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Wang Q, Zhang Y, Li S, Chen J, Yang B, Bai C, Yang L, Qiu Y, Wang C, Dong Y, Wang T. Predicting pre- and post-operative acute kidney injury in elderly patients with coronary artery disease. Heliyon 2024; 10:e33988. [PMID: 39050416 PMCID: PMC11268338 DOI: 10.1016/j.heliyon.2024.e33988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/06/2023] [Revised: 07/01/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Background Limited evidence exists regarding the clinical baseline characteristics at admission for acute kidney injury (AKI) before and after interventional cardiac procedures (ICP) in elderly patients with coronary artery disease (CAD). Methods A total of 488 elderly patients were enrolled in this retrospective single-center study conducted from January 2019 to July 2022, and a classification and regression tree (CART) analysis was performed to identify the high-risk population. Results The AKI incidence was 21.1 % (103/488) in this study, with 27 and 76 individuals developing AKI before and after ICP, respectively. CART analysis revealed that exposure to nephrotoxic drugs and diuretics had the strongest predictive capacities for identifying patients at risk of developing pre-ICP AKI, with the incidence among these high-risk patients ranging from 6.5 % to 13.8 %. Meanwhile, the optimum discriminators for identifying those at high risk of post-ICP AKI were the administration of diuretics, D-value ≤ -860 mL, age >73 years, and administration of nephrotoxic drugs, and the latter model predicted that the AKI incidence among high-risk patients was between 50.0 % and 60.0 %. Conclusions Elderly patients with CAD exhibited an elevated incidence of AKI. CART models suggested that exposure to nephrotoxic drugs and diuretics, D-value, and age were significantly associated with AKI in the elderly with CAD. Importantly, these baseline characteristics at admission could be utilized to identify elderly patients at high risk of pre- and post-ICP AKI.
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Affiliation(s)
- Quanfang Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yijing Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Sihan Li
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jiaojiao Chen
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Bo Yang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chuqi Bai
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Luting Yang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yulan Qiu
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Chuhui Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Yalin Dong
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Taotao Wang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
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Zhu S, Zheng Z, Wang L, Luo G, Zhang Y, Jia T, Wang Y, Dong H, Lei C. Association Between Loop Diuretics and Mortality in Patients With Cardiac Surgery-Associated Acute Kidney Injury: A Retrospective Propensity Score-Weighted Analysis. Anesth Analg 2024; 139:124-134. [PMID: 38009938 DOI: 10.1213/ane.0000000000006748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Although loop diuretics (LDs) have been widely used in clinical practice, their effect on mortality when administered to patients experiencing cardiac surgery-associated acute kidney injury (CS-AKI) remains unknown. The study aimed to investigate the effectiveness of LD use in patients with CS-AKI. METHODS Patients who underwent cardiac surgery with AKI were identified from the Medical Information Mart for Intensive Care III. Postoperative LD use in intensive care units (ICUs) was exposure. There were 2 primary outcome measures, the in-hospital mortality and ICU mortality; both were treated as time-to-event data and were analyzed via multivariable Cox proportional hazard models. Inverse probability weighting (IPW) was used to minimize bias. RESULTS The study enrolled a total of 5478 patients, with a median age of 67 years, among which 2205 (40.3%) were women. The crude in-hospital and ICU mortality rates were significantly lower in the LD use group (525 of 4150 [12.7%] vs 434 of 1328 [32.7%], P < .001; 402 of 4150 [9.69%] vs 333 of 1328 [25.1%], P < .001). Adjusted hazard ratios suggested significant reductions in both in-hospital (hazard ratio [HR], 0.428; 95% confidence interval [CI], 0.374-0.489) and ICU mortality (HR, 0.278; 95% CI, 0.238-0.327). The IPW data showed a similar reduction, in-hospital mortality (HR, 0.434; 95% CI, 0.376-0.502) and ICU mortality (HR, 0.296; 95% CI, 0.251-0.349). Such association may act differently for patients with different fluid balance ( P value for interaction < .001). CONCLUSIONS LD use is associated with lower hospital and ICU mortality in CS-AKI patients in general. Patients under different conditions showed diverse responses toward such treatment indicating that personalized management is needed.
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Affiliation(s)
- Shouqiang Zhu
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ziyu Zheng
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- Anesthesia Clinical Research Center, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Lini Wang
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Gang Luo
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yue Zhang
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Tao Jia
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yi Wang
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hailong Dong
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chong Lei
- From the Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Kwiatkowski DM, Alten JA, Raymond TT, Selewski DT, Blinder JJ, Afonso NS, Coghill MT, Cooper DS, Koch JD, Krawczeski CD, Mah KE, Neumayr TM, Rahman AKMF, Reichle G, Tabbutt S, Webb TN, Borasino S. Peritoneal catheters in neonates undergoing complex cardiac surgery: a multi-centre descriptive study. Cardiol Young 2024; 34:272-281. [PMID: 37337694 DOI: 10.1017/s104795112300135x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND The use of peritoneal catheters for prophylactic dialysis or drainage to prevent fluid overload after neonatal cardiac surgery is common in some centres; however, the multi-centre variability and details of peritoneal catheter use are not well described. METHODS Twenty-two-centre NEonatal and Pediatric Heart Renal Outcomes Network (NEPHRON) study to describe multi-centre peritoneal catheter use after STAT category 3-5 neonatal cardiac surgery using cardiopulmonary bypass. Patient characteristics and acute kidney injury/fluid outcomes for six post-operative days are described among three cohorts: peritoneal catheter with dialysis, peritoneal catheter with passive drainage, and no peritoneal catheter. RESULTS Of 1490 neonates, 471 (32%) had an intraoperative peritoneal catheter placed; 177 (12%) received prophylactic dialysis and 294 (20%) received passive drainage. Sixteen (73%) centres used peritoneal catheter at some frequency, including six centres in >50% of neonates. Four centres utilised prophylactic peritoneal dialysis. Time to post-operative dialysis initiation was 3 hours [1, 5] with the duration of 56 hours [37, 90]; passive drainage cohort drained for 92 hours [64, 163]. Peritoneal catheter were more common among patients receiving pre-operative mechanical ventilation, single ventricle physiology, and higher complexity surgery. There was no association with adverse events. Serum creatinine and daily fluid balance were not clinically different on any post-operative day. Mortality was similar. CONCLUSIONS In neonates undergoing complex cardiac surgery, peritoneal catheter use is not rare, with substantial variability among centres. Peritoneal catheters are used more commonly with higher surgical complexity. Adverse event rates, including mortality, are not different with peritoneal catheter use. Fluid overload and creatinine-based acute kidney injury rates are not different in peritoneal catheter cohorts.
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Affiliation(s)
- David M Kwiatkowski
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jeffrey A Alten
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tia T Raymond
- Department of Pediatrics, Medical City Children's Hospital, Dallas, TX, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Joshua J Blinder
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Natasha S Afonso
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Matthew T Coghill
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David S Cooper
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joshua D Koch
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | - Kenneth E Mah
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Tara M Neumayr
- Department of Pediatrics, Washington University School of Medicine, St. Louis. MO, USA
| | - A K M Fazlur Rahman
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Garret Reichle
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Sarah Tabbutt
- Department of Pediatrics, University of California - San Francisco School of Medicine, San Francisco, CA, USA
| | - Tennille N Webb
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Santiago Borasino
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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Jiang M, Pan CQ, Li J, Xu LG, Li CL. Explainable machine learning model for predicting furosemide responsiveness in patients with oliguric acute kidney injury. Ren Fail 2023; 45:2151468. [PMID: 36645039 PMCID: PMC9848233 DOI: 10.1080/0886022x.2022.2151468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Although current guidelines didn't support the routine use of furosemide in oliguric acute kidney injury (AKI) management, some patients may benefit from furosemide administration at an early stage. We aimed to develop an explainable machine learning (ML) model to differentiate between furosemide-responsive (FR) and furosemide-unresponsive (FU) oliguric AKI. METHODS From Medical Information Mart for Intensive Care-IV (MIMIC-IV) and eICU Collaborative Research Database (eICU-CRD), oliguric AKI patients with urine output (UO) < 0.5 ml/kg/h for the first 6 h after ICU admission and furosemide infusion ≥ 40 mg in the following 6 h were retrospectively selected. The MIMIC-IV cohort was used in training a XGBoost model to predict UO > 0.65 ml/kg/h during 6-24 h succeeding the initial 6 h for assessing oliguria, and it was validated in the eICU-CRD cohort. We compared the predictive performance of the XGBoost model with the traditional logistic regression and other ML models. RESULTS 6897 patients were included in the MIMIC-IV training cohort, with 2235 patients in the eICU-CRD validation cohort. The XGBoost model showed an AUC of 0.97 (95% CI: 0.96-0.98) for differentiating FR and FU oliguric AKI. It outperformed the logistic regression and other ML models in correctly predicting furosemide diuretic response, achieved 92.43% sensitivity (95% CI: 90.88-93.73%) and 95.12% specificity (95% CI: 93.51-96.3%). CONCLUSION A boosted ensemble algorithm can be used to accurately differentiate between patients who would and would not respond to furosemide in oliguric AKI. By making the model explainable, clinicians would be able to better understand the reasoning behind the prediction outcome and make individualized treatment.
