AKI Current Awareness Bulletin July 2020

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Title: Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection? Citation: Journal of Human HypertensionJournal of Human Hypertension; Jun 2020; vol. 34 (no. 6); p. 420-431 Author(s): Cortese F.; Andriani A.; Truncellito L.; Cecere A.; Valente F.; Matteo Ciccone M.; Maria Cortese A.; Giordano P. Abstract: Arterial hypertension is a systemic condition characterized by elevated blood pressure in the vascular system. Despite the great effort of scientific community to sensitize population to the problem, enforcing the preventive and treatment measures, this condition continues to be responsible for a large portion of global mortality, as it represents one of the major modifiable risk factors of cardiovascular disease. The significant and substantial clinical implications of high blood pressure on cardiovascular morbidity and mortality are explained by the effect of hypertension on specific organs, particularly sensitive to the effects of changes in blood pressure, resulting cardiac remodeling, cerebrovascular disease, renal failure, atherosclerotic vascular disease, and retinopathy, hence the term "target organ damage". The aim of this review is to give an overview of several noninvasive tools useful in the detection of organ damage related to arterial hypertension. Copyright © 2020, The Author(s), under exclusive licence to Springer Nature Limited.

Title: Infection Post-AKI: Should We Worry? Citation: Nephron; Jun 2020 ; p. 1-4 Author(s): Gist K.M.; Faubel S. Abstract: Acute kidney injury (AKI) continues to be a major problem among hospitalized patients, and there is a growing appreciation that the high mortality in AKI may be due to its deleterious systemic effects. Recent research has begun to disentangle kidney-organ cross talk, wherein the host response to AKI becomes maladaptive, resulting in effects on numerous remote organs such as the lung, heart, liver, spleen, and brain. AKI also adversely affects immune function and is widely considered an immunosuppressed state. A wealth of data has accumulated that patients with AKI have a substantial increased risk of subsequent infection and sepsis. Indeed, sepsis is the leading cause of death in patients with established AKI. Unfortunately, little is known regarding the nature of the abnormal immune response that increases the risk for septic complications which may be persistent and prolonged. Until mechanistic pathways that drive the AKI-immune system-infection process are identified, and physicians should attempt to minimize AKI, its severity, and duration and anticipate infectious complications. Copyright © 2020 S. Karger AG, Basel.

Title: Acute Kidney Injury and Special Considerations during Renal Replacement Therapy in Children with Coronavirus Disease-19: Perspective from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care. Citation: Blood purification; Jul 2020 ; p. 1-11 Author(s): Deep, Akash; Bansal, Mehak; Ricci, Zaccaria Abstract: Children seem to be less severely affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as compared to adults. Little is known about the prevalence and pathogenesis of acute kidney injury (AKI) in children affected by SARS-CoV-2. Dehydration seems to be the most common trigger factor, and meticulous attention to fluid status is imperative. The principles of initiation, prescription, and complications related to renal replacement therapy are the same for coronavirus disease (COVID) patients as for non-COVID patients. Continuous renal replacement therapy (CRRT) remains the most common modality of treatment. When to initiate and what modality to use are dependent on the available resources. Though children are less often and

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less severely affected, diversion of all hospital resources to manage the adult surge might lead to limited CRRT resources. We describe how these shortages might be mitigated. Where machines are limited, one CRRT machine can be used for multiple patients, providing a limited number of hours of CRRT per day. In this case, increased exchange rates can be used to compensate for the decreased duration of CRRT. If consumables are limited, lower doses of CRRT (15-20 mL/kg/h) for 24 h may be feasible. Hypercoagulability leading to frequent filter clotting is an important issue in these children. Increased doses of unfractionated heparin, combination of heparin and regional citrate anticoagulation, or combination of prostacyclin and heparin might be used. If infusion pumps to deliver anticoagulants are limited, the administration of low-molecular-weight heparin might be considered. Alternatively in children, acute peritoneal dialysis can successfully control both fluid and metabolic disturbances. Intermittent hemodialysis can also be used in patients who are hemodynamically stable. The keys to successfully managing pediatric AKI in a pandemic are flexible use of resources, good understanding of dialysis techniques, and teamwork.

Title: Gender differences in the susceptibility of hospital-acquired acute kidney injury: more questions than answers. Citation: International urology and nephrology; Jul 2020 Author(s): Schiffl, Helmut Abstract: Hospital-acquired acute kidney injury (HA-AKI) is a heterogeneous renal syndrome which occurs in different clinical settings. It is characterized by multiple aetiologies, various pathogeneses and unpredictable outcomes. HA-AKI, once predominantly viewed as a self-limited and reversible short-term condition, is now recognized as a harbinger for chronic kidney disease and a cause of long-term morbidity with an increased risk of cardiovascular, renal and cancer mortality. Recent clinical studies contradict the generally held belief that female sex is a risk factor for HA-AKI. They show, consistent with basic research performed with experimental models of AKI, that only male sex is associated with HA-AKI. The presence of testosterone, more likely than the absence of estrogen, plays a critical role in sex differences in the susceptibility of ischemia/reperfusion kidney injury. The conflicting data in epidemiological studies related to sex as susceptibility variable for human AKI, underscore the need for more rigorous, well designed observational studies taking into account the menopausal status and hormone therapy.

Title: AKI: an increasingly recognized risk factor for CKD development and progression. Citation: Journal of nephrology; Jul 2020 Author(s): Kurzhagen, J T; Dellepiane, S; Cantaluppi, V; Rabb, H Abstract: Acute kidney injury (AKI) is an increasing health burden with high morbidity and mortality rates worldwide. AKI is a risk factor for chronic kidney disease (CKD) development and progression to end stage renal disease (ESRD). Rapid action is required to find treatment options for AKI, plus to anticipate the development of CKD and other complications. Therefore, it is essential to understand the pathophysiology of AKI to CKD transition. Over the last several years, research has revealed maladaptive repair to be an interplay of cell death, endothelial dysfunction, tubular epithelial cell senescence, inflammatory processes and more-terminating in fibrosis. Various pathological mechanisms have been discovered and reveal targets for potential interventions. Furthermore, there have been clinical efforts measures for AKI prevention and progression including the development of novel biomarkers and prediction models. In this review, we provide an overview of pathophysiological mechanisms involved in kidney fibrosis. Furthermore, we discuss research gaps and promising therapeutic approaches for AKI to CKD progression.

