BACKGROUND: Femoral neck fracture is common in the elderly population. Acute kidney injury (AKI) is an important risk factor for mortality in patients who have had such fracture. We evaluated the incidence of AKI in patients who had femoral neck fracture and identified risk factors for AKI and mortality. METHODS: This was an observational cohort study including 285 patients who were ≥ 65 years of age and who underwent femoral neck fracture surgery between 2013 and 2017. RESULTS: The mean age was 78.63 ± 6.75 years. A total of 67 (23.5%) patients developed AKI during the hospital stay: 57 (85.1%), 5 (7.5%), and 5 (7.5%) patients were classified as having stage 1, 2, and 3 AKI, respectively. Patients with AKI had a lower baseline estimated glomerular filtration rate and higher left atrial dimension, left ventricular mass index, pulmonary artery pressure, and the ratio of early mitral inflow velocity to early diastolic mitral annulus velocity (E/e’) and were more likely to have diabetes or hypertension (HTN) (P < 0.05). The presence of HTN (odds ratio [OR], 4.570; 95% confidence interval [CI], 1.632–12.797) higher E/e’ (OR, 1.105; 95% CI, 1.019–1.198), and lower hemoglobin (OR, 0.704; 95% CI, 0.528–0.938) were independently associated with a higher risk for developing AKI. Severe AKI (OR, 24.743; 95% CI, 2.822–212.401) was associated with a higher risk of mortality. CONCLUSION: Elderly patients with femoral neck fracture had a high incidence of AKI. Diastolic dysfunction was associated with AKI. Severe AKI was associated with in-hospital mortality.
Acute Kidney Injury ; Aged ; Cohort Studies ; Femoral Neck Fractures ; Femur Neck ; Glomerular Filtration Rate ; Heart Failure, Diastolic ; Hospital Mortality ; Humans ; Hypertension ; Incidence ; Length of Stay ; Mortality ; Pulmonary Artery ; Risk Factors

The high mortality rates associated with acute kidney injury are mainly due to extra-renal complications that occur following distant-organ involvement. Damage to these organs, which is commonly referred to as multiple organ dysfunction syndrome, has more severe and persistent effects. The brain and its sub-structures, such as the hippocampus, are vulnerable organs that can be adversely affected. Acute kidney injury may be associated with numerous brain and hippocampal complications, as it may alter the permeability of the blood-brain barrier. Although the pathogenesis of acute uremic encephalopathy is poorly understood, some of the underlying mechanisms that may contribute to hippocampal involvement include the release of multiple inflammatory mediators that coincide with hippocampus inflammation and cytotoxicity, neurotransmitter derangement, transcriptional dysregulation, and changes in the expression of apoptotic genes. Impairment of brain function, especially of a structure that has vital activity in learning and memory and is very sensitive to renal ischemic injury, can ultimately lead to cognitive and functional complications in patients with acute kidney injury. The objective of this review was to assess these complications in the brain following acute kidney injury, with a focus on the hippocampus as a critical region for learning and memory.
Acute Kidney Injury* ; Blood-Brain Barrier ; Brain Diseases ; Brain* ; Hippocampus* ; Humans ; Inflammation ; Learning ; Memory ; Mortality ; Multiple Organ Failure ; Neurotransmitter Agents ; Permeability ; Uremia

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

OBJECTIVETo investigate the epidemiological profile of acute kidney injury (AKI) in the Chinese critical patients.

METHODSThe hospitalization data and serum creatinine data of critically ill adult patients were collected from 9 regional central hospitals across China in 2013. Kidney Disease Improving Global Outcomes (KDIGO 2012) criteria was used to define and stage AKI. The demographic characteristics of the patients, comorbidities, stage of AKI, in-hospital outcomes and risk factors were retrospectively analyzed.