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Affiliation(s)
- Meng Jiang
- Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,CONTACT Meng Jiang Emergency and Trauma Center, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003Zhejiang Province, China
| | - Chun-qiu Pan
- Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China,Chun-qiu Pan Department of Emergency Medicine, Nanfang Hospital, Southern Medical University, 510515Guangzhou, China
| | - Jian Li
- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li-gang Xu
- Department of Critical Care Medicine, Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chang-li Li
- Department of FSTC Clinic of The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Chang-li Li Department of FSTC Clinic of The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003Zhejiang Province, China
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Sykes JE, Francey T, Schuller S, Stoddard RA, Cowgill LD, Moore GE. Updated ACVIM consensus statement on leptospirosis in dogs. J Vet Intern Med 2023; 37:1966-1982. [PMID: 37861061 PMCID: PMC10658540 DOI: 10.1111/jvim.16903] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/21/2023] Open
Abstract
Since publication of the last consensus statement on leptospirosis in dogs, there has been revision of leptospiral taxonomy and advancements in typing methods, widespread use of new diagnostic tests and vaccines, and improved understanding of the epidemiology and pathophysiology of the disease. Leptospirosis continues to be prevalent in dogs, including in small breed dogs from urban areas, puppies as young as 11 weeks of age, geriatric dogs, dogs in rural areas, and dogs that have been inadequately vaccinated for leptospirosis (including dogs vaccinated with 2-serovar Leptospira vaccines in some regions). In 2021, the American College of Veterinary Internal Medicine (ACVIM) Board of Regents voted to approve the topic for a revised Consensus Statement. After identification of core panelists, a multidisciplinary group of 6 experts from the fields of veterinary medicine, human medicine, and public health was assembled to vote on the recommendations using the Delphi method. A draft was presented at the 2023 ACVIM Forum, and a written draft posted on the ACVIM website for comment by the membership before submission to the editors of the Journal of Veterinary Internal Medicine. This revised document provides guidance for veterinary practitioners on disease in dogs as well as cats. The level of agreement among the 12 voting members (including core panelists) is provided in association with each recommendation. A denominator lower than 12 reflects abstention of ≥1 panelists either because they considered the recommendation to be outside their scope of expertise or because there was a perceived conflict of interest.
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Affiliation(s)
- Jane E. Sykes
- Department of Medicine and EpidemiologyUniversity of California, DavisDavisCalifornia95616USA
| | - Thierry Francey
- Department of Clinical Veterinary ScienceVetsuisse Faculty, University of BernBernSwitzerland
| | - Simone Schuller
- Department of Clinical Veterinary ScienceVetsuisse Faculty, University of BernBernSwitzerland
| | - Robyn A. Stoddard
- Bacterial Special Pathogens BranchCenters for Disease Control and PreventionAtlantaGeorgia30333USA
| | - Larry D Cowgill
- Department of Medicine and EpidemiologyUniversity of California, DavisDavisCalifornia95616USA
| | - George E. Moore
- Department of Veterinary AdministrationPurdue UniversityWest Lafayette, Indiana 47907USA
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Yuan Y, Qiu H, Hu X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. A risk score model of contrast-induced acute kidney injury in patients with emergency percutaneous coronary interventions. Front Cardiovasc Med 2022; 9:989243. [PMID: 36312242 PMCID: PMC9606750 DOI: 10.3389/fcvm.2022.989243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/01/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background The previously built score models of contrast-induced acute kidney injury (CI-AKI) were principally founded on selective percutaneous coronary intervention (PCI) cases. Our study was to form a risk score model of CI-AKI and make a temporal validation in a population who underwent emergency PCIs. Methods We included patients who underwent emergency PCIs from 2013 to 2018 and divided them into the derivation and validation cohorts. Logistic regression analysis was harnessed to create the risk model. In this research, we defined CI-AKI as an increase in serum creatinine (SCr) ≥0.5 mg/dL (44.2 μmol/L) above baseline within seven days following exposure to contrast medium. Results A total of 3564 patients who underwent emergency PCIs were enrolled and divided into the derivation (2376 cases) and validation cohorts (1188 cases), with CI-AKI incidence of 6.61 and 5.39%, respectively. By logistic analysis, the CI-AKI risk score model was constituted by 8 variables: female (1 point), history of transient ischemic attack (TIA)/stroke (1 point), left ventricular ejection fraction (LVEF) classification (1 point per class), big endothelin-1 (ET-1) classification (1 point per class), estimated glomerular filtration rate (eGFR) classification (1 point per class), intra-aortic balloon pump (IABP) application (1 point), left anterior descending (LAD) stented (1 point), and administration of diuretic (2 points). The patients could be further divided into three groups: low-risk, moderate-risk, and high-risk groups, in accordance with the risk scores of 3–6, 7–10, and ≥11 points, and to the CI-AKI rates of 1.4, 11.9, and 42.6%. The CI-AKI risk score model performed well in discrimination (C statistic = 0.787, 95% CI: 0.731–0.844) and calibration ability, and showed a superior clinical utility. Conclusion We developed a simple CI-AKI risk score model which performs well as a tool for CI-AKI prediction in patients who underwent emergency PCIs.
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Affiliation(s)
- Ying Yuan
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Qiu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China,*Correspondence: Hong Qiu
| | - Xiaoying Hu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Erkoç SK, Kırımker EO, Büyük S, Baskan EB, Yılmaz AA, Balcı D, Karayalçın K, Bayar MK. Reducing Risk for Acute Kidney Injury After Living Donor Hepatectomy by Protocolized Fluid Restriction: Single-Center Experience. Transplant Proc 2022; 54:2243-2247. [PMID: 36088129 DOI: 10.1016/j.transproceed.2022.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 03/31/2022] [Revised: 07/07/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a potential complication after restricted fluid therapy for major surgery. The aim of this study was to evaluate the incidence of AKI for living liver donor hepatectomy in which applied intraoperative protocolized fluid restriction was used targeting a low central venous pressure (CVP) level with high pulse pressure variation (PPV) and systolic pressure variation (SPV). MATERIAL AND METHODS Living liver donors were admitted for this retrospective observational study. Low CVP <5 mm Hg with high PPV<20% and SPV<15% were the targets of the clinical protocol to reduce intraoperative blood loss via protocolized fluid management until the end of the hepatic parenchymal division. KDIGO criteria were used for AKI definition. The SPSS version 11.5 program was used for statistical analysis. RESULTS The study included 130 patients, 79 (60.8%) men and 51 (39.2%) women, with from 18 to 58 years of age. Donors underwent right and left lobe hepatectomies (116 and 14, respectively). The baseline CVP, the lowest CVP of hepatectomy, and the highest CVP measured after hepatectomy were 7.45 ± 2.41, 4.28 ± 1.12, 7.67 ± 2.09 mm Hg, respectively. Only 4 patients with right lobe hepatectomy developed AKI stage I (3.1%) in the first 24 hours. The 4 patients were recovered at 48 hours postoperatively. CONCLUSION This study demonstrated that a CVP target of <5 mm Hg and high PPV/SPV via a simple fluid management modality with protocolized-fluid restriction until the procurement may not cause AKI in living liver donors in a closed follow-up anesthesia approach.
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Affiliation(s)
| | - Elvan Onur Kırımker
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Sevcan Büyük
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Elif Beyza Baskan
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Ali Abbas Yılmaz
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
| | - Deniz Balcı
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Kaan Karayalçın
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
| | - Mustafa Kemal Bayar
- Ankara University School of Medicine, Department of Anesthesiology, Ankara, Turkey
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Zhou L, Li Y, Gao Q, Lin Y, Su L, Chen R, Cao Y, Xu R, Luo F, Gao P, Zhang X, Li P, Nie S, Tang Y, Xu X. Loop Diuretics Are Associated with Increased Risk of Hospital-Acquired Acute Kidney Injury in Adult Patients: A Retrospective Study. J Clin Med 2022; 11:jcm11133665. [PMID: 35806949 PMCID: PMC9267783 DOI: 10.3390/jcm11133665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/10/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The association between loop diuretics and acute kidney injury (AKI) remains unclear. Methods: The population studied was selected from the Epidemiology of AKI in Chinese Hospitalized patients (EACH) study. Exposure to loop diuretics was defined as any filled prescription prior to the date when AKI was detected in patients with HA-AKI, and prior to the last date of SCr testing in those without AKI. The outcome was AKI, defined by the Kidney Disease Improving Global Outcomes criteria. Associations between loop diuretics and HA-AKI were examined by Cox proportional hazards models adjusted for baseline and time-dependent covariates. Results: Of the 150,020 patients, 16,437 (11.0%) were prescribed loop diuretics, and 5717 (3.8%) experienced HA-AKI events. The crude rates of HA-AKI in patients who were and were not prescribed loop diuretics were 1632 (9.9%) and 3262 (2.8%), respectively. A multivariate cox proportional hazards analysis showed that exposure to loop diuretics was associated with significantly increased risks of HA-AKI compared with non-users (hazard ratio (HR), 1.61; 95% CI (confidence interval), 1.55–1.67), other diuretics (HR, 1.09; 95% CI, 1.03–1.15), and osmotic diuretics (HR, 1.30; 95% CI, 1.20–1.42). Compared with other diuretics, the use of loop diuretics was associated with higher risks of HA-AKI in women, in patients without hypertension, in patients without heart failure, in patients without liver cirrhosis, and in patients not requiring surgery. Conclusions: Loop diuretics are widely used and are associated with increased risks of HA-AKI in hospitalized adults. Renal function should be more closely monitored during the use of loop diuretics.
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Affiliation(s)
- Liping Zhou
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yanqin Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Qi Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yuxin Lin
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Licong Su
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruixuan Chen
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Yue Cao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ruqi Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Fan Luo
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Peiyan Gao
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Xiaodong Zhang
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Pingping Li
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Sheng Nie
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
| | - Ying Tang
- Division of Nephrology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510515, China
- Correspondence: (Y.T.); (X.X.)
| | - Xin Xu
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Division of Nephrology, Nanfang Hospital of Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.); (Q.G.); (Y.L.); (L.S.); (R.C.); (Y.C.); (R.X.); (F.L.); (P.G.); (X.Z.); (P.L.); (S.N.)