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Title: Device Based Approaches to the Prevention of Contrast-Induced Acute Kidney Injury. Citation: Interventional cardiology clinics; Jul 2020; vol. 9 (no. 3); p. 395-401 Author(s): Nanayakkara, Shane; Kaye, David M Abstract: Contrast-induced acute kidney injury is not uncommon after percutaneous coronary intervention, particularly in high-risk patients. Pharmacologic approaches have not demonstrated significant benefit, and numerous device-based approaches exist targeting a variety of pathways. In this review, we summarize the most recent interventions and the evidence behind them.

Title: Contrast-Induced Acute Kidney Injury-Definitions, Epidemiology, and Implications. Citation: Interventional cardiology clinics; Jul 2020; vol. 9 (no. 3); p. 299-309 Author(s): Azzalini, Lorenzo; Kalra, Sanjog Abstract: Contrast-induced acute kidney injury (CI-AKI) is the acute onset of renal injury following exposure to iodinated contrast media. Several definitions have been used, which complicates the estimation of the epidemiological relevance of this condition and comparisons in outcome research. The incidence of CI-AKI increases as a function of patient and procedure complexity in coronary, endovascular, and structural interventions. CI-AKI is associated with a high burden of short- and long-term adverse events, and leads to increased healthcare costs. This review will provide an overview of the definitions, epidemiology, and implications of CI-AKI in patients undergoing coronary, endovascular, and structural catheter-based procedures.

Title: Pathophysiology of Contrast-Induced Acute Kidney Injury. Citation: Interventional cardiology clinics; Jul 2020; vol. 9 (no. 3); p. 293-298 Author(s): Bansal, Shweta; Patel, Rahul N Abstract: Passing contrast media through the renal vascular bed leads to vasoconstriction. The perfusion decrease leads to ischemia of tubular cells. Through ischemia and direct toxicity to renal tubular cells, reactive oxygen species formation is increased, enhancing the effect of vasoconstrictive mediators and decreasing the bioavailability of vasodilative mediators. Reactive oxygen species formation leads to oxidative damage to tubular cells. These interacting pathways lead to tubular necrosis. In the pathophysiology of contrast-induced acute kidney injury, low osmolar and iso-osmolar agents have theoretic advantages and disadvantages; however, clinically the difference in incidence of contrast-induced acute kidney injury has not changed.

Title: The need for disruptive innovation in acute kidney injury. Citation: Clinical and experimental nephrology; Jun 2020 Author(s): Doi, Kent Abstract: Acute kidney injury (AKI) is a threatening medical condition associated with poor outcomes at different settings. The development of standardized diagnostic criteria and new biomarkers addressed significant clinical impacts of AKI and the need for an early AKI detection, respectively. There have been some breakthroughs in understanding the pathogenesis of AKI through basic research; however, treatments against AKI aside from renal replacement therapy (RRT) have not shown adequate successful results. Biomarkers that could identify good responders to certain treatment are expected to facilitate translation of basic research findings. Most patients with severe AKI treated with RRT died due to multiple-organ failure, not renal dysfunction. Hence, it is essential to

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identify other organ dysfunctions induced by AKI as organ crosstalk. Also, a multidisciplinary approach of critical care nephrology is needed to evaluate a complex organ crosstalk in AKI. For disruptive innovation for AKI, we further explore these new aspects of AKI, which previously were considered outside the scope of nephrology.

Title: Piperacillin-Tazobactam Added to Vancomycin Increases Risk for Acute Kidney Injury: Fact or Fiction? Citation: Clinical Infectious Diseases; Jul 2020; vol. 71 (no. 2); p. 426-432 Author(s): Avedissian ; Pais, Gwendolyn M; Liu, Jiajun; Rhodes, Nathaniel J; Scheetz, Marc H Abstract: Vancomycin and piperacillin-tazobactam are 2 of the most commonly prescribed antibiotics in hospitals. Recent data from multiple meta-analyses suggest that the combination increases the risk for vancomycin-induced kidney injury when compared to alternative viable options. However, these studies are unable to prove biologic plausibility and causality as randomized controlled trials have not been performed. Furthermore, these studies define acute kidney injury according to thresholds of serum creatinine rise. Serum creatinine is not a direct indicator of renal injury, rather a surrogate of glomerular function. More reliable, specific, and sensitive biomarkers are needed to truly define if there is a causal relationship with increased toxicity when piperacillin-tazobactam is added to vancomycin. This viewpoint will explore the available evidence for and against increased acute kidney injury in the setting of vancomycin and piperacillin-tazobactam coadministration.

