Risk Factors and Prognostic Factors of Acute Kidney Injury in Children: a Retrospective Study between 2003 and 2013

Summary： Recent report on epidemiology of acute kidney injury （AKI） is lacking for Chinese children. We aimed to investigate the risk factors for stage and prognostic factors for renal recovery in hospital- ized children. Pediatric patients （〈18 years old） admitted during 2003 to 2013 were enrolled in this study. AKI was defined and staged using Kidney Disease Improving Global Outcomes （KDIGO） crite- ria. Logistic regression analysis was performed to determine the risk factors and prognostic factors. The morbidity of pediatric AKI was 0.31% （205/65 237）. There were 45 （22.0%） cases in stage I, 30 （14.6%） cases in stage II and 130 （63.4%） cases in stage Ill. The majority of etiologies were intrinsic renal defects （85.4%）. Age, weight, vomit, etiology, blood urea nitrogen （BUN） at admission and sev- eral blood gas measurements were associated with AKI stage III. Age （OR=0.894; 95% CI, 0.832- 0.962; P=0.003）, vomit （OR=2.375; 95% CI, 1.058-5.333; P=0.036） and BUN at admission （OR=1.135;95% CI, 1.085-1.187; P〈0.001） were identified as independent risk factors for AKI stage Ill. After treatment, 172 （83.9%） patients achieved complete or partial recovery. The mortality was 3.9%. Variables were found as prognostic factors for renal recovery, such as age, stage, hospital stay, BUN at discharge, white blood cells, red blood cells, platelets （PLTs）, blood pH and urine blood. Among them, AKI stage（stage III vs. stage I ; OR, 6.506; 95% CI, 1.640-25.816; P=0.008）, BUN at discharge （OR, 0.918; 95% CI, 0.856-0.984; P=0.016） and PLTs （OR, 1.007; 95% CI, 1.001- 1.013; P=0.027） were identified as independent prognostic factors. AKI is still common in Chinese hos- pitalized children. Identified risk factors and prognostic factors provide guiding information for clinical management of AKI.

Risk factors for acute kidney injury following coronary artery bypass graft surgery in a Chinese population and development of a prediction model

BACKGROUND Acute kidney injury(AKI)after coronary artery bypass graft(CABG)surgery is associated with significant morbidity and mortality.This retrospective study aimed to establish a risk score for postoperative AKI in a Chinese population.METHODS A total of 1138 patients undergoing CABG were collected from September 2018 to May 2020 and divided into a derivation and validation cohort.AKI was defined according to the Kidney Disease Improving Global Outcomes(KDIGO)criteria.Multivariable logistic regression analysis was used to determine the independent predictors of AKI,and the predictive ability of the model was determined using a receiver operating characteristic(ROC)curve.RESULTS The incidence of cardiac surgery–associated acute kidney injury(CSA-AKI)was 24.17%,and 0.53%of AKI patients required dialysis(AKI-D).Among the derivation cohort,multivariable logistic regression showed that age≥70 years,body mass index(BMI)≥25 kg/m2,estimated glomerular filtration rate(eGFR)≤60 mL/min per 1.73 m2,ejection fraction(EF)≤45%,use of statins,red blood cell transfusion,use of adrenaline,intra-aortic balloon pump(IABP)implantation,postoperative low cardiac output syndrome(LCOS)and reoperation for bleeding were independent predictors.The predictive model was scored from 0 to32 points with three risk categories.The AKI frequencies were as follows:0-8 points(15.9%),9-17 points(36.5%)and≥18 points(90.4%).The area under of the ROC curve was 0.730(95%CI:0.691-0.768)in the derivation cohort.The predictive index had good discrimination in the validation cohort,with an area under the curve of 0.735(95%CI:0.655-0.815).The model was well calibrated according to the Hosmer-Lemeshow test(P=0.372).CONCLUSION The performance of the prediction model was valid and accurate in predicting KDIGO-AKI after CABG surgery in Chinese patients,and could improve the early prognosis and clinical interventions.