- Correspondence: (Y.T.); (X.X.)
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9
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Alkhairy S, Celi LA, Feng M, Zimolzak AJ. Acute kidney injury detection using refined and physiological-feature augmented urine output. Sci Rep 2021; 11:19561. [PMID: 34599217 PMCID: PMC8486770 DOI: 10.1038/s41598-021-97735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 02/17/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022] Open
Abstract
Acute kidney injury (AKI) is common in the intensive care unit, where it is associated with increased mortality. AKI is often defined using creatinine and urine output criteria. The creatinine-based definition is more reliable but less expedient, whereas the urine output based definition is rapid but less reliable. Our goal is to examine the urine output criterion and augment it with physiological features for better agreement with creatinine-based definitions of AKI. The objectives are threefold: (1) to characterize the baseline agreement of urine output and creatinine definitions of AKI; (2) to refine the urine output criteria to identify the thresholds that best agree with the creatinine-based definition; and (3) to build generalized estimating equation (GEE) and generalized linear mixed-effects (GLME) models with static and time-varying features to improve the accuracy of a near-real-time marker for AKI. We performed a retrospective observational study using data from two independent critical care databases, MIMIC-III and eICU, for critically ill patients who developed AKI in intensive care units. We found that the conventional urine output criterion (6 hr, 0.5 ml/kg/h) has specificity and sensitivity of 0.49 and 0.54 for MIMIC-III database; and specificity and sensitivity of 0.38 and 0.56 for eICU. Secondly, urine output thresholds of 12 hours and 0.6 ml/kg/h have specificity and sensitivity of 0.58 and 0.48 for MIMIC-III; and urine output thresholds of 10 hours and 0.6 ml/kg/h have specificity and sensitivity of 0.49 and 0.48 for eICU. Thirdly, the GEE model of four hours duration augmented with static and time-varying features can achieve a specificity and sensitivity of 0.66 and 0.61 for MIMIC-III; and specificity and sensitivity of 0.66 and 0.64 for eICU. The GLME model of four hours duration augmented with static and time-varying features can achieve a specificity and sensitivity of 0.71 and 0.55 for MIMIC-III; and specificity and sensitivity of 0.66 and 0.60 for eICU. The GEE model has greater performance than the GLME model, however, the GLME model is more reflective of the variables as fixed effects or random effects. The significant improvement in performance, relative to current definitions, when augmenting with patient features, suggest the need of incorporating these features when detecting disease onset and modeling at window-level rather than patient-level.
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Affiliation(s)
- Sahar Alkhairy
- Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Leo A Celi
- Massachusetts Institute of Technology, Cambridge, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mengling Feng
- Massachusetts Institute of Technology, Cambridge, MA, USA.,Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore, Singapore
| | - Andrew J Zimolzak
- Baylor College of Medicine, Houston, TX, USA.,Michael E. DeBakey VA Medical Center, Houston, TX, USA
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10
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Shimamura Y, Abe K, Maeda T, Ogawa Y, Takizawa H, Ishigami J, Matsushita K. Association between diuretic administration before diagnosis and incidence of acute kidney injury in patients with minimal change disease: A single-center observational study. Medicine (Baltimore) 2021; 100:e25845. [PMID: 33950999 PMCID: PMC8104140 DOI: 10.1097/md.0000000000025845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 12/01/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
We examined the association between diuretic administration before the diagnosis of minimal change disease and the incidence of acute kidney injury. Moreover, we examined whether the use of diuretics affected the time to complete remission in adults with such disease.The present study was a single-center, retrospective, observational cohort study. We included 107 patients with biopsy-proven minimal change disease who were treated at a tertiary referral center in Japan between January 1, 2000 and March 31, 2019. All biopsy specimens were examined by a board-certified renal pathologist. The patients were considered to have minimal change disease when the kidney biopsy specimen had no glomerular lesions or only mild focal mesangial prominence (not exceeding 3 or 4 cells per segment) by light microscopy and/or foot process effacement by electron microscopy. Logistic regression and Kaplan-Meier curve analyses were performed, comparing the data of patients who received diuretics or not.The median age was 47 (28-66) years, 52% of patients were women, and the median proteinuria dosage was 8.3 (5.3-11.2) g/d. When minimal change disease was diagnosed, 27% of patients were taking diuretics. Within 30 days after the diagnosis, acute kidney injury occurred in 27% of patients. On multivariable logistic regression analysis, the use of diuretics was significantly associated with a higher risk of acute kidney injury. The use of diuretics was also associated with a longer time to complete remission.Diuretic administration can be associated with an elevated acute kidney injury risk and longer remission time in adult patients with newly diagnosed minimal change disease.
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Affiliation(s)
| | - Koki Abe
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Takuto Maeda
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan
| | | | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Abdel-Rahman EM, Turgut F, Gautam JK, Gautam SC. Determinants of Outcomes of Acute Kidney Injury: Clinical Predictors and Beyond. J Clin Med 2021; 10:jcm10061175. [PMID: 33799741 PMCID: PMC7999959 DOI: 10.3390/jcm10061175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 01/23/2021] [Revised: 03/05/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
Acute kidney injury (AKI) is a common clinical syndrome characterized by rapid impairment of kidney function. The incidence of AKI and its severe form AKI requiring dialysis (AKI-D) has been increasing over the years. AKI etiology may be multifactorial and is substantially associated with increased morbidity and mortality. The outcome of AKI-D can vary from partial or complete recovery to transitioning to chronic kidney disease, end stage kidney disease, or even death. Predicting outcomes of patients with AKI is crucial as it may allow clinicians to guide policy regarding adequate management of this problem and offer the best long-term options to their patients in advance. In this manuscript, we will review the current evidence regarding the determinants of AKI outcomes, focusing on AKI-D.
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Affiliation(s)
- Emaad M. Abdel-Rahman
- Division of Nephrology, University of Virginia, Charlottesville, VA 22908, USA;
- Correspondence: ; Tel.: +1-(434)-243-2671
| | - Faruk Turgut
- Internal Medicine/Nephrology, Faculty of Medicine, Mustafa Kemal University, Antakya/Hatay 31100, Turkey;
| | - Jitendra K. Gautam
- Division of Nephrology, University of Virginia, Charlottesville, VA 22908, USA;
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12
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Prevent deterioration and long-term ventilation: intensive care following thoracic surgery. Curr Opin Anaesthesiol 2021; 34:20-24. [PMID: 33315639 DOI: 10.1097/aco.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Patients with indication for lung surgery besides the pulmonary pathology often suffer from independent comorbidities affecting several other organ systems. Preventing patients from harmful complications due to decompensation of underlying organ insufficiencies perioperatively is pivotal. This review draws attention to the peri- and postoperative responsibility of the anaesthetist and intensivist to prevent patients undergoing lung surgery deterioration. RECENT FINDINGS During the last decades we had to accept that 'traditional' intensive care medicine implying deep sedation, controlled ventilation, liberal fluid therapy, and broad-spectrum antimicrobial therapy because of several side-effects resulted in prolongation of hospital length of stay and a decline in quality of life. Modern therapy therefore should focus on the convalescence of the patient and earliest possible reintegration in the 'life-before.' Avoidance of sedative and anticholinergic drugs, early extubation, prophylactic noninvasive ventilation and high-flow nasal oxygen therapy, early mobilization, well-adjusted fluid balance and reasonable use of antibiotics are the keystones of success. SUMMARY A perioperative interprofessional approach and a change in paradigms are the prerequisites to improve outcome and provide treatment for elder and comorbid patients with an indication for thoracic surgery.
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13
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Heyman SN, Gorelik Y, Zorbavel D, Rosenberger C, Abassi Z, Rosen S, Khamaisi M. Near-drowning: new perspectives for human hypoxic acute kidney injury. Nephrol Dial Transplant 2020; 35:206-212. [PMID: 30768198 DOI: 10.1093/ndt/gfz016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/16/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Abstract
Concepts regarding hypoxic acute kidney injury (AKI) are derived from widely used warm ischemia-reflow (WIR) models, characterized by extensive proximal tubular injury and associated with profound inflammation. However, there is ample clinical and experimental data indicating that hypoxic AKI may develop without total cessation of renal blood flow, with a different injury pattern that principally affects medullary thick limbs in the outer medulla. This injury pattern likely reflects an imbalance between blood and oxygen supply and oxygen expenditure, principally for tubular transport. Experimental models of hypoxic AKI other than WIR are based on mismatched oxygen delivery and consumption, particularly within the physiologically hypoxic outer medulla. However, evidence for such circumstances in human AKI is lacking. Recent analysis of the clinical course and laboratory findings of patients following near-drowning (ND) provides a rare glimpse into such a scenario. This observation supports the role of renal hypoxia in the evolution of AKI, as renal impairment could be predicted by the degree of whole-body hypoxia (reflected by lactic acidosis). Furthermore, there was a close association of renal functional impairment with indices of reduced oxygen delivery (respiratory failure and features of intense sympathetic activity) and of enhanced oxygen consumption for active tubular transport (extrapolated from the calculated volume of consumed hypertonic seawater). This unique study in humans supports the concept of renal oxygenation imbalance in hypoxic AKI. The drowning scenario, particularly in seawater, may serve as an archetype of this disorder, resulting from reduced oxygen delivery, combined with intensified oxygen consumption for tubular transport.
