement and Reporting System. Finally, KPIs will be appraised for potential operational characteristics, potential to be integrated into electronic medical records, adoptability by stakeholders and affordability, if applicable.

ETHICS AND DISSEMINATION

Ethics approval is not required as primary data will not be collected. Findings of this review will be disseminated through peer-related publication.

PROSPERO REGISTRATION NUMBER

CRD42022074444.

C-C motif chemokine ligand 14 characterization for prediction of persistent severe AKI in post-cardiac surgery children

BACKGROUND

We evaluate the association of early postoperative urinary c-c motif chemokine ligand 14 (CCL14) and persistent severe acute kidney injury (AKI) in pediatric post-cardiac surgery patients.

METHODS

This is a retrospective single-center cohort study of patients < 18 years of age undergoing cardiac surgery who provided a biorepository urine sample within the first 24 postoperative hours. Persistent severe AKI was defined as any AKI stage lasting for ≥ 72 h with at least one time point of AKI stage 2 or 3 during that time frame. Patients with persistent severe AKI were matched 2:1 with non-AKI patients on age and sex. Urine samples were measured for CCL14 concentration. Logistic regression was used to evaluate associations between CCL14 and persistent severe AKI.

RESULTS

Persistent severe AKI occurred in 14 (5.4%) patients and was more common in patients with higher surgical complexity and longer cardiopulmonary bypass and cross-clamp duration. Patients with persistent severe AKI had longer median cardiac intensive care unit (CICU) (5 [3, 10] vs. 2 [1.5, 5.5], p-value = 0.039) and hospital length of stays (13.5 [7.8, 16.8] vs. 6 [4,8], p-value = 0.009). There was no difference in CCL14 levels between patients with and without persistent severe AKI (46.7 pg/ml [31.0, 82.9] vs. 44.2 pg/ml [25.1, 74.9], p-value = 0.49) in univariable and logistic regression.

CONCLUSIONS

In this heterogenous cohort of children undergoing cardiac surgery, CCL14 was not associated with persistent severe AKI. Future studies are needed to evaluate the use of CCL14 for predicting persistent severe AKI in children.

A Dual-Response DNA Origami Platform for Imaging and Treatment of Sepsis-Associated Acute Kidney Injury

Current diagnostics for sepsis-associated acute kidney injury (SA-AKI) detect kidney damage only at advanced stages, limiting opportunities for timely intervention. A DNA origami-based nanoplatform is developed for the early diagnosis and treatment of SA-AKI. Modified with a fluorophore (Cy5) and quencher (BHQ3), the DNA origami remains nonfluorescent under normal conditions. During SA-AKI, elevated microRNA-21 triggers a strand displacement reaction that restores the fluorescence signal, enabling real-time detection. Additionally, the photoacoustic changes of BHQ3, driven by different excretion rates of the nanostructure and released DNA strands, enable dual-mode imaging, enhancing diagnostic accuracy. Therapeutically, DNA origami scavenges reactive oxygen species and, when conjugated with the antimicrobial peptide Leucine-Leucine-37 (LL-37), exhibits bactericidal effects. This combination boosts survival rates by 80% in SA-AKI models. This dual-response nanoplatform integrates precise imaging and targeted therapy, offering a powerful strategy for SA-AKI management and advancing applications of DNA origami in precision nanomedicine.

HUWE1-Mediated Degradation of MUTYH Facilitates DNA Damage and Mitochondrial Dysfunction to Promote Acute Kidney Injury

The role of MUTYH, a DNA repair glycosylase in the pathogenesis of acute kidney injury (AKI) is unclear. In this study, it is found that MUTYH protein levels are significantly decreased in the kidneys of cisplatin- or folic acid (FA)-induced mouse AKI models and patients with AKI. MUTYH deficiency aggravates renal dysfunction and tubular injury following cisplatin and FA treatment, along with the accumulation of 7, 8-dihydro-8-oxoguanine (8-oxoG) and impairs mitochondrial function. Importantly, the overexpression of type 2 MUTYH (nuclear) significantly ameliorates cisplatin-induced apoptosis, oxidative stress, mitochondrial dysfunction, and DNA damage in vivo and in vitro. In contrast, overexpression of type 1 MUTYH (mitochondrial) shows a marginal effect against cisplatin-induced injury, indicating the chief role of type 2 MUTYH in antagonizing AKI. Interestingly, the results also indicate that the upregulation of the E3 ligase HUWE1 causes the ubiquitination and degradation of MUTYH in tubular epithelial cells. HUWE1 knockout or treatment with the HUWE1 inhibitor BI8622 significantly protect against cisplatin-induced AKI. Taken together, these results suggest that the ubiquitin E3 ligase HUWE1-mediates ubiquitination and degradation of MUTYH can aggravate DNA damage in the nucleus and mitochondria and promote AKI. Targeting the HUWE1/MUTYH pathway may be a potential strategy for AKI treatment.

Epidemiology, trajectories and outcomes of acute kidney injury among hospitalized patients: a large retrospective multicenter cohort study

BACKGROUND

Acute kidney injury (AKI) is a clinical syndrome affecting almost one-fifth of hospitalized patients, as well as over half of the patients who are admitted to the intensive care unit (ICU). Stratifying AKI patients into groups based on severity and duration would facilitate targeted efforts for treating AKI.

METHODS

In a retrospective, multicenter longitudinal cohort study of 2,187,254 hospital encounters from 935,679 patients who were admitted between 2012 and 2020 to health centers in the OneFlorida + Network, we analyzed the impact of AKI trajectories (i.e. rapidly reversed AKI, persistent AKI with renal recovery, and persistent AKI without renal recovery) on patients' clinical outcomes, including hospital, 30-day, 1-year, and 3-year mortality, kidney replacement therapy, new chronic kidney disease (CKD) within 90 days or 1-year of discharge, CKD progression within 1-year of discharge, resource utilization, hospital disposition, and major complications during hospitalization.

RESULTS

Among all encounters, 14% of patients had AKI, of whom 63%, 21%, and 16% had Stage 1, 2, and 3, respectively, as the worst AKI stage. The fraction of patients with persistent AKI was 31%. Patients with AKI had worse clinical outcomes and increased resource utilization compared to patients without the condition. One-year mortality was 5 times greater for patients with persistent AKI compared to those without AKI.

CONCLUSIONS

Persistent AKI was associated with prolonged hospitalization, increased ICU admission and greater mortality compared to the other groups. This may emphasize the critical need for devising strategies targeting effective management of AKI and prevention of persisting AKI.

Deep learning‑based prediction of in‑hospital mortality for acute kidney injury

Acute kidney injury (AKI) is a prevalent clinical syndrome that causes over one-fifth of hospitalized patients worldwide to suffer from AKI. We proposed the GCAT, which aims to identify high-risk AKI patients in the hospital settings using the MIMIC-III dataset. Firstly, it fully explores the similarity of attribute features among a large number of patients and calculates the attribute similarity values between patients to generate a node similarity matrix. Then, it selects nodes with high similarity to construct a patient feature similarity network (PFSN). Experiments demonstrate that the GCAT achieves an accuracy of 88.57%, its effectiveness is superior to state-of-the-art methods.

The challenges for developing prognostic prediction models for acute kidney injury in hospitalized children: A systematic review

Importance

Acute kidney injury (AKI) is common in hospitalized children which could rapidly progress into chronic kidney disease if not timely diagnosed. Prognostic prediction models for AKI were established to identify AKI early and improve children's prognosis.

Objective

To appraise prognostic prediction models for pediatric AKI.

Methods

Four English and four Chinese databases were systematically searched from January 1, 2010, to June 6, 2022. Articles describing prognostic prediction models for pediatric AKI were included. The data extraction was based on the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies checklist. The risk of bias (ROB) was assessed according to the Prediction model Risk of Bias Assessment Tool guideline. The quantitative synthesis of the models was not performed due to the lack of methods regarding the meta-analysis of prediction models.