Incidence and Risk Factors of Acute Kidney Injury in ICU Patients of Omdurman Teaching Hospital

Background: Acute kidney injury (AKI) is a common complication in critically ill patients and it is commonly associated with high mortality and morbidity with adverse short and long term outcome. Objectives: The main objective of this study was to determine the incidence of acute kidney injury in ICU patients in Omdurman teaching hospital, and to assess the risk factors associated with the development of acute kidney injury in a critically ill patient. We also intended to find out the impact of acute kidney injury on ICU outcomes. Methods: In this descriptive prospective, cohort hospital-based study, 211 patients were studied and followed up during admission in ICU from November 2019 until July 2020 in Omdurman teaching hospital. Results: 61 patients of the total 211 patients developed renal impairment during their stay in ICU. 64% (39 patients) were males and 36% (22 patients) were female, mean age was 41 ± 5, renal impairment developed after a mean of 5 days of admission and the most common cause was decreased level of consciousness and severe hypotension, sepsis accounting for 40% of the admission. The outcome in ICU showed that the mortality rate was high up to 41% in patients who developed acute kidney injury, Sepsis accounted for over 96% (24 patients) who have passed away. Conclusions: Development of AKI in ICU is an important risk factor for poor outcomes in critically setting. Prevention is the best method for avoiding AKI, with the early identification and recognition of high-risk patients.

Risk factors and outcomes of acute kidney injury after intracoronary stent implantation

BACKGROUND:Acute kidney injury following percutaneous coronary intervention(PCI) is associated with a worse outcome.However,the risk factors and outcomes of acute kidney injury(AKI) in patients after intracoronary stent implantation are still unknown.METHODS:A retrospective case control study was done in 325 patients who underwent intracoronary stent implantation from January 2010 to March 2011 at the Drum Tower Hospital of Nanjing University School of Medicine.Those were excluded from the study if they had incomplete clinical data.The patients were divided into a normal group and a AKI group according to the standard of post-operation day 7 to identify AKI.The parameters of the patients included:1) pre-operative ones:age,gender,hypertension,diabetes mellitus,cerebrovascular disease,left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate(eGFR),hyperuricemia,proteinuria,emergency operation,hydration,medications(ACEI/ARBs,statins);2) intraoperative ones:dose of contrast media,operative time,hypotension;and 3) postoperative one:hypotension.The parameters were analyzed with univariate analysis and multivariate logistical regression analysis.RESULTS:Of the 325 patients,51(15.7%) developed AKI.Hospital day and in-hospital mortality were increased significantly in the AKI-group.Univariate analysis showed that age,pre-operative parameters(left ventricular insufficiency,peripheral angiopathy,creatinine,urea nitrogen,estimated glomerular filtration rate,hyperuricemia,proteinuria,hydration),emergency operation,intraoperative parameters(operative time,hypotension) and postoperative hypotension were significantly different.However,multivariate logistic regression analysis revealed that increased age(OR=0.253,95%CI=0.088-0.727),pre-operative proteinuria(OR=5.351,95%CI=2.128-13.459),pre-operative left ventricular insufficiency(OR=8.704,95%CI=3.170-23.898),eGFR<60 ml/min/1.73 m^2(OR=6.677,95%CI = 1.167-38.193),prolonged operative time,intraoperative hypotension(OR=25.245,95%CI=1.001-1.034) were independent risk factors of AKI.CONCLUSIONS:AKI is a common complication and associated with ominous outcome following intracoronary stent implantation.Increased age,pre-operative proteinuria,pre-operative left ventricular insufficiency,pre-operative low estimated glomerular filtration rate,prolonged operative time,intraoperative hypotension were the significant risk factors of AKI.

Risk Factors for Acute Kidney Injury in Patients Receiving Antibiotic Therapy:A Systematic Review and Meta-Analysis

[Objectives]To systematically analyze the risk factors for acute kidney injury(AKI)in patients treated with antibiotics and to conduct a meta-analysis of published clinical studies.[Methods]PubMed,Web of Science,and Embase were searched for relevant cohort and case-control studies from January 1,2001,to October 31,2022.Meta-analysis was performed using RevMan5.4 and StataMP15.[Results]A total of 22 studies were included.Regarding patient factors,serum creatinine(SCr;MD=1.03,95%CI of-0.07 to-0.02)was associated with increased antibiotic-associated AKI.Regarding the comorbidities and clinical factors,diabetes(OR=1.34,95%CI of 1.06 to 1.69,tumor(OR=2.07,95%CI of 1.13 to 3.79),pneumonia(OR=1.83,95%CI of 1.24 to 2.71),mechanical ventilation(OR=3.44,95%CI of 1.93 to 6.12),and ICU admission(OR=2.83,95%CI of 2.13 to 3.75)increased the risk of AKI in patients receiving antibiotic therapy.Regarding drug factors,diuretics(OR=2.76,95%CI of 2.16 to 3.52)increased the risk of antibiotic-associated AKI.[Conclusions]This paper may assist clinicians in predicting the risk factors for AKI in patients receiving antibiotic therapy.

