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Stuart L Goldstein - One of the best experts on this subject based on the ideXlab platform.
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furosemide response predicts Acute Kidney Injury in children after cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Jamie Penk, Stuart L Goldstein, Katja M Gist, Eric L Wald, Laura Kitzmiller, Tennille N Webb, David S Cooper, Rajit K BasuAbstract:Abstract Objective A standardized assessment of response to furosemide is predictive of Acute Kidney Injury progression in adults, but a paucity of data exists in pediatric patients. We evaluate furosemide responsiveness in a multicenter cohort of pediatric patients after cardiac surgery. Methods Children who underwent cardiac surgery with a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery score of 3 or greater were retrospectively identified. The first dose of furosemide after surgery was recorded, and hourly urine output for 6 hours was recorded after the index dose. Urine flow rate calculated as urine output per hour was used to predict development of Acute Kidney Injury. Results A total of 166 patients from 4 institutions (median age, 6.3 months; interquartile range, 0.4-27.7) were included. Acute Kidney Injury occurred in 54 patients (33%). Compared with those without Acute Kidney Injury, the 2- and 6-hour urine flow rates were significantly lower in patients in whom Acute Kidney Injury developed: 2.9 (0.9-6.5) versus 5.0 (2.5-9.0) mL/kg/h for 2-hour urine flow rate, P = .004, and 2.4 (1.2-4.0) versus 4.0 (2.3-5.9) mL/kg/h for 6-hour flow rate, P = .001. In multivariable regression analysis, 2-hour (odds ratio, 1.2, P = .002) and 6-hour (odds ratio, 1.40, P Conclusions Lower urine flow rate after furosemide administration, when evaluated in a heterogeneous cohort of children from multiple institutions after pediatric cardiac surgery, was independently associated with subsequent Acute Kidney Injury and longer length of stay. Future prospective studies are needed to validate furosemide responsiveness as a predictor of Acute Kidney Injury.
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epidemiology of Acute Kidney Injury in critically ill children and young adults
The New England Journal of Medicine, 2017Co-Authors: Ahmad Kaddourah, Rajit K Basu, Sean M Bagshaw, Stuart L GoldsteinAbstract:BackgroundThe epidemiologic characteristics of children and young adults with Acute Kidney Injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe Acute Kidney Injury. MethodsWe used the Kidney Disease: Improving Global Outcomes criteria to define Acute Kidney Injury. Severe Acute Kidney Injury was defined as stage 2 or 3 Acute Kidney Injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. ResultsA total of 4683 patients were evaluated; Acute Kidney Injury developed in 1261 patients (26.9%; 95% co...
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congenital heart surgery in infants effects of Acute Kidney Injury on outcomes
The Journal of Thoracic and Cardiovascular Surgery, 2012Co-Authors: Joshua J Blinder, Stuart L Goldstein, Veivei Lee, Alixandra Baycroft, Charles D Fraser, David L Nelson, John L JefferiesAbstract:Objectives We sought to characterize factors and outcomes associated with postoperative Acute Kidney Injury in infants undergoing cardiac surgery. Methods We retrospectively studied 430 infants ( Results Postoperative Acute Kidney Injury occurred in 225 patients (52%): 135 patients (31%) reached maximum Acute Kidney Injury stage I, 59 (14%) reached stage II, and 31 (7%) reached stage III. On multivariable analysis, single-ventricle status (odds ratio, 1.6; 95% confidence interval, 1.08–2.37; P = .02), cardiopulmonary bypass (odds ratio, 1.2; 95% confidence interval 1.01–1.47; P = .04), and higher reference serum creatinine (odds ratio, 5.1; 95% confidence interval, 1.94–13.2; P = .0009) were associated with postoperative Acute Kidney Injury. Thirty-two (7%) patients died in the hospital. Multivariable logistic regression showed that more severe Acute Kidney Injury was associated with in-hospital mortality (maximum Acute Kidney Injury stage II odds ratio, 5.1; 95% confidence interval, 1.7–15.2; P = .004; maximum Acute Kidney Injury stage III odds ratio, 9.46; 95% confidence interval, 2.91–30.7; P = .0002) and longer mechanical ventilation and inotropic support. All Acute Kidney Injury stages were associated with longer intensive care durations. Stage III Acute Kidney Injury was associated with systemic ventricular dysfunction at hospital discharge. Conclusions Perioperative Acute Kidney Injury is common in infant heart surgery and portends a poor clinical outcome.
