Acute Kidney Injury After CT in Emergency Patients with Chronic Kidney Disease: A Propensity Score-matched Analysis.
Ontology highlight
ABSTRACT: Introduction
Acute kidney injury (AKI) after intravenous contrast administration for computed tomography (CT) occurs infrequently, but certain patients may be susceptible. This study evaluated AKI incidence among emergency department (ED) patients with pre-existing chronic kidney disease (CKD) undergoing CT exams.Methods
This retrospective cohort study in an integrated healthcare system included ED patients previously diagnosed with CKD stages 3-5 (estimated glomerular filtration rate <60 milliliters per minute per 1.73 meters squared over at least three months), undergoing CT exams with or without intravenous contrast, from January 1, 2013-December 31, 2017. We excluded patients with CT prior to (30 days) or following (14 days) index CT and missing serum creatinine (sCr) measurements. We applied propensity score matching, and then multivariable regression adjustment for post-CT ED disposition and ED diagnosis, to calculate adjusted risk of AKI. Secondary patient-centered outcomes included 30-day mortality, end-stage renal disease (ESRD) diagnosis, and dialysis initiation.Results
Among 103,573 eligible ED patients undergoing CT, propensity score matching yielded 5,589 pairs. Adjusted risk ratio (ARR) for AKI was higher overall for contrast-enhanced CT (1.60; 95% confidence interval [CI], 1.43-1.79). However, secondary outcomes were infrequent: 19/5,589 non-contrast vs 40/5,589 contrast patients with new dialysis initiation at 30 days (adjusted risk 0.3% vs 0.7%; adjusted risk reduction 0.4%; 95% CI, 0.1%-0.7%).Conclusion
In ED patients with chronic kidney disease undergoing CT, intravenous contrast was associated with higher overall adjusted risk of AKI, but patient-centered secondary outcomes were rare. The clinical significance of transient kidney injury after CT is unclear, although patients with advanced chronic kidney disease appear to have elevated risk.
SUBMITTER: Kene M
PROVIDER: S-EPMC8203012 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:Acute kidney injury (AKI) is a common disease, but diagnosis is usually delayed or missed in hospitalized patients. The aim of this study was to investigate the impact of under-recognition of AKI (beyond 3 days after AKI onset) on short-time prognosis. Of 785 patients with under-recognition of AKI and 616 patients with timely-recognition of AKI were propensity matched in a 1:1 ratio. The two groups, with a total of 482 matched patients (241:241), were comparable in baseline covariates. Under-recognition of AKI was not associated with 30-day all-cause mortality in the logistic regression model with covariate adjustment (OR = 1.01, 95% CI = 0.62-1.64, p = 0.967). Sensitivity analyses and subgroup analyses also proved the association. There were also no significant differences in causes of 30-day mortality, in-hospital mortality, recovery of renal function at discharge, length of hospital stay, length of intensive care unit stay or hospitalization costs between the two groups, although timely-recognition group had more chance of renal consult and a little more interventions for AKI. In conclusion, under-recognition of AKI may not be associated with poor short-term outcomes of adult hospitalized patients via these propensity-score-matched analyses.
| S-EPMC6181969 | biostudies-literature
Project description:BackgroundThe association between preoperative aspirin use and postoperative acute kidney injury (AKI) in cardiovascular surgery is unclear. We sought to evaluate the effect of preoperative aspirin use on postoperative AKI in cardiac surgery.MethodsA total of 770 patients who underwent cardiovascular surgery under cardiopulmonary bypass were reviewed. Perioperative clinical parameters including preoperative aspirin administration were retrieved. We matched 108 patients who took preoperative aspirin continuously with patients who stopped aspirin more than 7 days or did not take aspirin for the month before surgery. The parameters used in the matching included variables related to surgery type, patient's demographics, underlying medical conditions and preoperative medications.ResultsIn the first seven postoperative days, 399 patients (51.8%) developed AKI, as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and 128 patients (16.6%) required hemodialysis. Most patients took aspirin 100 mg once daily (n = 195, 96.5%) and the remaining 75 mg once daily. Multivariable analysis showed that preoperative maintenance of aspirin was independently associated with decreased incidence of postoperative AKI (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.21-0.98, P = 0.048; after propensity score matching: OR 0.39, 95% CI 0.22-0.67, P = 0.001). Preoperative maintenance of aspirin was associated with less incidence of AKI defined by KDIGO both in the entire and matched cohort (n = 44 [40.7%] vs. 69 [63.9%] in aspirin and non-aspirin group, respectively in matched sample, relative risk [RR] 0.64, 95% CI 0.49, 0.83, P = 0.001). Preoperative aspirin was associated with decreased postoperative hospital stay after matching (12 [9-18] days vs. 16 [10-25] in aspirin and non-aspirin group, respectively, P = 0.038). Intraoperative estimated or calculated blood loss using hematocrit difference and estimated total blood volume showed no difference according to aspirin administration in both entire and matched cohort.ConclusionsPreoperative low dose aspirin administration without discontinuation was protective against postoperative AKI defined by KDIGO criteria independently in both entire and matched cohort. Preoperative aspirin was also associated with decreased hemodialysis requirements and decreased postoperative hospital stay without increasing bleeding. However, differences in AKI and hospital stay were not associated with in-hospital mortality.
