Introduction: Since the breakout of COVID-19 in December 2019, the virus has already affected and taken millions of lives over the past year. There is still much to learn about this disease. It has been postulated that the human kidney is a potential pathway for COVID-19 due to the presence of the ACE2 receptors found in the surfaces of kidney cells. Some studies that demonstrated acute tubular necrosis and lymphocyte infiltration among post mortem COVID-19 patients, concluding that the virus could directly damage the kidney, increasing the risk of the development of Acute Kidney Injury (AKI) among patients with COVID-19. This study investigated the incidence and severity of AKI among hospitalized COVID-19 patients and the association of the degree of AKI with regards to the severity and outcomes of COVID-19 patients. Methods: This was a single-center cross-sectional study retrospective chart review of COVID-19 patients who developed AKI. Descriptive statistics were used to summarize the general and clinical characteristics of the patients. Frequency and proportion were used for categorical variables. Shapiro-Wilk test was used to determine the normality distribution of continuous variables. Continuous quantitative data that met the normality assumption was described using mean and standard deviation, while those that did not were described using median and range. Continuous variables which are normally distributed were compared using the One-way ANOVA, while those variables that are not normally distributed were compared using the Kruskal-Wallis H test. For categorical variables, the Chi-square test was used to compare the outcomes. If the expected percentages in the cells are less than 5%, Fisher's Exact Test was used instead. Results: A total of 1441 COVID-19 in-patients from March 1, 2020 to March 1, 2021 were reviewed, 59 of whom were excluded. Among the adults with COVID-19 who developed AKI, 60% were in stage I, 10% in stage II, and 30% in stage III. The incidence of AKI among COVID-19 in-patients at Makati Medical Center was 13.10% (95% CI 11.36% - 14.99%). Among the 181 patients, 79 (43.65%, 95% CI 36.30 - 51.20) had died. The mortality rate is 22.02% for Stage I, 50% for Stage II, and 85.19% for Stage III. The median length of hospital stay was 12 days, ranging from 1 day up to 181 days. Full renal recovery on discharge was observed only in one-third of the patients. It was observed in 44.95% of those in Stage I, 27.78% of those in Stage II, and 5.56% of those in Stage III. Conclusion The study demonstrated that the incidence of AKI in hospitalized COVID-19 patients was 13.1% (95% CI 11.36% - 14.99%), which was lower than previously reported. This could be attributed to the longer study period wherein, to date, we have a better understanding of the disease and had already established a standard of care for treatment for the disease attributing to the decreased incidence of AKI among COVID-19 patients than what was initially reported. The development of AKI has a direct correlation with the degree of infection. Among patients who developed AKI, 20% required renal replacement therapy. Overall development of AKI increases the risk of mortality among hospitalized COVID-19 patients. The stage of AKI has a direct correlation with regards to mortality and has an indirect relationship with regards to renal recovery.
Acute Kidney Injury ; COVID-19 ; Renal Replacement Therapy ; Mortality

Despite substantial advances in dialysis techniques and machines, acute kidney injury (AKI) requiring renal replacement therapy (RRT) is still associated with up to 60% in-hospital mortality. However, there is little information on whether RRT overcomes the significant morbidity and mortality of AKI. What is most important in the treatment of AKI is that RRT is not a cause-specific therapy but life-supportive management. This review discusses the indications of, proper initiation of, and optimal prescription for RRT to improve the survival of critically ill patients with AKI.
Acute Kidney Injury* ; Critical Illness* ; Dialysis ; Hospital Mortality ; Humans ; Mortality ; Prescriptions ; Renal Replacement Therapy

Despite substantial advances in dialytic techniques and machines, acute kidney injury (AKI) requiring renal replacement therapy (RRT) is associated with up to 60% in-hospital mortality. But, there is no full detail of definite RRT to overcome the significant morbidity and mortality of AKI. What is most important in the treatment for AKI is that RRT is not a cause-specific therapy but a life-supportive management. This review discusses the indications of, proper initiation of, and optimal prescription for RRT to improve the survival of the patients with AKI.
Acute Kidney Injury ; Hospital Mortality ; Humans ; Kidney ; Prescriptions ; Renal Replacement Therapy

BACKGROUND: Many epidemiologic studies have reported on the controversial concept of the obesity paradox. The presence of acute kidney injury (AKI) can accelerate energy-consuming processes, particularly in patients requiring continuous renal replacement therapy (CRRT). Thus, we aimed to investigate whether obesity can provide a survival benefit in this highly catabolic condition. METHODS: We conducted an observational study in 212 patients who had undergone CRRT owing to various causes of AKI between 2010 and 2014. The study end point was defined as death that occurred within 30 days after the initiation of CRRT. RESULTS: Patients were categorized into three groups according to tertiles of body mass index (BMI). During ≥30 days after the initiation of CRRT, 39 patients (57.4%) in the highest tertile died, as compared with 58 patients (78.4%) in the lowest tertile (P = 0.02). In a multivariable analysis adjusted for cofounding factors, the highest tertile of BMI was significantly associated with a decreased risk of death (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.37–0.87; P = 0.01). This significant association remained unaltered for 60-day (HR, 0.64; 95% CI, 0.43–0.94; P = 0.03) and 90-day mortality (HR, 0.66; 95% CI, 0.44–0.97; P = 0.03). CONCLUSION: This study showed that a higher BMI confer a survival benefit over a lower BMI in AKI patients undergoing CRRT.
Acute Kidney Injury* ; Body Mass Index* ; Epidemiologic Studies ; Humans ; Mortality* ; Obesity ; Observational Study ; Renal Replacement Therapy*