Results

Eight studies with 16 models were included. There were significant deficiencies in reporting and all models were considered at high ROB. The area under the receiver operating characteristic curve to predict AKI ranged from 0.69 to 0.95. However, only about one-third of models have completed internal or external validation. The calibration was provided only in four models. Three models allowed easy bedside calculation or electronic automation, and two models were evaluated for their impacts on clinical practice.

Interpretation

Besides the modeling algorithm, the challenges for developing prediction models for pediatric AKI reflected by the reporting deficiencies included ways of handling baseline serum creatinine and age-dependent blood biochemical indexes. Moreover, few prediction models for pediatric AKI were performed for external validation, let alone the transformation in clinical practice. Further investigation should focus on the combination of prediction models and electronic automatic alerts.

Iron-Quercetin complex enhances mesenchymal stem cell-mediated HGF secretion and c-Met activation to ameliorate acute kidney injury through the prevention of tubular cell apoptosis

Background

Acute kidney injury (AKI) is a life-threatening clinical syndrome with no effective treatment currently available. This study aims to investigate whether Iron-Quercetin complex (IronQ) pretreatment can enhance the therapeutic efficacy of Mesenchymal stem cells (MSCs) in AKI and explore the underlying mechanisms.

Methods

A cisplatin-induced AKI model was established in male C57BL/6 mice, followed by the intravenous administration of 1x10ˆ6 MSCs or IronQ-pretreated MSCs (MSCIronQ). Renal function, histology, and tubular cell apoptosis were analyzed three days post-treatment. In vitro, apoptosis was induced in mouse tubular epithelial cells (mTECs) using cisplatin, followed by treatment with MSCs or MSCIronQ conditioned medium (CM). Apoptosis was evaluated using TUNEL assay, RT-PCR, and western blotting. Furthermore, RNA sequencing (RNA-seq) was performed on MSCIronQ to explore the underlying mechanisms.

Results

Compared to MSC-treated AKI mice, those treated with MSCIronQ showed significantly improved renal function and histological outcomes, with reduced tubular cell apoptosis. A similar effect was observed in cisplatin-treated mTECs exposed to MSCIronQ-CM. Mechanistically, RNA-seq and subsequent validation revealed that IronQ treatment markedly upregulated the expression and secretion of hepatocyte growth factor (HGF) in MSCs. Furthermore, RNA interference or antibody-mediated neutralization of HGF effectively abolished the anti-apoptotic effects of MSCIronQ on mTECs. This mechanistic insight was reinforced by pharmacological inhibition of c-Met, the specific receptor of HGF, in both in vitro and in vivo models.

Conclusions

IronQ pretreatment enhances MSCs efficacy in AKI by promoting HGF expression and secretion, activating the HGF/c-Met pathway to suppress tubular cell apoptosis. These findings indicate that IronQ improves MSC-based therapies and offers insights into molecular mechanisms, supporting the development of better AKI treatments.

Recovery of kidney function in acute kidney injury

Acute kidney injury (AKI) is associated with a significant burden of mortality worldwide. Each episode of AKI increases the long-term risk of death, especially if there is no recovery or insufficient renal recovery (i.e. restoration of kidney function). This narrative review summarizes relevant studies on the definition and prediction of renal recovery. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, Scopus. The period lasted from 1990 until 2024. The currently available criteria for renal recovery have been identified and discussed. Regarding restoration of kidney function prediction, seven studies on alternative or novel biomarkers have been reviewed. In the context of kidney replacement therapy and renal recovery, findings from four large, prospective randomized studies have been summarized. A standardized definition of renal recovery is presently not available. Specific biomarkers allow for an estimation of the likelihood of renal recovery under certain conditions. According to current knowledge, no dialysis method has been definitively shown to be advantageous for the recovery process.

Care That Fits: Optimizing Value-Based Care for Acute Kidney Injury Survivors

Acute kidney injury (AKI) survivors are at risk for substantial adverse outcomes, and the post-AKI setting is a source of high health care utilization. Kidney health is often not prioritized after discharge from an AKI hospitalization and can be complicated by patient and process-related barriers. Improving kidney care for AKI survivors has the potential to improve outcomes, though data on which care models are optimal for this population are lacking. Care models utilized in other patient populations, as well as prior trials of AKI survivor clinics, can provide insight as to how these models could be implemented in the post-AKI setting to improve outcomes in a cost-effective way. Potential care models range on a spectrum from the least specialized, most highly scalable, and cost-effective options, such as patient engagement programs and home health, to more generally accessible models including allied health-driven models, and primary care-embedded programs, to highly specialized and less scalable options, such as nephrology-led survivor clinics. Each has potential applications and limitations in the post-AKI setting. Ongoing studies that incorporate elements of multiple care models may have the most promise to improve value-based care in the care of AKI survivors.

Perspectives and Experiences of Patients with AKI: A Systematic Review

Key Points

Six themes have been identified reflecting the perspectives and experiences of adults with AKI. Patients are unaware of AKI diagnosis and prognosis, feel that care is fragmented, and are burdened by treatment. Providing education, reducing treatment burden, and ensuring excellence in care may help to address patients' needs and improve AKI management.

Background

AKI is associated with higher risk of mortality and progression to CKD. The challenges and uncertainty in the diagnosis, self-management, and prevention of AKI can be distressing for patients. We aimed to perform a systematic review of qualitative studies/surveys that reported the perspectives and experiences of adults with AKI.

Methods

We searched MEDLINE, Embase, PsycINFO, and CINAHL from inception to January 17, 2024. Thematic textual analysis was used to synthesize the findings.

Results

We included 20 studies (ten qualitative studies, ten surveys) involving 867 participants. We identified six themes: navigating the unknown (an unexpected and unfamiliar diagnosis, tossed about in a fragmented system, and dismissed and vulnerable at discharge); impaired life participation, relationships, and well-being (limiting ability to do daily activities and straining relationships); unbearable and unsustainable treatment burden (adding strain on family members, financial pressure because of medical expenses, and cumulative stress of ongoing monitoring); uncertain whether recovery is attainable (possible permanence of kidney damage, fear about nephrotoxic medications, and terrified about the need for dialysis); less consequential than other health priorities (short term and reversible and prioritizing other comorbidities and conditions); and empowered in managing own health (focusing on optimizing kidney health, gaining confidence in self-management, and reassured with social and clinical support).

Conclusions

Patients may be unaware of their AKI diagnosis and prognosis, feel that care is fragmented, and be burdened by treatment. Providing education, alleviating treatment burden, and implementing a comprehensive model of care may help to address the needs of patients with AKI leading to better outcomes.

AHA "Life's Essential 8" metrics and prognosis in patients with renal insufficiency: Results from the National Health and Nutrition Examination Survey, 2007-2018

BACKGROUND

The benefits of ideal cardiovascular-health metrics (ICVHMs) in patients with renal insufficiency remain unclear. This study aimed to investigate ICVHM associations with prognosis in a renal insufficiency population.

METHODS

The trial enrolled 29,682 participants from the US National Health and Nutrition Examination Survey (NHANES), 2007-2018, with mortality follow-up through December 31, 2019. Participants were divided into three groups based on estimated glomerular filtration rates. Cardiovascular health was assessed using new "Life's Essential 8" metrics. Cox regression analyses based on NHANES data were used to determine the associations between ICVHMs and cardiovascular mortality in patients with renal insufficiency.

