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Brenda R. C. Kurnik - One of the best experts on this subject based on the ideXlab platform.
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Cause of acute tubular necrosis affects its prognosis. The Auriculin Anaritide Acute Renal Failure Study Group.
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis the auriculin anaritide acute renal failure study group
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:BACKGROUND: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. OBJECTIVE: To test the hypothesis that the cause of ATN affects its clinical outcome. METHODS: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. RESULTS: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysis-free survival improved significantly and mortality tended to decline with advancing age. CONCLUSIONS: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious commorbidities in the ischemic ATN group. Advancing age was associated with improved dialysis-free survival and a tendency toward reduced mortality in patients with ischemic ATN.
Stuart L. Goldstein - One of the best experts on this subject based on the ideXlab platform.
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Blood transfusion rates in Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action)—a single-center experience
Pediatric Nephrology, 2021Co-Authors: Hailey W. Gavigan, Cara L. Slagle, Kelli A. Krallman, Brenda B. Poindexter, David K. Hooper, Stuart L. GoldsteinAbstract:Background Previous studies in non-critically ill hospitalized pediatric patients have shown that daily serum creatinine monitoring for the development of Nephrotoxic medication–associated acute kidney injury decreases both the rate of high Nephrotoxic medication exposure and associated acute kidney injury. Attempts to spread this successful screening program have been met with concerns that daily serum creatinine monitoring in critically ill neonates with high-risk Nephrotoxic medication exposure would lead to iatrogenic anemia and an increase in blood transfusion requirements. Methods We measured blood transfusion rates while implementing a system of daily serum creatinine monitoring in critically ill neonates at risk for high Nephrotoxic medication–associated acute kidney injury. Results There was no correlation between blood transfusion rates and serum creatinine monitoring rates. Conclusions We recommend that critically ill neonates identified as having high-risk Nephrotoxic medication exposure undergo daily screening for the development of Nephrotoxic medication–associated acute kidney injury.
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baby ninja Nephrotoxic injury negated by just in time action reduction of Nephrotoxic medication associated acute kidney injury in the neonatal intensive care unit
The Journal of Pediatrics, 2019Co-Authors: Stuart L. Goldstein, Christine Stoops, Sadie Stone, Emily Evans, Lynn Dill, Traci Henderson, Russell Griffin, Carl H Coghill, David J AskenaziAbstract:Objective(s) To test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of Nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting. Study design Quality improvement project that occurred between March 2015 and September 2017 in a single center, level IV neonatal intensive care unit. Infants were screened for high-risk Nephrotoxic medication exposure (≥3 Nephrotoxic medication within 24 hours or ≥4 calendar days of an intravenous [IV] aminoglycoside). If infants met criteria, a daily serum creatinine (SCr) was obtained until 2 days after end of exposure or end of AKI, whichever occurred last. The study was divided into 3 eras: pre-Nephrotoxic Injury Negated by Just-in-time Action (NINJA), initiation, and sustainability. Differences for 5 metrics across 3 eras were compared: SCr surveillance, high Nephrotoxic medication exposure rate (per 1000 patient-days), AKI rate (per 1000 patient-days), nephrotoxin-AKI percentage, and AKI intensity (number of AKI days per 100 susceptible patient-days). Results Comparing the initiation with sustainability era, there was a reduction in high Nephrotoxic medication exposures from 16.4 to 9.6 per 1000 patient-days (P = .03), reduction in percentage of Nephrotoxic medication-AKI from 30.9% to 11.0% (P Conclusion(s) A systematic surveillance program to identify high-risk infants can prevent Nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.
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evidence based development of a Nephrotoxic medication list to screen for acute kidney injury risk in hospitalized children
American Journal of Health-system Pharmacy, 2019Co-Authors: Elizabeth Goswami, Stuart L. Goldstein, Karyn Yonekawa, Richard K Ogden, William E Bennett, Richard Hackbarth, Michael J Somers, Jason MisuracAbstract:Purpose Medications are commonly associated with acute kidney injury (AKI). However, in both clinical practice and research, consideration of specific medications as Nephrotoxic varies widely. The Nephrotoxic Injury Negated by Just-in-time Action quality improvement collaborative was formed to focus on prevention or reduction of Nephrotoxic medication-associated AKI in noncritically ill hospitalized children. However, there were discrepancies among institutions as to which medications should be considered Nephrotoxic. The collaborative convened a Nephrotoxic Medication (NTMx) Subcommittee to develop a consensus for the classification of Nephrotoxic medications. Summary The NTMx Subcommittee initially included pediatric nephrologists, a pharmacist, and a pediatric intensivist. The committee reviewed NTMx lists from the collaborative and identified changes from the initial NTMx list. The NTMx Subcommittee conducted a literature review of the disputed medications and assigned an evidence grade based on the reported association with Nephrotoxicity and the quality of the data. The association between medication exposure and AKI was also determined using administrative data from the Pediatric Health Information Systems database. The NTMx Subcommittee then came to a majority consensus regarding which medications should be included on the list. The subcommittee's recommendations were presented to the larger collaborative for approval, and consensus was achieved. The list continues to be reviewed and updated annually. Conclusion Formation of a multicenter quality-improvement initiative exposed current limitations as to which medications are considered Nephrotoxic in clinical and research settings and presented an opportunity to approach this problem using an evidence-based process. A consensus definition of Nephrotoxic-medication exposure was achieved.
