Systematic Review of Risk factors and Incidence of Acute Kidney Injury Among Patients Treated with CAR-T Cell Therapies.
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ABSTRACT:
SUBMITTER: Kanduri SR
PROVIDER: S-EPMC8116758 | biostudies-literature | 2021 May
REPOSITORIES: biostudies-literature
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Systematic Review of Risk factors and Incidence of Acute Kidney Injury Among Patients Treated with CAR-T Cell Therapies.
Kanduri Swetha R SR Cheungpasitporn Wisit W Thongprayoon Charat C Petnak Tananchai T Lin Yi Y Kovvuru Karthik K Manohar Sandhya S Kashani Kianoush K Herrmann Sandra M SM
Kidney international reports 20210217 5
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Project description:BackgroundThe incidence and risk factors of acute kidney injury (AKI) in patients with malignancies receiving immune checkpoint inhibitors (ICIs) are being extensively reported with their widespread application.ObjectiveThis study aimed to quantify the incidence and identify risk factors of AKI in cancer patients treated with ICIs.MethodsWe searched the electronic databases of PubMed/Medline, Web of Science, Cochrane and Embase before 1 February 2023 on the incidence and risk factors of AKI in patients receiving ICIs and registered the protocol in PROSPERO (CRD42023391939). A random-effect meta-analysis was performed to quantify the pooled incidence estimate of AKI, identify risk factors with pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) and investigate the median latency period of ICI-AKI in patients treated with ICIs. Assessment of study quality, meta-regression, and sensitivity and publication bias analyses were conducted.ResultsIn total, 27 studies consisting of 24048 participants were included in this systematic review and meta-analysis. The overall pooled incidence of AKI secondary to ICIs was 5.7% (95% CI: 3.7%-8.2%). Significant risk factors were older age (OR: 1.01, 95% CI: 1.00-1.03), preexisting chronic kidney disease (CKD) (OR: 2.90, 95% CI: 1.65-5.11), ipilimumab (OR: 2.66, 95% CI: 1.42-4.98), combination of ICIs (OR: 2.45, 95% CI: 1.40-4.31), extrarenal immune-related adverse events (irAEs) (OR: 2.34, 95% CI: 1.53-3.59), and proton pump inhibitor (PPI) (OR: 2.23, 95% CI: 1.88-2.64), nonsteroidal anti-inflammatory drug (NSAID) (OR: 2.61, 95% CI: 1.90-3.57), fluindione (OR: 6.48, 95% CI: 2.72-15.46), diuretic (OR: 1.78, 95% CI: 1.32-2.40) and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) (pooled OR: 1.76, 95% CI: 1.15-2.68) use. Median time from ICIs initiation to AKI was 108.07 days. Sensitivity and publication bias analyses indicated robust results for this study.ConclusionThe occurrence of AKI following ICIs was not uncommon, with an incidence of 5.7% and a median time interval of 108.07 days after ICIs initiation. Older age, preexisting chronic kidney disease (CKD), ipilimumab, combined use of ICIs, extrarenal irAEs, and PPI, NSAID, fluindione, diuretics and ACEI/ARB use are risk factors for AKI in patients receiving ICIs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023391939.
| S-EPMC10258324 | biostudies-literature
Project description: Not available
| S-EPMC9939309 | biostudies-literature
Project description:The COVID-19 associated acute kidney injury (CAKI) has emerged as a potential intricacy during the management of patients. Navigating the rapidly growing body of scientific literature on CAKI is challenging, and ongoing critical appraisal of this complication is essential. This study aimed to summarize and critically appraise the systematic reviews (SRs) on CAKI to inform the healthcare providers about its prevalence, risk factors and outcomes. All the SRs were searched in major databases (PubMed, EMBASE, Web of Science) from inception date to December 2021. This study followed SR of SRs methodology, all the records were screened, extracted and subjected to quality assessment by assessing the methodological quality of systematic reviews (AMSTAR-2). The extracted data were qualitatively synthesized and tabulated. This review protocol was registered in PROSPERO (CRD42022299444). Of 3,833 records identified; 42 SRs were included in this overview. The quality appraisal of the studies showed that 17 SRs were of low quality, while 8 moderate and 17 were of high-quality SRs. The incidence of CAKI ranged from 4.3% to 36.4% in overall COVID-19 patients, 36%-50% in kidney transplant recipients (KTRs), and up to 53% in severe or critical illness. Old age, male gender, cardiovascular disease, chronic kidney disease, diabetes mellitus and hypertension were frequently reported risk factors of CAKI. The need of renal replacement therapy (RRT) was up to 26.4% in overall COVID-19 patients, and 39% among those having CAKI. The occurrence of acute kidney injury (AKI) was found independent predictor of death, where mortality rate among CAKI patients ranged from 50% to 93%. This overview of SRs underscores that CAKI occurs frequently among COVID-19 patients and associated with high mortality, need of RRT and adverse outcomes. However, the confidence of these results is moderate to low which warrants the need of more SRs having established methodological standards.Systematic review registration[https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=299444], identifier [CRD42022299444].