RESULTS

During a mean follow-up of 6.58 years, ideal cardiovascular health (hazard ratio [HR] = 0.42; 95% confidence interval [CI]; 0.25-0.70) and ideal health behavior (HR = 0.53; 95% CI; 0.39-0.73) reduced cardiovascular mortality in participants with renal insufficiency. For each one ICVHM increment, a 25% reduction in cardiovascular mortality was recorded (95% CI; 0.69-0.82). When compared with participants with normal renal function, for those with mild renal insufficiency, the HR for cardiovascular mortality gradually decreased from 1.47 (95% CI; 0.85-2.52) in those who had ≤1 ICVHMs to 0.30 (95% CI; 0.12-0.77) in participants who had >6 ICVHMs.

CONCLUSIONS

From an ICVHM perspective, enhanced cardiovascular benefits were observed in individuals with renal insufficiency, coupled with a reduced risk of all-cause mortality. Furthermore, when compared with individuals with normal renal function, increased ICVHMs can mitigate adverse risks associated with renal impairment.

Mortality of Acute Kidney Injury in Cirrhosis: A Systematic Review and Meta-Analysis of Over 5 Million Patients Across Different Clinical Settings

BACKGROUND

Acute kidney injury (AKI) represents a commonly seen condition in the natural course of cirrhosis associated with unfavourable outcomes.

AIMS

To evaluate and compare the pooled mortality rates of patients with cirrhosis, with versus without AKI, across different clinical settings and diagnostic criteria.

METHODS

A systematic search of several databases was performed up to Oct 2023. Meta-analysis was performed using a generalised linear mixed model with a random effects model for all calculations.

RESULTS

A total of 59 studies comparing patients with cirrhosis, with and without AKI, were included in the meta-analysis, encompassing 1,153,193 individuals with AKI and 4,630,814 without AKI. AKI development predisposed to significantly higher short (in-hospital and 30-days)-, intermediate (90-days)- and long (1-year)-term mortality rates in both inpatients and outpatients. Remarkably, patients with AKI admitted to intensive care unit (ICU) or diagnosed with acute-on-chronic liver failure (ACLF) experienced the higher short-term mortality rates, reaching 76% [95% confidence interval (CI): 73%-79%] and 54% (95%CI: 33%-73%), respectively. AKI staging correlated with mortality risk, with higher stages indicating higher mortality rates, while the timing of AKI development, whether community-acquired or hospital-acquired, plays a crucial role in patient prognosis, with distinct mortality patterns observed in each group. The selection of diagnostic criteria for AKI may also impact its association with the short-term mortality risk.

CONCLUSIONS

AKI substantially affects the prognosis of patients with cirrhosis, especially those in ICU and/or with ACLF. Prognosis is also greatly influenced by the AKI stage, timing of onset and diagnostic criteria.

Acute Kidney Injury in Autoimmune-Mediated Rheumatic Diseases

Acute kidney injury (AKI) is increasingly affecting hospitalized patients worldwide. Patients with inflammatory rheumatic diseases, although primarily impacted by functional impairment and sometimes structural damage to joints, bones, and muscle tissue, may also develop AKI during the course of their disease. This narrative review aimed to summarize potential causes of AKI and the associated disease patterns. The following databases were searched for references: PubMed, Web of Science, Cochrane Library, and Scopus. The search period covered from 1958 to 2024. Certain inflammatory rheumatic diseases increase the risk of AKI due to specific types of kidney disease. However, the most common conditions, such as rheumatoid arthritis and spondylarthritis, rarely cause AKI directly. Among the medications used for pain and sometimes disease activity control, nonsteroidal anti-inflammatory drugs (NSAIDs) can potentially induce AKI, even progressing to acute tubular necrosis. There is evidence that certain rheumatic diseases are associated with increased risk of AKI, independently of directly affecting kidney function or structure. However, the data on this topic are quite limited. AKI is a potentially significant issue for patients with inflammatory rheumatic diseases. Additional data on the increased risk of AKI, independent of direct kidney involvement, are needed.

Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data

PURPOSE

While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population.

METHODS

A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (<2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation.

RESULTS

Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90-1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07-1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59-14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group.

CONCLUSIONS

Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes.

Small cell carcinoma of the ovary, hypercalcaemic type causing an acute kidney injury

SummaryWe report a case of small cell carcinoma of the ovary, hypercalcaemic type, a rare and aggressive form of ovarian cancer, causing an acute kidney injury. A woman in her mid-30s presented with a large pelvic mass and abdominal distention, this was associated with rapidly deteriorating renal function, which did not improve with standardised kidney injury treatment. There was a high suspicion of ovarian cancer. She deteriorated and underwent emergency cytoreductive surgery, followed by systemic chemotherapy. Her presentation, acute kidney injury and electrolyte disturbance preoperatively and postoperatively suggest this was caused by her cancer. Renal dysfunction, due to paraneoplastic syndromes, is a rare oncological emergency seen with solid tumours. Awareness of the condition can lead to early recognition and timely management.

Assessing the Impact of the Prone Position on Acute Kidney Injury

Background: Prone positioning is a standard intervention in managing patients with severe acute respiratory distress syndrome (ARDS) and is known to improve oxygenation. However, its effects on other organs, particularly the kidneys, are less well understood. This study aimed to assess the association between prone positioning and the development of acute kidney injury (AKI), specifically in overweight and obese patients. Methods: A retrospective pre-post study was conducted on a cohort of 60 critically ill ARDS patients who were placed in the prone position during hospitalization. The development of AKI was assessed using the Acute Kidney Injury Network (AKIN) criteria, with AKI measured by both creatinine levels (AKINCr) and urine output (AKINUO). Patients were divided into two groups based on body mass index (BMI): overweight/obese (BMI ≥ 25) and non-obese (BMI < 25). Data were collected before and after prone positioning. Results: In overweight/obese patients (n = 39, 57 cases), both the median AKINCr and AKINUO scores increased significantly following prone positioning (from 0 to 1, median p < 0.01, and from 0 to 2, median p < 0.01, respectively). No statistically significant changes in AKIN scores were observed in non-obese patients nor were significant differences found in either group after repositioning to supine. Conclusions: Prone positioning is associated with an increased risk of acute kidney injury in overweight and obese ARDS patients. This may be due to the kidneys' susceptibility to intra-abdominal hypertension in these patients. Further research is needed to explore optimal proning strategies for overweight and obese populations.

Predictors and Impact of Cardiogenic Shock in Oldest-Old ST-Elevation Myocardial Infarction Patients

Background: Cardiogenic shock (CS) is the most frequent cause of in-hospital mortality after ST-elevation myocardial infarction (STEMI). Data about CS in very elderly (age ≥ 85 years) STEMI patients are scarce. We sought to assess the prognostic factors and the short- and mid-term impact of CS in this population. Methods: Consecutive very elderly STEMI patients undergoing invasive treatment were included in a retrospective multicenter registry. Results: Among 608 patients, 72 (11.8%) fulfilled experienced CS. Peripheral artery disease (PAD) (OR: 2.25, 95% CI: 1.29-3.92, p < 0.01) and cardiac arrest at presentation (OR: 4.36, 95% CI: 2.32-8.21, p < 0.01) were the major independent predictors of CS. Age (HR: 1.07, 95% CI: 1.03-1.11, p < 0.001), PAD (HR: 1.29, 95% CI: 1.01-1.66, p = 0.045), previous MI (HR: 2.16, 95% CI: 1.32-3.55, p = 0.002), and cardiac arrest at presentation (HR: 1.59, 95% CI: 1.29-1.96, p < 0.001) were the major independent predictors of death. CS was associated with a higher risk of mortality at 30 days (adjusted HR: 4.21, 95% CI: 2.19 to 7.78, p < 0.01) mostly driven by higher intraprocedural and in-hospital mortality. Among patients who survived the acute phase and hospitalization, CS at presentation was not associated with a higher mortality risk during the remaining follow-up period (log-rank p = 0.78). Conclusions: At short-term follow-up, very elderly STEMI patients presenting with CS had a higher risk of mortality when compared to non-CS patients. Interestingly, CS patients surviving the acute phase showed a similar survival rate to non-CS patients after discharge.