Burden of multiple myeloma in China:an analysis of the Global Burden of Disease,Injuries,and Risk Factors Study 2019

Background:There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma(MM)in China;therefore,this study determined the characteristics of the disease burden of MM at national and provincial levels in China.Methods:The burden of MM,including incidence,mortality,prevalence,and disability-adjusted life years(DALYs),with a 95%uncertainty interval(UI),was determined in China following the general analytical strategy used in the Global Burden of Disease,Injuries,and Risk Factors Study 2019.The trends in the burden of MM from 1990 to 2019 were also evaluated.Results:There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05(95%UI,12.31-20.77)per 100,000 in 2019.The estimated number of incident case and deaths of MM were 18,793 and 13,421,with age-standardized incidence and mortality rates of 0.93(95%UI,0.67-1.15)and 0.67(95%UI,0.50-0.82)per 100,000,respectively.The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak(93.82)in the 70 to 74 years age group.Males had a higher burden than females,with approximately 1.5-to 2.0-fold sex difference in age-specific DALY rates in all age groups.From 1990 to 2019,the DALYs of MM increased 134%,from 148,479 in 1990 to 347,453 in 2019.Conclusion:The burden of MM has doubled over the last three decades,which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.

Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese intensive care units： a prospective cohort study

Background Acute kidney injury （AKI） has been recognized as a major healthcare problem affecting millions of patients worldwide.However,epidemiologic data concerning AKI in China are still lacking.The objectives of this study were to characterize AKI defined by RIFLE criteria,assess the association with hospital mortality,and evaluate the impact of AKI in the context of other risk factors.Methods This prospective multicenter observational study enrolled 3,063 consecutive patients from 1 July 2009 to 31 August 2009 in 22 ICUs across China's Mainland.We excluded patients who were admitted for less than 24 hours （n=1623）,younger than 18 years （n=127）,receiving chronic hemodialysis （n=29）,receiving renal transplantation （n=1） and unknown reasons （n=28）.There were 1255 patients in the final analysis.AKI was diagnosed and classified according to RIFLE criteria.Results There were 396 patients （31.6％） who had AKI,with RIFLE maximum class R,I,and F in 126 （10.0％）,91 （7.3％）,and 179 （14.3％） patients,respectively.Renal function deteriorated in 206 patients （16.4％）.In comparison with non AKI patients,patients in the risk class on ICU admission were more likely to progress to the injury class （odds ratio （OR） 3.564,95％ confidence interval （CI） 1.706-7.443,P =0.001],while patients in the risk class （OR 5.215,95％ CI 2.798-9.719,P ＜0.001） and injury class （OR 13.316,95％ CI 7.507-23.622,P ＜0.001） had a significantly higher probability of deteriorating into failure class.The adjusted hazard ratios for 90-day mortality were 1.884 for the risk group,3.401 for the injury group,and 5.306 for the failure group.Conclusions The prevalence of AKI was high among critically ill patients in Chinese ICUs.In comparison with non-AKI patients,patients with RIFLE class R or class I on ICU admission were more susceptibility to progression to class I or class F.The RIFLE criteria were robust and correlated well with clinical deterioration and mortality.