Radiocontrast nephropathy (RCN) is one of the most common etiologies of hospital-acquired acute kidney injury (AKI), accounting for more than 10% of cases. Although most patients who develop RCN have mild and transient decrement in renal function and do not require renal replacement therapy, RCN is associated with significant prolongation of hospitalization and increased morbidity and mortality. Volume expansion with isotonic saline or isotonic sodium bicarbonate before and after radiocontrast administration has been shown to decrease the risk of RCN in high-risk patients. The infusion of isotonic saline or sodium bicarbonate has significant clinical limits, requiring the need for overnight hospitalization and causing volume overload in patients with renal dysfunction. On the contrary, N-acetylcysteine (NAC) is inexpensive, convenient and free of significant complications. It is therefore reasonable to employ this agent, albeit with recognition that its benefit may be limited in published trials. In this issue of the Journal, Seo and Kim compare the efficacy of oral NAC alone with half saline hydration for preventing radiocontrast nephropathy in patients with renal dysfunction. They found that there was no significant difference in the incidence of RCN in the two groups. In addition, although there was no statistical difference between both groups, they stressed the role of nitric oxide (NO) in the prevention of RCN. Consequently, they conclude that oral NAC alone may be effective to prevent RCN in patients with the risk of volume overload after bolus hydration. However, this is a single-center study and requires validation across additional clinical settings including the group of more rapid infusion rate than 12 h pre- and postprocedure used in this study. Therefore, additional large, multicenter, randomized, controlled trials will be required to define the true role of NAC in preventing RCN.
Acetylcysteine* ; Acute Kidney Injury ; Hospitalization ; Humans ; Incidence ; Mortality ; Nitric Oxide ; Renal Replacement Therapy ; Sodium Bicarbonate

BACKGROUND: The aim of this study was to investigate the incidence and clinical characteristics of intravenous (IV) or inhaled (IH) colistin-associated acute kidney injury (AKI) using the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. METHODS: From 2010 to 2014, 160 patients were treated with IV or IH colistin. Of these, we included 126 patients who received colistin for > 72 hours for the treatment of pneumonia and compared the incidence and clinical characteristics of patients in the IV (n = 107) and IH (n = 19) groups. RESULTS: The patients included 104 men and 22 women, with a mean age of 69 years (range, 24–91 years). The mortality rate was 45%, and AKI occurred in 75 (60%) patients. At the end of therapy, the bacteriologic cure rate was 66%. There were no differences in the clinical characteristics between the IV and IH groups except for age. In comparison with patients in the IV group, the patients in the IH group were older (74 ± 8 vs. 68 ± 12 years, P = 0.026). The incidence of AKI was not different between the 2 groups (62 vs. 47%, P = not significant), and there was no difference in the severity of AKI according to the Risk, Injury, Failure, Loss, End-stage Renal Disease criteria. Of the 83 patients with AKI, 6 and 1 patients underwent renal replacement therapy, respectively. CONCLUSION: The incidence of AKI in patients with colistin therapy is 60% in our center. It seems that IH colistin therapy could not be better in safety than IV colistin therapy.
Acute Kidney Injury* ; Colistin* ; Female ; Humans ; Incidence ; Kidney Failure, Chronic ; Male ; Mortality ; Nebulizers and Vaporizers ; Pneumonia ; Renal Replacement Therapy

Rapid correction of hyponatremia is frequently associated with increased morbidity and mortality. Therefore, it is important to estimate the proper volume and type of infusate required to increase the serum sodium concentration predictably. The major common management errors during the treatment of hyponatremia are inadequate investigation, treatment with fluid restriction for diuretic-induced hyponatremia and treatment with fluid restriction plus intravenous isotonic saline simultaneously. We present two cases of management errors. One is about the problem of rapid correction of hyponatremia in a patient with sepsis and acute renal failure during continuous renal replacement therapy in the intensive care unit. The other is the case of hypothyroidism in which hyponatremia was aggravated by intravenous infusion of dextrose water and isotonic saline infusion was erroneously used to increase serum sodium concentration.
Acute Kidney Injury ; Glucose ; Humans ; Hyponatremia ; Hypothyroidism ; Infusions, Intravenous ; Intensive Care Units ; Mortality ; Renal Replacement Therapy ; Sepsis ; Sodium ; Water