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risk factors for postoperative Acute Kidney Injury in pediatric cardiac surgery patients receiving angiotensin converting enzyme inhibitors
Pediatric Critical Care Medicine, 2011Co-Authors: Brady S Moffett, Stuart L Goldstein, Michelle Adusei, Julia Kuzin, Princy Mohan, Antonio R MottAbstract:BACKGROUND Angiotensin-converting enzyme inhibitor therapy is often initiated in pediatric patients who have had cardiac surgery. Acute Kidney Injury can occur in patients secondary to angiotensin-converting enzyme inhibitor initiation. Risk factors for Acute Kidney Injury after angiotensin-converting enzyme inhibitor initiation have yet to be defined in postoperative pediatric cardiac patients. OBJECTIVES To identify the frequency of Acute Kidney Injury in patients receiving angiotensin-converting enzyme inhibitor therapy in postoperative pediatric cardiac surgical patients and to identify risk factors for Acute Kidney Injury in this patient population. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The pharmacy and surgery databases were used to identify all patients <18 yrs of age who received angiotensin-converting enzyme inhibitor therapy after cardiac surgery at our institution from January 2006 to December 2007. Patients who did not have a baseline serum creatinine and at least one serum creatinine obtained after angiotensin-converting enzyme inhibitor initiation were excluded. Data collection included demographic information and cardiac pathophysiology/surgery, diuretic and/or nephrotoxic medication use, and angiotensin-converting enzyme inhibitor characteristics and initiation date. Baseline, daily, and maximum serum creatinine values were collected. Acute Kidney Injury was defined as the maximum change in pediatric-modified RIFLE (Risk, Injury, Failure, Loss, End-stage) Acute Kidney Injury criteria within 48 hrs of initiation or increase in dose of angiotensin-converting enzyme inhibitor. Descriptive statistics were used to characterize the patient population, and a multivariate logistic regression model was developed to identify independent predictors of angiotensin-converting enzyme inhibitor-associated Acute Kidney Injury. The study included 415 patient admissions (386 patients), 57% (n = 239) being male and infants (31 days to 2 yrs) being the most common age group. A functional single ventricle was present in 46% of the patients. Enalapril was initiated in 60% (n = 250) and captopril in 40% (n = 165) of patient admissions. Acute Kidney Injury occurred in 21% (n = 88) of patients initiated on an angiotensin-converting enzyme inhibitor (pediatric-modified RIFLE categories: R = 15%, I = 3%, F = 4%). Logistic regression identified cyanosis, coadministration of furosemide, and baseline estimated creatinine clearance as independent risk factors for any degree of angiotensin-converting enzyme inhibitor-associated Acute Kidney Injury (p < .05). The hospital lengths of stay of patients with angiotensin-converting enzyme inhibitor-associated Acute Kidney Injury (median 12 days, range 4-298 days) were greater compared to those of patients without angiotensin-converting enzyme inhibitor-associated Acute Kidney Injury (median 10 days, range 3-199 days, p < .05). CONCLUSIONS Initiation of angiotensin-converting enzyme inhibitor after cardiac surgery in pediatric patients may result in Acute Kidney Injury. The presence of cyanosis and coadministration of furosemide are independent risk factors for Acute Kidney Injury in patients receiving angiotensin-converting enzyme inhibitor.
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modified rifle criteria in critically ill children with Acute Kidney Injury
Kidney International, 2007Co-Authors: Ayse Akcanarikan, Michael Zappitelli, Laura Loftis, Kimberly K Washburn, Larry S Jefferson, Stuart L GoldsteinAbstract:A classification system has been proposed to standardize the definition of Acute Kidney Injury in adults. These criteria of risk, Injury, failure, loss, and end-stage renal disease were given the acronym of RIFLE. We have modified the criteria based on 150 critically ill pediatric RIFLE (pRIFLE) patients to assess Acute Kidney Injury incidence and course along with renal and/or non-renal comorbidities. Of these children, 11 required dialysis and 24 died. Patients without Acute Kidney Injury in the first week of intensive care admission were less likely to subsequently develop renal Injury or Failure; however, 82% of Acute Kidney Injury occurred in this initial week. Within this group of 123 children, 60 reached pRIFLEmax for Risk, 32 reached Injury, and 31 reached Failure. Acute Kidney Injury during admission was an independent predictor of intensive care; hospital length of stay and an increased risk of death independent of the Pediatric Risk of Mortality (PRISM II) score (odds ratio 3.0). Our results show that a majority of critically ill children develop Acute Kidney Injury by pRIFLE criteria and do so early in the course of intensive care. Acute Kidney Injury is associated with mortality and may lead to increased hospital costs. We suggest that the pRIFLE criteria serves to characterize the pattern of Acute Kidney Injury in critically ill children.