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Affiliation(s)
- Samuel N Heyman
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem, Israel
| | - Yuri Gorelik
- Department of Medicine D, Rambam Health Care Campus and Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel
| | - Danny Zorbavel
- Department of Medicine D, Rambam Health Care Campus and Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel
| | | | - Zaid Abassi
- Department of Physiology, Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel.,Department of Laboratory Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Seymour Rosen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mogher Khamaisi
- Department of Medicine D, Rambam Health Care Campus and Ruth & Bruce Rappaport Faculty of Medicine, Technion-IIT, Haifa, Israel
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Zou Z, Chen S, Li Y, Cai J, Fang Y, Xie J, Fang W, Kang D, Xu Y. Risk factors for renal failure and short-term prognosis in patients with spontaneous intracerebral haemorrhage complicated by acute kidney injury. BMC Nephrol 2020; 21:311. [PMID: 32727417 PMCID: PMC7391601 DOI: 10.1186/s12882-020-01949-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/01/2019] [Accepted: 07/13/2020] [Indexed: 11/21/2022] Open
Abstract
Background Although acute kidney injury (AKI) is a known risk factor for adverse clinical outcomes in patients with spontaneous intracerebral haemorrhage (SICH), little is known about the predisposing factors that contribute to renal failure and short-term prognosis in the setting of SICH already complicated by AKI. In this study, we aimed to identify the renal failure factors in SICH patents with AKI. Methods Five hundred forty-three patients with SICH complicated by differential severities of AKI who were admitted to the First Affiliated Hospital of Fujian Medical University from January 2016 to December 2018 were retrospectively studied. Logistic regression and receiver operator characteristic (ROC) curve analysis were performed to determine the best predictive and discriminative variables. Multivariate Cox regression analysis was performed to identify prognostic factors for renal recovery. Results In the multivariable adjusted model, we found that hypernatremia, metabolic acidosis, elevated serum creatine kinase, hyperuricaemia, proteinuria, and the use of colloids and diuretics were all independent risk factors for the occurrence of stage 3 AKI in SICH patients. The area under the curve analysis indicated that hypernatremia and hyperuricaemia were predictive factors for stage 3 AKI, and the combination of these two parameters increased their predictability for stage 3 AKI. Kaplan-Meier survival curves revealed that the renal recovery rate in SICH patients with stages 1 and 2 AKI was significantly higher than that in SICH patients with stage 3 AKI. Multivariate Cox regression analysis suggested that hypernatremia and the occurrence of stage 3 AKI are predictors for poor short-term renal recovery. Conclusions These findings illustrate that hypernatremia and hyperuricaemia represent potential risk factors for the occurrence of stage 3 AKI in SICH patients. Those patients with hypernatremia and stage 3 AKI were associated with a poor short-term prognosis in renal recovery.
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Affiliation(s)
- Zhenhuan Zou
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Siying Chen
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Yinshuang Li
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Jiawei Cai
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yulu Fang
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Jingzhi Xie
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China
| | - Wenhua Fang
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Dezhi Kang
- Department of Neurosurgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Yanfang Xu
- Department of Nephrology, First Affiliated Hospital, Fujian Medical University, Chazhong Road 20, Fuzhou, 350005, China.
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15
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Baar W, Kaufmann K, Silbach K, Jaenigen B, Pisarski P, Goebel U, Kalbhenn J, Heinrich S, Knoerlein J. Early Postoperative Use of Diuretics After Kidney Transplantation Showed Increase in Delayed Graft Function. Prog Transplant 2020; 30:95-102. [PMID: 32242491 DOI: 10.1177/1526924820913505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In acute renal injury, diuretics are widely considered to be harmful. Nevertheless, they are used frequently after kidney transplantation. We hypothesized that diuretics administered in the early postoperative treatment after kidney transplantation increase the incidence of delayed graft function (DGF). METHODS In this monocentric, retrospective cohort analysis, we screened the closed files of all consecutive patients who underwent kidney transplantation from 2011 to 2017. The outcome variable was DGF, defined as at least 1 hemodialysis within 7 days postoperatively. To stratify for baseline characteristics such as waiting time or cold ischemic period, we employed a propensity score-matched analysis. Further statistical processing included basic descriptive statistics, Mann-Whitney U test, and binary logistic regression analysis. RESULTS The unmatched cohort included 445 patients and showed a significantly increased rate of DGF for patients who received either furosemide or mannitol or a combination of both (5% vs 25%; P < .001). Mannitol (odds ratio [OR]: 4.094) and furosemide (OR: 2.915) showed a significant correlation with DGF in the multivariate regression analysis. Propensity score-based matching resulted in a matched cohort of 214 patients with balanced baseline risk variables. In this matched cohort, the rate of DGF was significantly increased in patients who received diuretics in the early postoperative treatment (7% vs 16%; P = .031). CONCLUSION Our results show that postoperatively administered diuretics are associated with an increased rate of DGF even in a cohort with balanced preoperative risk variables. This study supports recently published reviews, which call diuretics in the transplantation process into question.
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Affiliation(s)
- Wolfgang Baar
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Kai Kaufmann
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Kai Silbach
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Bernd Jaenigen
- Faculty of Medicine, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetter Strasse, Freiburg, Germany
| | - Przemyslaw Pisarski
- Faculty of Medicine, Department of General and Visceral Surgery, Medical Center, University of Freiburg, Hugstetter Strasse, Freiburg, Germany
| | - Ulrich Goebel
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Johannes Kalbhenn
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Sebastian Heinrich
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
| | - Julian Knoerlein
- Faculty of Medicine, Department of Anesthesiology and Critical Care, Medical Center, University of Freiburg, Breisgau, Germany
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Gu CH, Wang XZ, Han YL, Jing QM, Ren LL, Zhang Y, Peng JY, Zhao X. Predictors of contrast-induced acute kidney injury in patients with coronary artery disease receiving contrast agents twice within 30 days. Mil Med Res 2020; 7:14. [PMID: 32216841 PMCID: PMC7098087 DOI: 10.1186/s40779-020-00243-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 07/15/2019] [Accepted: 03/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND None of study mentioned about contrast-induced acute kidney injury (CI-AKI) in people who have received contrast agents twice within in a short period of time. This study is trying to identify the predictors. METHODS We enrolled 607 patients between Oct. 2010 and Jul. 2015 who received contrast agents twice within 30 days in the Department of Cardiology of the General Hospital of Shenyang Military Region. The primary outcome was CI-AKI within 72 h after contrast agent exposure. Patients were divided into groups A (n = 559) and group B (n = 48) according to whether CI-AKI occurred after the second agent. RESULTS Patients in group B (CI-AKI occurred after the second agent) had a more rapid heart rate and more usage of diuretics and digitalis. In group B, CI-AKI occurred more frequently after the first agent. Multivariate logistic regression showed that diuretic (P = 0.006) and intra-aortic balloon pump (IABP) usage (P = 0.012) were independent predictors of CI-AKI after the first agent. Angiotensin-converting enzyme inhibitor/Angiotensin II receptor antagonist (ACEI/ARB) usage (P = 0.039), IABP usage (P = 0.040) and CI-AKI occurring after administration of the first agent (P = 0.015) were independent predictors of CI-AKI after the second. Furthermore, dividing the patients into tertiles of the time interval between the two agents showed that CI-AKI occurred more frequently when the second agent was administered within 1-3 days after the first exposure than within 4-6 days (12.4% vs. 5.0%, P = 0.008) or ≥ 7 days (12.4% vs. 6.4%, P = 0.039). CONCLUSIONS Diuretic and IABP usage are independent predictors of CI-AKI following exposure to a first contrast agent. The major predictors of CI-AKI after exposure to a second agent are time since the first contrast exposure, ACEI/ARB usage, and IABP usage. More importantly, a three-day interval between the two agents is associated with a higher incidence of CI-AKI following the second administration.
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Affiliation(s)
- Chong-Huai Gu
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China.,Department of Cardiovascular, Anqing Municipal Hospital, Anqing, 246000, Anhui, China
| | - Xiao-Zeng Wang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Ya-Ling Han
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Quan-Min Jing
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Li-Li Ren
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Yan Zhang
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Jun-Yin Peng
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China
| | - Xin Zhao
- Cardiovascular Research Institute and Department of Cardiology, General Hospital of Shenyang Military Region, Shenyang, 110840, China.
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Zhao GJ, Xu C, Ying JC, Lü WB, Hong GL, Li MF, Wu B, Yao YM, Lu ZQ. Association between furosemide administration and outcomes in critically ill patients with acute kidney injury. Crit Care 2020; 24:75. [PMID: 32131879 PMCID: PMC7057586 DOI: 10.1186/s13054-020-2798-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/19/2019] [Accepted: 02/18/2020] [Indexed: 02/25/2023] Open
Abstract
Background Although current guidelines for AKI suggested against the use of furosemide in AKI management, the effect of furosemide on outcomes in real-world clinical settings remains uncertain. The aim of the present study was to investigate the association between furosemide administration and outcomes in critically ill patients with AKI using real-world data. Methods Critically ill patients with AKI were identified from the Medical Information Mart for Intensive Care (MIMIC)-III database. Propensity score (PS) matched analysis was used to match patients receiving furosemide to those without diuretics treatment. Linear regression, logistic regression model, and Cox proportional hazards model were used to assess the associations between furosemide and length of stay, recovery of renal function, and in-hospital and 90-day mortality, respectively. Results A total of 14,154 AKI patients were included in the data analysis. After PS matching, 4427 pairs of patients were matched between the patients who received furosemide and those without diuretics treatment. Furosemide was associated with reduced in-hospital mortality [hazard ratio (HR) 0.67; 95% CI 0.61–0.74; P < 0.001] and 90-day mortality [HR 0.69; 95% CI 0.64–0.75; P < 0.001], and it was also associated with the recovery of renal function [HR 1.44; 95% CI 1.31–1.57; P < 0.001] in over-all AKI patients. Nevertheless, results illustrated that furosemide was not associated with reduced in-hospital mortality in patients with AKI stage 0–1 defined by UO criteria, AKI stage 2–3 according to SCr criteria, and in those with acute-on-chronic (A-on-C) renal injury. Conclusions Furosemide administration was associated with improved short-term survival and recovery of renal function in critically ill patients with AKI. Furosemide was especially effective in patients with AKI UO stage 2–3 degree. However, it was not effective in those with AKI SCr stage 2–3 and chronic kidney disease. The results need to be verified in randomized controlled trials.
