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Birkelo BC, Pannu N, Siew ED. Overview of Diagnostic Criteria and Epidemiology of Acute Kidney Injury and Acute Kidney Disease in the Critically Ill Patient. Clin J Am Soc Nephrol 2022; 17:717-735. [PMID: 35292532 PMCID: PMC9269585 DOI: 10.2215/cjn.14181021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Since the description ischuria renalis by William Heberden (1), AKI has remained a prominent complication of critical illness. Beyond KRT, treatment has been limited by the capacity to phenotype this condition. Here, we chronicle the evolution of attempts to classify AKI, including the adoption of consensus definitions, the expansion of diagnosis and prognosis with novel biomarkers, and emerging tools such as artificial intelligence (AI).
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Affiliation(s)
- Bethany C. Birkelo
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for Acute Kidney Injury Research (VIP-AKI), Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Neesh Pannu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Edward D. Siew
- Vanderbilt Center for Kidney Disease (VCKD) and Integrated Program for Acute Kidney Injury Research (VIP-AKI), Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee
- Health Services Research and Development, Veterans Affairs Tennessee Valley, Nashville, Tennessee
- Veterans Affairs Geriatrics Research Education and Clinical Center (GRECC), Tennessee Valley Health System (THVS), Veteran’s Health Administration, Nashville, Tennessee
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Birkelo BC, Parr SK, Perkins AM, Greevy RA, Arroyo JP, Hung AM, Vincz AJ, Shah SC, Kapoor T, Matheny ME, Siew ED. Renin-Angiotensin-Aldosterone System Inhibitors and the Risk of AKI in COVID-19 Compared with Influenza. Clin J Am Soc Nephrol 2022; 17:423-425. [PMID: 35110376 PMCID: PMC8975037 DOI: 10.2215/cjn.11190821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Bethany C. Birkelo
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee
| | - Sharidan K. Parr
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee,Veterans Affairs Geriatrics Research Education and Clinical Center, Nashville, Tennessee
| | - Amy M. Perkins
- Veterans Affairs Geriatrics Research Education and Clinical Center, Nashville, Tennessee,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A. Greevy
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee,Veterans Affairs Geriatrics Research Education and Clinical Center, Nashville, Tennessee,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee
| | - Juan Pablo Arroyo
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee
| | - Adriana M. Hung
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee
| | - Andrew J. Vincz
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee
| | - Shailja C. Shah
- Gastroenterology Section, Veterans Affairs San Diego Health System, San Diego, California
| | - Tarun Kapoor
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee
| | - Michael E. Matheny
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee,Veterans Affairs Geriatrics Research Education and Clinical Center, Nashville, Tennessee,Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Edward D. Siew
- Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee,Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee,Veterans Affairs Geriatrics Research Education and Clinical Center, Nashville, Tennessee
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Birkelo BC, Parr SK, Perkins AM, Greevy RA, Hung AM, Shah SC, Arroyo JP, Denton J, Vincz AJ, Matheny ME, Siew ED. Comparison of COVID-19 versus influenza on the incidence, features, and recovery from acute kidney injury in hospitalized United States Veterans. Kidney Int 2021; 100:894-905. [PMID: 34111501 PMCID: PMC8183091 DOI: 10.1016/j.kint.2021.05.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/30/2021] [Accepted: 05/06/2021] [Indexed: 01/19/2023]
Abstract
Acute kidney injury is a common complication in patients hospitalized with SARSCoV-2 (COVID-19), with prior studies implicating multiple potential mechanisms of injury. Although COVID-19 is often compared to other respiratory viral illnesses, few formal comparisons of these viruses on kidney health exist. In this retrospective cohort study, we compared the incidence, features, and outcomes of acute kidney injury among Veterans hospitalized with COVID-19 or influenza and adjusted for baseline conditions using weighted comparisons. A total of 3402 hospitalizations for COVID-19 and 3680 hospitalizations for influenza admitted between October 1, 2019 and May 31, 2020 across 127 Veterans Administration hospitals nationally were studied using the electronic medical record. Acute kidney injury occurred more frequently among those with COVID-19 compared to those with influenza (40.9% versus 29.4%, weighted analysis) and was more severe. Patients with COVID-19 were more likely to require mechanical ventilation and vasopressors and experienced higher mortality. Proteinuria and hematuria were frequent in both groups but more common in COVID-19. Recovery of kidney function was less common in patients with COVID-19 and acute kidney injury but was similar among survivors. Thus, findings from this study confirm that acute kidney injury is more common and severe among patients hospitalized with COVID-19 compared to influenza, a finding that may be driven largely by illness severity. Hence, the combined impact of these two illnesses on kidney health may be significant and have important implications for resource allocation.
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Affiliation(s)
- Bethany C Birkelo
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA
| | - Sharidan K Parr
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amy M Perkins
- Veterans Affairs Geriatrics Research Education and Clinical Center, Tennessee Valley Health System, Veteran's Health Administration, Nashville, Tennessee, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Greevy
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee, USA
| | - Adriana M Hung
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee, USA
| | - Shailja C Shah
- Gastroenterology Section, VA San Diego Health System, San Diego, California, USA; Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Juan Pablo Arroyo
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA
| | - Jason Denton
- Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee, USA
| | - Andrew J Vincz
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Clinical Sciences Research and Development, Nashville, Tennessee, USA
| | - Michael E Matheny
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Veterans Affairs Geriatrics Research Education and Clinical Center, Tennessee Valley Health System, Veteran's Health Administration, Nashville, Tennessee, USA; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
| | - Edward D Siew
- Vanderbilt University Medical Center, Division of Nephrology and Hypertension, Vanderbilt Center for Kidney Disease and Integrated Program for Acute Kidney Injury Research, Nashville, Tennessee, USA; Veterans Affairs Tennessee Valley, Health Services Research and Development, Nashville, Tennessee, USA; Veterans Affairs Geriatrics Research Education and Clinical Center, Tennessee Valley Health System, Veteran's Health Administration, Nashville, Tennessee, USA.
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