Rinaldo Bellomo - One of the best experts on this subject based on the ideXlab platform.
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histopathology of septic Acute Kidney Injury a systematic review of experimental data
Critical Care Medicine, 2016Co-Authors: Junko Kosaka, Clive N May, Yugeesh R Lankadeva, Rinaldo BellomoAbstract:Objective:The histopathologic changes associated with septic Acute Kidney Injury are poorly understood, in part, because of the lack of biopsy data in humans. Animal models of septic Acute Kidney Injury may help define such changes. Therefore, we performed a systematic review of the histopathologic
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renal histopathology during experimental septic Acute Kidney Injury and recovery
Critical Care Medicine, 2014Co-Authors: Christoph Langenberg, Glenda C Gobe, Sally G Hood, Clive N May, Rinaldo BellomoAbstract:Objectives: Our understanding of septic Acute Kidney Injury is limited. We therefore assessed renal histopathological changes induced by septic Acute Kidney Injury and their evolution during recovery.
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Acute Kidney Injury
The Lancet, 2012Co-Authors: Rinaldo Bellomo, John A Kellum, Claudio RoncoAbstract:Acute Kidney Injury (formerly known as Acute renal failure) is a syndrome characterised by the rapid loss of the Kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. It is the clinical manifestation of several disorders that affect the Kidney Acutely. Acute Kidney Injury is common in hospital patients and very common in critically ill patients. In these patients, it is most often secondary to extrarenal events. How such events cause Acute Kidney Injury is controversial. No specific therapies have emerged that can attenuate Acute Kidney Injury or expedite recovery; thus, treatment is supportive. New diagnostic techniques (eg, renal biomarkers) might help with early diagnosis. Patients are given renal replacement therapy if Acute Kidney Injury is severe and biochemical or volume-related, or if uraemic-toxaemia-related complications are of concern. If patients survive their illness and do not have premorbid chronic Kidney disease, they typically recover to dialysis independence. However, evidence suggests that patients who have had Acute Kidney Injury are at increased risk of subsequent chronic Kidney disease.
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a comparison of the rifle and Acute Kidney Injury network classifications for cardiac surgery associated Acute Kidney Injury a prospective cohort study
The Journal of Thoracic and Cardiovascular Surgery, 2009Co-Authors: Michael Haase, Rinaldo Bellomo, George Matalanis, Paolo Calzavacca, Duska Dragun, Anja HaasefielitzAbstract:Objectives There is an intense debate on whether the RIFLE (R–renal risk, I–Injury, F–failure, L–loss of Kidney function, E–end-stage renal disease) classification or its recent modification, the Acute Kidney Injury Network definition and classification system should be used to standardize research on Acute Kidney Injury. In this study we compared these classifications with regard to (1) the detection of Acute Kidney Injury, (2) their agreement according to the grading of Acute Kidney Injury across classes, and (3) their prognostic value. Methods We prospectively enrolled 282 cardiac surgery patients undergoing cardiopulmonary bypass and assigned a RIFLE and Acute Kidney Injury Network class to each patient. The incidence of Acute Kidney Injury and in-hospital mortality across classes was compared by using the χ 2 test, and their prognostic value was compared by using the area under the curve receiver-operating characteristic for in-hospital mortality. Results According to the RIFLE (45.8%) or Acute Kidney Injury Network (44.7%) classification, a similar proportion of patients had Acute Kidney Injury. There was large agreement between classifications according to patients graded as having nonAcute Kidney Injury; however, there was some disagreement across classes for staging the severity of Acute Kidney Injury. The area under the curve for in-hospital mortality was similar for all classifications: 0.91 for the RIFLE classification (95% confidence interval, 0.82–0.99) and 0.94 for the Acute Kidney Injury Network classification (95% confidence interval, 0.81–0.97; P = .6 for area under the curve comparison). Conclusions In patients undergoing cardiac surgery, modifications of the RIFLE classification for Acute Kidney Injury do not materially improve the clinical usefulness of the definition. Other factors, such as the applicability of the Acute Kidney Injury definition and classification system to be applied, need to be considered.