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Affiliation(s)
- Guang-Ju Zhao
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Chang Xu
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Jian-Chao Ying
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Wen-Biao Lü
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Guang-Liang Hong
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Meng-Fang Li
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Bing Wu
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China
| | - Yong-Ming Yao
- Trauma Research Center, Fourth Medical of the Chinese PLA General Hospital, Beijing, 100048, People's Republic of China.
| | - Zhong-Qiu Lu
- Emergency Intensive Care Unit, Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, People's Republic of China.
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Winther‐Olesen M, Møller MH, Johansen KK, Aasvang EK. Effects of post-operative furosemide in adult surgical patients: A systematic review and meta-analysis of randomised clinical trials. Acta Anaesthesiol Scand 2020; 64:282-291. [PMID: 31742656 DOI: 10.1111/aas.13513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/26/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with increased morbidity and mortality and may present as oliguria in the post-operative phase. Diuretics, including furosemide, are commonly used in post-operative patients. Accordingly, we aimed to assess the balance between benefits and harms of furosemide post-operatively in adult surgical patients. METHODS We conducted a systematic review with meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements, the Cochrane Handbook and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. We included randomised clinical trials (RCTs) comparing post-operative treatment with furosemide vs no furosemide in adult surgical patients. Risk ratios (RR) with 95% confidence intervals (CI) were estimated by conventional meta-analysis and trial sequential analysis (TSA). RESULTS Two thousand five hundred and sixty seven records were identified and four trials with 325 patients in total were included. All were adjudicated as having overall high risk of bias. We observed no statistically significant difference between furosemide- vs no furosemide-treated patients in any of the predefined outcome measures, including AKI (RR 1.07, 95% CI 0.43-2.65), all-cause mortality (RR 1.73, 95% CI 0.62-4.80, use of vasopressors post-operatively (RR 1.04, 95% CI 0.74-1.44) or need for renal replacement therapy (RR 3.87, 95% CI 0.44-33.99). TSA highlighted sparse data, and the overall quality of evidence was very low. CONCLUSION In this systematic review, we found that the quantity and quality of evidence for using furosemide post-operatively in adult surgical patients were very low with no firm evidence for benefit or harm.
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Affiliation(s)
- Marie Winther‐Olesen
- Anesthesiological Department The Abdominal Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
- Department of Intensive Care 4131 Copenhagen University HospitalRigshospitalet Copenhagen Denmark
- Anesthesiological Department Holbæk Hospital Region Zealand Denmark
| | - Morten Hylander Møller
- Department of Intensive Care 4131 Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Karina K. Johansen
- Anesthesiological Department The Abdominal Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
| | - Eske K. Aasvang
- Anesthesiological Department The Abdominal Centre Copenhagen University HospitalRigshospitalet Copenhagen Denmark
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19
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An S, Luo H, Wang J, Gong Z, Tian Y, Liu X, Ma J, Jiang R. An acute kidney injury prediction nomogram based on neurosurgical intensive care unit profiles. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:194. [PMID: 32309341 PMCID: PMC7154440 DOI: 10.21037/atm.2020.01.60] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Academic Contribution Register] [Indexed: 12/16/2022]
Abstract
Background Acute kidney injury (AKI) is a common and serious complication with high mortality within the neural-critical care unit, and can limit the treatment of osmotic diuresis and body fluid equilibrium. Given its seriousness, it is necessary to find a tool to predict the likelihood of AKI and to prevent its occurrence. Methods In this retrospective study, patients’ clinical profiles, laboratory test results, and doctors’ prescriptions were collected. Least absolute shrinkage and selection operator (LASSO) regression was used to select variables, and a logistic regression model was then applied to find independent risk factors for AKI. Based on the results of multivariate analysis, we established a nomogram to evaluate the probability of AKI, which was verified through the use of a receiver operating characteristic (ROC) curve and its calibration curves. Results Risk factors given by logistic regression were Glasgow Coma Scale (GCS) classification (1.593; 95% CI: 0.995–2.549; P=0.0523), coefficient of variation (CV) of GCS (1.017; 95% CI: 0.995–1.04; P=0.1367), hypertension (2.238; 95% CI: 1.124–4.456; P=0.0219), coronary heart disease (2.924; 95% CI: 1.2–7.126; P=0.0182), pneumonia within 7 days (3.032; 95% CI: 1.511–6.085; P=0.0018), heart failure within 7 days (6.589; 95% CI: 2.235–19.42; P=0.0006), furosemide (1.011; 95% CI: 1.005–1.016; P<0.0001), torasemide (1.028; 95% CI: 0.976–1.082; P=0.297), dopamine (1; 95% CI: 1–1.001, P=0.3297), and norepinephrine (1.007; 95% CI: 1–1.015; P=0.0474). The area under the curve (AUC) of the prediction model was 0.8786, and the calibration curves showed that the model had a good ability to predict AKI occurrence. Conclusions This study presents an AKI prediction nomogram based on LASSO, logistic regression, and clinical risk factors. The clinical use of the nomogram may allow for the timely detection of AKI occurrence and thus improve the prognosis of patients.
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Affiliation(s)
- Shuo An
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Hongliang Luo
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jiao Wang
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Ye Tian
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
| | - Jun Ma
- Department of Health Statistics, College of Public Health, Tianjin Medical University, Tianjin 300070, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin 300052, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Tianjin Medical University General Hospital, Ministry of Education and Tianjin City, Tianjin 300052, China
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20
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The Neutrophil Percentage-to-Albumin Ratio Is Associated with All-Cause Mortality in Critically Ill Patients with Acute Kidney Injury. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5687672. [PMID: 32219136 PMCID: PMC7049452 DOI: 10.1155/2020/5687672] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Academic Contribution Register] [Received: 11/07/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 02/08/2023]
Abstract
Background There is no evidence to suggest the predictive power of neutrophil percentage-to-albumin ratio (NPAR) in patients with acute kidney injury (AKI). We hypothesized that NPAR would correlate with all-cause mortality in critically ill patients with AKI. Methods From the MIMIC-III V1.4 database, we extracted demographics, vital signs, comorbidities, laboratory tests, and other clinical data. The clinical endpoints were 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI. Cox proportional hazards models were used to evaluate the prognostic values of NPAR, and subgroup analyses were performed to measure mortality across various subgroups. Results A total of 7,481 eligible subjects were enrolled. In multivariate analysis, after adjustments for age, ethnicity, gender, and other confounding factors, higher NPARs were associated with an increased risk of 30-, 90- and 365-day all-cause mortality in critically ill patients with AKI (tertile 3 versus tertile 1: adjusted HR, 95% CI: 1.48, 1.30–1.69; 1.47, 1.31–1.66; 1.46, 1.32–1.62, respectively; P trend <0.01). A similar trend was observed in the NPAR group division by quintiles. Subgroup analysis revealed no significant interactions in most strata. Conclusions Increased NPAR correlates with increased risk of all-cause mortality in critically ill patients with AKI.
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Dai X, Chen J, Li W, Bai Z, Li X, Wang J, Li Y. Association Between Furosemide Exposure and Clinical Outcomes in a Retrospective Cohort of Critically Ill Children. Front Pediatr 2020; 8:589124. [PMID: 33585362 PMCID: PMC7874070 DOI: 10.3389/fped.2020.589124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 07/30/2020] [Accepted: 12/16/2020] [Indexed: 12/29/2022] Open
Abstract
Furosemide is commonly prescribed in critically ill patients to increase the urine output and prevent fluid overload (FO) and acute kidney injury (AKI), but not supported by conclusive evidence. There remain conflicting findings on whether furosemide associates with AKI and adverse outcomes. Information on the impact of furosemide on adverse outcomes in a general population of pediatric intensive care unit (PICU) is limited. The aim of the cohort study was to investigate the associations of furosemide with AKI and clinical outcomes in critically ill children. Study Design: We retrospectively reviewed a cohort of 456 critically ill children consecutively admitted to PICU from January to December 2016. The exposure of interest was the use of furosemide in the first week after admission. FO was defined as ≥5% of daily fluid accumulation, and mean FO was considered significant when mean daily fluid accumulation during the first week was ≥5%. The primary outcomes were AKI in the first week after admission and mortality during PICU stay. AKI diagnosis was based on Kidney Disease: Improving Global Outcomes criteria with both serum creatinine and urine output. Results: Furosemide exposure occurred in 43.4% of all patients (n = 456) and 49.3% of those who developed FO (n = 150) in the first week after admission. Patients who were exposed to furosemide had significantly less degree of mean daily fluid accumulation than those who were not (1.10 [-0.33 to 2.61%] vs. 2.00 [0.54-3.70%], P < 0.001). There was no difference in the occurrence of AKI between patients who did and did not receive furosemide (22 of 198 [11.1%] vs. 36 of 258 [14.0%], P = 0.397). The mortality rate was 15.4% (70 of 456), and death occurred more frequently among patients who received furosemide than among those who did not (21.7 vs. 10.5%, P = 0.002). Furosemide exposure was associated with increased odds for mortality in a multivariate logistic regression model adjusted for body weight, gender, illness severity assessed by PRISM III score, the presence of mean FO, and AKI stage [adjusted odds ratio (AOR) 1.95; 95%CI, 1.08-3.52; P = 0.026]. Conclusion: Exposure to furosemide might be associated with increased risk for mortality, but not AKI, in critically ill children.
