• Acute kidney injury
• Biomarker
• Cystatin C
• Kidney replacement therapy
• Neutrophil gelatinase-associated lipocalin
• Proenkephalin 119–159

• AKI-D
• dialysis prognosis
• ensemble machine learning
• prediction models
• risk factors

• the National Science and Technology Council Grant

• Adult
• Child
• Humans
• Quality of Life/psychology
• Critical Illness
• Acute Kidney Injury/therapy
• Acute Kidney Injury/complications
• Renal Replacement Therapy
• Critical Care

• Acute kidney injury
• Discontinuation
• Predictive factors
• Renal replacement therapy
• Success

• Humans
• Prospective Studies
• Critical Illness/therapy
• Creatinine
• Renal Replacement Therapy/methods
• C-Reactive Protein
• Acute Kidney Injury/therapy

• AKI
• Acute kidney injury
• Biomarker
• ELAIN
• Proenkephalin A
• Renal replacement therapy
• penKid

• acute kidney injury
• loop of Henle
• olfactomedin 4
• septic AKI
• urine biomarker

• Acute Kidney Injury/complications
• Acute Kidney Injury/diagnosis
• Animals
• Biomarkers
• Child
• Extracellular Matrix Proteins
• Glycoproteins
• Humans
• Lipocalin-2
• Loop of Henle
• Mice
• Prospective Studies
• Sepsis/complications
• Sepsis/diagnosis
• Uromodulin

• P50 DK096418 NIDDK NIH HHS

• Acute kidney injury
• Chronic kidney diseases
• Critical care outcomes
• Kidney replacement therapy
• Pediatric intensive care unit
• Recovery of function

Half of the critically ill patients with renal replacement therapy (RRT) dependent acute kidney injury (AKI) die within one year despite RRT. General intensive care prediction models perform inadequately in AKI. Predictive models for mortality would be an invaluable complementary tool to aid clinical decision making. We aimed to develop and validate new prediction models for intensive care unit (ICU) and hospital mortality customized for patients with RRT dependent AKI in a retrospective single-center study. The models were first developed in a cohort of 471 critically ill patients with continuous RRT (CRRT) and then validated in a cohort of 193 critically ill patients with intermittent hemodialysis (IHD) as the primary modality for RRT. Forty-two risk factors for mortality were examined at ICU admission and CRRT initiation, respectively, in the first univariate models followed by multivariable model development. Receiver operating characteristics curve analyses were conducted to estimate the area under the curve (AUC), to measure discriminative capacity of the models for mortality. AUCs of the respective models ranged between 0.76 and 0.83 in the CRRT model development cohort, thereby showing acceptable to excellent predictive power for the mortality events (ICU mortality and hospital mortality). The models showed acceptable external validity in a validation cohort of IHD patients. In the IHD validation cohort the AUCs of the MALEDICT RRT initiation model were 0.74 and 0.77 for ICU and hospital mortality, respectively. The MALEDICT model shows promise for mortality prediction in critically ill patients with RRT dependent AKI. After further validation, the model might serve as an additional clinical tool for estimating individual mortality risk at the time of RRT initiation.

• Patient Reported Outcome Measures
• acute kidney injury
• acute kidney injury and ICU nephrology
• kidney disease
• quality of life

• Colistin
• acute kidney injury
• length of hospital stay
• nephrotoxicity

• Acute kidney disease
• Acute kidney injury
• Kidney replacement therapy
• Long-term outcomes

• Acute kidney injury (AKI)
• acute PD
• peritoneal dialysis (PD)
• renal replacement therapy

The association between regional economic status and the probability of renal recovery among patients with dialysis-requiring AKI (AKI-D) is unknown. The nationwide prospective multicenter study enrolled critically ill adult patients with AKI-D in four sampled months (October 2014, along with January, April, and July 2015) in Taiwan. The regional economic status was defined by annual disposable income per capita (ADIPC) of the cities the hospitals located. Among the 1,322 enrolled patients (67.1 ± 15.5 years, 36.2% female), 833 patients (63.1%) died, and 306 (23.1%) experienced renal recovery within 90 days following discharge. We categorized all patients into high (n = 992) and low economic status groups (n = 330) by the best cut-point of ADIPC determined by the generalized additive model plot. By using the Fine and Gray competing risk regression model with mortality as a competing risk factor, we found that the independent association between regional economic status and renal recovery persisted from model 1 (no adjustment), model 2 (adjustment to basic variables), to model 3 (adjustment to basic and clinical variables; subdistribution hazard ratio, 1.422; 95% confidence interval, 1.022–1.977; p = 0.037). In conclusion, high regional economic status was an independent factor for renal recovery among critically ill patients with AKI-D.