Title: Relationship of body mass index, serum creatine kinase, and acute kidney injury after severe trauma. Citation: The journal of trauma and acute care surgery; Jul 2020; vol. 89 (no. 1); p. 179-185 Author(s): Vasquez, Charles R; DiSanto, Thomas; Reilly, John P; Forker, Caitlin M; Holena, Daniel N; Wu, Qufei; Lanken, Paul N; Christie, Jason D; Shashaty, Michael G S Objectives: Body mass index (BMI) is associated with acute kidney injury (AKI) after trauma, but underlying mechanisms are unclear. Body mass index correlates with both excess adiposity and increased muscle mass. Since the latter could predispose to severe rhabdomyolysis after trauma, we hypothesized that the BMI-AKI association may be partially explained by a direct relationship of BMI with serum creatine kinase (CK). Methods: Prospective cohort study of 463 critically ill patients admitted to a level I trauma center from 2005 to 2015 with Injury Severity Score of >15 and serum CK measured in the first 7 days. We defined AKI by AKI Network creatinine criteria. We used simple linear regression to determine the association of BMI with peak CK and multivariable logistic regression to adjust the BMI-AKI association for peak CK and confounders. Results: Median age was 43 years, 350 (76%) were male, 366 (79%) had blunt mechanism, and median Injury Severity Score was 24. Body mass index was associated with peak CK (R = 0.05, p < 0.001). Acute kidney injury developed in 148 patients (32%), and median time to peak CK was 29 hours (interquartile range, 15-56 hours) after presentation. Body mass index was significantly associated with AKI in multivariable models adjusted for age, race, sex, diabetes, injury mechanism and severity, and red blood cell transfusions (odds ratio [OR], 1.31 per 5 kg/m; 95% confidence interval [CI], 1.09-1.58; p = 0.004). Adding peak CK to the model partially attenuated the association of BMI with AKI (OR, 1.26 per 5 kg/m; 95% CI, 1.04-1.52; p = 0.018), and peak CK was also associated with AKI (OR, 1.19 per natural log; 95% CI, 1.00-1.41; p = 0.049). Peak CK remained associated with AKI when restricted to patients with values of <5,000 U/L (OR, 1.31 per natural log; 95% CI, 1.01-1.69; p = 0.043). Conclusion: Serum CK correlated with BMI and partially attenuated the association of BMI with AKI after major trauma, suggesting that excess muscle injury may contribute to the BMI-AKI association. Level Of Evidence: Epidemiologic study, level III.

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Title: An Overview of Contrast-Associated Acute Kidney Injury Following Lower-Extremity Percutaneous Peripheral Interventions. Citation: The Journal of invasive cardiology; Jul 2020; vol. 32 (no. 7); p. 276-282 Author(s): Nguyen, Tung H; Sheikh, Omar; Sha'ar, Momhammed; Bansal, Shweta; Prasad, Anand Abstract: Contrast-associated acute kidney injury, resulting from the use of iodinated contrast media, is a well-known adverse event following endovascular procedures and is associated with poor prognosis when it happens. There is an abundance of literature studying acute kidney injury following percutaneous coronary interventions, with very few studies done in the setting of percutaneous peripheral intervention. Although both percutaneous coronary intervention and percutaneous peripheral intervention utilize iodinated contrast media, several differences exist that can affect the incidence and management of contrast-associated acute kidney injury. This article aims to review what we currently know about contrast-associated acute kidney injury and available prevention strategies, specifically following percutaneous peripheral interventions.

Title: Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study. Citation: The British journal of surgery; Jul 2020; vol. 107 (no. 8); p. 1023-1032 Author(s): STARSurg Collaborative Background: This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. Methods: This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery. Results: A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498). Conclusion: There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Title: Acute kidney injury in patients hospitalized with COVID-19. Citation: Kidney international; Jul 2020; vol. 98 (no. 1); p. 209-218 Author(s): Hirsch, Jamie S; Ng, Jia H; Ross, Daniel W; Sharma, Purva; Shah, Hitesh H; Barnett, Richard L; Hazzan, Azzour D; Fishbane, Steven; Jhaveri, Kenar D; Northwell COVID-19 Research Consortium; Northwell Nephrology COVID-19 Research Consortium Abstract: The rate of acute kidney injury (AKI) associated with patients hospitalized with Covid-19, and associated outcomes are not well understood. This study describes the presentation, risk factors and outcomes of AKI in patients hospitalized with Covid-19. We reviewed the health records for all

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patients hospitalized with Covid-19 between March 1, and April 5, 2020, at 13 academic and community hospitals in metropolitan New York. Patients younger than 18 years of age, with end stage kidney disease or with a kidney transplant were excluded. AKI was defined according to KDIGO criteria. Of 5,449 patients admitted with Covid-19, AKI developed in 1,993 (36.6%). The peak stages of AKI were stage 1 in 46.5%, stage 2 in 22.4% and stage 3 in 31.1%. Of these, 14.3% required renal replacement therapy (RRT). AKI was primarily seen in Covid-19 patients with respiratory failure, with 89.7% of patients on mechanical ventilation developing AKI compared to 21.7% of non-ventilated patients. 276/285 (96.8%) of patients requiring RRT were on ventilators. Of patients who required ventilation and developed AKI, 52.2% had the onset of AKI within 24 hours of intubation. Risk factors for AKI included older age, diabetes mellitus, cardiovascular disease, black race, hypertension and need for ventilation and vasopressor medications. Among patients with AKI, 694 died (35%), 519 (26%) were discharged and 780 (39%) were still hospitalized. AKI occurs frequently among patients with Covid-19 disease. It occurs early and in temporal association with respiratory failure and is associated with a poor prognosis.

Title: Acute Kidney Injury and Postoperative Atrial Fibrillation In Patients Undergoing Cardiac Surgery. Citation: Journal of cardiothoracic and vascular anesthesia; Jul 2020; vol. 34 (no. 7); p. 1783-1790 Author(s): Cole, Oana M; Tosif, Shervin; Shaw, Matthew; Lip, Gregory Y H Objective: To test the hypothesis that acute kidney injury (AKI) in the postoperative period could be an additional risk factor for the development of atrial fibrillation (AF) and to examine the risk factors for postoperative AF in the authors' cohort of patients. Design: A retrospective observational study. Setting: Large regional cardiothoracic surgical center in the UK. Participants: Patients undergoing elective cardiac surgery at the authors' institution between July 1, 2013, and December 31, 2018. Interventions: None. Measurements and Main Results: A total of 5,588 patients were included in the study. The incidence of postoperative AF was 1,384 (24.8%), and postoperative AKI occurred in 686 patients (12.3%). Postoperative AKI was significantly associated with postoperative AF after adjustment for preoperative variables (adjusted odds ratio = 1.572; 95% confidence interval = 1.295-1.908; p < 0.001). Other factors associated with postoperative AF were increasing age; increasing body mass index; New York Heart Association class ≥III; previous congestive heart failure; and recent myocardial infarction, coronary artery bypass graft with valve surgery, and aortic surgery (all p < 0.05). Conclusions: This analysis of a large, contemporary cohort of patients identifies postoperative AKI as an associated risk factor for postoperative AF, along with other perioperative variables. Early identification of this patient cohort would allow targeted preventative treatment to reduce the incidence of postoperative AF.