| S-EPMC5417712 | biostudies-literature
Project description:BackgroundSevere acute kidney injury (AKI) is associated with subsequent infection. Whether AKI followed by a return to baseline creatinine is associated with incident infection is unknown.ObjectiveWe hypothesized that risk of both short and long term infection would be higher among patients with AKI and return to baseline creatinine than in propensity score matched peers without AKI in the year following a non-infectious hospital admission.DesignRetrospective, propensity score matched cohort study.ParticipantsWe identified 494 patients who were hospitalized between January 1, 1999 and December 31, 2009 and had AKI followed by return to baseline creatinine. These were propensity score matched to controls without AKI.Main measuresThe predictor variable was AKI defined by International Classification of Diseases, Ninth Revision (ICD-9) codes and by the Kidney Disease Improving Global Outcomes definition, with return to baseline creatinine defined as a decrease in serum creatinine level to within 10% of the baseline value within 7 days of hospital discharge. The outcome variable was incident infection defined by ICD-9 code within 1 year of hospital discharge.ResultsAKI followed by return to baseline creatinine was associated with a 4.5-fold increased odds ratio for infection (odds ratio 4.53 [95% CI, 2.43-8.45]; p<0.0001) within 30 days following discharge. The association between AKI and subsequent infection remained significant at 31-60 days and 91 to 365 days but not during 61-90 days following discharge.ConclusionAmong patients from an integrated health care delivery system, non-infectious AKI followed by return to baseline creatinine was associated with an increased odds ratio for infection in the year following discharge.
| S-EPMC6590794 | biostudies-literature
Project description:Background Acute kidney injury (AKI) remains a concern in hospitalized children undergoing CT with intravenous iodinated contrast material (ICM). Adult studies have shown frequencies of AKI after CT with intravenous ICM to be similar to propensity score-matched ICM-unexposed patient groups; similar data in pediatric patients are lacking. Purpose To evaluate the association between intravenous ICM exposure and AKI in hospitalized pediatric patients with stable kidney function undergoing contrast material-enhanced CT by comparing with a propensity score-matched ICM-unexposed patient sample undergoing abdominal US. Materials and Methods In this retrospective observational study, hospitalized patients aged 18 years or younger with stable kidney function and available serum creatinine (SCr) measurement before and after imaging who underwent CT with intravenous ICM or abdominal US (control group) between January 2009 and November 2018 were identified. The 1:1 propensity score matching was performed by using 23 covariates, stratified by estimated glomerular filtration rate (eGFR) before imaging (≥60 mL/min/1.73 m2 or <60 mL/min/1.73 m2). AKI was defined by using Acute Kidney Injury Network SCr-related criteria. Multivariable logistic regression was performed to identify risk factors for AKI after imaging, including the effects of eGFR and intravenous ICM exposure before imaging. Results A total of 1850 unique patients were included in the propensity score-matched sample (925 exposed to ICM [mean age ± standard deviation, 8 years ± 6; 484 female patients]; 925 unexposed to ICM [mean age, 7 years ± 6; 484 female patients]). Frequency of AKI with eGFR greater than or equal to 60 mL/min/1.73 m2 was 2.2% (20 of 889) for CT and US (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.52, 1.86; adjusted P = .95) and with eGFR less than 60 mL/min/1.73 m2 was 5.6% (two of 36) and 11.1% (four of 36) for CT and US, respectively (OR: 0.75; 95% CI: 0.11, 5.00; adjusted P = .76). Significant multivariable predictors of AKI included eGFR before imaging (OR: 0.99; 95% CI: 0.98, 0.995; P = .001), body mass index (OR: 1.06; 95% CI: 1.02, 1.10; P = .003), acquired kidney disease (OR: 1.95; 95% CI: 1.004, 3.78; P = .049), and nephrotoxic antibiotic exposure (OR: 2.86; 95% CI: 1.55, 5.25; P < .001). Intravenous ICM exposure was not predictive (OR: 0.91; 95% CI: 0.51, 1.64; P > .05). Conclusion Hospitalized children with stable kidney function who underwent CT with intravenous iodinated contrast material (ICM) had a similar frequency of acute kidney injury (AKI) compared with a propensity score-matched ICM-unexposed patient group. In pediatric inpatients with estimated glomerular filtration rate greater than or equal to 60 mL/min/1.73 m2, ICM was not independently associated with AKI. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Paltiel in this issue.