| S-EPMC9672072 | biostudies-literature
Project description:BackgroundTo analyze the incidence and risk factors of acute kidney injury (AKI) after partial nephrectomy (PN) in patients with solitary kidney, and to build AKI prediction models using logistic regression and machine learning (ML) approaches.MethodsClinical data of 87 solitary kidney patients with renal mass who received PN from January 2003 to March 2019 were collected. The diagnosis of AKI was based on KDIGO criteria. Logistic regression analysis and ML method were used to build prediction models.ResultsAKI developed in 52 (59.8%) patients. The logistic regression model had three variables: ischemia time (P=0.003), surgery time (P=0.001) and preoperative fasted blood glucose level (FBG) (P=0.049). The area under curve (AUC) was 0.826, with the specificity and sensitivity of optimal threshold value 82.9% and 69.2%. The ML model had the following variables: ischemia time, surgery time, age, FBG, mean arterial pressure (MAP), colloid, crystalloid, etc. XGBoost model has the best prediction performance. The AUC was 0.749, lower than that of the logistic regression model with no statistical difference (P=0.258), with the specificity and sensitivity 62.9% and 84.6%, respectively.ConclusionsThe incidence of AKI after PN in patients with a solitary kidney was relatively high, it was associated with longer ischemia time, surgery time and higher FBG level, etc. The performance of ML model had no significant difference with logistic regression model. Prospective studies with larger sample sizes are awaited to test and verify our research findings.
| S-EPMC7354300 | biostudies-literature
Project description:Background:Multimodal computed tomography (CT) guides decision-making regarding use of thrombolytic agents in acute ischemic stroke patients. However, postcontrast acute kidney injury (PC-AKI) is a potential adverse effect of the contrast media used, which may require hemodialysis and cause a longer hospital stay. The incidence and risk factors of PC-AKI in acute ischemic stroke patients, particularly in Thailand, remain unclear. Goal. We aimed at determining the incidence and risk factors of PC-AKI in patients with acute ischemic stroke undergoing multimodal CT. Methods:We conducted a retrospective review of Thai acute ischemic stroke patients admitted to the King Chulalongkorn Memorial Hospital between January 2014 and December 2017 who received multimodal CT and thrombolytic treatment with alteplase. Result:Overall, 109 patients were included for analysis; eight patients (7.3%) developed PC-AKI. Estimated glomerular filtration rate (eGFR) ? 30?mL/min and mechanical thrombectomy were risk factors significantly associated with PC-AKI. Conclusion:The incidence of PC-AKI in a real practice setting did not differ from previous reports. Two factors were associated with PC-AKI, eGFR ? 30?mL/min and mechanical thrombectomy. Patients without these risk factors may not need to wait for the results of renal function testing prior to multimodal CT.