Risk Factors of Contrast-induced Acute Kidney Injury in Patients Undergoing Emergency Percutaneous Coronary Intervention

Background： Previous studies of contrast-induced acute kidney injury （CI-AK1） were mostly based on selective percutaneous coronary intervention （PCI） cases, and risk factors of CI-AKI after emergency PCI are unclear. The aim of this study was to explore the risk factors of CI-AKi in a Chinese population undergoing emergency PCI. Methods： A total of 1061 consecutive patients undergoing emergency PCI during January 2013 and June 2015 were enrolled and divided into CI-AK1 and non-CI-AKl group. Univariable and multivariable analyses were used to identity the risk factors of CI-AKI in emergency PCI patients. CI-AKI was defined as an increase in serum creatinine ≥25% or ≥0.5 mg/dl （44.2 μmol/L） above baseline within 3 days alter exposure to contrast medium. Results： The incidence of C1-AKI in patients undergoing emergency PCI was 22.7% （241/1061）. Logistic multivariable analysis showed that body surface area （BSA） （odds ratio [OR] 0.213, 95% confidence interval [CI]： 0.075-0.607, P = 0.004）, history, of myocardial infarction （MI） （OR 1.642, 95% CI. 1.079-2.499, P- 0.021 ）, left ventricular ejection fraction （LVEF） （OR 0.969, 95% CI： 0.944-0.994, P = 0.015）, hemoglobin （Hb） （OR 0.988, 95% CI. 0.976-1.000, P 1.018 1.037, P 〈 0.001 ）, left anterior descending （LAD） stented （OR 1 0.009 0.987, P- 0.049）, and diuretics use （OR 1.850, 95% CI： 1.233-2 0.045）, estimated glomerular filtration rate （OR 1.027, 95% CI： 464, 95% CI： 1.000 2.145, P 0.050）, aspirin （OR 0.097, 95%CI： .777, P - 0.003） were independent predictors of CI-AKI in patients undergoing emergency PCI. Conclusion： History of MI, low BSA, LVEF and Hb level, LAD stented, and diuretics use are associated with increased risk of CI-AK1 in patients undergoing emergency PCI.

Risk factors of prognosis after acute kidney injury in hospitalized patients

The risk factors, especially laboratory indicators, of prognosis after acute kidney injury （AK1） remain unclear. We conducted a retrospective survey of Chinese People＇s Liberation Army General Hospital from January 1, 2012 to December 31, 2012 according to the AKI diagnosis standard issued by Kidney Disease Improving Global Outcomes. The epidemiological features and factors influencing hospital mortality and renal function recovery were evaluated through logistic regression analysis. Among 77 662 cases of hospitalized patients, 1387 suffered from AKI. The incidence rate and mortality of AKI were 1.79~ and 14.56%, respectively. Multivariate logistic regression analysis revealed that high AKI stage, age greater than 80 years, neoplastic disease, low cardiac output, increased white blood cell count, and decreased platelet count and serum albumin levels were the risk factors affecting the mortality of AKI patients. Conversely, body mass index between 28 and 34.9 was a protective factor. Increased AKI stage, tumor disease, post-cardiopulmonary resuscitation, and RRT were the risk factors of renal function recovery upon discharge. In addition to traditional risk factors, white blood cell count, platelet count, albumin, and BMI were the predictors of the mortality of AKI patients. No laboratory indicators were found to be the risk factors of renal function recovery in AKI patients.

Two acute kidney injury risk scores for critically ill cancer patients undergoing non-cardiac surgery

BACKGROUND:Several risk scoures have been used in predicting acute kidney injury(AKI)of patients undergoing general or specific operations such as cardiac surgery.This study aimed to evaluate the use of two AKI risk scores in patients who underwent non-cardiac surgery but required intensive care.METHODS:The clinical data of patients who had been admitted to ICU during the first 24 hours of ICU stay between September 2009 and August 2010 at the Cancer Institute,Chinese Academy of Medical Sciences & Peking Union Medical College were retrospectively collected and analyzed.AKI was diagnosed based on the acute kidney injury network(AKIN) criteria.Two AKI risk scores were calculated:Kheterpal and Abelha factors.RESULTS:The incidence of AKI was 10.3%.Patients who developed AKI had a increased ICU mortality of 10.9%vs.1.0%and an in-hospital mortality of 13.0 vs.1.5%,compared with those without AKI.There was a significant difference between the classification of Kheterpal's AKI risk scores and the occurrence of AKI(P<0.001).There was no significant difference between the number of Abelha's AKI risk scores and the occurrence of AKI(P=0.499).Receiver operating characteristic curves demonstrated an area under the curve of 0.655±0.043(P=0.001,95%confidence interval:0.571-0.739) for Kheterpal's AKI risk score and 0.507±0.044(P=0.879,95%confidence interval:0.422-0.592) for Abelha's AKI risk score.CONCLUSION:Kheterpal's AKI risk scores are more accurate than Abelha's AKI risk scores in predicting the occurrence of AKI in patients undergoing non-cardiac surgery with moderate predictive capability.