| S-EPMC7053230 | biostudies-literature
Project description:ObjectivesTo investigate the relationship between low kidney volume and subsequent estimated glomerular filtration rate (eGFR) decline in eGFR category G2 (60-89 mL/min/1.73 m2) population.MethodsIn this retrospective study, we evaluated 5531 individuals with eGFR category G2 who underwent medical checkups at our institution between November 2006 and October 2017. Exclusion criteria were absent for follow-up visit, missing data, prior renal surgery, current renal disease under treatment, large renal masses, and horseshoe kidney. We developed a 3D U-net-based automated system for renal volumetry on CT images. Participants were grouped by sex-specific kidney volume deviations set at mean minus one standard deviation. After 1:1 propensity score matching, we obtained 397 pairs of individuals in the low kidney volume (LKV) and control groups. The primary endpoint was progression of eGFR categories within 5 years, assessed using Cox regression analysis.ResultsThis study included 3220 individuals (mean age, 60.0 ± 9.7 years; men, n = 2209). The kidney volume was 404.6 ± 67.1 and 376.8 ± 68.0 cm3 in men and women, respectively. The low kidney volume (LKV) cutoff was 337.5 and 308.8 cm3 for men and women, respectively. LKV was a significant risk factor for the endpoint with an adjusted hazard ratio of 1.64 (95% confidence interval: 1.09-2.45; p = 0.02).ConclusionLow kidney volume may adversely affect subsequent eGFR maintenance; hence, the use of imaging metrics may help predict eGFR decline.Critical relevance statementLow kidney volume is a significant predictor of reduced kidney function over time; thus, kidney volume measurements could aid in early identification of individuals at risk for declining kidney health.Key points• This study explores how kidney volume affects subsequent kidney function maintenance. • Low kidney volume was associated with estimated glomerular filtration rate decreases. • Low kidney volume is a prognostic indicator of estimated glomerular filtration rate decline.
| S-EPMC10997556 | biostudies-literature
Project description:ObjectiveSodium-glucose cotransporter-2 (SGLT2) inhibitors are new medications that improve cardiovascular and renal outcomes in patients with type 2 diabetes (T2D). However, the Food and Drug Administration has issued alerts regarding increased acute kidney injury (AKI) risk with canagliflozin and dapagliflozin. We aimed to assess the real-world risk of AKI in new SGLT2 inhibitor users in two large health care utilization cohorts of patients with T2D.Research design and methodsWe used longitudinal data from the Mount Sinai chronic kidney disease registry and the Geisinger Health System cohort. We selected SGLT inhibitor users and nonusers (patients with T2D without SGLT2 inhibitor prescription). We determined AKI by the KDIGO (Kidney Disease: Improving Global Outcomes) definition (AKIKDIGO). We performed 1:1 nearest-neighbor propensity matching and calculated unadjusted hazard ratios (HRs) and adjusted HRs (aHRs; accounting for covariates poorly balanced) for AKI in primary and sensitivity analyses.ResultsWe identified 377 SGLT2 inhibitor users and 377 nonusers in the Mount Sinai cohort, of whom 3.8 and 9.7%, respectively, had an AKIKDIGO event over a median follow-up time of 14 months. The unadjusted hazards of AKIKDIGO were 60% lower in users (HR 0.4 [95% CI 0.2-0.7]; P = 0.01), which was unchanged (aHR 0.4 [95% CI 0.2-0.7]; P = 0.004) postadjustment. Similarly, we identified 1,207 SGLT2 inhibitor users and 1,207 nonusers in the Geisinger cohort, of whom 2.2 and 4.6% had an AKIKDIGO event. AKIKDIGO unadjusted hazards were lower in users (HR 0.5 [95% CI 0.3-0.8]; P < 0.01) with modest attenuation postadjustment for covariates (aHR 0.6 [95% CI 0.4-1.1]; P = 0.09). These estimates did not qualitatively change across several sensitivity analyses.ConclusionsOur findings do not suggest an increased risk of AKI associated with SGLT2 inhibitor use in patients with T2D in two large health systems.