Exosome-based therapies for inflammatory disorders: a review of recent advances

Exosomes, small extracellular vesicles secreted by cells, have emerged as focal mediators in intercellular communication and therapeutic interventions across diverse biomedical fields. Inflammatory disorders, including inflammatory bowel disease, acute liver injury, lung injury, neuroinflammation, and myocardial infarction, are complex conditions that require innovative therapeutic approaches. This review summarizes recent advances in exosome-based therapies for inflammatory disorders, highlighting their potential as diagnostic biomarkers and therapeutic agents. Exosomes have shown promise in reducing inflammation, promoting tissue repair, and improving functional outcomes in preclinical models of inflammatory disorders. However, further research is needed to overcome the challenges associated with exosome isolation, characterization, and delivery, as well as to fully understand their mechanisms of action. Current limitations and future directions in exosome research underscore the need for enhanced isolation techniques and deeper mechanistic insights to harness exosomes' full therapeutic potential in clinical applications. Despite these challenges, exosome-based therapies hold great potential for the treatment of inflammatory disorders and may offer a new paradigm for personalized medication.

Primary Care Providers Barriers, Comfort and Awareness in Follow-up Care of Acute Kidney Injury Patients: A Comprehensive Survey on Current Practices

Background

Patients who experienced acute kidney injury (AKI) may benefit from dedicated care following hospital discharge. Most of these patients will be followed by primary care providers. There is a lack of data on current practices and comfort for these care providers when offering post-AKI care.

Objective

We surveyed nurse practitioners and family physicians to assess their awareness, perceptions, practice patterns and comfort regarding post-AKI care.

Design/Setting

We distributed a web-based self-administered survey among clinicians from the Province of Quebec. We asked about their awareness and perceptions on how AKI should be disclosed and followed, the barriers encountered regarding the process of care following hospital discharge, and their level of comfort and expertise in offering dedicated post-AKI care. The survey integrated direct and scenario-based questions and was conducted from December 2022 to April 2023.

Participants

We distributed the survey to practicing family physicians and nurse practitioners through the mailing list of the Fédération des Médecins Omnipraticiens du Québec, and the Association des infirmières praticiennes spécialisées du Québec, respectively. No incentives were provided.

Methods

We conducted descriptive analyses and used chi-squared analysis to compare responses between family physicians and nurse practitioners and between hospital-based and cabinet-based practice.

Results

The survey was opened by 779 potential participants. Of these, the response rate was 9% (70/779). Most participants were family physicians (79%) and dedicated 70% (±32) of their time in community outpatient clinics. Participants reported that 59% (±20) of all patients seen daily had at least 1 risk factor for AKI, whereas they estimated that 21% (±12) of recently discharged patients suffered from an AKI episode. The lack of awareness by the patient and lack of details on the discharge summary were the barriers most frequently reported impacting the overall process of care at follow-up. Most nurse practitioners (60%) and 33% of family physicians reported at least some levels of discomfort and lack of expertise when offering post-AKI.

Limitations

The generalizability of our study is limited by its response rate. However, this is comparable with typical response rates seen in electronic surveys. The distribution was limited to a single province of Canada.

Conclusions

We reported significant barriers regarding the hospital-to-community transition of care in patients who experienced AKI and the suboptimal comfort and expertise of primary care providers when offering dedicated post-AKI care. This reflects the need to improve communication, collaboration, and AKI training with primary care providers.

Shikonin Inhibits Endoplasmic Reticulum Stress-Induced Apoptosis to Attenuate Renal Ischemia/Reperfusion Injury by Activating the Sirt1/Nrf2/HO-1 Pathway

INTRODUCTION

Shikonin is the major bioactive compound abundant in Lithospermum erythrorhizon and possesses diverse pharmacological properties. This study aimed to examine shikonin roles in experimental renal ischemia/reperfusion (I/R) injury.

METHODS

Renal tissues and blood were collected from experimental renal I/R injury models. Kidney functions, structural injuries, and cellular death were assessed. Markers of endoplasmic reticulum (ER) stress were evaluated by RT-qPCR and Western blotting. The effect of shikonin on Sirt1/Nrf2/HO-1 signaling was detected by Western blotting and immunofluorescence staining. HK-2 cells that underwent hypoxia/reoxygenation (H/R) process were used to perform CCK-8 and flow cytometry.

RESULTS

For in vivo analysis, renal dysfunctions and tissue structural damage induced by I/R were relieved by shikonin. Additionally, shikonin alleviated ER stress-induced apoptosis in I/R mice. For in vitro analysis, shikonin inhibited ER stress-stimulated apoptosis of H/R cells. Mechanistically, shikonin activated Sirt1/Nrf2/HO-1 signaling post-I/R, and inhibition of Sirt1 limited shikonin-mediated protection against ER stress-stimulated apoptosis in both animal and cellular models.

CONCLUSION

By activating Sirt1/Nrf2/HO-1 signaling, shikonin inhibits apoptosis caused by ER stress and relieves renal I/R injury.

Impact of the prognostic nutritional index on renal replacement therapy-free survival and mortality in patients on continuous renal replacement therapy

BACKGROUND

The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status.

OBJECTIVES

The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT.

METHODS

We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality.

RESULTS

Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status.

CONCLUSIONS

PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.

Role of mitochondria in renal ischemia-reperfusion injury

Acute kidney injury (AKI) induced by renal ischemia-reperfusion injury (IRI) has a high morbidity and mortality, representing a worldwide problem. The kidney is an essential organ of metabolism that has high blood perfusion and is the second most mitochondria-rich organ after the heart because of the high ATP demands of its essential functions of nutrient reabsorption, acid-base and electrolyte balance, and hemodynamics. Thus, these energy-intensive cells are particularly vulnerable to mitochondrial dysfunction. As the bulk of glomerular ultrafiltrate reabsorption by proximal tubules occurs via active transport, the mitochondria of proximal tubules must be equipped for detecting and responding to fluctuations in energy availability to guarantee efficient basal metabolism. Any insults to mitochondrial quality control mechanisms may lead to biological disruption, blocking the clearance of damaged mitochondria and resulting in morphological change and tissue dysfunction. Extensive research has shown that mitochondria have pivotal roles in acute kidney disease, so in this article, we discuss the role of mitochondria, their dynamics and mitophagy in renal ischemia-reperfusion injury.

Clinical characteristics and outcomes of patients on haemodialysis at Jimma medical center, Ethiopia: a 7-Year review

BACKGROUND

Haemodialysis is the primary kidney replacement therapy modality in Africa. In Ethiopia, the number of patients undergoing Haemodialysis is increasing, yet data on their outcomes is scarce. This study assesses the clinical characteristics and outcomes of Haemodialysis patients at Jimma Medical Center.

METHODS

A retrospective cross-sectional study was conducted from April 08 to 12, 2024, involving patients who underwent Haemodialysis at Jimma Medical Center from June 2017 to March 2024. The data were coded and entered into EpiData version 3.1, then exported to the Statistical Package for Social Sciences version 26.0 for analysis. Descriptive statistics summarized the patients' clinical characteristics and outcomes, and Kaplan-Meier curves were used to assess survival status.

RESULTS

During the seven-year study period, 68 patients underwent Haemodialysis at Jimma Medical Center, with a predominance of males (69.1%). The average age of patients was 42.7 (± 12.8) years with 69.1% (95% CI: 57.5-79.1%) diagnosed with chronic kidney disease, while 30.9% (95% CI: 20.9-42.5%) had acute kidney injury. Among chronic kidney disease patients, common clinical features included nausea and vomiting (100%), proteinuria (95.7%), and body swelling (82.9%), while acute kidney injury patients frequently presented with oliguria (100%), nausea and vomiting (90.5%), and hematuria (52.4%). Hypertensive nephropathy was the leading cause of chronic kidney disease (40.4%), and acute glomerulonephritis (38.1%) and severe malaria (33.3%) were the predominant causes of acute kidney injury. Mortality was observed at 47.6% (95% CI: 27.7-68.6%) in acute kidney injury patients and 40.4% (95% CI: 27.3-54.7%) in chronic kidney disease patients. Emergency vascular access was required in 95.7% of chronic kidney disease and 100% of acute kidney injury patients.