Title: Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure. Citation: European journal of internal medicine; Jul 2020; vol. 77 ; p. 66-72 Author(s): Sanchez-Serna, Juan; Hernandez-Vicente, Alvaro; Garrido-Bravo, Iris P; Pastor-Perez, Francisco; Noguera-Velasco, Jose A; Casas-Pina, Teresa; Rodriguez-Serrano, Ana I; Núñez, Julio; Pascual-Figal, Domingo Background: Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated heart failure (HF). Currently, AKI definitions consider creatinine levels at admission as reference of baseline renal function (RF). However, renal impairment may already be present at admission. We aimed to study the impact on AKI detection of considering outpatient RF as reference.

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Methods: In a cohort of 458 patients hospitalized for decompensated HF, we studied the occurrence of AKI using the standardized KDIGO criteria and grading (stages: 1, 2, 3), and considering two different definitions according to the RF used as reference or baseline: the latest outpatient measurement prior to admission vs. the first measurement at admission. We compared the prevalence, timing and prognostic value for both AKI definitions. Results: The definition based on outpatient RF was associated with an increase in overall AKI detection from 20.1% to 33.8% (p < 0.001), and from 3.1% to 5.0% for advanced stages (2-3) (p < 0.001); additionally, 12.5% of patients already had criteria of AKI at admission (36.8% of AKI cases). Both definitions were associated with longer hospital stay. However, only AKI already present at admission, as based on pre-hospital creatinine, was independently associated with all-cause death, in-hospital and after discharge, and death or HF readmission in the follow-up: 1 stage (HR 2.72, 95%CI 1.83-4.06, p < 0.001) and 2-3 stage (HR 7.29, 95%CI, 3.02-17.64, p < 0.001). Conclusions: Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since it improves early identification of AKI and has implications for risk assessment.

Title: Renal Trajectory Patterns Are Associated With Postdischarge Mortality in Patients With Cirrhosis and Acute Kidney Injury. Citation: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association; Jul 2020; vol. 18 (no. 8); p. 1858 Author(s): Mindikoglu, Ayse L; Hernaez, Ruben; Liu, Yan; Kramer, Jennifer R; Taylor, Thomas; Rana, Abbas; Kanwal, Fasiha Background & Aims: Little is known about long-term outcomes of acute kidney injury (AKI) in patients with cirrhosis. Outcomes can vary with stage of AKI, chronic kidney disease, and trajectory of renal function. Methods: We collected data from the Department of Veterans Affairs and identified 6917 patients with cirrhosis who developed AKI during hospitalization at any of its 127 hospitals, from 2004 through 2014. We used latent class analysis of serial creatinine measurements during the index hospitalization to determine trajectories of renal function. Results: Overall, 32% of patients died within 90 days of discharge from the hospital and 48% of patients died within 1 year. We identified 5 distinct in-hospital renal trajectories: mild AKI with full improvement (24.8% of patients died 90 within days), severe AKI with rapid improvement (24.7% of patients died within 90 days), moderate AKI with partial improvement (33.7% of patients died within 90 days), moderate to severe AKI with partial improvement (42.0% of patients died within 90 days), and severe AKI with minimal improvement (48.0% of patients died within 90 days). Trajectories were associated significantly with mortality within 90 days and 1 year of mortality. Patients with severe AKI with minimal improvement had the highest risk of death within 90 days (adjusted odds ratio, 3.08; 95% CI, 2.54-3.72) and within 1 year (adjusted odds ratio, 2.71; 95% CI, 2.25-3.27) compared with patients with mild AKI with full improvement. The highest 90-day postdischarge mortality (65.2%) was observed in patients with normal or near-normal prehospitalization renal function who developed severe AKI with minimal improvement during hospitalization. Conclusions: In an analysis of almost 7000 veterans with cirrhosis who were hospitalized for AKI, we found the pattern of renal trajectory to be associated with mortality after discharge. Renal trajectory patterns can be used to identify subgroups of patients with cirrhosis and AKI who should receive intensive postdischarge management.

Title: Contrast-induced acute kidney injury. Citation: Cardiovascular intervention and therapeutics; Jul 2020; vol. 35 (no. 3); p. 209-217 Author(s): Chandiramani, Rishi; Cao, Davide; Nicolas, Johny; Mehran, Roxana

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Abstract: Although major advancements in the field of cardiology have allowed for an increasing number of patients to undergo minimally invasive imaging and interventional procedures, contrast-induced acute kidney injury (CI-AKI) continues to be a dreaded complication among patients receiving intravascular contrast media. CI-AKI is characterized by progressive decline in kidney function within a few days of contrast medium administration. Physiological changes resulting from the direct nephrotoxic effect of contrast media on tubular epithelial cells and release of vasoactive molecules have been implicated in creating a state of increased oxidative stress and subsequent ischemic renal cell injury. Over the last several years, preventive strategies involving intravenous hydration, pharmaceutical agents and renal replacement therapies have resulted in lower rates of CI-AKI. However, due to the evolving paradigm of diagnostic and therapeutic interventions, several unanswered questions remain. This review highlights the epidemiology, pathogenesis and preventive strategies of CI-AKI.