In critically ill patients, acute kidney injury (AKI) and sepsis often coexist. This confounds the assessment of outcomes of both sepsis and AKI in these patients. Hence, in this study, we compare the outcomes of AKI with sepsis, AKI without sepsis, and sepsis without AKI against a control cohort comprising patients with neither AKI nor sepsis.

Prospective observational study conducted in our critical care unit (CCU) between January and July 2009. Data including demographic details, acute physiology and chronic health evaluation (APACHE) III score, presence of AKI, presence of sepsis, intensive care unit (ICU) length of stay (LOS), and outcomes were collected for all patients. Acute Kidney Injury Network (AKIN) criteria were used to define the presence of AKI and American College of Critical Care Medicine 2001 definition was used to define the presence of sepsis.

A total of 250 patients were included in the study and 8 patients were excluded from analysis as they were discharged from hospital against medical advice. The remaining 242 patients (mean age 52.8 ± 17 years; 61.6% male; APACHE III score: 48.2 ± 24.1) were analyzed, and AKI was seen in 111 patients (45.8%). Among the patients with AKI, 55.8% (62/111) had sepsis and 44.2% (49/111) had nonseptic AKI. There was a higher need for renal replacement therapy (RRT) among patients with septic AKI in comparison to those with nonseptic AKI (19.3% vs 6.1%; p = 0.04), but no mortality difference was seen between the two groups (25.8% vs 20.4%, p = 0.5). Patients with sepsis and AKI had a significantly higher mortality (25.8%) compared to the patients with sepsis alone (5.6%; p < 0.01).

Patients with septic AKI had a higher RRT requirement compared to patients with nonseptic AKI, but no significant differences in mortality were seen between the groups. Occurrence of AKI in septic patients substantially increases their mortality.

Nandagopal N, Reddy PK, Ranganathan L, Ramakrishnan N, Annigeri R, Venkataraman R. Comparison of Epidemiology and Outcomes of Acute Kidney Injury in Critically Ill Patients with and without Sepsis. Indian J Crit Care Med 2020;24(4):258–262.

• Acute kidney injury
• Acute kidney injury network
• Sepsis

Supplemental Digital Content is available in the text.

To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland.

Retrospective observational cohort study.

Multicenter study including four tertiary ICUs.

Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013.

None.

: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥ 65 yr) subgroups. Overall 1-year survival was 76% (n = 2,304), and of 1-year survivors, 37% (n = 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05).

During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.

• Cardiac arrest
• Cost-effectiveness
• Healthcare costs
• Long-term outcome
• Neurological outcome
• Outcome
• Survival

• Acute kidney injury
• Continuous renal replacement therapy
• Long-term outcome

• Acute kidney injury
• Emergency general surgery
• Surgical complications

• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/mortality
• Acute Kidney Injury/physiopathology
• Acute Kidney Injury/therapy
• Humans
• Incidence
• Multiple Organ Failure
• Renal Replacement Therapy
• Risk Factors
• Treatment Outcome

• Acute kidney injury (AKI)
• Outcomes
• Pediatric
• Quality of life (QOL)

• Acute kidney injury
• Cardiovascular disease
• End-stage renal disease
• Mortality

• acute kidney injury
• epidemiology
• incidence
• intensive care unit
• population base

• acute kidney injury
• initiation time
• meta-analysis
• mortality
• renal replacement therapy

• Critical illness
• Diabetes mellitus
• Follow-up studies
• Intensive care
• Survivors

• Acute kidney injury
• Endothelium
• Immune response
• Ischemia reperfusion injury
• Microvasculature
• Tissue hypoxia

• Acute Kidney Injury/pathology
• Animals
• Child
• Humans
• Kidney/blood supply
• Microvessels/pathology

