Acute kidney injury (AKI) is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting (CABG) combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate (eGFR), preoperative New York Heart Association (NYHA) score>Ⅱ, previous cardiac surgery, cadiopulmonary bypass (CPB) time and low cardiac output syndrome (LCOS) are included in many risks prediction models (>3 times). In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy (RRT)-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.
Objective To evaluate the efficacy and safety of intermittent hemodialysis (IHD) and continuous renal replacement therapy (CRRT) on patients with acute kidney injury (AKI) after bee sting. Methods A prospective observational analysis was made on patients with AKI after bee sting treated in Jianyang People’s Hospital or West China Hospital of Sichuan University between July 2015 and December 2020. According to different initial renal replacement therapy modes, the patients were divided into IHD group and CRRT group. The IHD group received hemodialysis for 4 hours each time, once a day or 3-5 times a week; the CRRT group used Prismaflex machine for continuous veno-venous hemofiltration or continuous veno-venous hemodiafiltration within 72 hours after admission, for at least 12 hours a day, followed by CRRT or IHD, depending on the patient’s condition. Both groups could be treated with hemoperfusion (HP) and symptomatic support such as glucocorticoid, blood transfusion and fluid rehydration. The IHD group was divided into IHD subgroup and IHD+HP subgroup, and the CRRT group was divided into CRRT subgroup and CRRT+HP subgroup according to whether renal replacement therapy was combined with HP. The basic information of patients and clinical laboratory examination results were collected, and the renal function recovery and mortality rates of patients in the two groups were compared, as well as the changes of laboratory indicators. Results A total of 106 patients were enrolled, 50 in the IHD group and 56 in the CRRT group. There was no statistical difference in the rate of complete renal function recovery 30, 60, or 90 days after treatment between the two groups (28.2% vs. 31.2%, P=0.758; 46.2% vs. 50.0%, P=0.721; 82.1% vs. 81.2%, P=0.924). But in the CRRT subgroup analysis, there was a statistical difference in the 30-day renal function recovery rate of CRRT+HP patients compared with CRRT alone (47.6% vs. 18.5%, P=0.031), while no statistical difference was found in the IHD subgroup analysis. After 3 days of treatment, the levels of creatine kinase of the IHD+HP subgroup and the CRRT+HP subgroup were lower than those in the IHD and CRRT subgroups, and the differences were statistically significant [(7875±6871) vs. (15157±8546) U/L, P=0.026; (10002±8256) vs. (14498±10362) U/L, P=0.032]. There was no statistical difference in 30-day mortality or incidence of serious adverse reactions between the two groups (P>0.05). Conclusions There is no obvious difference in improving renal prognosis or reducing mortality between CRRT and IHD for patients with AKI after bee sting. However, CRRT combined with HP therapy could shorten the recovery time of renal function and increase the 30-day kidney recovery rate. HP may contribute to early renal function recovery in patients with AKI after bee sting, but more high-quality randomized controlled trials are needed to further confirm this.
ObjectiveTo determine the predictive value of the preoperative prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after non-coronary artery bypass grafting (CABG) cardiac surgery.MethodsThe clinical data of 584 patients who underwent elective non-CABG cardiac surgery with cardiopulmonary bypass (CPB) in our hospital from May to September 2019 were reviewed. There were 268 (45.9%) males and 316 (54.1%) females, with a mean age of 52.1±11.6 years. The mean cardiopulmonary time and aortic-clamp time was 124.8±50.1 min and 86.4±38.9 min, respectively. Totally 449 (76.9%) patients received isolate valve surgery. We developed the risk prediction model of AKI using multivariable logistic regression. The predictive values of preoperative PNI, Cleveland Clinic Score (CCS) and risk prediction model were estimated by the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The improvement of preoperative PNI to predictive values of CCS or AKI risk prediction models were defined by the net reclassification index (NRI) and variation of AUC.ResultsThe preoperative PNI could neither effectively predict the occurrence of AKI following non-CABG cardiac surgery (AUC=0.553, 95%CI 0.489-0.617, P=0.095) nor improve the predictive effect of other AKI predictive models. The risk prediction model of AKI structured by our study had high predictive value on AKI or severe AKI (stage 2-3) (AUC=0.741, 95%CI 0.686-0.796, P<0.001) and superior to CCS (AUC=0.512, 95%CI 0.449-0.576, P=0.703).ConclusionThe preoperative PNI can neither predict the occurrence of AKI following elective non-CABG cardiac surgery nor improve the prediction values of other AKI prediction models.