John A Kellum - One of the best experts on this subject based on the ideXlab platform.
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Acute Kidney Injury from sepsis current concepts epidemiology pathophysiology prevention and treatment
Kidney International, 2019Co-Authors: Sadudee Peerapornratana, Carlos L Manriquecaballero, Hernando Gomez, John A KellumAbstract:Sepsis-associated Acute Kidney Injury (S-AKI) is a frequent complication of the critically ill patient and is associated with unacceptable morbidity and mortality. Prevention of S-AKI is difficult because by the time patients seek medical attention, most have already developed Acute Kidney Injury. Thus, early recognition is crucial to provide supportive treatment and limit further insults. Current diagnostic criteria for Acute Kidney Injury has limited early detection; however, novel biomarkers of Kidney stress and damage have been recently validated for risk prediction and early diagnosis of Acute Kidney Injury in the setting of sepsis. Recent evidence shows that microvascular dysfunction, inflammation, and metabolic reprogramming are 3 fundamental mechanisms that may play a role in the development of S-AKI. However, more mechanistic studies are needed to better understand the convoluted pathophysiology of S-AKI and to translate these findings into potential treatment strategies and add to the promising pharmacologic approaches being developed and tested in clinical trials.
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Acute Kidney Injury in critically ill patients after noncardiac major surgery early versus late onset
Critical Care Medicine, 2019Co-Authors: Shu Wang, Priyanka Priyanka, John A KellumAbstract:OBJECTIVES Acute Kidney Injury is a common complication of major surgery. However, Acute Kidney Injury occurring within the first 48 hours after surgery (early Acute Kidney Injury) and therefore likely related to the surgery itself is possibly different from Acute Kidney Injury occurring after 48 hours (late Acute Kidney Injury). The aim of this study was to describe the epidemiology and identify differences in risk factors and outcomes between early and late Acute Kidney Injury following major surgery. DESIGN Retrospective cohort study. SETTING Academic Medical Center. PATIENTS Patients admitted to ICU following noncardiac major surgery. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed data from 3,499 patients and defined Acute Kidney Injury according to full Kidney Disease: Improving Global Outcomes criteria and classified as early (48 hr or less) or late (> 48 hr to 7 d) based on time from surgery. Separate multivariable logistic regression models were fit to identify risk factors of early Acute Kidney Injury compared with no Acute Kidney Injury and risk factors of late Acute Kidney Injury compared with no Acute Kidney Injury. Overall 41.7% (1,459/3,499) developed early Acute Kidney Injury versus 14.4% (504/3,499) late Acute Kidney Injury. Most Acute Kidney Injury occurred within 48 hours following surgery and 12 hours was the peak interval. Risk factors for early Acute Kidney Injury included increased age, body mass index, decreased estimated glomerular filtration rate, and anemia, whereas late Acute Kidney Injury cases were closely associated with postoperative factors, like sepsis, mechanical ventilation, positive fluid balance, blood transfusions and exposure to diuretics, vasopressors, and nonsteroidal anti-inflammatory drugs. After adjusting for age, body mass index, estimated glomerular filtration rate, comorbidities, surgery type, both early Acute Kidney Injury (odds ratio [95% CI], 1.84 [1.50-2.27]) and late Acute Kidney Injury (odds ratio [95% CI], 1.42 [1.09-1.85]) were associated with higher 1-year mortality compared with patients without Acute Kidney Injury. We found similar results in a validation cohort of 10,723 patients admitted between 2008 and 2014. CONCLUSIONS Most surgery-related Acute Kidney Injury occurred within 48 hours of surgery. Acute Kidney Injury occurring within the first 48 hours was associated with underlying health, whereas Acute Kidney Injury occurring after 48 hours was related to postoperative complications or drugs. Design of clinical and experimental interventions for Acute Kidney Injury in this population should consider these differences.
