Browsing by Subject "acute kidney injury"

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    Assessment Of Urinary Metabolites In Risk Prediction Of Acute Kidney Injury
    (2020-05) Gisewhite, Sarah
    Acute kidney injury (AKI) is the sudden decrease or loss of kidney function caused by direct kidney injury or functional impairment. Many patients do not recover renal function, leading to poor quality of life and high healthcare costs. Previous work has been done to evaluate urinary biomarkers associated with AKI, but these studies have focused on a few proteins with questionable diagnostic ability. Due to the complex pathophysiology of AKI, it may be necessary to create a panel of biomarkers for diagnostic and prognostic assessment of AKI. We explored metabolic biomarkers of AKI in combat casualties using metabolomics. In this study, we used proton nuclear magnetic resonance (1H-NMR) spectroscopy to identify urinary metabolic biomarkers associated with the following outcomes: AKI diagnosis, injury severity score (ISS), AKI stage, or a primary outcome of death or need for renal replacement therapy (RRT).
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    Outpatient Acute Kidney Injury Increases Risk of Mortality and Chronic Kidney Disease
    (2017-05) Leither, Maxwell
    Introduction: Limited data exist regarding outcomes of patients with outpatient acute kidney injury (AKI). To determine whether outpatient AKI is associated with increased mortality and chronic kidney disease (CKD), we conducted a retrospective cohort study utilizing an electronic health record in Minnesota. Methods: All adult patients receiving primary care through Fairview Health Services were included. All outpatient Cr values during an 18 month exposure period were used to define five comparator groups as follows: No outpatient AKI (reference group), outpatient AKI with recovery, outpatient AKI without recovery, outpatient AKI without repeat Cr, or no Cr. A Cox proportional hazard model was utilized to assess whether outpatient AKI was associated with an increase in mortality, CKD stage 4 and secondary outcomes including hospitalization and recurrent AKI. Results: The cohort consisted of 384,869 patients and 51% had at least one Cr measured during the exposure period. Outpatient AKI occurred in 1.4% of patients during the 18 month exposure period and 37.8% recovered while 26.5% had no repeat Cr. Mortality was 3.2% over an average follow-up of 5.3 years. Outpatient AKI was associated with an increased risk of mortality (aHR 1.90, 95% CI 1.76-2.06) and CKD stage 4 (aHR 1.33, 95% CI 1.11-1.59) including those that recovered from their AKI (mortality aHR 2.15, 95% CI 1.91-2.41; CKD aHR 1.73, 95% CI 1.37-2.19) and in those with stage 1 AKI (mortality aHR 1.90, 95% CI 1.74-2.07; CKD aHR 1.34, 95% CI 1.10-1.62). Outpatient AKI was also associated with with an increased risk of hospitalization (aHR 1.71, 95% CI 1.63-1.79), hospital AKI (aHR 2.14, 95% CI 1.93-2.37), and recurrent outpatient AKI (aHR 2.75, 95% CI 2.57-2.93). Conclusion: Outpatient AKI is common and is a risk factor for death, CKD, hospitalization, and recurrent AKI, including those with stage 1 AKI and those that recover.