| S-EPMC7152976 | biostudies-literature
Project description:BackgroundThe association between acute cholangitis (AC) and acute kidney injury (AKI) remains unclear. We investigated the incidence, and clinical course of AKI in patients with AC, and the long-term prognosis.MethodsWe performed a single-center retrospective study of patients hospitalized with AC in a tertiary care center from January 2011 to December 2017. The risk factors for AKI were evaluated, and AKI severity was analyzed using the Systemic Inflammatory Response System (SIRS), quick sequential organ failure assessment (qSOFA) score, and 2018 Tokyo Guidelines (TG) grade. To calculate the relative risk of death based on AKI, hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained using Cox's proportional hazard models.ResultsA total of 1,438 patients with AC were included, of whom 18.2% (n = 261) developed AKI. AKI patients were older, and had a lower systolic blood pressure and more comorbidities including hypertension (HT), chronic kidney disease, and cardiovascular accidents. Disease severity (as assessed by SIRS, qSOFA, and the Tokyo Guidelines grade) was higher in the AKI group, as was the in-hospital mortality rate. Multivariate analysis revealed that age, HT, SIRS and qSOFA scores ≥ 2, and TG grade of III were significant risk factors for AKI. Kaplan-Meier analysis revealed significantly higher mortality in the AKI than non-AKI group. AKI (HR = 1.853; 95% CI: 1.115-3.079) and TG grade III (HR = 2.139; 95% CI: 1.190-3,846) were independent predictors of all-cause AC mortality, even after adjusting for all covariates. The annual rate of decline in the estimated glomerular filtration rate was faster in the AKI than non-AKI group (2.9 ± 6.7 vs. 0.5 ± 5.3 mL/min/1.73 m2/year, p < 0.001).ConclusionsAKI development increased AC severity and mortality. Our results suggest that clinicians should monitor AKI status and perform appropriate management as soon as possible.
| S-EPMC9009613 | biostudies-literature
Project description:BackgroundCOVID-19 is a multisystemic disorder that frequently causes acute kidney injury (AKI). However, the precise clinical and biochemical variables associated with AKI progression in patients with severe COVID-19 remain unclear.MethodsWe performed a retrospective study on 278 hospitalized patients who were admitted to the ward and intensive care unit (ICU) with COVID-19 between March 2020 and June 2020, at the University Hospital, São Paulo, Brazil. Patients aged ≥ 18 years with COVID-19 confirmed on RT-PCR were included. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria. We evaluated the incidence of AKI, several clinical variables, medicines used, and outcomes in two sub-groups: COVID-19 patients with AKI (Cov-AKI), and COVID-19 patients without AKI (non-AKI). Univariate and multivariate analyses were performed.ResultsFirst, an elevated incidence of AKI (71.2%) was identified, distributed across different stages of the KDIGO criteria. We further observed higher levels of creatinine, C-reactive protein (CRP), leukocytes, neutrophils, monocytes, and neutrophil-to-lymphocyte ratio (NLR) in the Cov-AKI group than in the non-AKI group, at hospital admission. On univariate analysis, Cov-AKI was associated with older age (>62 years), hypertension, CRP, MCV, leucocytes, neutrophils, NLR, combined hydroxychloroquine and azithromycin treatment, use of mechanical ventilation, and vasoactive drugs. Multivariate analysis showed that hypertension and the use of vasoactive drugs were independently associated with a risk of higher AKI in COVID-19 patients. Finally, we preferentially found an altered erythrocyte and leukocyte cellular profile in the Cov-AKI group compared to the non-AKI group, at hospital discharge.ConclusionsIn our study, the development of AKI in patients with severe COVID-19 was related to inflammatory blood markers and therapy with hydroxychloroquine/azithromycin, with vasopressor requirement and hypertension considered potential risk factors. Thus, attention to the protocol, hypertension, and some blood markers may help assist doctors with decision-making for the management of COVID-19 patients with AKI.