| S-EPMC5652593 | biostudies-literature
Project description:OBJECTIVE:Atrial fibrillation (AF) is associated with adverse outcomes in the general population, but its impact on patients with chronic kidney disease (CKD) remains unclear. In this study, we assessed the association between AF and risks of all-cause mortality and stroke in Chinese adults with CKD. METHODS:We enrolled adults aged 45 years or older with CKD (defined as an estimated glomerular filtration rate <60 mL/min per 1.73 m2 and/or proteinuria identified using the urine dipstick method) from the Kailuan study between 2008 and 2014. AF was identified by 12-lead electrocardiography or hospital discharge diagnostic codes. Mortality data were collected from the provincial vital statistics, and physician-diagnosed ischemic or hemorrhagic stroke was confirmed in the biennial interview. RESULTS:Among the 21587 CKD adults, 216 patients were identified with AF, the median follow-up duration was 5.21 years (5.69 ± 1.96 years); During follow-up, there were 70 cases of death, and 16 cases of ischemic stroke and 6 cases of hemorrhagic stroke in the participants with AF in comparison with 2572 cases of death and 656 cases of ischemic stroke and 184 cases of hemorrhagic stroke among the participants without AF. After adjustment for potential confounders, AF was associated with an 86% increase in the rate of death (hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.33-2.59, P<0.001), a 104% (HR, 2.04; 95% CI, 1.09-3.83, P = 0.026) and 325% (HR, 4.25; 95% CI, 1.74-10.36, P = 0.001) increase in the rate of ischemic stroke and hemorrhagic stroke, respectively. These associations were still consistent and strong after propensity score-matched analysis. CONCLUSION:Our study shows that AF is independently associated with increased risk of all-cause mortality, ischemic and hemorrhagic stroke in Chinese CKD adults. Future studies are required to elucidate the physiological mechanisms underlying this association.
| S-EPMC7080277 | biostudies-literature
Project description:Increased in-hospital mortality associated with weekend admission has been reported for many acute conditions, but no study has investigated "weekend effect" for acute kidney injury requiring dialysis (AKI-D).In this large, propensity score matched cohort of AKI-D, we examined the impact of weekend admission and in-centre nephrology services in 53,170 AKI-D admissions between 1st April 2003 and 31st March 2015 using a hospital episode statistic dataset. Propensity score matching (PSM) was performed to match 4284 weekend admissions with AKI-D with 14,788 admissions on weekdays.Of the 53,170 admissions with AKI-D in the whole dataset, 12,357 (23%) were at weekends. The unadjusted mortality for weekend admissions was significantly higher compared to admissions on weekdays (40·6% versus 39·6%, p 0·046). However, in multivariable analysis of the PSM cohort, the odds of death for weekend admissions with AKI-D was 1·01 (95%CI 0·93,1·09). Mortality was higher for weekend admissions in West Midlands (odds ratio (OR) 1·32, 95% confidence interval (CI) 1·05, 1·66) and lower in East of England (OR 0·77, 95%CI 0·59, 1·00) but was not different to weekday admissions in all other regions. In 2003-04, weekend admissions had lower odds of death (OR 0·45, 95%CI 0·21, 0·96) and in 2010-11 higher odds of death (OR 1·28, 95%CI 1·00, 1·63) but in the other ten years observed, there was no significant difference in mortality between weekday and weekend admissions. Provision of in-centre nephrology services was associated with lower odds of death at 0·57 (95%CI 0·54, 0·62).Weekend admissions in patients with AKI-D had no effect on mortality. Further research is warranted to elucidate the reasons for the lower mortality in hospitals with in-centre nephrology services.