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Acute Kidney Injury an increasing global concern
The Lancet, 2013Co-Authors: Norbert Lameire, John A Kellum, Neesh Pannu, Arvind Bagga, Kathleen D Liu, Dinna N Cruz, Jan De Maeseneer, Zoltan H Endre, Ravindra L Mehta, Wim Van BiesenAbstract:Despite an increasing incidence of Acute Kidney Injury in both high-income and low-income countries and growing insight into the causes and mechanisms of disease, few preventive and therapeutic options exist. Even small Acute changes in Kidney function can result in short-term and long-term complications, including chronic Kidney disease, end-stage renal disease, and death. Presence of more than one comorbidity results in high severity of illness scores in all medical settings. Development or progression of chronic Kidney disease after one or more episode of Acute Kidney Injury could have striking socioeconomic and public health outcomes for all countries. Concerted international action encompassing many medical disciplines is needed to aid early recognition and management of Acute Kidney Injury.
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Acute Kidney Injury
The Lancet, 2012Co-Authors: Rinaldo Bellomo, John A Kellum, Claudio RoncoAbstract:Acute Kidney Injury (formerly known as Acute renal failure) is a syndrome characterised by the rapid loss of the Kidney's excretory function and is typically diagnosed by the accumulation of end products of nitrogen metabolism (urea and creatinine) or decreased urine output, or both. It is the clinical manifestation of several disorders that affect the Kidney Acutely. Acute Kidney Injury is common in hospital patients and very common in critically ill patients. In these patients, it is most often secondary to extrarenal events. How such events cause Acute Kidney Injury is controversial. No specific therapies have emerged that can attenuate Acute Kidney Injury or expedite recovery; thus, treatment is supportive. New diagnostic techniques (eg, renal biomarkers) might help with early diagnosis. Patients are given renal replacement therapy if Acute Kidney Injury is severe and biochemical or volume-related, or if uraemic-toxaemia-related complications are of concern. If patients survive their illness and do not have premorbid chronic Kidney disease, they typically recover to dialysis independence. However, evidence suggests that patients who have had Acute Kidney Injury are at increased risk of subsequent chronic Kidney disease.
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Acute Kidney Injury in non severe pneumonia is associated with an increased immune response and lower survival
Kidney International, 2010Co-Authors: Raghavan Murugan, Vijay Karajalasubramanyam, Minjae Lee, Sachin Yende, Lan Kong, Melinda Carter, Derek C Angus, John A KellumAbstract:While sepsis is a leading cause of Acute Kidney Injury in critically ill patients, the relationship between immune response and Acute Kidney Injury in less severely ill patients with infection is not known. Here we studied the epidemiology, 1-year mortality, and immune response associated with Acute Kidney Injury in 1836 hospitalized patients with community-acquired severe and non-severe pneumonia. Acute Kidney Injury developed in 631 patients of whom 329 had severe and 302 had non-severe sepsis. Depending on the subgroup classification, 16–25% of the patients with non-severe pneumonia also developed Acute Kidney Injury. In general, patients with Acute Kidney Injury were older, had more comorbidity, and had higher biomarker concentrations (interleukin-6, tumor necrosis factor, D-dimer) even among patients without severe sepsis. The risk of death associated with Acute Kidney Injury varied when assessed by Gray's survival model and after adjusting for differences in age, gender, ethnicity, and comorbidity. This risk was significantly higher immediately after hospitalization but gradually fell over time in the overall cohort and in those with non-severe pneumonia. A significantly higher risk of death (hazard ratio 1.29) was also present in those never admitted to an intensive care unit. Hence Acute Kidney Injury is common even among patients with non-severe pneumonia and is associated with higher immune response and an increased risk of death.
Marisa De Feo - One of the best experts on this subject based on the ideXlab platform.
