The impact of acute kidney injury on frailty status in critical illness survivors-is there enough evidence?

Relationship between Braden Scale scores and acute kidney injury among patients with acute coronary syndrome: a multicentre retrospective cohort study

OBJECTIVES

To evaluate the impact of pressure ulcer events assessed by the Braden Scale (BS) on acute kidney injury (AKI) in patients with acute coronary syndrome (ACS).

DESIGN

A multicentre retrospective cohort study.

SETTING

Chest pain centres from seven tertiary hospitals in China.

PARTICIPANTS

We analysed 3185 patients with ACS from the Retrospective Evaluation of Acute Chest Pain study. The patients were divided into three groups (B1, B2 and B3) according to their BS scores (≤12 vs 13-14 vs ≥15, respectively) at admission.

OUTCOME MEASURES

AKI was defined according to the criteria of the 2012 Kidney Disease: Improving Global Outcomes. Multivariate logistic analysis was used to evaluate the relationship between the BS score and AKI.

RESULTS

There were 461 patients (14.5%) with ACS who had the complication of AKI. Patients with a lower score on the BS had a higher incidence of AKI (p<0.001). Multivariate logistic regression analysis showed that adjusted ORs of the BS score for AKI were 2.242 (B1 vs B3: 95% CI: 1.643 to 3.060, p<0.001) and 1.566 (B2 vs B3: 95% CI: 1.186 to 2.069, p=0.002). The receiver operating characteristic curve analysis showed that the area under the curve of the BS score was 0.719 (95% CI: 0.702 to 0.736; p<0.001) for AKI.

CONCLUSIONS

The BS score was independently associated with AKI. It may be a useful tool to identify those who may benefit from further prediction and prevention of AKI in patients with ACS.

TRAIL REGISTRATION NUMBER

ChiCTR1900024657 (http://www.chictr.org.cn/). The satge rekates to results.

Impact of postoperative acute kidney injury in patients undergoing major gastrointestinal surgery on 1-year survival and renal outcomes: a national multicentre cohort study

Background

The intermediate-term impact of acute kidney injury (AKI) in patients after major gastrointestinal and liver surgery has not been well characterized. This study aimed to evaluate the 1-year mortality rate and renal outcomes associated with postoperative AKI in a national prospective cohort.

Methods

This prospective multicentre, observational cohort with 1-year postoperative follow-up included adults undergoing major gastrointestinal and liver surgery across the UK and Ireland between 23 September and 18 November 2015. AKI was defined according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The primary outcome was death at 1-year after surgery, and the secondary outcome was Major Adverse Kidney Events (MAKE-365). Cox proportionate and multilevel logistic regression were used to account for case mix.

Results

Of 5745 patients across 173 centres, 1-year follow-up data was completed for 3504 patients (62.2 per cent, 126 centres), with attrition largely explained by centre non-participation (63.1 per cent). Some 13.6 per cent (475 of 3504) patients developed AKI by 7 days after surgery (stage 1: 9.2 per cent; stage 2/3: 4.3 per cent). At 1 year, 10.8 per cent (378 patients) experienced a MAKE-365 endpoint (303 patients had died, 61 had renal replacement therapy and 78 had renal dysfunction). Patients who experienced AKI by 7 days after surgery had a higher hazard of death at 1 year for KDIGO stage 1 (hazard ratio 1.50 (95 per cent c.i. 1.08 to 2.08), P = 0.016) and KDIGO stage 2/3 (hazard ratio 2.96 (95 per cent c.i. 2.02 to 4.33), P < 0.001). Both KDIGO stage 1 (odds ratio 2.09 (95 per cent c.i. 1.50 to 2.92), P < 0.001) and stage 2/3 (odds ratio 9.26 (95 per cent c.i. 6.31 to 13.59), P < 0.001) AKI were independently associated with MAKE-365.

Conclusion

AKI events within 7 days after gastrointestinal or liver surgery are associated with significantly worse survival and renal outcomes at 1 year.

Association of acute kidney injury with frailty in elderly population: a systematic review and meta-analysis

Aim: The objective of this study was to assess whether an elderly patient's frailty was associated with acute kidney injury (AKI) and to examine whether severe frailty group had an increased risk of AKI than mild-moderate group.Methods: We searched The Cochrane Library, PubMed, and EMBASE for relevant studies without language limitations before 1 March 2019 with a priori defined inclusion and exclusion criteria. Five population-based cohort studies were included for systematic review and meta-analysis.Results: Compared with the control group, the frailty group is significantly associated AKI (Odds Ratio = 2.05; 95% CI: 1.23-3.43). The moderate-severe frailty group has an increased risk of AKI than mild frailty group (Hazard Ratio = 2.87; 95% CI: 1.60-5.17.Conclusion: In conclusion, the available best evidence support an association between frailty and AKI among elder patients, thus relevant interventions should be taken among elderly under potential risk of AKI.