| S-EPMC8148326 | biostudies-literature
Project description:BackgroundThe incidence and the risk factors of in-hospitalized acute kidney injury (AKI) in patients hospitalized for atrial fibrillation (AF) were unclear.MethodsThe Improving Care for Cardiovascular Disease in China-AF (CCC-AF) project is an ongoing registry and quality improvement project, with 240 hospitals recruited across China. We selected 4527 patients hospitalized for AF registered in the CCC-AF from January 2015 to January 2019. Patients were divided into the AKI and non-AKI groups according to the changes in serum creatinine levels during hospitalization.ResultsAmong the 4527 patients, the incidence of AKI was 8.0% (361/4527). Multivariate logistic analysis results indicated that the incidence of in-hospital AKI in patients with AF on admission was 2.6 times higher than that in patients with sinus rhythm (OR 2.60, 95% CI 1.77-3.81). Age (per 10-year increase, OR 1.22, 95% CI 1.07-1.38), atrial flutter/atrial tachycardia on admission (OR 2.16, 95% CI 1.12-4.15), diuretics therapy before admission (OR 1.48, 95% CI 1.07-2.04) and baseline hemoglobin (per 20 g/L decrease, OR 1.21, 95% CI 1.10-1.32) were independent risk factors for in-hospital AKI. β blockers therapy given before admission (OR 0.67, 95% CI 0.51-0.87) and non-warfarin therapy during hospitalization (OR 0.71, 95% CI 0.53-0.96) were associated with a decreased risk of in-hospital AKI. After adjustment for confounders, in-hospital AKI was associated with a 34% increase in risk of major adverse cardiovascular (OR 1.34, 95% CI 1.02-1.90, p = 0.023).ConclusionsClinicians should pay attention to the monitoring and prevention of in-hospital AKI to improve the prognosis of patients with AF.
| S-EPMC8218696 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) is frequent and influences the prognosis of intensive care unit (ICU) patients. The aim of this study was to estimate the incidence, time-course, risk factors, and mortality of AKI among unselected ICU patients.MethodsAll adult ICU patients admitted to the ICU at the University Hospital in Central Norway from 2010 to 2015 with a stay of 24 h or more were included in the study. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. All patients were followed with respect to reversal of AKI. Risk factors for AKI were analyzed using Cox regression.ResultsAmong 2325 ICU patients, 1245 developed AKI during the ICU stay, corresponding to an incidence of 53.5 % (CI, 51.5-55.5). The incidence according to KDIGO AKI stages 1, 2, and 3 was 26.2, 11.7, and 15.7%, respectively. The median duration of AKI was 24 (CI 19-24), 32 (CI 26-39), and 101 (CI 75-164) hours for AKI KDIGO stage 1, 2, and 3, respectively. AKI was transient, persistent, or AKD in 73.4, 16.5, and 10.0% of the patients with a known outcome. AKI reversal was observed in 72.9% of all AKI patients. Independent risk factors for AKI in a multivariate analysis were hypertension, diabetes, heart disease, and higher body weight. Episodes of mean arterial pressure below 73 mmHg were associated with a higher risk of AKI.ConclusionsIn our material, the incidence of AKI was comparable to what has been reported previously. Risk factors for the development of AKI were a MAP below 73, hypertension, diabetes, heart disease, chronic kidney disease, and higher body weight. Most AKI patients regain their kidney function during the ICU stay, particularly in the KDIGO AKI stages 1 and 2.
| S-EPMC9543500 | biostudies-literature
Project description:BackgroundThere are significant differences in the incidence and risk factors of tumor patients, and there is no relevant statistical data. Therefore, this study aims to clarify the incidence and risk factors of acute kidney injury (AKI) in malignant tumor patients and compare critically ill patients with non-critically ill patients.MethodsRelevant literature on the occurrence of AKI in malignant tumors was retrieved from databases. Two authors independently screened and evaluated the eligibility and quality of the literature and extracted the data. The Stata 12.0 software was used for meta-analysis.ResultsA total of 3922 articles were initially retrieved, and 24 articles were finally included, 8 of which were about critically ill malignant tumor patients, and 16 were about malignant tumor patients. Among the 4107 patients included in the 8 studies on critically ill malignant tumors, 1932 developed AKI, with an incidence rate of 52% (95%CI 34-70%, I2 = 99%). The risk factors for AKI in critically ill malignant tumor patients were sepsis and hypovolemia, which were different from those in non-critically ill patients. Among the 292,874 patients included in the 16 studies on malignant tumors, 51,211 developed AKI, and the combined incidence rate was 24% (95%CI 17-30%, I2 = 100%). The risk factors for AKI in critical malignant tumor patients were sepsis and hypovolemia.ConclusionThis meta-analysis shows that the incidence of AKI in critically ill malignant tumor patients is consistent with that in other critically ill patients, and independent risk factors are sepsis and hypovolemia. The incidence of AKI in malignant tumor patients is higher than that in other patients, and tumor is a risk factor for AKI. This study has been registered in INPLASY (INPLASY202320079),Registered February 18,2023.
| S-EPMC10656870 | biostudies-literature