• K01 DK096996 NIDDK NIH HHS
• P30 DK079307 NIDDK NIH HHS
• T32 DK061296 NIDDK NIH HHS

• Acute kidney injury
• Bibliometric analysis
• Top 100 cited articles

• Acute Kidney Injury
• Biomedical Research/standards
• Biomedical Research/statistics & numerical data
• Humans
• Journal Impact Factor
• Periodicals as Topic/standards
• Periodicals as Topic/statistics & numerical data

• Acid-Base Equilibrium/physiology
• Acute Kidney Injury/physiopathology
• Critical Illness/rehabilitation
• Disease Management
• Humans
• Kidney/physiology
• Kidney/physiopathology
• Morbidity
• Renal Dialysis/adverse effects
• Renal Dialysis/mortality
• Risk Factors
• Time Factors
• Uremia/physiopathology
• Water-Electrolyte Balance/physiology

• Continuous renal replacement therapy
• ICU nurse staff
• Nursing activity
• Nursing work load
• Regional citrate anticoagulation

• Aged
• Anticoagulants/therapeutic use
• Critical Illness/rehabilitation
• Female
• Hemodiafiltration/nursing
• Humans
• Male
• Middle Aged
• Renal Replacement Therapy/methods
• Renal Replacement Therapy/nursing
• Retrospective Studies
• Time Factors
• Workload/standards

Critically ill patients with acute kidney injury (AKI) in need of renal replacement therapy (RRT) may have a protracted and often incomplete rehabilitation. Their long-term outcome has rarely been investigated.

Survivors of the HANnover Dialysis OUTcome (HANDOUT) study were evaluated after 5 years for survival, health status, renal function, and quality of life (QoL). The HANDOUT study had examinded mortality and renal recovery of patients with AKI receiving either standard extendend or intensified dialysis after multi organ failure.

One hundred fifty-six former HANDOUT participants were analyzed. In-hospital mortality was 56.4%. Five-year survival after AKI/RRT was 40.1% (86.5% if discharged from hospital). Main causes of death were cardiovascular complications and sepsis. A total of 19 survivors presented to the outpatient department of our clinic and had good renal recovery (mean estimated glomerular filtration rate 72.5±30 mL/min/1.73 m²; mean proteinuria 89±84 mg/d). One person required maintenance dialysis. Seventy-nine percent of the patients had a pathological kidney sonomorphology. The Charlson comorbidity score was 2.2±1.4 and adjusted for age 3.3±2.1 years. Numbers of comorbid conditions averaged 2.38±1.72 per patient (heart failure [52%] > chronic kidney disease/myocardial infarction [each 29%]). Median 36-item short form health survey (SF-36™) index was 0.657 (0.69 physical health/0.66 mental health). Quality-adjusted life-years after 5 years were 3.365.

Mortality after severe AKI is higher than short-term prospective studies show, and morbidity is significant. Kidney recovery as well as general health remains incomplete. Reduction of QoL is minor, and social rehabilitation is very good. Affectivity is heterogeneous, but most patients experience emotional well-being. In summary, AKI in critically ill patients leads to incomplete rehabilitation but acceptable QoL after 5 years.

• HANDOUT
• QoL
• acute kidney injury
• long-term follow-up
• multiorgan failure
• renal replacement therapy

To analyze the epidemiological and prognostic differences between critical surgical patients admitted to intensive care unit (ICU) according to length of stay in the ICU.

Retrospective observational study on patients with surgical pathology admitted to ICU of a tertiary hospital, during 7 years, with a stay ≥ 5 days. The variables analyzed were age, sex, Acute Physiology and Chronic Health Evaluation II (APACHE II), duration of stay, hospital and ICU mortality, original service, reason for admission, geographical place of residence, and the use of invasive techniques such as mechanical ventilation (MV), tracheotomy, and techniques of continuous renal replacement (CRR). Two groups were defined; one with intermediate stay, the one that exceeds the average of our population (> 5 days) and another with long stay patients (> 14 days). Readmissions were excluded. Firstly, the analysis of differential characteristics of patients was performed, this was according to the duration of their stay using either a contrast equal averages when the variable contrast between the two groups was quantitative or the Chi-square test when the variable analyzed was qualitative. For both tests, the existence of significant differences between groups was considered when the significance level was less than 5%. And, secondly, a model forecast ICU survival of these patients, regardless of length of stay in ICU, using a binary logistic regression analysis was performed.