CONCLUSION

This study highlights the substantial burden of chronic kidney disease and acute kidney injury among hemodialysis patients at Jimma Medical Center, revealing distinct clinical profiles and outcomes. Although acute kidney injury patients exhibited a longer median survival time, the significant mortality risk within the first year underscores the urgent need for improved treatment access and resource allocation. Enhancing early intervention and ensuring the availability of critical medications, such as erythropoietin, are essential for optimizing patient outcomes for both chronic kidney disease and acute kidney injury groups.

CLINICAL TRIAL NUMBER

Not applicable.

Exploring the role of Artificial Intelligence in Acute Kidney Injury management: a comprehensive review and future research agenda

This study reviews the studies utilizing Artificial Intelligence (AI) and AI-driven tools and methods in managing Acute Kidney Injury (AKI). It categorizes the studies according to medical specialties, analyses the gaps in the existing research, and identifies opportunities for future research directions. PRISMA guidelines were adopted using the three most common databases (PubMed, Scopus, and EBSCO), which resulted in 27 eligible studies, published between 2012 and 2023. The study showed significant heterogeneity in the design of the models, with variations in clinical settings, patient characteristics, cohort regions, and statistical methods. Most models were developed for AKI in hospitalized patients, particularly those undergoing surgery or in intensive care units. Compact models with a subset of significant predictors were deemed more clinically applicable than full models with all predictors. The findings suggest that AI tools, such as machine learning (ML) algorithms, have high prediction capabilities despite the dynamic and complex association among the influencing factors and AKI. Based on these findings and the recognized need for broader inclusivity, future studies should consider adopting a more inclusive approach by incorporating diverse healthcare settings, including resource-limited or developing countries. This inclusivity will lead to a more holistic understanding of AKI management challenges and facilitate the development of adaptable and universally applicable AI-driven solutions. Additionally, further investigations should focus on refining AI models to enhance their accuracy and interpretability, promoting seamless integration and implementation of AI-based tools in real-world clinical practice. Addressing these key aspects will elevate the effectiveness and impact of AI-driven approaches in managing AKI.

Cystatin C and Kidney Function Recovery in Patients Requiring Continuous KRT for Acute Kidney Injury

Key Points

Plasma cystatin C is decreased in participants with AKI requiring continuous KRT (CKRT) with early kidney function recovery. Despite being cleared by CKRT, plasma cystatin C in the first 3 days of CKRT may be a useful clinical tool to help predict the prognosis of AKI requiring CKRT.

Background

Plasma cystatin C is a reliable marker to estimate kidney function; however, it is unknown whether this remains true in patients receiving continuous KRT (CKRT). In this study, we tested the hypothesis that lower concentrations of plasma cystatin C during the first 3 days of CKRT would predict kidney function recovery.

Methods

We performed a retrospective observational study of 72 patients from a 126-patient, single-center CKRT study. We studied two a priori defined cohorts of patients without advanced CKD who had AKI requiring CKRT: (1 ) with early kidney function recovery defined as liberation from KRT within 7 days of CKRT initiation versus (2 ) with delayed kidney function recovery defined as receipt of KRT for >21 days or death while on KRT. Subsequent analysis included patients with advanced CKD and intermediate kidney function recovery (liberation between 8 and 21 days). Cystatin C was then measured on stored plasma, urine, and dialysis effluent collected before CKRT initiation and on days 1, 2, and 3 of CKRT.

Results

Plasma cystatin C was significantly lower in patients with early kidney function recovery in comparison with patients with delayed kidney function recovery on days 1 (1.79 versus 2.39 mg/L), 2 (1.91 versus 2.38 mg/L), and 3 (2.04 versus 2.67 mg/L) of CKRT. Sieving coefficient and CKRT clearance of cystatin C were similar for patients with early and delayed kidney function recovery. The lowest plasma cystatin C concentration on days 1–3 of CKRT predicted early kidney function recovery with an area under the receiver operating curve of 0.77 (P =0.002), positive likelihood ratio of 5.60 for plasma cystatin C <1.30 mg/L, and negative likelihood ratio of 0.17 for plasma cystatin C ≥1.88 mg/L.

Conclusions

Lower plasma cystatin C concentrations during the first 3 days of CKRT are associated with early kidney function recovery.

Machine learning approaches toward an understanding of acute kidney injury: current trends and future directions

Acute kidney injury (AKI) is a significant health challenge associated with adverse patient outcomes and substantial economic burdens. Many authors have sought to prevent and predict AKI. Here, we comprehensively review recent advances in the use of artificial intelligence (AI) to predict AKI, and the associated challenges. Although AI may detect AKI early and predict prognosis, integration of AI-based systems into clinical practice remains challenging. It is difficult to identify AKI patients using retrospective data; information preprocessing and the limitations of existing models pose problems. It is essential to embrace standardized labeling criteria and to form international multi-institutional collaborations that foster high-quality data collection. Additionally, existing constraints on the deployment of evolving AI technologies in real-world healthcare settings and enhancement of the reliabilities of AI outputs are crucial. Such efforts will improve the clinical applicability, performance, and reliability of AKI Clinical Support Systems, ultimately enhancing patient prognoses.

Neutrophil-Mediated Nanozyme Delivery System for Acute Kidney Injury Therapy

Reactive oxygen species (ROS) scavenging of nanozymes toward acute kidney injury (AKI) is a current promising strategy, however, the glomerular filtration barrier (GFB) limits their application for treating kidney related diseases. Here, a neutrophil-mediated delivery system able to hijack neutrophil to transport nanozyme-loaded cRGD-liposomes to inflamed kidney for AKI treatment by cRGD targeting integrin αvβ1 is reported. The neutrophil-mediated nanozyme delivery system demonstrated great antioxidant and anti-apoptosis ability in HK-2 and NRK-52E cell lines. Moreover, in ischemia-reperfusion (I/R) induced AKI mice, a single dose of LM@cRGD-LPs 12 h post-ischemia significantly reduces renal function indicators, alleviates renal pathological changes, and inhibits apoptosis of renal tubular cells and the expression of renal tubular injured marker, thus remarkably reducing the damage of AKI. Mechanistically, the treatment of LM@cRGD-LPs markedly inhibits the process of Nrf2 to the nucleus and reduces the expression of the downstream HO-1, achieves a 99.51% increase in renal tissue Nrf2 levels, and an 86.31% decrease in HO-1 levels after LM@cRGD-LPs treatment. In short, the strategy of neutrophil-mediated nanozyme delivery system hold great promise as a potential therapy for AKI or other inflammatory diseases.

Incidence of Acute Kidney Injury and Associated Mortality among Individuals with Drug-Susceptible Tuberculosis in Uganda

Key Points

AKI is thought to be a rare complication in patients with tuberculosis (TB) infection and is mostly attributed to TB drugs. Our findings show AKI occurs more often than previously thought and approximately 33% of patients with drug-susceptible TB may have kidney dysfunction. According to our study findings, monitoring kidney function should be routine among patients diagnosed with TB even before treatment initiation.

Background

Although tuberculosis (TB) is associated with significant mortality and morbidity, its impact on kidney function is not well understood and is often attributed to anti-TB drugs. We aimed to assess the incidence of AKI in the immediate post-TB diagnosis period in Uganda, a TB/HIV-endemic country in sub-Saharan Africa.