An effective model for predicting acute kidney injury after liver transplantation

BACKGROUND: Acute kidney injury (AKI) is a common complication in the early period after liver transplantation (LT), posing an enormous obstacle to treatment efficiency and patient survival. However, the exact influencing factors of AKI are still unclear and a predictive model is desperately required in the clinic. METHODS: Data of 102 consecutive LTs were reviewed. A model for predicting AKI was established and further validated in a prospective study of 44-patients receiving LT. RESULTS: The incidence of AKI was 32.4%. AKI patients showed a significantly lower survival rate than non-AKI patients. Multivariate analysis demonstrated the independent influencing factors of AKI were preoperative serum creatinine >1.2 mg/dl, intraoperative urine output <= 60 ml/h, intraoperative hypotension status, and intraoperative use of noradrenaline. A model was then established and showed a sensitivity of 75.0%, a specificity of 93.8%, and an accuracy of 88.6% in predicting AKI. CONCLUSIONS: High preoperative serum creatinine, low intraoperative urine output, and intraoperative hypotension contribute to the development of AKI, and intraoperative use of noradrenaline serves as a protective factor. The predictive model could potentially facilitate early prediction and surveillance of AKI. (Hepatobilinty Pancreat Dis Int 2010; 9:259-263)

Effects of acute kidney injury on acute pancreatitis patients’ survival rate in intensive care unit: A retrospective study

BACKGROUND Acute kidney injury(AKI)is one of the most common acute pancreatitis(AP)-associated complications that has a significant effect on AP,but the factors affecting the AP patients’survival rate remains unclear.AIM To assess the influences of AKI on the survival rate in AP patients.METHODS A total of 139 AP patients were included in this retrospective study.Patients were divided into AKI group(n=72)and non-AKI group(n=67)according to the occurrence of AKI.Data were collected from medical records of hospitalized patients.Then,these data were compared between the two groups and further analysis was performed.RESULTS AKI is more likely to occur in male AP patients(P=0.009).AP patients in AKI group exhibited a significantly higher acute physiologic assessment and chronic health evaluation II score,higher Sequential Organ Failure Assessment score,lower Glasgow Coma Scale score,and higher demand for mechanical ventilation,infusion of vasopressors,and renal replacement therapy than AP patients in non-AKI group(P<0.01,P<0.01,P=0.01,P=0.001,P<0.01,P<0.01,respectively).Significant differences were noted in dose of norepinephrine and adrenaline,duration of mechanical ventilation,maximum and mean values of intra-peritoneal pressure(IPP),maximum and mean values of procalcitonin,maximum and mean serum levels of creatinine,minimum platelet count,and length of hospitalization.Among AP patients with AKI,the survival rate of surgical intensive care unit and in-hospital were only 23%and 21%of the corresponding rates in AP patients without AKI,respectively.The factors that influenced the AP patients’survival rate included body mass index(BMI),mean values of IPP,minimum platelet count,and hospital day,of which mean values of IPP showed the greatest impact.CONCLUSION AP patients with AKI had a lower survival rate and worse relevant clinical outcomes than AP patients without AKI,which necessitates further attention to AP patients with AKI in surgical intensive care unit.

Traditional Chinese medicine understanding of common complications of multiple myeloma

Multiple myeloma(MM)is a heterogeneous disease of the hematological system,characterized by different subtypes and different prognosis.Age,tumor burden,biological characteristics and treatment response can affect the prognosis.MM cells accumulate in bone marrow and produce abnormal immunoglobulin.Abnormal immunoglobulin does not participate in immune response and inhibits adaptive immune system is the most significant pathophysiological characteristics of MM.Hyperviscosity,amyloidosis,infection and kidney injury are the important complications of MM.This paper analyzes the traditional Chinese medicine(TCM)understanding of these important complications,and summarizes the commonly used clinical Chinese medicine,in order to provide important basis for the TCM treatment of multiple myeloma.