RESULTSOf the total of 14 305 critically ill patients included in the study, 4298 (30.04%) were identified to have AKI, including 2240 (52.1%) in stage 1, 845 (19.7%) in stage 2, and 1213 (28.2%) in stage 3. The in-hospital mortality rate was 16.7% (716/4298) and the odds ratio for death was 7.59 (95%CI 6.54-8.79, P<0.001). The length of hospital stay, daily cost, and mortality rate were associated with the stage of AKI. Multivariate analysis identified chronic kidney disease (OR=5.45, 95%CI: 4.71-6.32, P<0.001), extra-renal organ failure (OR=12.57, 95%CI: 11.24-14.07, P<0.001), shock (OR=2.44, 95%CI: 2.01-2.96, P<0.001) and cardiac surgery (OR=5.96, 95%CI: 5.16-6.87, P<0.001) as the independent risk factors for AKI. Only 5.4% of the AKI patients whose serum creatinine change met the KDIGO criteria during hospitalization received the diagnosis of AKI upon discharge.

CONCLUSIONAKI is common in critically ill patients and associated with high mortality rates and poor outcomes. The stage of AKI is related with the in-hospital outcomes of the patients. Chronic kidney disease, extra-renal organ failure, shock and cardiac surgery are the major risk factors for AKI in these patients. Missed diagnosis occurs in most of the AKI cases, which urges more awareness of the condition in the critically ill patients during hospitalization.

Acute Kidney Injury ; epidemiology ; Adult ; Cardiac Surgical Procedures ; China ; Critical Illness ; Hospital Mortality ; Humans ; Kidney ; physiopathology ; Kidney Function Tests ; Length of Stay ; Multiple Organ Failure ; epidemiology ; Odds Ratio ; Renal Insufficiency, Chronic ; epidemiology ; Retrospective Studies ; Risk Factors ; Shock ; epidemiology

BACKGROUND: We aimed to evaluate the incidence, predictive factors, and impact of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR). METHODS: A total of 53 patients who underwent 57 TEVAR operations between 2008 and 2015 were reviewed for the incidence of AKI as defined by the RIFLE (risk, injury, failure, loss, and end-stage kidney disease risk) consensus criteria. The estimated glomerular filtration rate was determined in the perioperative period. Comorbidities and postoperative outcomes were retrospectively reviewed. RESULTS: Underlying aortic pathologies included 21 degenerative aortic aneurysms, 20 blunt traumatic aortic injuries, six type B aortic dissections, five type B intramural hematomas, three endoleaks and two miscellaneous diseases. The mean age of the patients was 61.2+/-17.5 years (range, 15 to 85 years). AKI was identified in 13 (22.8%) of 57 patients. There was an association of preoperative stroke and postoperative paraparesis and paraplegia with AKI. The average intensive care unit (ICU) stay in patients with AKI was significantly longer than in patients without AKI (5.3 vs. 12.7 days, p=0.017). The 30-day mortality rate in patients with AKI was significantly higher than patients without AKI (23.1% vs. 4.5%, p=0.038); however, AKI did not impact long-term survival. CONCLUSION: Preoperative stroke and postoperative paraparesis and paraplegia were identified as predictors for AKI. Patients with AKI experienced longer average ICU stays and greater 30-day mortality than those without AKI. Perioperative identification of high-risk patients, as well as nephroprotective strategies to reduce the incidence of AKI, should be considered as important aspects of a successful TEVAR procedure.
Acute Kidney Injury* ; Aortic Aneurysm ; Comorbidity ; Consensus ; Endoleak ; Glomerular Filtration Rate ; Hematoma ; Humans ; Incidence ; Intensive Care Units ; Kidney Failure, Chronic ; Mortality ; Paraparesis ; Paraplegia ; Pathology ; Perioperative Period ; Retrospective Studies ; Risk Factors* ; Stroke

OBJECTIVETo compare the acute kidney injury classification systems of RIFLE,AKIN,KDIGO and conventional criteria for determining prognosis of acute-on-chronic liver failure (ACLF) patients.

METHODSPatients with ACLF admitted to our hospital between July 2008 and March 2014 were enrolled in the study. The incidence, stages, and outcomes of acute kidney injury were determined according to the RIFLE, AKIN,KDIGO and conventional criteria.ROC curves were generated to compare the predictive ability for 30-day mortality of the four systems.Chi-square test and Fisher's exact test were used for statistical analyses, as well.