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preoperative anemia in patients undergoing coronary artery bypass grafting predicts Acute Kidney Injury
The Journal of Thoracic and Cardiovascular Surgery, 2009Co-Authors: Luca Salvatore De Santo, Gianpaolo Romano, Alessandro Della Corte, Vincenzo De Simone, Francesco Grimaldi, M Cotrufo, Marisa De FeoAbstract:Objectives Recent authoritative studies suggested that low preoperative hemoglobin concentration may affect cardiac surgery outcomes. This study aimed, primarily, to investigate whether preoperative anemia is an independent determinant of adverse events after coronary artery bypass grafting and, secondarily, to evaluate the potential dose responsiveness between anemia severity and primary end points. Methods This single-center prospective study investigated 1214 consecutive patients undergoing coronary artery bypass grafting between January 2004 and June 2007, collecting 100 variables per patient. In 1047 patients (median age 64 years, 18.8% female, 38.9% diabetic, 31.9% urgent/emergency, 15.3% with low preoperative left ventricular ejection fraction) who underwent on-pump procedures and received no preoperative transfusion, the prevalence of preoperative anemia (according to World Health Organization definition) and its unadjusted and adjusted relationships with in-hospital death, cardiac morbidity, and Acute Kidney Injury (AKI–RIFLE [Risk, Injury, Failure, Loss, End-stage Kidney disease] criteria) were obtained. Results The prevalence of preoperative anemia was 28%. In-hospital death averaged 3.9%, cardiac morbidity 7.3%, and Acute Kidney Injury 4%. Unadjusted odds ratios (Ors) for in-hospital death, cardiac morbidity, and Acute Kidney Injury were 3.8 (95% confidence interval [CI] 2.0–7.3), 1.7 (95% CI 1.1–2.8), and 4.0 (95% CI 2.1–7.6), respectively. Adjusting for anemia in confounders proved an independent predictor of Acute Kidney Injury (OR 2.06; 95% CI 1.14–3.70), whereas the cardiac morbidity and in-hospital mortality were independently predicted by Kidney function. No dose–response relationship emerged between anemia severity and Acute Kidney Injury. Conclusions Preoperative anemia is independently associated with Acute Kidney Injury after coronary artery bypass grafting. Further studies are warranted to determine whether preoperative low hemoglobin concentration is a marker of severity of illness or a modifiable risk factor.
Rajit K Basu - One of the best experts on this subject based on the ideXlab platform.
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furosemide response predicts Acute Kidney Injury in children after cardiac surgery
The Journal of Thoracic and Cardiovascular Surgery, 2019Co-Authors: Jamie Penk, Stuart L Goldstein, Katja M Gist, Eric L Wald, Laura Kitzmiller, Tennille N Webb, David S Cooper, Rajit K BasuAbstract:Abstract Objective A standardized assessment of response to furosemide is predictive of Acute Kidney Injury progression in adults, but a paucity of data exists in pediatric patients. We evaluate furosemide responsiveness in a multicenter cohort of pediatric patients after cardiac surgery. Methods Children who underwent cardiac surgery with a Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery score of 3 or greater were retrospectively identified. The first dose of furosemide after surgery was recorded, and hourly urine output for 6 hours was recorded after the index dose. Urine flow rate calculated as urine output per hour was used to predict development of Acute Kidney Injury. Results A total of 166 patients from 4 institutions (median age, 6.3 months; interquartile range, 0.4-27.7) were included. Acute Kidney Injury occurred in 54 patients (33%). Compared with those without Acute Kidney Injury, the 2- and 6-hour urine flow rates were significantly lower in patients in whom Acute Kidney Injury developed: 2.9 (0.9-6.5) versus 5.0 (2.5-9.0) mL/kg/h for 2-hour urine flow rate, P = .004, and 2.4 (1.2-4.0) versus 4.0 (2.3-5.9) mL/kg/h for 6-hour flow rate, P = .001. In multivariable regression analysis, 2-hour (odds ratio, 1.2, P = .002) and 6-hour (odds ratio, 1.40, P Conclusions Lower urine flow rate after furosemide administration, when evaluated in a heterogeneous cohort of children from multiple institutions after pediatric cardiac surgery, was independently associated with subsequent Acute Kidney Injury and longer length of stay. Future prospective studies are needed to validate furosemide responsiveness as a predictor of Acute Kidney Injury.
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epidemiology of Acute Kidney Injury in critically ill children and young adults
The New England Journal of Medicine, 2017Co-Authors: Ahmad Kaddourah, Rajit K Basu, Sean M Bagshaw, Stuart L GoldsteinAbstract:BackgroundThe epidemiologic characteristics of children and young adults with Acute Kidney Injury have been described in single-center and retrospective studies. We conducted a multinational, prospective study involving patients admitted to pediatric intensive care units to define the incremental risk of death and complications associated with severe Acute Kidney Injury. MethodsWe used the Kidney Disease: Improving Global Outcomes criteria to define Acute Kidney Injury. Severe Acute Kidney Injury was defined as stage 2 or 3 Acute Kidney Injury (plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours) and was assessed for the first 7 days of intensive care. All patients 3 months to 25 years of age who were admitted to 1 of 32 participating units were screened during 3 consecutive months. The primary outcome was 28-day mortality. ResultsA total of 4683 patients were evaluated; Acute Kidney Injury developed in 1261 patients (26.9%; 95% co...