Management of acute kidney injury in gastrointestinal tumor:An overview

Gastrointestinal tumors remain a global health problem.Acute kidney injury(AKI)is a common complication during the treatment of gastrointestinal tumors.AKI can cause a decrease in the remission rate and an increase in mortality.In this review,we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients.The possible mechanisms of AKI were divided into three groups:pretreatment,intrafraction and post-treatment causes.Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.

Risk factors for acute kidney injury in patients with acute myocardial infarction

Background:Acute kidney injury (AKI) is a serious and fatal complication of acute myocardial infarction (AMI).It has high shortand long-term mortality rates and a poor prognosis but is potentially preventable.However,the current incidence,risk factors,and outcomes of AKI in the Chinese population are not well understood and would serve the first step to identify high-risk patients who could receive preventative care.Methods:The medical data of 1124 hospitalized patients diagnosed with AMI from October 2013 to September 2015 were reviewed.AKI was defined according to the 2012 Kidney Disease Improving Global Outcomes criteria.All the patients were divided into either the AKI group or the non-AKI group.A univariate comparison analysis was performed to identify possible risk factors associated with AKI.A multiple logistic regression analysis was used to identify the independent risk factors for AKI in patients with AMI.Results:Overall,the incidence of AKI was 26.0%.The mortality rate of the AKI group was 20.5 %,and the mortality rate of the nonAKI group was 0.6%(P < 0.001).Logistic regression analysis showed that the independent risk factors for AKI in patients with AMI included:age (>60 years old)(odds ratio [OR] 1.04,95% confidence interval [CI] 1.02-1.05,P =0.000),hypertension (OR 2.51,95% CI 1.62-3.87,P =0.000),chronic kidney disease (OR 3.52,95% CI 2.01-6.16,P =0.000),Killip class ≥3 (OR 5.22,95% CI 3.07-8.87,P =0.000),extensive anterior myocardial infarction (OR 3.02,95% CI 1.85--4.93,P =0.000),use of furosemide (OR 1.02,95% CI 1.02-1.03,P =0.000),non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker (OR 1.58,95% CI 1.04-2.40,P =0.032).These factors provided an accurate tool to identify patients at high risk of developing AKI.Contusions:Approximately 26.0% of patients undergoing AMI developed AKI,and the development of AKI was strongly correlated with in-hospital mortality.The risk factors for AKI in patients with AMI were determined to help identify high-risk patients and make appropriate clinical decisions.

Incidence and risk factors for early renal dysfunction after liver transplantation

AIM: To determine renal dysfunction post liver transplantation, its incidence and risk factors in patients from a Belgian University Hospital.METHODS: Orthotopic liver transplantations performed from January 2006 until September 2012 were retrospectively reviewed(n = 187). Patients with no renal replacement therapy(RRT) before transplantation were classified into four groups according to their highest creatinine plasma level during the first postoperative week. The first group had a peak creatinine level below 12 mg/L, the second group between 12 and 20 mg/L, the third group between 20 and 35 mg/L, and the fourth above 35 mg/L. In addition, patients who needed RRT during the first week after transplantation were also classified into the fourth group. Perioperative parameters were recorded as risk factors, namely age, sex, bodymass index(BMI), length of preoperative hospital stay, prior bacterial infection within one month, preoperative ascites, preoperative treatment with β-blocker, angiotensin-converting enzyme inhibitor or non steroidal anti-inflammatory drugs, preoperative creatinine and bilirubin levels, donor status(cardiac death or brain death), postoperative lactate level, need for intraoperative vasopressive drugs, surgical revision, mechanical ventilation for more than 24 h, postoperative bilirubin and transaminase peak levels, postoperative hemoglobin level, amount of perioperative blood transfusions and type of immunosuppression. Univariate and multivariate analysis were performed using logistic ordinal regression method. Post hoc analysis of the hemostatic agent used was also done.RESULTS: There were 78 patients in group 1(41.7%), 46 in group 2(24.6%), 38 in group 3(20.3%) and 25 in group 4(13.4%). Twenty patients required RRT: 13(7%) during the first week after transplantation. Using univariate analysis, the severity of renal dysfunction was correlated with presence of ascites and prior bacterial infection, preoperative bilirubin, urea and creatinine level, need for surgical revision, use of vasopressor, postoperative mechanical ventilation, postoperative bilirubin and urea, aspartate aminotransferase(ASAT), and hemoglobin levels and the need for transfusion. The multivariate analysis showed that BMI(OR = 1.1, P = 0.004), preoperative creatinine level(OR = 11.1, P < 0.0001), use of vasopressor(OR = 3.31, P = 0.0002), maximal postoperative bilirubin level(OR = 1.44, P = 0.044) and minimal postoperative hemoglobin level(OR = 0.059, P = 0.0005) were independent predictors of early post-liver transplantation renal dysfunction. Neither donor status nor ASAT levels had significant impact on early postoperative renal dysfunction in multivariate analysis. Absence of renal dysfunction(group 1) was also predicted by the intraoperative hemostatic agent used, independently of the extent of bleeding and of the preoperative creatinine level.CONCLUSION: More than half of receivers experienced some degree of early renal dysfunction after liver transplantation. Main predictors were preoperative renal dysfunction, postoperative anemia and vasopressor requirement.