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Affiliation(s)
- Xiaomei Dai
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jiao Chen
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Wenjing Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Zhenjiang Bai
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
| | - Jian Wang
- Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Yanhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China.,Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
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22
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Alscher MD, Erley C, Kuhlmann MK. Acute Renal Failure of Nosocomial Origin. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:149-158. [PMID: 30961801 DOI: 10.3238/arztebl.2019.0149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Academic Contribution Register] [Received: 10/02/2018] [Revised: 10/02/2018] [Accepted: 01/13/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND 10-20% of hospitalized patients develop acute kidney injury (AKI)/acute renal failure during their hospital stay. The mortality of nosocomial AKI is approximately 30%. METHODS This review is based on relevant publications retrieved by a search in multiple databases (PubMed and Uptodate), archives, and pertinent medical journals. RESULTS The most common causes of nosocomial AKI are volume depletion, sepsis, heart diseases, polytrauma, liver diseases, and drug toxicity. AKI can also be of postrenal (obstructive) origin, or a result of renal diseases including glomeruloneph- ritis, vasculitis, tubulointerstitial nephritis, and cholesterol embolism. In about 13% of cases, nosocomial AKI develops on the basis of pre-existing chronic renal disease. Patients with AKI are at elevated risk of developing chronic renal disease and must be followed up appropriately after they are discharged from the hospital. Indispens- able elements of the evaluation of nosocomial AKI include renal ultrasonography, the exclusion of postrenal obstruction, urine chemistry, and microbiological urinaly- sis. Potentially nephrotoxic drugs and those that impair renal hemodynamics must be avoided to the greatest possible extent in patients with acute renal damage. Hypotension must be avoided as well. CONCLUSION Early, specific nephrological diagnosis and treatment are important components of the management of nosocomial AKI, particularly because causally directed treatment is available for some of the conditions that underlie it.
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23
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Fluid Overload Associates With Major Adverse Kidney Events in Critically Ill Patients With Acute Kidney Injury Requiring Continuous Renal Replacement Therapy. Crit Care Med 2019; 47:e753-e760. [DOI: 10.1097/ccm.0000000000003862] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 02/03/2023]
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24
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[New kidney function tests: Renal functional reserve and furosemide stress test]. Med Klin Intensivmed Notfmed 2018; 115:37-42. [PMID: 29327197 DOI: 10.1007/s00063-017-0400-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 05/19/2017] [Revised: 07/06/2017] [Accepted: 12/09/2017] [Indexed: 12/21/2022]
Abstract
Acute kidney injury (AKI) occurs in 30-50% of all intensive care patients. Renal replacement therapy (RRT) has to be initiated in 10-15%. The early in-hospital mortality is about 50%. Up to 20% of all survivors develop chronic kidney disease after intensive care discharge and progress to end-stage kidney disease within the next 10 years. For timely initiation of prophylactic or therapeutic interventions, it is crucial to exactly determine the actual kidney function, i. e., glomerular filtration rate (GFR), and to gain insight into the further development of kidney function. Traditionally, renal function has been estimated using serum levels of creatinine or urea. Unfortunately, both are notoriously unreliable and insensitive in intensive care patients. Cystatin C has fewer non-GFR determinants when compared to creatinine and is more sensitive and accurate to detect early decreases of GFR. At present, new functional tests are discussed, namely the furosemide stress test (FST) and renal functional reserve (RFR). The FST consists of an intravenous infusion of 1.0-1.5 mg/kgBW furosemide to critically ill patients with AKI. An increase in urine output to >100 ml/h is indicative of a GFR >20 ml/min and almost certainly excludes progression to AKI stage III and need for RRT. Estimation of RFR can be made by short-term oral or intravenous administration of a high protein load. A subsequent increase in GFR defines the presence and the magnitude of functional reserve which can be activated. Loss of RFR is an indicator of loss of functioning nephron mass and incomplete recovery following AKI. Both FST and RFR can help to improve diagnosis and care of high-risk patients with acute and chronic kidney disease.
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25
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Qureshi SH, Patel NN, Murphy GJ. Vascular endothelial cell changes in postcardiac surgery acute kidney injury. Am J Physiol Renal Physiol 2017; 314:F726-F735. [PMID: 29357431 DOI: 10.1152/ajprenal.00319.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 01/03/2023] Open
Abstract
Acute kidney injury (AKI) is common complication of cardiac surgery; however, the phenotype of this condition is poorly defined. The aim of this study was to characterize changes in endothelial structure and function that underlie postcardiopulmonary bypass (post-CPB) AKI. Adult pigs ( n = 16) were randomized to undergo the following procedures ( n = 8 per group): group 1: sham operation, neck dissection with 2.5 h of general anesthesia; and group 2: CPB, 2.5 h of cardiopulmonary bypass. CPB resulted in the depletion of specific epitopes of glycosaminoglycans side chains of the endothelial glycocalyx: Dolichos biflorus agglutinin: mean difference (MD) [95% confidence interval (CI)], P value: -0.26 (-0.42, -0.09), P = 0.0024, Triticum vulgaris (wheat germ) agglutinin: -0.83 (-1.2, -0.38), P = 0.0005, and Ulex europaeus agglutinin 1: -0.25 (-0.49, -0.009), P = 0.041; endothelial membrane protein: thrombomodulin: -3.13 (-5.6, -0.65), P = 0.02; and adherens junction: VE-cadherin: -1.06 (-1.98, -0.145), P = 0.02. CPB also resulted in reductions in microvascular cortical perfusion: -0.62 (-1.02, -0.22), P = 0.006, and increased renal cortex adenosine levels: 2.32 (0.83, 3.8), P = 0.0059. These changes were accompanied by significant reduction in creatinine clearance at 1.5 h postintervention, MD 95% CI; -51.7 (-99.7, -3.7), P = 0.037, and at 24 h, MD (95% CI): -47.3 (-87.7, -7.6), P = 0.023, and proteinuria immediately postintervention MD (95% CI): 18.79 (2.17, 35.4), P = 0.03 vs. sham. In our experimental CPB model, endothelial injury was associated with loss of autoregulation, increase in microvascular permeability, and reduced glomerular filtration. Interventions that promote endothelial homeostasis may have clinical utility in the prevention of postcardiac surgery AKI.
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Affiliation(s)
- Saqib H Qureshi
- University of Leicester, Clinical Sciences Wing, Glenfield General Hospital , Leicester , United Kingdom
| | - Nishith N Patel
- National Heart and Lung Institute, Hammersmith Hospital Campus, Imperial College London , London , United Kingdom
| | - Gavin J Murphy
- University of Leicester, Clinical Sciences Wing, Glenfield General Hospital , Leicester , United Kingdom
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26
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Abstract
Acute kidney injury (AKI) occurs frequently in the surgical intensive care unit and results in significant morbidity and mortality. AKI needs to be identified early and underlying causes treated or eliminated. Sepsis, major surgery such as coronary artery bypass, and hypovolemia are the most common causes and patients with underlying comorbidities have increased susceptibility. Treatment should begin by ensuring that patients are adequately resuscitated and all contributing causes are replaced or eliminated. After stabilization of hemodynamic status and elimination of contributing causes, treatment becomes largely supportive and may require the use of a renal replacement therapy.
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Affiliation(s)
- Robert A Maxwell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, TN, USA.
| | - Christopher Michael Bell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Chattanooga, TN, USA
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27
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Yuan Y, Qiu H, Song L, Hu X, Luo T, Zhao X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. A New Risk Factor Profile for Contrast-Induced Acute Kidney Injury in Patients Who Underwent an Emergency Percutaneous Coronary Intervention. Angiology 2017; 69:523-531. [PMID: 29082747 DOI: 10.1177/0003319717736157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 11/16/2022]
Abstract
We developed a new risk factor profile for contrast-induced acute kidney injury (CI-AKI) under a new definition in patients who underwent an emergency percutaneous coronary intervention (PCI). Consecutive patients (n = 1061) who underwent an emergency PCI were divided into a derivation group (n = 761) and a validation group (n = 300). The rates of CI-AKI were 23.5% (definition 1: serum creatinine [SCr] increase ≥25% in 72 hours), 4.3% (definition 2: SCr increase ≥44.2 μmol/L in 72 hours), and 7.0% (definition 3: SCr increase ≥44.2 μmol/L in 7 days). Due to the high sensitivity of definition 1 and the high rate of missed cases for late diagnosis of CI-AKI under definition 2, definition 3 was used in the study. The risk factor profile included body surface area <1.6 m2 ( P = .030), transient ischemic attack/stroke history ( P = .001), white blood cell count >15.00 × 109/L ( P = .047), estimated glomerular filtration rate <60 mL/min/1.73 m2 ( P = .002) or baseline SCr >133 μmol/L ( P = .007), intra-aortic balloon pump application ( P = .006), and diuretics administration ( P < .001), showing a significant predictive power in the derivation group and validation group. The new risk factor profile of CI-AKI under a new CI-AKI definition in emergency PCI patients is easily applicable with a useful predictive value.