Severe bee stings can trigger a systemic inflammatory response and multi-organ dysfunction, potentially resulting in fatality. Acute kidney injury (AKI) is a frequent complication in patients with severe bee stings, and conventional comprehensive treatment combined with various blood purification therapies is commonly employed in clinical practice to promptly manage the condition and reduce the average hospital stay duration. This article primarily delves into the significance of enhanced clinical nursing care for patients with bee stings-induced AKI undergoing blood purification therapy. Specifically, it underscores the importance of patient education regarding treatment-related considerations, nursing techniques for vascular access during treatment, potential complications, and corresponding nursing interventions.
Rhabdomyolysis-induced acute kidney injury (RIAKI) is a serious clinical disease in intensive care unit, characterized by high mortality and low cure rate. Continuous renal replacement therapy (CRRT) is a common form of treatment for RIAKI. There are currently no guidelines to guide the application of CRRT in RIAKI. To solve this problem, this article reviews the advantages and limitations of CRRT in the treatment of RIAKI, as well as new viewpoints and research progress in the selection of treatment timing, treatment mode, treatment dose and filtration membrane, with the aim of providing theoretical guidance for the treatment of CRRT in RIAKI patients.
Objective To retrospectively analyze the clinical characteristics of different lactate trajectories in sepsis patients receiving mechanical ventilation (MV) and to investigate their associations with acute kidney injury (AKI) and in-hospital death risk, aiming to provide references for early renal protection in critically ill sepsis patients. Methods Data from sepsis patients receiving MV were extracted from the Medical Information Mart for Intensive Care Ⅳ (MIMIC-Ⅳ) database. The daily mean lactate values over the first 10 days were calculated. The latent class trajectory model (LCTM) was used to identify lactate trajectories over time and group the patients accordingly. AKI was the primary outcome measure, while in-hospital death was the secondary outcome measure. Logistic regression and Cox regression analyses were used to explore the associations between different lactate trajectories and these outcomes. Kaplan-Meier curves were drawn to compare in-hospital death risks among different lactate trajectory groups. Results A total of 2 062 MV-treated sepsis patients were included. After LCTM analysis, 1 396 patients were classified into the low lactate trajectory group, 451 into the moderate lactate trajectory group, and 215 into the high lactate trajectory group. After adjusting for confounding factors, the high lactate trajectory group was associated with an increased risk of AKI and in-hospital death (P<0.05). Conclusions In sepsis patients receiving MV, those with high lactate trajectories have a higher risk of AKI. Lactate trajectory changes can serve as an early assessment indicator for AKI and mortality risk in critically ill sepsis patients.