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Reduction in Nephrotoxic Antimicrobial Exposure Decreases Associated Acute Kidney Injury in Pediatric Hematopoietic Stem Cell Transplant Patients
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 2019Co-Authors: Stefanie W. Benoit, Stuart L. Goldstein, Devesh Dahale, David B. Haslam, Adam S. Nelson, Kori Truono, Stella M. DaviesAbstract:Exposure to Nephrotoxic medications is a common risk factor for acute kidney injury (AKI) in pediatric stem cell transplantation (SCT). We hypothesized that reducing Nephrotoxic antimicrobial exposure for SCT patients would be associated with lower nephrotoxin-associated AKI (NTMx-AKI) rates and no increase in infection treatment failures. We conducted a prospective cohort analysis of all inpatient SCT patients at Cincinnati Children's Hospital Medical Center between January 2014 and December 2017. In January 2016, first line fever coverage was changed from piperacillin-tazobactam to cefepime, acknowledging that the change resulted in a loss of enterococcal coverage, and the duration of antimicrobial exposures was limited, specifically including vancomycin. We collected data using prospective NTMx-AKI and antimicrobial utilization monitoring platforms within the electronic health record. AKI days and severity were extracted for patients exposed to 3+ nephrotoxins, 3+ days of IV aminoglycosides, or 3+ days of IV vancomycin. AKI was identified using KDIGO serum creatinine criteria. We assessed rates of nephrotoxin exposure and NTMx-AKI in all SCT inpatients for 2 years pre- and post-intervention. Data were grouped and analyzed by calendar month, normalized to a denominator of 1000 patient-days. Statistical process control methods were used to monitor adherence to the intervention and identify changes in mean rate of nephrotoxin exposure and NTMx-AKI. Infection rates, alternate antimicrobial usage rates, and the fraction of repeat positive cultures were used to identify treatment failures. PTZ usage decreased from 196 to 33 days/1000 patient days, cefepime usage increased from 62 to 290 days/1000 patient days, and vancomycin usage decreased from 62 to 41 days/1000 patient days. High nephrotoxin exposure decreased by 33% (143 to 96 days/1000 patient days), and NTMx-AKI decreased by 74% (24 to 6 days/1000 patient days). Rates of all KDIGO stages of NTMx-AKI decreased ≥50% after the intervention. Stage 3, the most severe, decreased by >80%. The fraction of repeat positive cultures remained stable between the two eras at .1 (standard deviation 0.21) and .07 (standard deviation 0.17), respectively. There were no increases in infection rates, alternate antimicrobial usage rates, or treatment failures. Reduction of Nephrotoxic antimicrobial exposure can decrease the amount and severity of NTMx-AKI in SCT patients without an increase in treatment failures.
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Nephrotoxicities.
F1000Research, 2017Co-Authors: Stuart L. GoldsteinAbstract:Nephrotoxic medication exposure is nearly ubiquitous in hospitalized patients and represents one of the most common causes of acute kidney injury (AKI) in the hospitalized setting. Although provision of medications that are Nephrotoxic has led to improved outcomes in terms of treatment of underlying illness, unnecessary Nephrotoxic medication exposure can be viewed as a potentially modifiable adverse safety event if AKI can be prevented. The advancements in electronic health record development, standardization of AKI definitions, and the ability to identify AKI risk and development in near real time provide opportunities to reduce harm from Nephrotoxicity.
Scott M. Sutherland - One of the best experts on this subject based on the ideXlab platform.