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Affiliation(s)
- Ying Yuan
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Qiu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Song
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoying Hu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong Luo
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Wu
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Nusshag C, Weigand MA, Zeier M, Morath C, Brenner T. Issues of Acute Kidney Injury Staging and Management in Sepsis and Critical Illness: A Narrative Review. Int J Mol Sci 2017; 18:E1387. [PMID: 28657585 PMCID: PMC5535880 DOI: 10.3390/ijms18071387] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 06/07/2017] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 12/19/2022] Open
Abstract
Acute kidney injury (AKI) has a high incidence on intensive care units around the world and is a major complication in critically ill patients suffering from sepsis or septic shock. The short- and long-term complications are thereby devastating and impair the quality of life. Especially in terms of AKI staging, the determination of kidney function and the timing of dialytic AKI management outside of life-threatening indications are ongoing matters of debate. Despite several studies, a major problem remains in distinguishing between beneficial and unnecessary "early" or even harmful renal replacement therapy (RRT). The latter might prolong disease course and renal recovery. AKI scores, however, provide an insufficient outcome-predicting ability and the related estimation of kidney function via serum creatinine or blood urea nitrogen (BUN)/urea is not reliable in AKI and critical illness. Kidney independent alterations of creatinine- and BUN/urea-levels further complicate the situation. This review critically assesses the current AKI staging, issues and pitfalls of the determination of kidney function and RRT timing, as well as the potential harm reflected by unnecessary RRT. A better understanding is mandatory to improve future study designs and avoid unnecessary RRT for higher patient safety and lower health care costs.
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Affiliation(s)
- Christian Nusshag
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, 162, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
| | - Thorsten Brenner
- Department of Anesthesiology, Heidelberg University Hospital, 110, Im Neuenheimer Feld, D-69120 Heidelberg, Germany.
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29
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Yuan Y, Qiu H, Hu X, Luo T, Gao X, Zhao X, Zhang J, Wu Y, Qiao S, Yang Y, Gao R. Predictive value of inflammatory factors on contrast-induced acute kidney injury in patients who underwent an emergency percutaneous coronary intervention. Clin Cardiol 2017; 40:719-725. [PMID: 28543803 DOI: 10.1002/clc.22722] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 03/04/2017] [Revised: 04/11/2017] [Accepted: 04/16/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Contrast-induced acute kidney injury (CI-AKI) is one of the most serious complications in patients who undergo percutaneous coronary intervention (PCI), especially in those with acute coronary syndrome. It has been shown that inflammation may play an important role in the pathophysiology of CI-AKI. HYPOTHESIS Inflammatory factors may play a predominant role in the prediction of CI-AKI in patients who undergo emergency PCI. METHODS Patients who underwent emergency PCI from 2013 to 2015 were consecutively enrolled and were divided into CI-AKI and non-CI-AKI groups. Logistic analysis was used to identify the risk factors of CI-AKI. Receiver operator characteristic curve analysis was performed to evaluate the area under the curve (AUC) and to establish the optimal cutoff. RESULTS A total of 1061 patients were included, and the CI-AKI rate was 5.47% (58/1061). Logistic analysis showed that the white blood cell (WBC) count (odds ratio [OR]: 1.103, 95% confidence interval [CI]: 1.018-1.195, P = 0.016), neutrophil (N) count (OR: 1.134, 95% CI: 1.045-1.232, P = 0.003), neutrophil to lymphocyte ratio (NLR) (OR: 1.105, 95% CI: 1.044-1.169, P = 0.001), C-reactive protein (CRP) level (OR: 1.006, 95% CI: 1.001-1.011, P = 0.020), high-sensitivity C-reactive protein (hs-CRP) level (OR: 1.099, 95% CI: 1.020-1.184, P = 0.013), and big endothelin-1 (ET-1) level (OR: 4.030, 95% CI: 1.989-8.165, P < 0.001) were all significant predictors for CI-AKI, as was the left ventricular ejection fraction and diuretic administration. The AUC of the big ET-1 level was the highest (0.793, 95% CI: 0.733-0.853), followed by the NLR (0.708, 95% CI: 0.641-0.774), hs-CRP level (0.705, 95% CI: 0.627-0.782), CRP level (0.684, 95% CI: 0.607-0.761), N count (0.655, 95% CI: 0.584-0.726), WBC count (0.620, 95% CI: 0.544-0.695), and erythrocyte sedimentation rate (0.611, 95% CI: 0.527-0.695). CONCLUSIONS The WBC count, N count, NLR, CRP level, hs-CRP level, and big ET-1 level are all associated with an increased risk of CI-AKI, and among which, the big ET-1 level, NLR, and the hs-CRP level might have high predictive value for CI-AKI after an emergency PCI.
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Affiliation(s)
- Ying Yuan
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Qiu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoying Hu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tong Luo
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojin Gao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueyan Zhao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Zhang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Wu
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Analyse des recommandations britanniques 2015 sur la prévention et la prise en charge du syndrome de lyse tumorale. Rev Med Interne 2017; 38:36-43. [DOI: 10.1016/j.revmed.2016.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 11/14/2015] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
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Prieto-García L, Pericacho M, Sancho-Martínez SM, Sánchez Á, Martínez-Salgado C, López-Novoa JM, López-Hernández FJ. Mechanisms of triple whammy acute kidney injury. Pharmacol Ther 2016; 167:132-145. [PMID: 27490717 DOI: 10.1016/j.pharmthera.2016.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 12/26/2022]
Abstract
Pre-renal acute kidney injury (AKI) results from glomerular haemodynamic alterations leading to reduced glomerular filtration rate (GFR) with no parenchymal compromise. Renin-angiotensin system inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor antagonists (ARAs), non-steroidal anti-inflammatory drugs (NSAIDs) and diuretics, are highly prescribed drugs that are frequently administered together. Double and triple associations have been correlated with increased pre-renal AKI incidence, termed "double whammy" and "triple whammy", respectively. This article presents an integrative analysis of the complex interplay among the effects of NSAIDs, ACEIs/ARAs and diuretics, acting alone and together in double and triple therapies. In addition, we explore how these drug combinations alter the equilibrium of regulatory mechanisms controlling blood pressure (renal perfusion pressure) and GFR to increase the odds of inducing AKI through the concomitant reduction of blood pressure and distortion of renal autoregulation. Using this knowledge, we propose a more general model of pre-renal AKI based on a multi whammy model, whereby several factors are necessary to effectively reduce net filtration. The triple whammy was the only model associated with pre-renal AKI accompanied by a course of other risk factors, among numerous potential combinations of clinical circumstances causing hypoperfusion in which renal autoregulation is not operative or is deregulated. These factors would uncouple the normal BP-GFR relationship, where lower GFR values are obtained at every BP value.
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Affiliation(s)
- Laura Prieto-García
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Theranostics for Renal and Cardiovascular Diseases (TERCARD), Edificio Departamental, Campus Miguel de Unamuno, Salamanca, Spain
| | - Miguel Pericacho
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain
| | - Sandra M Sancho-Martínez
- Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Theranostics for Renal and Cardiovascular Diseases (TERCARD), Edificio Departamental, Campus Miguel de Unamuno, Salamanca, Spain
| | - Ángel Sánchez
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Hospital Universitario de Salamanca, Unidad de Hipertensión, Salamanca, Spain
| | - Carlos Martínez-Salgado
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Theranostics for Renal and Cardiovascular Diseases (TERCARD), Edificio Departamental, Campus Miguel de Unamuno, Salamanca, Spain
| | - José Miguel López-Novoa
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Theranostics for Renal and Cardiovascular Diseases (TERCARD), Edificio Departamental, Campus Miguel de Unamuno, Salamanca, Spain
| | - Francisco J López-Hernández
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Paseo de San Vicente, 58-182 - Hospital Virgen Vega, Planta 10, 37007 Salamanca, Spain; Department of Physiology & Pharmacology, University of Salamanca, Salamanca, Spain; Instituto Reina Sofía de Investigación Nefrológica, Fundación Iñigo Álvarez de Toledo, Madrid, Spain; Group of Biomedical Research in Critical Care Medicine (BioCritic), Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Group of Theranostics for Renal and Cardiovascular Diseases (TERCARD), Edificio Departamental, Campus Miguel de Unamuno, Salamanca, Spain.
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Abstract
Acute kidney injury (AKI) is one of the most relevant complications after major surgery and is a predictor of mortality. In Western countries, patients at risk of developing AKI are mainly those undergoing cardiovascular surgical procedures. In this category of patients, AKI depends on a multifactorial etiology, including low ejection fraction, use of contrast media, hemodynamic instability, cardiopulmonary bypass, and bleeding. Despite a growing body of literature, the treatment of renal failure remains mainly supportive (e.g. hemodynamic stability, fluid management, and avoidance of further damage); therefore, the management of patients at risk of AKI should aim at prevention of renal damage. Thus, the present narrative review analyzes the pathophysiology underlying AKI (specifically in high-risk patients), the preoperative risk factors that predispose to renal damage, early biomarkers related to AKI, and the strategies employed for perioperative renal protection. The most recent scientific evidence has been considered, and whenever conflicting data were encountered possible suggestions are provided.
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Affiliation(s)
- Nora Di Tomasso
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Monaco
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Bihari S, Holt AW, Prakash S, Bersten AD. Addition of indapamide to frusemide increases natriuresis and creatinine clearance, but not diuresis, in fluid overloaded ICU patients. J Crit Care 2016; 33:200-6. [PMID: 26948252 DOI: 10.1016/j.jcrc.2016.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 10/28/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fluid and sodium overload are a common problem in critically ill patients. Frusemide may result in diuresis in excess of natriuresis. The addition of indapamide may achieve a greater natriuresis, and also circumvent some of the problems associated with frusemide. The objective of this study was to examine the effect of adding indapamide to frusemide on diuresis, natriuresis, creatinine clearance and serum electrolytes. METHODS Fluid overloaded ICU patients were randomised to either intravenous frusemide (Group F) or intravenous frusemide and enteral indapamide (Group F + I). Comprehensive exclusion criteria were applied to address confounders. 24 hour urine was analysed for electrolytes and creatinine. Serum electrolytes were measured before and 24 hours after administration of diuretics. RESULTS Forty patients (20 in each group) were included in the study. The groups were similar in their baseline characteristics. Over the 24 h study period, patients in Group F + I, had a larger natriuresis (P = 0.01), chloride loss (P = 0.01) and kaliuresis (P = 0.047). Patients in Group F + I also had a greater 24 hour urinary creatinine clearance (P = 0.01). The 24 hour urine volume and fluid balance was similar between the groups. Patients in Group F had an increase in serum sodium (P = 0.04), while patients in Group F + I had a decrease in both serum chloride (P = 0.01) and peripheral oedema (P < 0.001) during the study duration. CONCLUSION In fluid overloaded ICU patients, addition of indapamide to frusemide led to a greater natriuresis and creatinine clearance. Such a strategy might be utilised in optimising sodium balance in ICU patients.