Among the 540 patients analyzed, no significant differences were observed, depending on the length of stay in the ICU, except the need for invasive techniques such as MV or tracheotomy in those of longer stay (P = 0.000). However, ICU mortality was significantly higher for patients with intermediate stay (30 vs 17: 5%; P = 0.000), without observing differences in hospital mortality. ICU survival was influenced by age, APACHE II levels, admission to the ICU in a coma state, and the application of the three invasive techniques discussed.

Surgical patients who survive in the ICU, regardless of the length of their stay in it, have the same odds of hospital survival. Found as predictors of mortality in ICU APACHE II, age, admission in a coma state, and application of invasive techniques.

• Critical illness
• prognosis
• stay
• surgery

• AKI
• Acute kidney injury
• Hyperuricemia
• Hypouricemia
• Medical database analysis

Acute kidney injury (AKI) is a common complication in intensive care unit (ICU) patients and is associated with increased morbidity and mortality. We compared long-term outcome and quality of life (QOL) in ICU patients with AKI treated with renal replacement therapy (RRT) with matched non-AKI-RRT patients.

Over 1 year, consecutive adult ICU patients were included in a prospective cohort study. AKI-RRT patients alive at 1 year and 4 years were matched with non-AKI-RRT survivors from the same cohort in a 1:2 (1 year) and 1:1 (4 years) ratio based on gender, age, Acute Physiology and Chronic Health Evaluation II score, and admission category. QOL was assessed by the EuroQoL-5D and the Short Form-36 survey before ICU admission and at 3 months, 1 and 4 years after ICU discharge.

Of 1953 patients, 121 (6.2 %) had AKI-RRT. AKI-RRT hospital survivors (44.6 %; N = 54) had a 1-year and 4-year survival rate of 87.0 % (N = 47) and 64.8 % (N = 35), respectively. Forty-seven 1-year AKI-RRT patients were matched with 94 1-year non-AKI-RRT patients. Of 35 4-year survivors, three refused further cooperation, three were lost to follow-up, and one had no control. Finally, 28 4-year AKI-RRT patients were matched with 28 non-AKI-RRT patients. During ICU stay, 1-year and 4-year AKI-RRT patients had more organ dysfunction compared to their respective matches (Sequential Organ Failure Assessment scores 7 versus 5, P < 0.001, and 7 versus 4, P < 0.001). Long-term QOL was, however, comparable between both groups but lower than in the general population. QOL decreased at 3 months, improved after 1 and 4 years but remained under baseline level. One and 4 years after ICU discharge, 19.1 % and 28.6 % of AKI-RRT survivors remained RRT-dependent, respectively, and 81.8 % and 71 % of them were willing to undergo ICU admission again if needed.

In long-term critically ill AKI-RRT survivors, QOL was comparable to matched long-term critically ill non-AKI-RRT survivors, but lower than in the general population. The majority of AKI-RRT patients wanted to be readmitted to the ICU when needed, despite a higher severity of illness compared to matched non-AKI-RRT patients, and despite the fact that one quarter had persistent dialysis dependency.

The online version of this article (doi:10.1186/s13054-015-1004-8) contains supplementary material, which is available to authorized users.

• AKI
• RRT
• kidney function recovery
• progression of renal failure
• survival

• Acute Kidney Injury/epidemiology
• Acute Kidney Injury/etiology
• Acute Kidney Injury/therapy
• Aged
• Cardiac Surgical Procedures/adverse effects
• Cause of Death/trends
• Female
• Follow-Up Studies
• Humans
• Incidence
• Male
• Middle Aged
• Minnesota/epidemiology
• Postoperative Care/methods
• Postoperative Complications
• Renal Replacement Therapy/methods
• Retrospective Studies
• Risk Factors
• Survival Rate/trends
• Time Factors

• Acute Kidney Injury/mortality
• Adult
• Comorbidity
• Critical Illness/mortality
• Demography
• Female
• Hospital Mortality
• Hospitalization
• Humans
• Kaplan-Meier Estimate
• Kidney/physiopathology
• Kidney Function Tests
• Male
• Middle Aged
• Multivariate Analysis
• Patient Discharge
• Retrospective Studies
• Time Factors