Epidemiology of acute kidney injury in intensive care septic patients based on the KDIGO guidelines

Background Acute kidney injury （AKI） is a common complication of sepsis,which is associated with higher risks of adverse outcomes.Recently,kidney disease：improving global outcomes （KDIGO） recommended a new guideline forAKI,including a little modification on the AKI staging criteria.Methods This retrospective study included 211 septic patients admitted to the intensive care unit （ICU） at Xiangya Hospital,Central South University from January 2008 to January 2011.AKI was diagnosed and classified according to the KDIGO or acute kidney injury network （AKIN） criteria.Differences between the AKI and non-AKI groups for baseline characteristics,laboratory examinations,etiology,outcomes,as well as the risk factors for AKI and 28-day mortality were analyzed.The reliability of the KDIGO criteria was also evaluated by comparing it with the AKIN criteria.Results The overall incidence of AKI in septic patients was 47.9％,and the 28-day mortality was 32.7％.The incidence of AKI was significantly higher in patients with more severe sepsis.Indicators of hepatic and respiratory function were significantly worse in the AKI group.Furthermore,a higher proportion of patients were infected with Enterobacter cloacae in the AKI group.The independent risk factors for AKI were shock,the number of organ failures,blood urea nitrogen （BUN）levels,and the use of vasopressors.The independent risk factors for mortality were BUN and creatine kinase-MB （CK-MB）levels.Both the KDIGO criteria and the AKIN criteria were significantly associated with 28-day mortality.Conclusions The incidence and 28-day mortality of AKI were very high in ICU septic patients.Greater attention should be paid to AKI-induced hepatic and respiratory dysfunction in clinical practice.Patients with an intra-abdominal source of infection were more likely to develop AKI.KDIGO criteria are reliable in AKI staging.

Acute kidney injury following adult lung transplantation

Background:Acute kidney injury(AKI)is a common and serious complication following lung transplantation(LTx),and it is associated with high mortality and morbidity.This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.Methods:This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019.The outcomes were AKI incidence,risk factors,mortality,and kidney recovery.Multivariate analysis was performed to identify independent risk factors.Survival analysis was presented using the Kaplan-Meier curves.Results:AKI occurred in 137 of the 191 patients(71.7%),with transient AKI in 43(22.5%)and persistent AKI in 94(49.2%).AKI stage 1 occurred in 27/191(14.1%),stage 2 in 46/191(24.1%),and stage 3 in 64/191(33.5%)of the AKI patients.Renal replacement therapy(RRT)was administered to 35/191(18.3%)of the patients.Male sex,older age,mechanical ventilation(MV),severe hypotension,septic shock,multiple organ dysfunction(MODS),prolonged extracorporeal membrane oxygenation(ECMO),reintubation,and nephrotoxic agents were associated with AKI(P<0.050).Persistent AKI was independently associated with pre-operative pulmonary hypertension,severe hypotension,post-operative MODS,and nephrotoxic agents.Severe hypotension,septic shock,MODS,reintubation,prolonged MV,and ECMO during or after LTx were related to severe AKI(stage 3)(P<0.050).Patients with persistent and severe AKI had a significantly longer duration of MV,longer duration in the intensive care unit(ICU),worse downstream kidney function,and reduced survival(P<0.050).Conclusions:AKI is common after LTx,but the pathogenic mechanism of AKI is complicated,and prerenal causes are important.Persistent and severe AKI were associated with poor short-and long-term kidney function and reduced survival in LTx patients.