PURPOSE: Continuous renal replacement therapy (CRRT) has been developed and it has advantages, although the patients receiving CRRT still have a high mortality. This study was designed to compare the clinical characteristics of patients treated with CRRT between survivors and non-survivors. METHODS: From May 1992 to February 2000, continuous venovenous hemofiltration(CVVH) treatment was applied to 51 patients. Underlying disease, duration of CVVH treatment, blood pressure before and after the treatment were reviewed and APACHE III score, number of organ failures, blood pressure at the begining were compared between two groups. RESULTS: The average age was 56.3+/-5.6 years and the mortality was 86.3%(44 patients). The comorbid conditions were sepsis(66.7% of total patients), hepatic failure(33.3%), congestive heart failure(17.6%) and adult respiratory distress syndrome(9.8%). Mean arterial pressure(MAP) at the begining was 66.9+/-9.7 mmHg and MAP 2 hours after the treatment was 59.3+/-1.5 mmHg(p=0.076). APACHE III score was 59.5+/-3.5 in non-survivors and 56.0+/-0.9 in survivors and mean number of organ failures was 2.63+/-.98 in non-survivors and 1.68+/-.34 in survivors, but there was no difference between two groups(p=0.072). MAP at begining was significantly higher in survivors than that of non-survivors(87.86+/-3.15 vs. 63.49+/-7.04)(p=0.002). CONCLUSION: Most of the patients receiving CVVH have more than two organ failures. There were no significant difference in the number of organ failures and APACHE III score between survivor group and non-survivor group. It may be due to underlying disease of patients that MAP at the begining was lower in non-survivors than survivors. APACHE III score would not be a good prognostic predictor.
Acute Kidney Injury ; Adult ; APACHE ; Blood Pressure ; Estrogens, Conjugated (USP) ; Heart ; Humans ; Mortality ; Renal Replacement Therapy* ; Survivors

BACKGROUND: The purpose of this study was to assess the role of hypophosphatemia in major clinical outcomes of patients treated with low- or high-intensity continuous renal replacement therapy (CRRT). METHODS: We performed a retrospective analysis of data collected from 492 patients. We divided patients into two CRRT groups based on treatment intensity (greater than or equal to or less than 40 mL/kg/hour of effluent generation) and measured serum phosphate level daily during CRRT. RESULTS: We obtained a total of 1,440 phosphate measurements on days 0, 1, and 2 and identified 39 patients (7.9%), 74 patients (15.0%), and 114 patients (23.1%) with hypophosphatemia on each of these respective days. In patients treated with low-intensity CRRT, there were 23 episodes of hypophosphatemia/1,000 patient days, compared with 83 episodes/1,000 patient days in patients who received high-intensity CRRT (P < 0.01). Multiple Cox proportional hazards analysis showed that Acute Physiology and Chronic Health Evaluation (APACHE) III score, utilization of vasoactive drugs, and arterial pH on the second day of CRRT were significant predictors of mortality, while serum phosphate level was not a significant contributor to mortality. CONCLUSION: APACHE score, use of vasoactive drugs, and arterial pH on the second CRRT day were identified as significant predictors of mortality. Hypophosphatemia might not be a major risk factor of increased mortality in patients treated with CRRT.
Acute Kidney Injury* ; APACHE ; Critical Illness* ; Humans ; Hydrogen-Ion Concentration ; Hypophosphatemia* ; Mortality ; Renal Replacement Therapy* ; Retrospective Studies ; Risk Factors

BACKGROUND: Although acute renal failure (ARF) after coronary artery bypass graft (CABG) is relatively rare, but devastating complication with high mortality. Our study aims to evaluate the effectiveness of early application of CRRT in patients with ARF which developed after on-pump CABG. MATERIAL AND METHOD: Two hundred and eighty seven patients underwent isolated on-pump CABG between May 2002 and Feb. 2006 at our institution, of whom 15 (5.2%) needed CRRT (11 patients for postoperatively developed ARF and the remaining 4 patients with pre- existing dialysis-dependent chronic renal failure (CRF) for postoperative hemodynamic and metabolic control). Criteria for early application of CRRT were as follows; decreased urine output less than 0.5 cc/h/kg for 2 consecutive hours and elevated serum creatinine level greater than 2.0 mg/dL. RESULT: The incidence of ARF requiring CRRT after on-pump CABG was 3.9% (11/283) and the overall hospital mortality of patient with CRRT was 33.3% (5/15). Of 5 deaths, 4 were patients with postoperatively developed ARF, and 1 was a patient with pre-existing dialysis- dependent CRF patient. The mean time between the operation and the initiation of CRRT was 25.8+/-5.8 hours and the mean duration of CRRT was 62.1+/-41.2 hours. Of the 7 survivors who were not on dialysis-dependent preoperatively, 6 patients fully recovered renal function during hospital stay and 1 patient required permanent renal supportive treatment after discharge from hospital. CONCLUSION: Early application of CRRT could maintain stable postoperative hemodynamic status and make outcomes better than those of previous reports in patients with ARF which developed after on-pump CABG.
Acute Kidney Injury* ; Coronary Artery Bypass ; Creatinine ; Hemodynamics ; Hospital Mortality ; Humans ; Incidence ; Kidney Failure, Chronic ; Length of Stay ; Mortality ; Renal Replacement Therapy* ; Survivors ; Transplants