Title: Impact of severe acute kidney injury and chronic kidney disease on allogeneic hematopoietic cell transplant recipients: a retrospective single center analysis. Citation: Bone marrow transplantation; Jul 2020; vol. 55 (no. 7); p. 1264-1271 Author(s): Gutiérrez-García, Gonzalo; Villarreal, Jesús; Garrote, Marta; Rovira, Montserrat; Blasco, Miquel; Suárez-Lledó, María; Rodríguez-Lobato, Luis Gerardo; Charry, Paola; Rosiñol, Laura; Marín, Pedro; Pedraza, Alexandra; Solano, María Teresa; Ramos, Carla; de Llobet, Noemí; Lozano, Miquel; Cid, Joan; Martínez, Carmen; Poch, Esteban; Carreras, Enric; Urbano-Ispizua, Álvaro; Fernández-Avilés, Francesc; Pereira, A; Quintana, Luis F Abstract: Acute kidney injury (AKI) increases early mortality in allogeneic hematopoietic cell transplant (allo-HCT) recipients and may accelerate chronic kidney disease (CKD) development. We analyzed prospective variables related to AKI and CKD in 422 allo-HCT recipients to establish risk factors of severe acute renal failure and CKD. Renal function and creatinine were periodically assessed from baseline till the last follow-up. Sixty-three patients (14%) developed severe AKI (AKI-3) at 100 days post transplant and 15% at 12 months. Variables associated with AKI-3 were age above 55 years [hazard ratio (HR): 2.4; p = 0.019], total body irradiation (TBI) (HR: 1.8; p = 0.044), high-risk cytomegalovirus reactivation (HR: 1.8; p = 0.041), and methotrexate as GVHD prophylaxis (HR: 2.1; p = 0.024). AKI-3 increased the mortality risk (HR: 2.5, 95% confidence interval: 1.9-3.4). The CKD prevalence in 161 living patients was 10.2% at the last follow-up and in most, CKD developed 1 year post HCT, independent of AKI. The CKD at 1 year post HCT was associated with increased mortality (HR: 3.54; p < 0.001). Interestingly, pretransplant CKD was associated with early mortality (HR: 5.6; p < 0.001). In fact, pre- and posttransplant CKD had independent unfavorable long-term outcomes. These pretransplant factors can potentially be targeted to improve allo-HCT outcomes.

Title: Point-of-care creatinine measurements to predict acute kidney injury. Citation: Acta anaesthesiologica Scandinavica; Jul 2020; vol. 64 (no. 6); p. 766-773 Author(s): Vaara, Suvi T; Glassford, Neil; Eastwood, Glenn M; Canet, Emmanuel; Mårtensson, Johan; Bellomo, Rinaldo Background: Plasma creatinine (Cr) is a marker of kidney function and typically measured once daily. We hypothesized that Cr measured by point-of-care technology early after ICU admission would be a good predictor of acute kidney injury (AKI) the next day in critically ill patients. Methods: We conducted a retrospective database audit in a single tertiary ICU database. We included patients with normal first admission Cr (CrF ) and identified a Cr value (CrP ) obtained within 6-12 hours from ICU admission. We used their difference converted into percentage (delta-Cr-%) to predict subsequent AKI (based on Cr and/or need for renal replacement therapy) the next day. We assessed predictive value by calculating area under the receiver characteristic curve (AUC), logistic regression models for AKI with and without delta-Cr-%, and the category-free net reclassifying index (cfNRI).

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Results: We studied 780 patients. Overall, 70 (9.0%) fulfilled the Cr AKI definition by CrP measurement. On day 2, 148 patients (19.0%) were diagnosed with AKI. AUC (95% CI) for delta-Cr-% to predict AKI on day 2 was 0.82 (95% CI 0.78-0.86), and 0.74 (95% CI 0.69-0.80) when patients with AKI based on the CrP were excluded. Using a cut-off of 17% increment, the positive likelihood ratio (95% CI) for delta-Cr-% to predict AKI was 3.5 (2.9-4.2). The cfNRI was 90.0 (74.9-106.1). Conclusions: Among patients admitted with normal Cr, early changes in Cr help predict AKI the following day.

Title: Association between transfusion of blood products and acute kidney injury following cardiac surgery. Citation: Acta anaesthesiologica Scandinavica; Jul 2020 Author(s): Rasmussen, S R; Kandler, K; Nielsen, R V; Jakobsen, P C; Ranucci, M; Ravn, H B Background: Acute kidney injury (AKI) is a serious complication following cardiac surgery associated with increased mortality. Red blood cell transfusion enhances the risk of developing AKI. However, the impact of other blood products on AKI is virtually unexplored. The aim of this study was to explore if transfusion of red blood cells, fresh frozen plasma and platelets alone or in combination was associated with postoperative AKI. Methods: Patients undergoing elective on-pump cardiac surgery were included (n=1960) between 2012 to 2014. Transfusion data were collected intraoperatively and until the first postoperative day. AKI was classified according to the KDIGO criteria. Data were analysed using univariate and stepwise multiple logistic regression with adjustment for clinical risk factors and complementary blood products. Results: AKI was observed in 542 patients (27.7%). In univariate analysis and following adjustment for clinical risk factors, administration of red blood cells, fresh-frozen plasma and platelets were all independently associated with KDIGO stage 2-3. Following additional adjustment for complementary blood products, only RBC transfusion remained significantly associated with AKI. A dose-dependent association between volume of RBC and degree of AKI severity was observed. Conclusion: Transfusion of all blood products in a dose-dependent manner increased the risk for AKI. However, in multivariate analysis combining all blood products, only RBC transfusion remained significantly associated with AKI development.

Title: Short Versus Extended Duration Vancomycin and Piperacillin/Tazobactam and the Incidence of Acute Kidney Injury in Noncritically Ill Patients. Citation: Journal of pharmacy practice; Jun 2020 ; p. 897190020933488 Author(s): Traversa, Alfredo; Hammond, Drayton A; Peksa, Gary D; DeMott, Joshua M Background: Vancomycin plus piperacillin-tazobactam (VPT) is a commonly used empiric combination of antimicrobials. Recently, studies have demonstrated an increase in acute kidney injury (AKI) associated with combination therapy of VPT. However, the majority of studies required patients to be on VPT for a minimum of 48 to 72 hours to be considered for inclusion and had extended treatment durations longer than most empiric, short course regimens. Objective: To assess the incidence of AKI in noncritically ill patients being treated with VPT for short-courses (24 to 60 hours) compared to patients receiving extended-courses (72 hours to 7 days). Methods: This was a retrospective cohort study comparing the incidence of AKI in noncritically ill patients receiving VPT for short and extended durations between January 2016 and August 2018. Fishers exact tests were used for differences in nominal data between groups and Mann-Whitney U tests were used for continuous data. Results: Of the 2567 screened, 154 patients were included in the short-course group and 106 were included in the extended-course group. The incidence of AKI for patients in the short-course group was 12% (19/154) versus 26% (28/106) in the extended-course group (odds ratio: 2.55, 95% CI: 1.33-4.87; P = .004).