Risk factors of prolonged recovery after Fontan operation

Background With low rates of mortality and morbidity, Fontan procedure has become the preferred approach for patients with univentricular heart disease. However, risk factors associated with prolonged postoperative recovery still remain uncertain. Methods Data on all patients admitted to the surgical intensive care unit （SICU） after a Fontan procedure from Jan 2010 to December 2014 were retrospectively analyzed. We excluded all patients who were expired. The study cohort was further divided into a prolonged recovery group that includ- ed patients with 〉75% ile for duration of SICU stay and mechanical ventilation, and a normal recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic and physiological variables between the prolonged and normal recovery groups. Results There were 164 Fon- tan operations performed and 159 patients in the study cohort. Groups were similar in demographic characteris- tics, preoperative hemodynamic parameters, and operative and immediate postoperative managements. A Fenes- trated Fontan procedure was present in 133 （83.6%）. The external Fontan procedure was present in 124 （78.0%）. Within the study population, 41 （25.8%） patients met criteria for prolonged recovery. Univariate risk factors for prolonged recovery included acute kidney injury （AKI, P=0.001）, preoperative prothrombin time and internation- al normalized ratio （P=0.02 and 0.018）, immediate postoperative red blood cell （RBC）, hematocrit, neutrophil and platelet （P=0.019, 0.006, 0.019, and 0.043）, and postoperative nosocomial infection, incision infection, blood urea nitrogen, and creatinine （P=0.011, 0.016, 0.014, and 0.005）. In a multivariable model, the independent risk factors for prolonged recovery after the Fontan operation were postoperative AKI （OR 1.753, 95% CI 1.238, 2.484） and postoperative higher RBC （OR 1.667, 95% CI 1.110, 2.503）. Fenestrated procedure might be a protec- tive factor （OR 0.355, 95% CI 0.138, 0.913）. Conclusions Postoperative AKI and higher RBC are the indepen- dent risk factors contributing to prolonged recovery of Fontan operations, while fenestrated procedure might be a protective factor. Postoperative AKI and higher RBC may represent perioperative unstable hemodynamics and insufficient effective circulating blood volume which may result in prolonged recovery.

Endothelial injury and inflammation in patients with hyperuricemic nephropathy at chronic kidney disease stages 1-2 and 3-4

BACKGROUND Endothelial injury and inflammation are the main pathological changes in hyperuricemic nephropathy(HN);however,they have not been assessed in patients in the early,middle,and late phases of HN.AIM To investigate endothelial injury and inflammatory conditions between patients with HN at chronic kidney disease(CKD)stages 3-4 and CKD 1-2.METHODS This study enrolled 80 patients(49 and 31 with HN at CKD stage 1-2 and 3-4,respectively)from the Department of Nephrology,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine between July 2021 and January 2022.Plasma levels of heparan sulfate,endocan,oxidized low-density lipoprotein(Ox-LDL),E-selectin,soluble intercellular adhesion molecule-1(slCAM1),interleukin(IL)-1β,and IL-6 and urine levels of lipocalin-type prostaglandin D synthase(L-PGDS),IL-1β,and IL-6 were measured using enzyme-linked immunosorbnent assay.RESULTS Comparison between patients with HN at CKD 1-2 and those with HN at CKD 3-4 showed that age and disease course were significant factors(P<0.001 and P<0.010,respectively).There were no statistical differences in sex,heart rate,body mass index,and systolic and diastolic blood pressures.The incidence of hypertension was also significant(P=0.03).Plasma levels of heparin sulfate(P<0.001),endocan(P=0.034),E-selectin(P<0.001),slCAM1(P<0.001),IL-1β(P=0.006),and IL-6(P=0.004)and the urine levels of L-PGDS(P<0.001),IL-1β(P=0.003),and IL-6(P<0.001)were high in patients with HN at CKD 3-4 than in those with HN at CKD 1-2.The difference in plasma Ox-LDL levels was not significant(P=0.078).CONCLUSION Vascular endothelial injury and inflammation were higher in patients with HN at CKD3-4 than at CKD 1-2.Plasma heparin sulfate and slCAM1 levels are synergistic factors for CKD staging in HN.