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Nephrotoxins and Nephrotoxic acute kidney injury
Pediatric Nephrology, 2019Co-Authors: Amanda M Uber, Scott M. SutherlandAbstract:Although the concept of Nephrotoxicity has been recognized for more than 80 years, interest in nephrotoxins has intensified dramatically over the past two decades. Much of this attention has rightfully been focused on pharmaceutical agents and iatrogenic harm; however, it is important for providers to recognize that nephrotoxins can be found in naturally occurring substances as well. Although nephrotoxins exist in a myriad of forms, the means by which they induce injury can be organized into a few categories. For most of these agents, regardless of the mechanism, the final common pathway is acute kidney injury (AKI). Unfortunately, therapeutic options are limited and no treatments currently exist to reverse Nephrotoxic AKI once it occurs. As a result, current strategies focus on increased awareness, nephrotoxin avoidance, early injury detection, and mitigation of disease severity. The goal of this review is to summarize our current understanding of Nephrotoxic mechanisms and the epidemiology of Nephrotoxic AKI. Additionally, avoidance and preventative strategies are discussed, screening approaches are suggested, and chronic monitoring recommendations are made.
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electronic health record enabled big data approaches to nephrotoxin associated acute kidney injury risk prediction
Pharmacotherapy, 2018Co-Authors: Scott M. SutherlandAbstract:Nephrotoxin-associated acute kidney injury (NTx-AKI) has become one of the most common causes of AKI among hospitalized adults and children; across acute and intensive care populations, exposure to nephrotoxins accounts for 15-25% of AKI cases. Although some interventions have shown promise in observational studies, no treatments currently exist for NTx-AKI once it occurs. Thus, nearly all effective strategies are aimed at prevention. The primary obstacle to prevention is risk prediction and the determination of which patients are more likely to develop NTx-AKI when exposed to medications with Nephrotoxic potential. Historically, traditional statistical modeling has been applied to previously recognized clinical risk factors to identify predictors of NTx-AKI. However, increased electronic health record adoption and the evolution of "big-data" approaches to predictive analytics may offer a unique opportunity to prevent NTx-AKI events. This article describes prior and current approaches to NTx-AKI prediction and offers three novel use cases for electronic health record-enabled NTx-AKI forecasting and risk profiling.
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Electronic Health Record–Enabled Big‐Data Approaches to Nephrotoxin‐Associated Acute Kidney Injury Risk Prediction
Pharmacotherapy, 2018Co-Authors: Scott M. SutherlandAbstract:Nephrotoxin-associated acute kidney injury (NTx-AKI) has become one of the most common causes of AKI among hospitalized adults and children; across acute and intensive care populations, exposure to nephrotoxins accounts for 15-25% of AKI cases. Although some interventions have shown promise in observational studies, no treatments currently exist for NTx-AKI once it occurs. Thus, nearly all effective strategies are aimed at prevention. The primary obstacle to prevention is risk prediction and the determination of which patients are more likely to develop NTx-AKI when exposed to medications with Nephrotoxic potential. Historically, traditional statistical modeling has been applied to previously recognized clinical risk factors to identify predictors of NTx-AKI. However, increased electronic health record adoption and the evolution of "big-data" approaches to predictive analytics may offer a unique opportunity to prevent NTx-AKI events. This article describes prior and current approaches to NTx-AKI prediction and offers three novel use cases for electronic health record-enabled NTx-AKI forecasting and risk profiling.
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Nephrotoxin exposure and acute kidney injury in critically ill children undergoing congenital cardiac surgery.
Pediatric nephrology (Berlin Germany), 2018Co-Authors: Amanda M Uber, Maria E. Montez-rath, David M. Kwiatkowski, Catherine D. Krawczeski, Scott M. SutherlandAbstract:Though acute kidney injury (AKI) is often multifactorial, investigators are now emphasizing the specific contribution of nephrotoxins. This study examines the epidemiology of nephrotoxin exposure and nephrotoxin-associated AKI among children undergoing congenital heart surgery (CHS). This is a retrospective cohort study of children admitted following CHS between June 1, 2014, and September 30, 2014. Nephrotoxins were defined according to the Nephrotoxic Injury Negated by Just-in-time-Action (NINJA) collaborative; high nephrotoxin exposure was defined as receipt of ≥ 3 nephrotoxins concurrently. AKI was diagnosed according to KDIGO creatinine criteria. Severe AKI was defined as KDIGO stage ≥ 2. Poisson models were used to compute adjusted relative risk (aRR) of high nephrotoxin exposure for AKI. One hundred fifty-four children (median age 20.4 months, IQR 2.3–59.5) were included. One hundred thirty-one (85.1%) received at least one nephrotoxin; 32 (20.8%) received ≥ 3 nephrotoxins. The most commonly administered medications were ketorolac (n = 74, 48.1%), aspirin (n = 62, 40.3%), ibuprofen (n = 51, 33.1%), vancomycin (n = 39, 25.3%), piperacillin/tazobactam (n = 35, 22.7%), and enalapril (n = 14, 9.1%). AKI occurred more commonly in those exposed to ≥ 3 nephrotoxins (62.5 vs. 50.8%); this was not statistically significant after adjusting for confounders (aRR = 1.2, 95% CI 0.9–1.7). Severe AKI was similar between those with and without high nephrotoxin exposure (21.9 vs. 19.7%, p = 0.78). Nephrotoxin use is common following pediatric CHS. While we found no association between high nephrotoxin exposure and AKI, this may be related to the multifactorial nature of AKI in this population. For many common nephrotoxins, less injurious agents exist and nephrotoxin exposure may represent a modifiable risk factor for AKI.