Methods

We included patients enrolled in an observational cohort study of adults diagnosed with drug-susceptible TB followed longitudinally. Adults (≥18 years) without known kidney disease were enrolled between August 2022 and July 2023 at three regional hospitals serving 12.5% of the Ugandan population. Our primary outcome was incidence of Kidney Disease Improving Global Outcomes-defined AKI within 2 weeks of TB diagnosis. Other outcomes included predictors of AKI and its association with 30-day survival.

Results

A total of 156 adults were included. The median age was 39 (interquartile range, 28–53) years, most patients were male (68.6%), and 49.4% had HIV. People with HIV had shorter time to TB diagnosis from symptom onset (21 days; interquartile range, 7–30) compared with HIV-negative participants (60 days; interquartile range, 23–90), P < 0.001. The incidence of AKI was 33.3% (52/156) and was similar between people with and without HIV. Proteinuria or hematuria at enrollment was associated with higher odds of AKI (odds ratio, 2.68; 95% confidence interval, 1.09 to 6.70; P approximately 0.033). AKI was associated with a significant risk of mortality (adjusted hazard ratio, 8.22; 95% confidence interval, 1.94 to 34.72; P approximately 0.004) independent of HIV status.

Conclusions

The overall incidence of AKI in the immediate post-TB diagnosis period is high and associated with increased mortality risk. Our findings suggest that monitoring kidney function should be routine for patients with TB, including before treatment initiation.

Identification of TACSTD2 as novel therapeutic targets for cisplatin-induced acute kidney injury by multi-omics data integration

Cisplatin-induced acute kidney injury (CP-AKI) is a common complication in cancer patients. Although ferroptosis is believed to contribute to the progression of CP-AKI, its mechanisms remain incompletely understood. In this study, after initially processed individual omics datasets, we integrated multi-omics data to construct a ferroptosis network in the kidney, resulting in the identification of the key driver TACSTD2. In vitro and in vivo results showed that TACSTD2 was notably upregulated in cisplatin-treated kidneys and BUMPT cells. Overexpression of TACSTD2 accelerated ferroptosis, while its gene disruption decelerated ferroptosis, likely mediated by its potential downstream targets HMGB1, IRF6, and LCN2. Drug prediction and molecular docking were further used to propose that drugs targeting TACSTD2 may have therapeutic potential in CP-AKI, such as parthenolide, progesterone, premarin, estradiol and rosiglitazone. Our findings suggest a significant association between ferroptosis and the development of CP-AKI, with TACSTD2 playing a crucial role in modulating ferroptosis, which provides novel perspectives on the pathogenesis and treatment of CP-AKI.

Mitochondrial Function and Resistance to Oxidative Stress in the Kidney during Pregnancy

We demonstrated that the serum of pregnant rats increases viability of kidney epithelial cells and promotes their proliferation. The intensity of oxidative stress in the kidneys was also reduced during pregnancy, but only in rats that were not exposed to acute ischemic kidney injury. This decrease in oxidative stress was not associated with changes in transmembrane mitochondrial potential, the size of mitochondria, time of opening of mitochondrial permeability transition pore (mPTP), mitochondrial respiration rate, antioxidant activity, or nitric oxide level.

Association between hydroxyethyl starch 130/0.4 administration during noncardiac surgery and postoperative acute kidney injury: A propensity score-matched analysis of a large cohort in China

STUDY OBJECTIVE

The use of hydroxyethyl starch 130/0.4 has been linked to renal injury in critically ill patients, but its impact on surgical patients remains uncertain.

DESIGN

A retrospective cohort study.

SETTING

This study was conducted at one tertiary care hospital in China.

PATIENTS

We evaluated the records of 51,926 Chinese adults who underwent noncardiac surgery from 2013 to 2022. Patients given a combination of hydroxyethyl starch 130/0.4 and crystalloids were propensity-matched at a 1: 1 ratio of baseline characteristics to patients given only crystalloids (11,725 pairs).

INTERVENTIONS

Eligible patients were divided into those given a combination of hydroxyethyl starch 130/0.4 and crystalloid during surgery and a reference crystalloid group consisting of patients who were not given any colloid.

MEASUREMENTS

The primary outcome was the incidence of acute kidney injury. Secondarily, acute kidney injury stage, need for renal replacement therapy, intensive care unit transfer rate, and duration of postoperative hospitalization were considered.

MAIN RESULTS

After matching, hydroxyethyl starch use [8.5 (IQR: 7.5-10.0) mL/kg] did not increase the incidence of acute kidney injury compared with that in the crystalloid group [2.0 vs. 2.2%, OR: 0.90 (0.74-1.08), P = 0.25]. Nor did hydroxyethyl starch use worsen acute kidney injury stage [OR 0.90 (0.75-1.08), P = 0.26]. No significant differences between the fluid groups were observed in renal replacement therapy [OR 0.60 (0.41-0.90), P = 0.02)] or intensive care unit transfers [OR 1.02 (0.95-1.09), P = 0.53] after Bonferroni correction. Even in a subset of patients at high risk of renal injury, hydroxyethyl starch use was not associated with worse outcomes.

CONCLUSIONS

Hydroxyethyl starch 130/0.4 use was not significantly associated with a greater incidence of postoperative acute kidney injury compared to receiving crystalloid solutions only.

Incidence of Acute Kidney Injury and Mortality Post Successful Cardiac Surgery in a Kashmiri Cohort: A Prospective Comparison of the RIFLE and KDIGO Criteria

Background and objectives In critically ill patients, acute kidney injury (AKI) influences mortality and morbidity. Few studies have looked at mortality and the frequency of AKI following successful heart and thoracic operations. The current study investigates the association between AKI and mortality rates among patients undergoing post-cardiac surgery care within the Cardiology & Cardio Vascular Thoracic Surgery (CVTS) Intensive Care Unit (ICU). Methodology In this prospective research, 124 patients who underwent successful cardiovascular and thoracic procedures between June 2022 and June 2023 were admitted to the CVTS ICU. To determine mortality, we contrasted the two scoring methods, Kidney Disease-Improving Global Outcomes (KDIGO) and Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE). Results Based on the KDIGO criteria, AKI was identified in 37.90% (n = 47) of the patients, and it was identified in 15.32% (n = 19) of the patients utilizing RIFLE. Notably, patients diagnosed with AKI using either the RIFLE criteria or KDIGO criteria exhibited considerably higher mortality rates (p< 0.001). Receiver operating characteristic (ROC) analysis demonstrated the effectiveness of both scoring systems in identifying mortality (area under the ROC curve for RIFLE = 0.224 and KDIGO = 0.150). Conclusion Post-cardiac surgery, AKI escalates both mortality and morbidity rates. Despite KDIGO detecting more severe renal injury and mortality, both scoring systems exhibit comparable sensitivity and specificity in predicting death among patients undergoing various cardiovascular and thoracic procedures.

Urantide alleviates atherosclerosis-related liver and kidney injury via the Wnt/β-catenin signaling pathway in ApoE(-/-) mice

OBJECTIVE

To investigate the role of urantide in the prevention and treatment of atherosclerosis (AS)-related liver and kidney injury by antagonizing the urotensin II/urotensin receptor (UII/UT) system and regulating the Wnt/β-catenin signaling pathway.

METHODS

Atherosclerotic ApoE-/- mice were treated with 20 mg/kg, 30 mg/kg, and 40 mg/kg urantide for 14 days.

RESULTS

When ApoE-/- mice developed AS, significant pathological changes occurred in the liver and kidney, and the UII/UT system in tissue was highly activated; furthermore, the Wnt/β-catenin signalling pathway was activated, and proteins related to this signalling pathway, such as GSK-3β, AXIN2, CK‑1, and APC, were significantly downregulated. After urantide treatment, the pathological damage to the liver and kidney was effectively improved, the activity of the UII/UT system was effectively inhibited, and the expression of the Wnt/β-catenin signalling pathway and related proteins was restored. Wnt/β-catenin signals were mainly localized in the cytoplasm, renal tubules, and interstitium.