RESULTSAll four classification systems detected acute kidney injury among the patients in the study population (n =358), but the detection rates were not consistent (expressed as % of total): KDIGO criteria: 45.0%, AKIN: 38.8%, rIFLE: 35.5%, conventional criterion: 20.4%. The KDIGO and AKIN criteria showed higher sensitivity (72%), especially to early kidney injury, but the conventional criterion showed higher specificity (92%). The AUC for 30-day mortality was highest for the conventional criteria (0.75), followed by AKIN (0.72), rIFLE (0.70) and KDIGO (0.69) (all, P less than 0.05). In-hospital mortality increased with severity of AKI in a stepwise manner.

CONCLUSIONAmong the four common evaluation systems for acute kidney injury, the conventional criteria has the highest specificity for predicting short-term prognosis of patients with ACLF, while the AKIN and KDIGO criteria have the highest sensitivity for the presence of acute kidney injury, especially at the early stage.

Acute Kidney Injury ; classification ; diagnosis ; Acute-On-Chronic Liver Failure ; diagnosis ; Hospital Mortality ; Humans ; Incidence ; Prognosis ; ROC Curve ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: Continuous renal replacement therapy (CRRT) has been established for critically ill acute kidney injury (AKI) patients. In addition, some centers consist of a specialized CRRT team (SCT) with physicians and nurses. To our best knowledge, however, ona a few studies have yet been carried out on the superiority of SCT management. MATERIALS AND METHODS: A total of 551 patients, who received CRRT between January 2008 and March 2009, were divided into two groups based on the controller of CRRT. The impact of the CRRT management on 28-day mortality was compared between two groups by Kaplan-Meier curve and Cox analysis. RESULTS: During the study period, the number of filters used, down-time per day, and intensive care unit length of day were significantly higher in non-SCT group than in SCT group (6.2 hrs vs. 5.0 hrs, p=0.042; 5.0 hrs vs. 3.8 hrs, p<0.001; 27.5 days vs. 21.1 days, p=0.027, respectively), while net ultrafiltration rate was significantly lower in non-SCT group than SCT group (28.0 mL/kg/hr vs. 29.5 mL/kg/hr, p=0.043, respectively). In addition, 28-day mortality rate was significantly lower in SCT group than with non-SCT group (p=0.031). Moreover, Cox regression analysis showed that 28-day mortality rate was significantly lower in SCT control group, even after adjusting for age, gender, severity scores, biomarkers, risk, injury, failure, loss, and end-stage renal disease, and contributing factors (hazard ratio 0.91, p=0.046). CONCLUSION: A well-trained CRRT team could be beneficial for mortality improvement of AKI patients requiring CRRT.
Acute Kidney Injury/mortality/*therapy ; Adult ; Aged ; Aged, 80 and over ; Biological Markers ; Critical Illness/*mortality/therapy ; Female ; Humans ; Intensive Care Units ; Kaplan-Meier Estimate ; Kidney Failure, Chronic/*therapy ; Male ; Middle Aged ; Patient Care Team ; Proportional Hazards Models ; Renal Replacement Therapy/*methods ; Retrospective Studies ; Time Factors ; Treatment Outcome