Lawrence S Weisberg - One of the best experts on this subject based on the ideXlab platform.
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Cause of acute tubular necrosis affects its prognosis. The Auriculin Anaritide Acute Renal Failure Study Group.
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis the auriculin anaritide acute renal failure study group
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:BACKGROUND: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. OBJECTIVE: To test the hypothesis that the cause of ATN affects its clinical outcome. METHODS: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. RESULTS: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysis-free survival improved significantly and mortality tended to decline with advancing age. CONCLUSIONS: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious commorbidities in the ischemic ATN group. Advancing age was associated with improved dialysis-free survival and a tendency toward reduced mortality in patients with ischemic ATN.
F. C. Genter - One of the best experts on this subject based on the ideXlab platform.
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Cause of acute tubular necrosis affects its prognosis. The Auriculin Anaritide Acute Renal Failure Study Group.
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:Background: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. Objective: To test the hypothesis that the cause of ATN affects its clinical outcome. Methods: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. Results: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysisfree survival improved significantly and mortality tended to decline with advancing age. Conclusions: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious comorbidities in the ischemic ATN group. Advancing age was associated with improved dialysisfree survival and a tendency toward reduced mortality in patients with ischemic ATN. Arch Intern Med. 1997;157:1833-1838
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cause of acute tubular necrosis affects its prognosis the auriculin anaritide acute renal failure study group
JAMA Internal Medicine, 1997Co-Authors: Lawrence S Weisberg, F. C. Genter, Robin L. Allgren, Brenda R. C. KurnikAbstract:BACKGROUND: Acute tubular necrosis (ATN) is the most common type of acute renal failure in hospitalized patients and is associated with a high morbidity and mortality. The cause of ATN can be divided into Nephrotoxic, ischemic, or mixed. OBJECTIVE: To test the hypothesis that the cause of ATN affects its clinical outcome. METHODS: The study compares clinical outcomes of patients enrolled in the placebo arm of a multicenter, randomized, double-blinded, placebo-controlled trial of anaritide (Auriculin, synthetic atrial natriuretic peptide, Scios, Mountain View, Calif) in patients with well-defined ATN. Patients were divided prospectively into groups according to the cause of ATN: pure Nephrotoxic, pure ischemic, or mixed Nephrotoxic and ischemic. Outcomes of interest were dialysis-free survival and all-cause mortality on day 14 and day 21. The causal groups were compared with respect to the prevalence of several comorbidities suspected of affecting the clinical outcomes. RESULTS: Mortality was 10% in the Nephrotoxic group and 30% in the ischemic group on day 21. Dialysis-free survival was 66% in the Nephrotoxic group and 41% in the ischemic group on day 21. Outcomes in the mixed and ischemic groups were similar. Compared with the Nephrotoxic group, there was a significantly higher prevalence of cardiogenic shock, hypotension, sepsis, and respiratory failure and a tendency toward a higher prevalence of acute hepatic dysfunction in the ischemic group. Diabetes mellitus was more prevalent in the Nephrotoxic group. Among patients with ischemic ATN, dialysis-free survival improved significantly and mortality tended to decline with advancing age. CONCLUSIONS: Among patients with ATN, those in whom renal ischemia was causative had significantly higher mortality and lower dialysis-free survival than those whose ATN was purely Nephrotoxic in origin. This difference in clinical outcomes was associated with a higher prevalence of serious commorbidities in the ischemic ATN group. Advancing age was associated with improved dialysis-free survival and a tendency toward reduced mortality in patients with ischemic ATN.