| S-EPMC5634642 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) and obesity are independent risk factors for chronic kidney disease (CKD). This study aimed to determine if obesity modifies risk for CKD outcomes after AKI.MethodsThis prospective multisite cohort study followed adult survivors after hospitalization, with or without AKI. The primary outcome was a combined CKD event of incident CKD, progression of CKD and kidney failure, examined using time-to-event Cox proportional hazards models, adjusted for diabetes status, age, pre-existing CKD, cardiovascular disease status and intensive care unit admission, and stratified by study center. Body mass index (BMI) was added as an interaction term to examine effect modification by body size.ResultsThe cohort included 769 participants with AKI and 769 matched controls. After median follow-up of 4.3 years, among AKI survivors, the rate of the combined CKD outcome was 84.7 per1000-person-years with BMI ≥30 kg/m2, 56.4 per 1000-person-years with BMI 25-29.9 kg/m2, and 72.6 per 1000-person-years with BMI 20-24.9 kg/m2. AKI was associated with a higher risk of combined CKD outcomes; adjusted-HR 2.43 (95%CI 1.87-3.16), with no evidence that this was modified by BMI (p for interaction = 0.3). After adjustment for competing risk of death, AKI remained associated with a higher risk of the combined CKD outcome (subdistribution-HR 2.27, 95%CI 1.76-2.92) and similarly, there was no detectable effect of BMI modifying this risk.ConclusionsIn this post-hospitalization cohort, we found no evidence for obesity modifying the association between AKI and development or progression of CKD.
| S-EPMC8161937 | biostudies-literature
Project description:BackgroundAcute kidney injury (AKI) has been well documented in adults after noncardiac surgery and demonstrated to be associated with adverse outcomes. We report the prevalence of AKI after pediatric noncardiac surgery, the perioperative factors associated with postoperative AKI, and the association of AKI with postoperative outcomes in children undergoing noncardiac surgery.MethodsPatients ≤18 years of age who underwent noncardiac surgery with serum creatinine during the 12 months preceding surgery and no history of end-stage renal disease were included in this retrospective observational study at a single tertiary academic hospital. Patients were evaluated during the first 7 days after surgery for development of any stage of AKI, according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patients were classified into stages of KDIGO AKI for the purposes of describing prevalence. For further analyses, patients were grouped into those who developed any stage of AKI postoperatively and those who did not. Additionally, the time point at which each patient was first diagnosed with stage I AKI or greater was also assessed. Pre-, intra-, and postoperative factors were compared between the 2 groups. A multivariable Cox proportional hazards regression model was created to examine the time to first diagnosis of AKI using all nonredundant covariates. Analysis of the association of AKI with postoperative outcomes, mortality and 30-day readmission, was undertaken utilizing propensity score-matched controls and a multivariable Cox proportional hazards regression model.ResultsA total of 25,203 cases between 2013 and 2018 occurred; 8924 met inclusion criteria. Among this cohort, the observed prevalence of postoperative AKI was 3.2% (288 cases; confidence interval [CI], 2.9-3.6). The multivariable Cox model showed American Society of Anesthesiologists (ASA) status to be associated with the development of postoperative AKI. Several other factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models but found not to be significantly associated after adjustment. The multivariable Cox analyses with propensity-matched controls showed an estimated hazard ratio of 3.28 for mortality (CI, 1.71-6.32, P < .001) and 1.55 for 30-day readmission (CI, 1.08-2.23, P = .018) in children who developed AKI versus those who did not.ConclusionsIn children undergoing noncardiac surgery, postoperative AKI occurred in 3.2% of patients. Several factors, including intraoperative hypotension, were significantly associated with postoperative AKI in univariable models. After adjustment, only ASA status was found to be significantly associated with AKI in children after noncardiac surgery. Postoperative AKI was found to be associated with significantly higher rates of mortality and 30-day readmission in multivariable, time-varying models with propensity-matched controls.
| S-EPMC7855789 | biostudies-literature