BACKGROUND/AIMS: A revised classification system for renal dysfunction in patients with cirrhosis was proposed by the Acute Dialysis Quality Initiative and the International Ascites Club Working Group in 2011. The aim of this study was to determine the prevalence of renal dysfunction according to the criteria in this proposal. METHODS: The medical records of cirrhotic patients who were admitted to Konkuk University Hospital between 2006 and 2010 were reviewed retrospectively. The data obtained at first admission were collected. Acute kidney injury (AKI) and chronic kidney disease (CKD) were defined using the proposed diagnostic criteria of kidney dysfunction in cirrhosis. RESULTS: Six hundred and forty-three patients were admitted, of whom 190 (29.5%), 273 (42.5%), and 180 (28.0%) were Child-Pugh class A, B, and C, respectively. Eighty-three patients (12.9%) were diagnosed with AKI, the most common cause for which was dehydration (30 patients). Three patients had hepatorenal syndrome type 1 and 26 patients had prerenal-type AKI caused by volume deficiency after variceal bleeding. In addition, 22 patients (3.4%) were diagnosed with CKD, 1 patient with hepatorenal syndrome type 2, and 3 patients (0.5%) with AKI on CKD. CONCLUSIONS: Both AKI and CKD are common among hospitalized cirrhotic patients, and often occur simultaneously (16.8%). The most common type of renal dysfunction was AKI (12.9%). Diagnosis of type 2 hepatorenal syndrome remains difficult. A prospective cohort study is warranted to evaluate the clinical course in cirrhotic patients with renal dysfunction.
Acute Kidney Injury/*epidemiology/etiology/mortality ; Adult ; Aged ; Cohort Studies ; Female ; Hospital Mortality ; Humans ; Kidney Failure, Chronic/*epidemiology/etiology/mortality ; Liver Cirrhosis/complications/*diagnosis ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Severity of Illness Index ; Survival Rate

The aim of this study was to investigate the clinical characteristics of acute hepatitis A during a recent outbreak in Korea. Data of patients diagnosed with acute hepatitis A from 2007 to 2009 were collected from 21 tertiary hospitals retrospectively. Their demographic, clinical, and serological characteristics and their clinical outcomes were analyzed. A total of 4,218 patients (mean age 33.3 yr) were included. The median duration of admission was 9 days. The mean of the highest ALT level was 2,963 IU/L, total bilirubin was 7.3 mg/dL, prothrombin time INR was 1.3. HBsAg was positive in 3.7%, and anti-HCV positive in 0.7%. Renal insufficiency occurred in 2.7%, hepatic failure in 0.9%, relapsing hepatitis in 0.7%, and cholestatic hepatitis in 1.9% of the patients. Nineteen patients (0.45%) died or were transplanted. Complications of renal failure or prolonged cholestasis were more frequent in patients older than 30 yr. In conclusion, most patients with acute hepatitis A recover uneventfully, however, complication rates are higher in patients older than 30 yr than younger patients. Preventive strategies including universal vaccination in infants and active immunization of hepatitis A to adult population should be considered for prevention of community-wide outbreaks of hepatitis A in Korea.
Acute Disease ; Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; Cholestasis/epidemiology/etiology ; Demography ; Hepatitis A/complications/*diagnosis/mortality ; Humans ; Kidney Failure, Chronic/epidemiology/etiology ; Liver Transplantation ; Middle Aged ; Morbidity ; Republic of Korea ; Retrospective Studies ; Tertiary Care Centers ; Young Adult

We demonstrated that a mineral aqueous solution (MAS) administered to mice functionally and histologically protected against cisplatin-induced acute renal failure (ARF) and CCl4-induced acute liver failure (ALF). In ARF model, 0.4 and 0.2% MAS decreased mortality and the serum concentrations of blood urea nitrogen (BUN) and creatine in mice. Additionally, 0.4 and 0.2% MAS reduced contraction of distal convoluted tubules and suppressed expression of the proinflammatory cytokines interlukein-6 (IL-6) and tumor necrosis factor (TNF-alpha) in the kidney. In ALF model, 0.4 and 0.2% MAS decreased serum concentrations of alanine aminotransferase and aspartate aminotransferase in mice. Additionally, 0.4 and 0.2% MAS reduced necrotic areas and suppressed expression of IL-6 and TNF-alpha in the liver. These results indicate that a MAS might have protective effects against ARF and ALF.
Acute Kidney Injury ; Alanine Transaminase ; Animals ; Aspartate Aminotransferases ; Blood Urea Nitrogen ; Contracts ; Creatine ; Cytokines ; Interleukin-6 ; Kidney* ; Liver Failure, Acute ; Liver* ; Mice* ; Mortality ; Silicon ; Tumor Necrosis Factor-alpha