Incidence and outcome of early acute kidney injury in critically-ill trauma patients.

OBJECTIVE: To determine the incidence and effect on mortality of early acute kidney injury in severely injured trauma patients using the Acute Kidney Injury Network creatinine criteria. DESIGN: A retrospective cohort study of severely injured trauma patients admitted to the shock trauma intensive care unit. SETTING: Texas Trauma Institute, a state designated level I trauma unit certified by the American College of Surgeons Committee on Trauma. PATIENTS: 901 severely injured trauma patients admitted over a 15 month period to the shock trauma intensive care unit. INTERVENTIONS: Retrospective analysis of prospectively collected data abstracted from an electronic trauma database. MEASUREMENTS AND MAIN RESULTS: Of 901 eligible patients admitted to the shock trauma intensive care unit after traumatic injury, 54 patients (6%) developed acute kidney injury, of whom 10 (19%) required renal replacement therapy. The 30-day mortality rate for the entire cohort was 83/901 (9.2%). Patients with early acute kidney injury had a mortality rate of 16/54 (29.6%). When corrected for multiple covariates including injury severity scores, the development of early acute kidney injury was associated with a significantly higher risk of death at 30 days with an OR of 3.4 (95% CI 1.6-7.4). CONCLUSIONS: Applying the Acute Kidney Injury Network creatinine criteria in severely injured trauma patients, the incidence of early acute kidney injury was 6%. After correction for injury severity, development of early acute kidney injury was independently associated with significantly higher 30-day mortality

Prevalence of chronic kidney disease and progression of disease over time among patients enrolled in the Houston West Nile virus cohort.

INTRODUCTION: In experimental models of West Nile virus (WNV) infection, animals develop chronic kidney infection with histopathological changes in the kidney up to 8-months post-infection. However, the long term pathologic effects of acute infection in humans are largely unknown. The purpose of this study was to assess renal outcomes following WNV infection, specifically the development of chronic kidney disease (CKD). METHODS: In a cohort of 139 study participants with a previous diagnosis of WNV infection, we investigated the prevalence of CKD using the Kidney Disease Outcomes Quality Initiative (KDOQI) criteria based on the Modification of Diet in Renal Disease (MDRD) formula and urinary abnormalities, and assessed various risk factors and biomarkers. RESULTS: Study participants were primarily male (60%) and non-Hispanic white (86%) with a mean age of 57 years. Most (83%) were four to nine years post-infection at the time of this study. Based on the KDOQI definition, 40% of participants had evidence of CKD, with 10% having Stage III or greater and 30% having Stage I-II. By urinary dipstick testing, 26% of patients had proteinuria and 23% had hematuria. Plasma NGAL levels were elevated in 14% of participants while MCP-1 levels were increased in 12%. Over 1.5 years, the average change in eGFR was -3.71 mL/min/1.73 m(2). Only a history of Neuroinvasive WNV disease was independently associated with CKD following multivariate analysis. DISCUSSION: We found a high prevalence of CKD after long term follow-up in a cohort of participants previously infected with WNV. The majority of those with CKD are in Stage I-II indicating early stages of renal disease. Traditional risk factors were not associated with the presence of CKD in this population. Therefore, clinicians should regularly evaluate all patients with a history of WNV for evidence of CKD

Covariate adjusted mortality rates.

<p>OR: Odds ratio; CI: Confidence intervals; AKI: Acute Kidney Injury; RRT: Renal replacement therapy;</p><p>ISS: Injury Severity Score.</p

Baseline characteristics.

<p>AKI: Acute kidney injury; IQR: Inter-quartile range; SD: Standard deviation; ED: Emergency department;</p><p>AIS: Abbreviated injury score.</p>*<p>Lowest creatinine within 24 hours.</p

Crude mortality rates.

<p>AKI: Acute Kidney Injury; RRT: Renal replacement therapy.</p

AKIN AKI Criteria.

<p>AKIN: Acute Kidney Injury Network.</p><p>AKI: Acute Kidney Injury.</p><p>Adapted from reference 13.</p

Univariate logistic regression analysis between presence of CKD and CKD risk factors and indicators.

<p>Family History of Chronic Kidney Disease was excluded from the table since there were insufficient numbers to calculate statistical values. OR = Odds Ratio, CI = Confidence Interval.</p

Descriptive summary of cohort demographics, CKD risk factors, CKD indicators, and CKD biomarkers.

<p>Descriptive summary of cohort demographics, CKD risk factors, CKD indicators, and CKD biomarkers.</p

Change in eGFR values over time among 112 study participants, April 2010 to November 2011.

<p>Change in eGFR values over time among 112 study participants, April 2010 to November 2011.</p