CONCLUSION

Urantide could improve AS-related liver and kidney injury by antagonizing the UII/UT system, and the improvements in liver and kidney function in atherosclerotic ApoE-/- mice may be related to inhibition of the Wnt/β-catenin signalling pathway.

Intraoperative hypotension associated with postoperative acute kidney injury in hypertension patients undergoing non-cardiac surgery: a retrospective cohort study

Background

Acute kidney injury (AKI) is a common surgical complication and is associated with intraoperative hypotension. However, the total duration and magnitude of intraoperative hypotension associated with AKI remains unknown. In this study, the causal relationship between the intraoperative arterial pressure and postoperative AKI was investigated among chronic hypertension patients undergoing non-cardiac surgery.

Methods

A retrospective cohort study of 6552 hypertension patients undergoing non-cardiac surgery (2011 to 2019) was conducted. The primary outcome was AKI as diagnosed with the Kidney Disease-Improving Global Outcomes criteria and the primary exposure was intraoperative hypotension. Patients' baseline demographics, pre- and post-operative data were harvested and then analyzed with multivariable logistic regression to assess the exposure-outcome relationship.

Results

Among 6552 hypertension patients, 579 (8.84%) had postoperative AKI after non-cardiac surgery. The proportions of patients admitted to ICU (3.97 vs. 1.24%, p < 0.001) and experiencing all-cause death (2.76 vs. 0.80%, p < 0.001) were higher in the patients with postoperative AKI. Moreover, the patients with postoperative AKI had longer hospital stays (13.50 vs. 12.00 days, p < 0.001). Intraoperative mean arterial pressure (MAP) < 60 mmHg for >20 min was an independent risk factor of postoperative AKI. Furthermore, MAP <60 mmHg for >10 min was also an independent risk factor of postoperative AKI in patients whose MAP was measured invasively in the subgroup analysis.

Conclusions

Our work suggested that MAP < 60 mmHg for >10 min measured invasively or 20 min measured non-invasively during non-cardiac surgery may be the threshold of postoperative AKI development in hypertension patients. This work may serve as a perioperative management guide for chronic hypertension patients.

Trial registration

clinical trial number: ChiCTR2100050209 (8/22/2021). http://www.chictr.org.cn/showproj.aspx?proj=132277.

Impact of Preoperative Chemotherapy on Postoperative Renal Dysfunction After Major Abdominal Surgery: A Prospective Observational Study

Introduction The administration of anti-cancer drugs and major abdominal surgeries have been independently identified to have a negative effect on renal function. The objectives of the study are to determine the incidence of acute kidney injury (AKI) in patients undergoing major elective abdominal surgery following chemotherapy and identify the independent predictors of postoperative AKI among such cancer patients in a tertiary care cancer institute in North India. Methods The prospective observational study included 149 patients aged 18 years or more, scheduled for elective major abdominal cancer surgery. Based on the administration of preoperative chemotherapy, the participants were divided into two study cohorts (Group 1: received preoperative chemotherapy; Group 2: did not receive preoperative chemotherapy). Patients' preoperative characteristics, including the use of preoperative chemotherapeutic agents and intraoperative factors, were evaluated for associations with the development of AKI postoperatively using the Chi-square test and Mann-Whitney U test. Multivariable logistic regression was employed to identify the factors after adjusting for potential confounders. Results The overall incidence of postoperative AKI in major abdominal oncosurgery was 24.2% among our study participants, which was significantly higher among patients receiving preoperative chemotherapy (32.4%) as compared to those who did not receive preoperative chemotherapy (16%) (p=0.019). Besides preoperative chemotherapy, the present study also noted that high levels of preoperative urinary protein-to-creatinine ratio (UPCR) and intraoperative use of vasopressors were significantly associated with an increased risk of postoperative AKI development in the final model, after adjustment for all potential confounders. A preoperative UPCR≥0.345 predicted the development of postoperative AKI with 77.8% sensitivity and 83.2% specificity. Conclusion Considering the magnitude of the problem, identification of determinants of postoperative AKI in major abdominal surgeries in cancer patients may help anesthetists and surgeons in early detection of AKI, so that prompt precautionary measures can be put in place that can potentially impact prognosis.

Effects of ACE inhibitor/ARB therapy and long COVID on kidney disease: a retrospective cohort study using real-world data

Background

The association between angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and severe acute respiratory syndrome coronavirus 2 susceptibility, particularly via ACE-2 receptor upregulation in the kidneys, raises concerns about potential kidney disease risks in long coronavirus disease (COVID) patients. This study explores the association of ACEI/ARB therapy on acute kidney injury (AKI), chronic kidney disease (CKD) and all-cause mortality in patients with and without long COVID.

Methods

A retrospective cohort study using TriNetX datasets was conducted, with diagnoses of long COVID via International Classification of Diseases, Tenth Revision (ICD-10) codes and prescription for ACEI/ARB as the classification of four cohorts: long COVID ACEI/ARB users (LCAUs), long COVID ACEI/ARB non-users (LCANs), non-long COVID ACEI/ARB users (NLCAUs) and non-long COVID ACEI/ARB non-users (NLCANs). Multivariable stratified Cox proportional hazards regression models assessed the adjusted hazard ratios (aHRs) across groups. Additional analyses were conducted, including time-dependent exposure analysis and comparison with an active comparator, calcium channel blockers.

Results

Our study included 18 168 long COVID and 181 680 propensity score-matched non-long COVID patients from October 2021 to October 2023. ACEI/ARB use did not significantly affect the risk of AKI or CKD when comparing LCAUs with LCANs and NLCAUs with NLCANs. However, a protective effect against all-cause mortality was observed {aHR 0.79 [95% confidence interval (CI) 0.65-0.93]} in the NLCAU group compared with the NLCAN group. Conversely, long COVID was associated with increased risks of CKD [aHR 1.49 (95% CI 1.03-2.14)] and all-cause mortality [aHR 1.49 (95% CI 1.00-2.23)] when comparing LCANs with NLCANs. The additional analyses support the primary findings.

Conclusions

ACEI/ARB treatment does not increase the incidence of CKD or AKI, regardless of long COVID status. However, long COVID itself is associated with increasing risks of kidney diseases and all-cause mortality.

A machine learning-based approach for predicting renal function recovery in general ward patients with acute kidney injury

BACKGROUND

Acute kidney injury (AKI) is a significant challenge in healthcare. While there are considerable researches dedicated to AKI patients, a crucial factor in their renal function recovery, is often overlooked. Thus, our study aims to address this issue through the development of a machine learning model to predict restoration of kidney function in patients with AKI.

METHODS

Our study encompassed data from 350,345 cases, derived from three hospitals. AKI was classified in accordance with the Kidney Disease: Improving Global Outcomes. Criteria for recovery were established as either a 33% decrease in serum creatinine levels at AKI onset, which was initially employed for the diagnosis of AKI. We employed various machine learning models, selecting 43 pertinent features for analysis.

RESULTS

Our analysis contained 7,041 and 2,929 patients' data from internal cohort and external cohort respectively. The Categorical Boosting Model demonstrated significant predictive accuracy, as evidenced by an internal area under the receiver operating characteristic (AUROC) of 0.7860, and an external AUROC score of 0.7316, thereby confirming its robustness in predictive performance. SHapley Additive exPlanations (SHAP) values were employed to explain key factors impacting recovery of renal function in AKI patients.

CONCLUSION

This study presented a machine learning approach for predicting renal function recovery in patients with AKI. The model performance was assessed across distinct hospital settings, which revealed its efficacy. Although the model exhibited favorable outcomes, the necessity for further enhancements and the incorporation of more diverse datasets is imperative for its application in real- world.