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Conclusion: In noncritically ill patients, a short-course of VPT experienced less AKI compared to an extended-course. Clinicians should continue to practice strict antimicrobial stewardship for VPT therapies expected to continue beyond 72 hours.

Title: Mortality and pathophysiology of acute kidney injury according to time of occurrence in acute heart failure. Citation: ESC heart failure; Jun 2020 Author(s): Diebold, Matthias; Kozhuharov, Nikola; Wussler, Desiree; Strebel, Ivo; Sabti, Zaid; Flores, Dayana; Shrestha, Samyut; Martin, Jasmin; Staub, Daniel; Venge, Per; Mueller, Christian; Breidthardt, Tobias Aims: Acute kidney injury (AKI) during acute heart failure (AHF) is common and associated with increased morbidity and mortality. The underlying pathophysiological mechanism appears to have prognostic relevance; however, the differentiation of true, structural AKI from hemodynamic pseudo-AKI remains a clinical challenge. Methods and Results: The Basics in Acute Shortness of Breath Evaluation Study (NCT01831115) prospectively enrolled adult patients presenting with AHF to the emergency department. Mortality of patients was prospectively assessed. Haemoconcentration, transglomerular pressure gradient (n = 231) and tubular injury patterns (n = 253) were evaluated to investigate pathophysiological mechanisms underlying AKI timing (existing at presentation vs. developing during in-hospital period). Of 1643 AHF patients, 755 patients (46%) experienced an episode of AKI; 310 patients (19%; 41% of AKI patients) presented with community-acquired AKI (CA-AKI), 445 patients (27%; 59% of AKI patients) developed in-hospital AKI. CA-AKI but not in-hospital AKI was associated with higher mortality compared with no-AKI (adjusted hazard ratio 1.32 [95%-CI 1.01-1.74]; P = 0.04). Independent of AKI timing, haemoconcentration was associated with a lower two-year mortality. Transglomerular pressure gradient at presentation was significantly lower in CA-AKI compared to in-hospital AKI and no-AKI (P < 0.01). Urinary NGAL ratio concentrations were significantly higher in CA-AKI compared to in-hospital AKI (P < 0.01) or no-AKI (P < 0.01). Conclusions: CA-AKI but not in-hospital AKI is associated with increased long-term mortality and marked by decreased transglomerular pressure gradient and tubular injury, probably reflecting prolonged tubular ischemia due to reno-venous congestion. Adequate decongestion, as assessed by haemoconcentration, is associated with lower long-term mortality independent of AKI timing.

Title: Randomized Trial Comparing Double Versus Triple Bortezomib-Based Regimen in Patients With Multiple Myeloma and Acute Kidney Injury Due to Cast Nephropathy. Citation: Journal of clinical oncology : official journal of the American Society of Clinical Oncology; Jun 2020 ; p. JCO2000298\ Author(s): Bridoux, Frank; Arnulf, Bertrand; Karlin, Lionel; Blin, Nicolas; Rabot, Nolwenn; Macro, Margaret; Audard, Vincent; Belhadj, Karim; Pegourie, Brigitte; Gobert, Pierre; Cornec Le Gall, Emilie; Joly, Bertrand; Karras, Alexandre; Jaccard, Arnaud; Augeul-Meunier, Karine; Manier, Salomon; Royer, Bruno; Caillot, Denis; Tiab, Mourad; Delbes, Sébastien; Suarez, Felipe; Vigneau, Cécile; Caillard, Sophie; Arakelyan-Laboure, Nina; Roos-Weil, Damien; Chevret, Sylvie; Fermand, Jean Paul; MYRE study group Purpose: We report a multicenter controlled trial comparing renal recovery and tolerance profile of doublet versus triplet bortezomib-based regimens in patients with initial myeloma cast nephropathy (CN) and acute kidney injury (AKI) without need for dialysis. Methods: After symptomatic measures and high-dose dexamethasone, patients were randomly assigned to receive bortezomib plus dexamethasone (BD), or BD plus cyclophosphamide (C-BD). In patients with < 50% reduction of serum free light chains (sFLCs) after 3 cycles, chemotherapy was reinforced with either cyclophosphamide (BD group) or thalidomide (C-BD group).

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Results: Ninety-two patients were enrolled in each group. At random assignment, characteristics of the 2 groups were similar, including median age (68 years) and serum creatinine level (305.5 and 273.5 µmol/L in BD and C-BD group, respectively). At 3 months, renal response rate (primary end point) was not different (41 v 47 responders in the BD and C-BD groups, respectively; relative risk [RR], 0.87; P = .46). Very good partial response (free light chain reduction ≥ 90%) or more was achieved in 36 and 47 patients, respectively (RR, 0.76; P = .10). After 1 cycle of chemotherapy, 69 in the BD group and 67 patients in the C-BD group had achieved sFLC level ≤ 500 mg/L. Serious adverse events were recorded in 30 and 40 patients, respectively. At 12 months, 19 patients had died (9 in the BD group v 10 in the C-BD group), including 10 (6 in the BD group and 4 in the C-BD group) from myeloma progression and 3 (0 in the BD group and 3 in the C-BD group) from infection. Within median follow-up of 27 months, 43 and 42 patients switched to new therapy, respectively. Overall, 50 patients (24 in the BD group and 26 in the C-BD group) had died. Conclusion: This randomized study did not show any benefit of C-BD compared with BD on renal recovery of patients with initial CN not requiring dialysis. Adding cyclophosphamide did not sufficiently improve the efficacy-toxicity balance. Patients with myeloma with AKI are fragile, and indication for doublet or triplet regimen should be adapted to frailty.