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Affiliation(s)
- Shailesh Bihari
- Department of ICCU, Flinders Medical Centre, South Australia, 5042; Department of Critical Care Medicine, Flinders University, South Australia, 5042.
| | - Andrew W Holt
- Department of ICCU, Flinders Medical Centre, South Australia, 5042; Department of Critical Care Medicine, Flinders University, South Australia, 5042.
| | - Shivesh Prakash
- Department of ICCU, Flinders Medical Centre, South Australia, 5042; Department of Critical Care Medicine, Flinders University, South Australia, 5042.
| | - Andrew D Bersten
- Department of ICCU, Flinders Medical Centre, South Australia, 5042; Department of Critical Care Medicine, Flinders University, South Australia, 5042.
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Choi SS, Kim SH, Kim YK. Fluid management in living donor hepatectomy: Recent issues and perspectives. World J Gastroenterol 2015; 21:12757-12766. [PMID: 26668500 PMCID: PMC4671031 DOI: 10.3748/wjg.v21.i45.12757] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Academic Contribution Register] [Received: 04/28/2015] [Revised: 07/28/2015] [Accepted: 10/20/2015] [Indexed: 02/06/2023] Open
Abstract
The importance of the safety of healthy living liver donors is widely recognized during donor hepatectomy which is associated with blood loss, transfusion, and subsequent post-operative morbidity. Although the low central venous pressure (CVP) technique can still be effective, it may not be advantageous concerning the safety of healthy donors undergoing hepatectomy. Emerging evidence suggests that stroke volume variation (SVV), a simple and useful index for fluid responsiveness and preload status in various clinical situations, can be applied as a guide for fluid management to reduce blood loss during living donor hepatectomy. Synthetic colloid solutions are also associated with serious adverse events such as the use of renal replacement therapy and transfusion in critically ill or septic patients. However, it is uncertain whether the intra-operative use of colloid solution is associated with similarly adverse effects in patients undergoing living donor hepatectomy. In this review article we discuss the recent issues regarding the low CVP technique and the high SVV method, i.e., maintaining 10%-20% of SVV, for fluid management in order to reduce blood loss during living donor hepatectomy. In addition, we briefly discuss the effects of intra-operative colloid or crystalloid administration for surgical rather than septic or critically ill patients.
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Kingma JG, Simard D, Rouleau JR. Renocardiac syndromes: physiopathology and treatment stratagems. Can J Kidney Health Dis 2015; 2:41. [PMID: 26478820 PMCID: PMC4608312 DOI: 10.1186/s40697-015-0075-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 04/15/2015] [Accepted: 08/24/2015] [Indexed: 01/11/2023] Open
Abstract
Purpose of review Bidirectional inter-organ interactions are essential for normal functioning of the human body; however, they may also promote adverse conditions in remote organs. This review provides a narrative summary of the epidemiology, physiopathological mechanisms and clinical management of patients with combined renal and cardiac disease (recently classified as type 3 and 4 cardiorenal syndrome). Findings are also discussed within the context of basic research in animal models with similar comorbidities. Sources of information Pertinent published articles were identified by literature search of PubMed, MEDLINE and Google Scholar. Additional data from studies in the author’s laboratory were also consulted. Findings The prevalence of renocardiac syndrome throughout the world is increasing in part due to an aging population and to other risk factors including hypertension, diabetes and dyslipidemia. Pathogenesis of this disorder involves multiple bidirectional interactions between the kidneys and heart; however, participation of other organs cannot be excluded. Our own work supports the hypothesis that the uremic milieu, caused by kidney dysfunction, produces major alterations in vasoregulatory control particularly at the level of the microvasculature that results in impaired oxygen delivery and blood perfusion. Limitations Recent clinical literature is replete with articles discussing the necessity to clearly define or characterize what constitutes cardiorenal syndrome in order to improve clinical management of affected patients. Patients are treated after onset of symptoms with limited available information regarding etiology. While understanding of mechanisms involved in pathogenesis of inter-organ crosstalk remains a challenging objective, basic research data remains limited partly because of the lack of animal models. Implications Preservation of microvascular integrity may be the most critical factor to limit progression of multi-organ disorders including renocardiac syndrome. More fundamental studies are needed to help elucidate physiopathological mechanisms and for development of treatments to improve clinical outcomes.
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Affiliation(s)
- J G Kingma
- Faculté de Médecine, Pavillon Ferdinand-Vandry, 1050, Ave de la Médecine, Université Laval, Québec, G1V 0A6 Canada ; Centre de Recherche, Institut de Cardiologie et Pneumologie de Québec, 2725, Chemin Sainte-Foy, Québec, G1V 4G5 Canada
| | - D Simard
- Faculté de Médecine, Pavillon Ferdinand-Vandry, 1050, Ave de la Médecine, Université Laval, Québec, G1V 0A6 Canada
| | - J R Rouleau
- Faculté de Médecine, Pavillon Ferdinand-Vandry, 1050, Ave de la Médecine, Université Laval, Québec, G1V 0A6 Canada
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Choi SS, Jun IG, Cho SS, Kim SK, Hwang GS, Kim YK. Effect of stroke volume variation-directed fluid management on blood loss during living-donor right hepatectomy: a randomised controlled study. Anaesthesia 2015. [PMID: 26215206 DOI: 10.1111/anae.13155] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Indexed: 12/22/2022]
Abstract
Reducing blood loss is beneficial in living liver donor hepatectomy. Although it has been suggested that maintaining a low central venous pressure is important, it is known that low stroke volume variation may be associated with increased blood loss. Therefore, we compared the effect on blood loss of 40 patients randomly assigned to a high stroke volume variation group (maintaining 10-20% of stroke volume variation) vs 38 patients in a control group (maintaining < 10% stroke volume variation) during living-donor right hepatectomy. Mean (SD) blood loss during donor hepatectomy was significantly lower in the high stroke volume variation group than in the control group: 476 (131) ml vs 836 (341) ml, respectively (p < 0.001). Blood pressure and peri-operative laboratory values did not differ between the two groups. However, in the high stroke volume variation group, central venous pressure values were also significantly lower. We were unable to disentangle the effects of stroke volume variation and central venous pressure, but our results confirm that the two together appear beneficial.
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Affiliation(s)
- S-S Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - I-G Jun
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - S-S Cho
- Department of Occupational and Environmental Health, Graduate School of Public Health, Seoul National University, Seoul, Korea.,Department of Occupational and Environmental Medicine, Konkuk University Chungju Hospital, Chungju, Korea
| | - S-K Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G-S Hwang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Y-K Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Decuypere JP, Ceulemans LJ, Agostinis P, Monbaliu D, Naesens M, Pirenne J, Jochmans I. Autophagy and the Kidney: Implications for Ischemia-Reperfusion Injury and Therapy. Am J Kidney Dis 2015; 66:699-709. [PMID: 26169721 DOI: 10.1053/j.ajkd.2015.05.021] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Academic Contribution Register] [Received: 08/25/2014] [Accepted: 05/21/2015] [Indexed: 11/11/2022]
Abstract
Autophagy, an evolutionary conserved intracellular lysosome-dependent catabolic process, is an important mechanism for cellular homeostasis and survival during pathologic stress conditions in the kidney, such as ischemia-reperfusion injury (IRI). However, stimulation of autophagy has been described to both improve and exacerbate IRI in the kidney. We summarize the current understanding of autophagy in renal IRI and discuss possible reasons for these contradictory findings. Furthermore, we hypothesize that autophagy plays a dual role in renal IRI, having both protective and detrimental properties, depending on the duration of the ischemic period and the phase of the IRI process. Finally, we discuss the influence of currently used diuretics and immunosuppressive drugs on autophagy, underscoring the need to clarify the puzzling role of autophagy in renal IRI.
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Affiliation(s)
- Jean-Paul Decuypere
- Department of Microbiology and Immunology, Laboratory of Abdominal Transplantation, KU Leuven, University of Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Laurens J Ceulemans
- Department of Microbiology and Immunology, Laboratory of Abdominal Transplantation, KU Leuven, University of Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Patrizia Agostinis
- Department of Cellular and Molecular Medicine, Laboratory of Cell Death Research and Therapy, Leuven, Belgium
| | - Diethard Monbaliu
- Department of Microbiology and Immunology, Laboratory of Abdominal Transplantation, KU Leuven, University of Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Naesens
- Department of Microbiology and Immunology, Laboratory of Nephrology, KU Leuven, University of Leuven, Leuven, Belgium; Department of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Microbiology and Immunology, Laboratory of Abdominal Transplantation, KU Leuven, University of Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of Microbiology and Immunology, Laboratory of Abdominal Transplantation, KU Leuven, University of Leuven, Leuven, Belgium; Department of Abdominal Transplant Surgery, University Hospitals Leuven, Leuven, Belgium
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