Regional variation in incidence and prognosis of acute kidney injury

BACKGROUND

Examining regional variation in acute kidney injury (AKI) and associated outcomes may reveal inequalities and possibilities for optimization of the quality of care. Using the Danish medical databases, we examined regional variation in the incidence, follow-up and prognosis of AKI in Denmark.

METHODS

Patients with one or more AKI episodes in 2017 were identified using population-based creatinine measurements covering all Danish residents. Crude and sex-and-age-standardized incidence rates of AKI were estimated using census statistics for each municipality. Adjusted hazard ratios (aHR) of chronic kidney disease (CKD), all-cause death, biochemical follow-up and outpatient contact with a nephrology department after AKI were estimated across geographical regions and categories of municipalities, accounting for differences in demographics, comorbidities, medication use, lifestyle and social factors, and baseline kidney function.

RESULTS

We identified 63 382 AKI episodes in 58 356 adults in 2017. The regional standardized AKI incidence rates ranged from 12.9 to 14.9 per 1000 person-years. Compared with the Capital Region of Denmark, the aHRs across regions ranged from 1.04 to 1.25 for CKD, from 0.97 to 1.04 for all-cause death, from 1.09 to 1.15 for biochemical follow-up and from 1.08 to 1.49 for outpatient contact with a nephrology department after AKI. Similar variations were found across municipality categories.

CONCLUSIONS

Within the uniform Danish healthcare system, we found modest regional variation in AKI incidence. The mortality after AKI was similar; however, CKD, biochemical follow-up and nephrology follow-up after AKI varied across regions and municipality categories.

Predictive approach for liberation from acute dialysis in ICU patients using interpretable machine learning

Renal recovery following dialysis-requiring acute kidney injury (AKI-D) is a vital clinical outcome in critical care, yet it remains an understudied area. This retrospective cohort study, conducted in a medical center in Taiwan from 2015 to 2020, enrolled patients with AKI-D during intensive care unit stays. We aimed to develop and temporally test models for predicting dialysis liberation before hospital discharge using machine learning algorithms and explore early predictors. The dataset comprised 90 routinely collected variables within the first three days of dialysis initiation. Out of 1,381 patients who received acute dialysis, 27.3% experienced renal recovery. The cohort was divided into the training group (N = 1135) and temporal testing group (N = 251). The models demonstrated good performance, with an area under the receiver operating characteristic curve of 0.85 (95% CI, 0.81-0.88) and an area under the precision-recall curve of 0.69 (95% CI, 0.62-0.76) for the XGBoost model. Key predictors included urine volume, Charlson comorbidity index, vital sign derivatives (trend of respiratory rate and SpO2), and lactate levels. We successfully developed early prediction models for renal recovery by integrating early changes in vital signs and inputs/outputs, which have the potential to aid clinical decision-making in the ICU.

Clinical epidemiology and outcomes of emergency department-acute kidney injury: A systematic review

Background

Over half of all community-acquired acute kidney injury (CA-AKI) initially presented to emergency department (ED), but emergency department acute kidney injury (ED-AKI) is poorly characterised, poorly understood with no systematic review, often under-recognized and under-managed.

Objective

To review the incidence, risk factors, and outcomes of ED-AKI, and risk factors of post-ED-AKI mortality globally.

Methods

We included published prospective or retrospective observational studies, controlled trials, and systematic reviews reporting AKI in adult ED attendees within 24 h of ED admission. Iatrogenic causes of AKI from medical interventions were excluded. We used PubMed to identify articles from 1996 to August 14, 2021, and adopted the National Heart, Lung, and Blood Institute (NHLBI) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies to assess risk of bias. We used a Forest plot to present pooled ED-AKI incidence rates and I2 statistics. Other parameters were summarized narratively.

Results

Using 24 h from ED admission as the definition for ED-AKI we identified six articles from 2005 to 2018 in high-income settings and one article with a 48-h timeframe. The pooled incidence of ED-AKI was 20 per 1000 adult ED attendances. Risk factors for ED-AKI included increasing age, nursing home residence, previous hospital admission within 30 days, discharge diagnosis of diabetes, obstructive uropathy, sepsis, gastrointestinal medical conditions, high serum creatinine, bilirubin, C-reactive protein, white blood cell, alanine aminotransferase, low serum sodium or albumin on admission, poor premorbid renal function, antibiotic use, active malignancy, lung disease, hyperlipidaemia, and infection. Crude, all-cause 24-h mortality rate was 4.56 % and the one-year mortality rate was 35.04 %. Increasing age and comorbidities including cardiovascular disease and malignancy were associated with higher mortality rates.

Conclusion

The review reveals a paucity of relevant literature which calls for further research, increased vigilance, red flag identification, and standardized management protocols for ED-AKI.

Admission proteinuria predicts the incidence of acute kidney injury among patients with acute ST-segment elevation myocardial infarction: a retrospective cohort study

BACKGROUND

Proteinuria indicates renal dysfunction and is associated with the development of acute kidney injury (AKI) in several conditions, but the association between proteinuria and AKI in patients with ST-segment elevation myocardial infarction (STEMI) remains unclear. This research aims to investigate the predictive value of proteinuria for the development of AKI in STEMI patients.

METHODS

A total of 2735 STEMI patients were enrolled. The present study's endpoint was AKI incidence during hospitalization. AKI is defined according to the Kidney Disease: Improving Global Outcomes criteria. We defined proteinuria, measured with a dipstick, as mild (1+) or heavy (2+ to 4+). Multivariate logistic regression and subgroup analyses were used to testify to the association between proteinuria and AKI.

RESULTS

Overall, proteinuria was observed in 634 (23.2%) patients. Multivariate logistic regression analyses revealed that proteinuria [odds ratio (OR), 1.58; 95% confidence interval (CI), 1.25-2.00; P  < 0.001] was the independent predictive factor for AKI. Severe proteinuria was associated with a higher adjusted risk for AKI compared with the nonproteinuria group (mild proteinuria: OR, 1.35; 95% CI, 1.04-1.75; P  = 0.025; severe proteinuria: OR, 2.50; 95% CI, 1.70-3.68; P  < 0.001). The association was highly consistent across all studied subgroups. (all P for interaction >0.05).

CONCLUSION

Admission proteinuria measured using a urine dipstick is an independent risk factor for the development of AKI in STEMI patients.

Highly Sensitive Early Diagnosis of Kidney Damage Using Renal Clearable Zwitterion-Coated Ferrite Nanoprobe via Magnetic Resonance Imaging In Vivo

Iron oxide nanoprobes exhibit substantial potential in magnetic resonance imaging (MRI) of kidney diseases and can eliminate the nephrotoxicity of gadolinium-based contrast agents (GBCAs). Nevertheless, there is an extreme shortage of highly sensitive and renal clearable iron oxide nanoprobes suitable for early kidney damage detection through MRI. Herein, a renal clearable ultra-small ferrite nanoprobe (UMFNPs@ZDS) is proposed for highly sensitive early diagnosis of kidney damage via structural and functional MRI in vivo for the first time. The nanoprobe comprises a ferrite core coated with a zwitterionic layer, and possesses a high T1 relaxivity (12.52 mm-1s-1), a small hydrodynamic size (6.43 nm), remarkable water solubility, excellent biocompatibility, and impressive renal clearable ability. In a rat model of unilateral ureteral obstruction (UUO), the nanoprobe-based MRI can not only accurately visualize the locations of renal injury, but also provide comprehensive functional data including peak value, peak time, relative renal function (RRF), and clearance percentage via MRI. The findings prove the immense potential of ferrite nanoprobes as a superior alternative to GBCAs for the early diagnosis of kidney damage.