Title: Incidence and Risk Factors for Acute Kidney Injury in Severely Injured Patients Using Current Kidney Disease: Improving Global Outcomes Definitions. Citation: Journal of the American College of Surgeons; Jun 2020 Author(s): Emigh, Brent J; Sahi, Saad L; Teal, Lindsey N; Blake, Jennifer C; Heron, Charlotte H; Teixeira, Pedro G; Coopwood, Ben; Cardenas, Tatiana C; Trust, Marc D; Brown, Carlos Vr Background: Acute kidney injury (AKI) is a significant cause of morbidity and mortality for critically injured trauma patients. The Kidney Disease: Improving Global Outcomes (KDIGO) practice guideline is the most up-to-date classification for AKI. The aims of this study were to determine the incidence and risk factors for AKI in critically injured trauma patients using the current KDIGO definitions. Study Design: A prospective cohort study was performed at our academic, Level 1 trauma center from September 2017 to August 2018. All adult trauma patients admitted to the surgical ICU were included. The primary outcome was the development of AKI, as defined by KDIGO. Secondary outcomes include hospital and ICU length of stay, ventilator days, and mortality. Results: 466 patients were included and 314 (67%) developed AKI. Those who developed AKI were more often hypotensive on admission (7% vs 2%), had higher Injury Severity Scores (ISS) (19 vs 13), more likely to have severe injuries to the chest (40% vs 24%) and extremities (20% vs 6%), received transfusion (41% vs 21%), sustained crush injuries (8% vs 1%), received radiocontrast (75% vs 47%), nephrotoxic medications (74% vs 60%), or vasopressors (15% vs 3%). After multivariate analysis, risk factors independently associated with AKI include age, ISS, severe extremity injuries, and radiocontrast, and vasopressors. Those who developed AKI had higher mortality (9% vs 2%). Conclusions: Using current KDIGO criteria, the incidence of AKI in critically injured trauma patients was higher than previously reported. Older patients, with more severe injuries to their extremities and chest and who have suffered crush injuries, appear to be the most at-risk. AKI in the critically injured patient results in an almost 5-fold increase in mortality.

Title: The Impact of Severe Acute Kidney Injury Requiring Renal Replacement Therapy on Survival and Renal Function of Heart Transplant Recipients - A UK Cohort Study. Citation: Transplant international : official journal of the European Society for Organ Transplantation; Jun 2020 Author(s): Wang, Lu; Wang, Tengyao; Rushton, Sally N; Parry, Gareth; Dark, John H; Sheerin, Neil S

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Background: Severe acute kidney injury (AKI), defined as requiring renal replacement therapy (RRT), is associated with higher mortality post-heart transplantation, but its long-term renal consequences are not known. Methods: Anonymised data of 3365 patients, who underwent heart transplantation between 1995 and 2017, were retrieved from the UK Transplant Registry. Multivariable binary logistic regression was performed to identify risk factors for severe AKI requiring RRT, Kaplan-Meier analysis to compare survival and renal function deterioration of the RRT and non-RRT groups, and multivariable Cox regression model to identify predicting factors of mortality and end-stage renal disease (ESRD). Results: 26.0% of heart recipients received RRT post-transplant. The RRT group has lower survival rates at all time points, especially in the immediate post-transplant period. However, conditional on 3 months survival, older age, diabetes, and coronary heart disease, but not post-transplant RRT, were the risk factors for long-term survival. The predicting factors for ESRD were insulin-dependent diabetes, renal function at transplantation, eGFR decline in the first 3 months post-transplant, post-transplant severe AKI, and transplantation era. Conclusions: Severe AKI requiring RRT post-transplant is associated with worse short-term survival, but has no impact on long-term mortality. It also accelerates recipients' renal function deterioration in the long term.

Title: Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation. Citation: BJGP open; Jun 2020 Author(s): Tsang, Jung Yin; Murray, Jonathan; Kingdon, Edward; Tomson, Charlie; Hallas, Kyle; Campbell, Stephen; Blakeman, Tom Background: Acute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care. Aim: To establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI. Design & Setting: An appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK. Method: A 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria. Results: Taking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1-2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI. Conclusion: Systems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.

Title: Population attributable risk estimates of risk factors for contrast-induced acute kidney injury following coronary angiography: a cohort study. Citation: BMC cardiovascular disorders; Jun 2020; vol. 20 (no. 1); p. 289

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Author(s): Lei, Li; Xue, Yan; Guo, Zhaodong; Liu, Bowen; He, Yibo; Song, Feier; Liu, Jin; Sun, Guoli; Chen, Liling; Chen, Kaihong; Su, Zhiqi; Pan, Li; Huang, Zhidong; Huang, Yulu; Huang, Xiuqiong; Chen, Shiqun; Chen, Jiyan; Liu, Yong Background: Contrast-induced acute kidney injury (CI-AKI) is a common complication with poor outcomes following coronary angiography (CAG) or percutaneous coronary intervention (PCI). However, no study has explored the population attributable risks (PARs) of the CI-AKI risk factors. Therefore, we aimed to identify the independent risk factors of CI-AKI and estimate their PARs. Methods: We analyzed 3450 consecutive patients undergoing CAG/PCI from a prospective cohort in Guangdong Provincial People's Hospital. CI-AKI was defined as a serum creatinine elevation ≥50% or 0.3 mg/dL from baseline within the first 48 to 72 h after the procedure. Independent risk factors for CI-AKI were evaluated through stepwise approach and multivariable logistic regression analysis, and those that are potentially modifiable were of interest. PARs of independent risk factors were calculated with their odds ratios and prevalence among our cohort. Results: The overall incidence of CI-AKI was 7.19% (n = 248), which was associated with increased long-term mortality. Independent risk factors for CI-AKI included heart failure (HF) symptoms, hypoalbuminemia, high contrast volume, hypotension, hypertension, chronic kidney disease stages, acute myocardial infarction and age > 75 years. Among the four risk factors of interest, the PAR of HF symptoms was the highest (38.06%), followed by hypoalbuminemia (17.69%), high contrast volume (12.91%) and hypotension (4.21%). Conclusions: These modifiable risk factors (e.g., HF symptoms, hypoalbuminemia) could be important and cost-effective targets for prevention and treatment strategies to reduce the risk of CI-AKI. Intervention studies targeting these risk factors are needed.