Objective To investigate the early warning value of urinary selenium binding protein 1 (SBP1) in acute kidney injury (AKI) and its risk factor exposure, and compare it with urinary neutrophil gelatinase-associated lipocalin (NGAL). Methods Adult AKI inpatients and medical workers from the Department of Nephrology of the Second Affiliated Hospital of Xi’an Jiaotong University between April 2023 and April 2024 were selected. Patients who underwent percutaneous coronary intervention (PCI) in the Department of Cardiology of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Patients who received cisplatin treatment in the Respiratory Department of the Second Affiliated Hospital of Xi’an Jiaotong University were selected in June 2023. Urinary SBP1 and NGAL levels of patients and medical workers were detected by enzyme-linked immunosorbent assay. Results A total of 14 medical workers and 36 AKI patients were included. Except for gender, alanine aminotransferase, aspartate aminotransferase, total cholesterol (P>0.05), there were statistically significant differences in other indicators between the medical workers and the AKI patients (P<0.05). The urine SBP1 [100.30 (71.50, 138.75) vs.75.60 (65.90, 80.08) pg/mL; U=2.918, P=0.004] and NGAL [423.70 (73.93, 839.80) vs. 14.80 (5.83, 29.98) ng/mL; U=4.668, P<0.001] levels in the AKI group were higher than those in the control group. But the area under the curve of receiver operative characteristic curve of urine SBP1 was smaller than that of urine NGAL (0.768 vs. 0.929). The urine SBP1 level in AKI patients was positively correlated with alanine aminotransferase, aspartate aminotransferase, serum creatinine, and serum glucose (P＜0.05), but negatively correlated with estimated glomerular filtration rate and total cholesterol (P＜0.05). A total of 14 patients who underwent PCI were included. The urinary SBP1/creatinine levels of PCI patients increased 6 hours after surgery compared to preoperative levels [(39.54 ± 8.00) vs. (19.34±2.90) pg/μmol; F=8.862, P=0.011]. The urea nitrogen level decreased 72 hours after surgery compared to preoperative levels (P=0.036), while there were no statistically significant differences in other indicators at other time points (P>0.05). There was no significant change in urinary NGAL levels before and after PCI treatment in patients. A total of 19 patients received cisplatin treatment were included. After cisplatin treatment, the level of urinary SBP1 increased compared to before treatment (P=0.024), while there was no significant change in the level of urinary NGAL after treatment compared to before treatment (P=0.350). After treatment, the levels of urea nitrogen (P=0.041) and cystatin C (P=0.002) increased compared to before surgery, while there was no statistically significant difference in blood creatinine and estimated glomerular filtration rate compared to before treatment (P>0.05). Conclusions Urinary SBP1 levels have certain diagnostic value for AKI, but the diagnostic efficacy is not as good as urinary NGAL. Urinary SBP1 is more sensitive to renal tubular injury caused by nephrotoxic drugs than urinary NGAL.
Objective To retrospectively analyze the clinical characteristics of heat stroke (HS) and HS-acute kidney injury (AKI), analyze the risk factors leading to death in patients, and provide new ideas for the prevention and treatment of HS. Methods Patients with HS who visited 13 hospitals in Sichuan subtropical monsoon climate and HS high-incidence areas between July 2019 and September 2023 were retrospectively selected. According to whether in-hospital death or AKI occurred, the patients were divided into survival group and death group, AKI group and non-AKI group. According to serum creatinine level, patients in the AKI group were divided into AKI stage 1 group, AKI stage 2 group and AKI stage 3 group. The main clinical manifestations and important clinical data of the patients were analyzed, and the risk factors affecting the death of patients were analyzed by multivariate logistic regression. Results A total of 195 patients with HS and 115 patients with HS-AKI were included. The results of multivariate logistic regression analysis showed that AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer were independent risk factors for death (P＜0.05). The results of clinical characteristics analysis of HS-AKI showed that the mortality rate of patients with AKI stage 2 and AKI stage 3 was higher (P＜0.05). Conclusions AKI, abnormal coagulation function, nervous system injury, neutrophil/lymphocyte ratio, and D-dimer are independent risk factors for death in HS. Therefore, active treatment of patients with HS combined with AKI, abnormal coagulation function, and nervous system injury in the future will help reduce the risk of death in patients.
Sepsis is a common clinical critical illness, which often leads to multiple organ damage including the kidney damage, which is difficult to treat and has a high mortality rate. In recent years, extracorporeal blood purification therapy has made some progress in the field of sepsis. There are a variety of blood purification modes to choose, but there is still no unified standard for the initiation timing of blood purification therapy. Clinicians mainly evaluate the indicators and the initiation timing of blood purification therapy according to the patient’s needs for renal function replacement and/or inflammatory mediator clearance. This article mainly summarizes and discusses the initiation timing of blood purification therapy in sepsis.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