Title: Low hemoglobin levels are independently associated with neonatal acute kidney injury: a report from the AWAKEN Study Group. Citation: Pediatric research; Jun 2020 Author(s): Nada, Arwa; Askenazi, David; Boohaker, Louis J; Li, Linzi; Mahan, John D; Charlton, Jennifer; Griffin, Russell L; AWAKEN Study Group Background: Studies in adults showed a relationship between low hemoglobin (Hb) and acute kidney injury (AKI). We performed this study to evaluate this association in newborns. Methods: We evaluated 1891 newborns from the Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN) database. We evaluated the associations for the entire cohort and 3 gestational age (GA) groups: <29, 29-<36, and ≥36 weeks' GA. Results: Minimum Hb in the first postnatal week was significantly lower in neonates with AKI after the first postnatal week (late AKI). After controlling for multiple potential confounders, compared to neonates with a minimum Hb ≥17.0 g/dL, both those with minimum Hb ≤12.6 and 12.7-14.8 g/dL had an adjusted increased odds of late AKI (aOR 3.16, 95% CI 1.44-6.96, p = 0.04) and (aOR 2.03, 95% CI 1.05-3.93; p = 0.04), respectively. This association was no longer evident after controlling for fluid balance. The ability of minimum Hb to predict late AKI was moderate (c-statistic 0.68, 95% CI 0.64-0.72) with a sensitivity of 65.9%, a specificity of 69.7%, and a PPV of 20.8%. Conclusions: Lower Hb in the first postnatal week was associated with late AKI, though the association no longer remained after fluid balance was included. Impact: The current study suggests a possible novel association between low serum hemoglobin (Hb) and neonatal acute kidney injury (AKI).The study shows that low serum Hb levels in the first postnatal week are associated with increased risk of AKI after the first postnatal week. This study is the first to show this relationship in neonates. Because this study is retrospective, our observations cannot be considered proof of a causative role but do raise important questions and deserve further investigation. Whether the correction of low Hb levels might confer short- and/or long-term renal benefits in neonates was beyond the scope of this study.

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Title: Acute kidney injury demographics and outcomes: changes following introduction of electronic acute kidney injury alerts-an analysis of a national dataset. Citation: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association; Jun 2020 Author(s): Holmes, Jennifer; Donovan, Kieron; Geen, John; Williams, John; Phillips, Aled O Background: Electronic alerts for acute kidney injury (AKI) have been widely advocated. Our aim was to describe the changes in AKI demographics and outcomes following implementation of a national electronic AKI alert programme. Methods: A prospective national cohort study was undertaken to collect data on all cases of AKI in adult patients (≥18 years of age) between 1 April 2015 and 31 March 2019. Results: Over the period of data collection, there were 193 838 AKI episodes in a total of 132 599 patients. The lowest incidence of AKI was seen in the first year after implementation of electronic alerts. A 30-day mortality was highest in Year 1 and significantly lower in all subsequent years. A direct comparison of mortality in Years 1 and 4 demonstrated a significantly increased relative risk (RR) of death in Year 1: RR = 1.08 [95% confidence interval (CI) 1.054-1.114 P < 0.001]. This translates into a number needed to treat in Year 4 for one additional patient to survive of 69.5 (95% CI 51.7-106.2) when directly comparing the outcomes across the 2 years. The increase in the number of cases and improved outcomes was more pronounced in community-acquired AKI, and was associated with a significant increase in patient hospitalization. Conclusions: This study represents the first large-scale dataset to clearly demonstrate that a national AKI alerting system which highlights AKI is associated with a change in both AKI demographics and patient outcomes.

Title: Mortality and host response aberrations associated with transient and persistent acute kidney injury in critically ill patients with sepsis: a prospective cohort study. Citation: Intensive care medicine; Jun 2020 Author(s): Uhel, Fabrice; Peters-Sengers, Hessel; Falahi, Fahimeh; Scicluna, Brendon P; van Vught, Lonneke A; Bonten, Marc J; Cremer, Olaf L; Schultz, Marcus J; van der Poll, Tom; MARS consortium Purpose: Sepsis is the most frequent cause of acute kidney injury (AKI). The "Acute Disease Quality Initiative Workgroup" recently proposed new definitions for AKI, classifying it as transient or persistent. We investigated the incidence, mortality, and host response aberrations associated with transient and persistent AKI in sepsis patients. Methods: A total of 1545 patients admitted with sepsis to 2 intensive care units in the Netherlands were stratified according to the presence (defined by any urine or creatinine RIFLE criterion within the first 48 h) and evolution of AKI (with persistent defined as remaining > 48 h). We determined 30-day mortality by logistic regression adjusting for confounding variables and analyzed 16 plasma biomarkers reflecting pathways involved in sepsis pathogenesis (n = 866) and blood leukocyte transcriptomes (n = 392). Results: AKI occurred in 37.7% of patients, of which 18.4% was transient and 81.6% persistent. On admission, patients with persistent AKI had higher disease severity scores and more frequently had severe (injury or failure) RIFLE AKI stages than transient AKI patients. Persistent AKI, but not transient AKI, was associated with increased mortality by day 30 and up to 1 year. Persistent AKI was associated with enhanced and sustained inflammatory and procoagulant responses during the first 4 days, and a more severe loss of vascular integrity compared with transient AKI. Baseline blood gene expression showed minimal differences with respect to the presence or evolution of AKI. Conclusion: Persistent AKI is independently associated with sepsis mortality, as well as with sustained inflammatory and procoagulant responses, and loss of vascular integrity as compared with transient AKI.

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Sources Used: The following databases are used in the creation of this bulletin: CINAHL, EMBASE & Medline. Disclaimer: The results of your literature search are based on the request that you made, and consist of a list of references, some with abstracts. Royal United Hospital Bath Healthcare Library will endeavour to use the best, most appropriate and most recent sources available to it, but accepts no liability for the information retrieved, which is subject to the content and accuracy of databases, and the limitations of the search process. The library assumes no liability for the interpretation or application of these results, which are not intended to provide advice or recommendations on patient care.