Factors associated with acute kidney injury in acute respiratory distress syndrome

Abstract

BACKGROUND: Acute kidney injury (AKI) is the most frequent extra-pulmonary organ failure in acute respiratory distress syndrome (ARDS). The objective of this study was to assess the factors associated with the development and severity of AKI in patients with ARDS. METHODS: This is a retrospective cohort study of ARDS patients without acute or chronic kidney disease prior to the onset of ARDS over a 7-year period (2010-2017). AKI and severity of AKI were defined according to the Kidney Disease Improving Global Outcomes 2012 guidelines. RESULTS: Of the 634 ARDS patients, 357 patients met study criteria. A total of 244 (68.3%) patients developed AKI after ARDS onset: 60 (24.6%) had stage I AKI, 66 (27%) had stage II AKI, and 118 (48.4%) had stage III AKI. The median time of AKI onset for stage I AKI was 2 days (interquartile range, 1.5-5.5) while stage II and III AKI was 4 days. On multivariable analysis, factors associated with development of AKI were age [subdistribution hazard ratio (SHR) 1.01, 95% confidence interval (CI) 1.00-1.02], SOFA score (SHR 1.16, 95%CI 1.12-1.21), a history of diabetes mellitus (DM) (SHR 1.42, 95%CI 1.07-1.89), and arterial pH on day 1 of ARDS (SHR per 0.1 units decrease was 1.18, 95%CI 1.05-1.32). In severity of AKI, stage I AKI was associated with age (SHR 1.03, 95%CI 1.01-1.05) and serum bicarbonate on day 1 of ARDS (SHR 1.07, 95%CI 1.02-1.13). Stage II AKI was associated with age (SHR 1.03, 95%CI 1.01-1.05), serum bicarbonate on day 1 (SHR 1.12, 95%CI 1.06-1.18), SOFA score (SHR 1.19, 95%CI 1.10-1.30), history of heart failure (SHR 3.71, 95%CI 1.63-8.46), and peak airway pressure (SHR 1.04, 95%CI 1.00-1.07). Stage III AKI was associated with a higher BMI (SHR 1.02, 95%CI 1.00-1.03), a history of DM (SHR 1.79, 95%CI 1.18-2.72), SOFA score (SHR 1.29, 95%CI 1.22-1.36), and arterial pH on day 1 (SHR per 0.1 units decrease was 1.25, 95%CI 1.05-1.49). CONCLUSIONS: Age, a higher severity of illness, a history of diabetes, and acidosis were associated with development of AKI in ARDS patients. Severity of AKI was further associated with BMI, history of heart failure, and peak airway pressure.

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References 43

1. 1.

   Bellani G, Laffey JG, Pham T, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA. 2016;315(8):788-800.

   Not in our library10.1001/jama.2016.0291

2. 2.

   Bautista E, Arcos M, Jimenez-Alvarez L, et al. Angiogenic and inflammatory markers in acute respiratory distress syndrome and renal injury associated to A/H1N1 virus infection. Exp Mol Pathol. 2013;94(3):486-492.

   Not in our library10.1016/j.yexmp.2013.03.007

3. 3.

   Ranieri VM, Suter PM, Tortorella C, et al. Effect of mechanical ventilation on inflammatory mediators in patients with acute respiratory distress syndrome: a randomized controlled trial. JAMA. 1999;282(1):54-61.

   Not in our library10.1001/jama.282.1.54

4. 4.

   Ranieri VM, Giunta F, Suter PM, Slutsky AS. Mechanical ventilation as a mediator of multisystem organ failure in acute respiratory distress syndrome. JAMA. 2000;284(1):43-44.

   Not in our library10.1001/jama.284.1.43

5. 5.

   Liu KD, Glidden DV, Eisner MD, et al. Predictive and pathogenetic value of plasma biomarkers for acute kidney injury in patients with acute lung injury. Crit Care Med. 2007;35(12):2755-2761.

   Not in our library

6. 6.

   Clemens MS, Stewart IJ, Sosnov JA, et al. Reciprocal risk of acute kidney injury and acute respiratory distress syndrome in critically ill burn patients. Crit Care Med. 2016;44(10):e915-e922.

   Not in our library10.1097/ccm.0000000000001812

7. 7.

   Darmon M, Clec’h C, Adrie C, et al. Acute respiratory distress syndrome and risk of AKI among critically ill patients. Clin J Am Soc Nephrol. 2014;9(8):1347-1353.

   Not in our library10.2215/cjn.08300813

8. 8.
   Invasive mechanical ventilation as a risk factor for acute kidney injury in the critically ill: a systematic review and meta-analysis · 2013

   No notice
9. 9.

   Kuiper JW, Groeneveld AB, Slutsky AS, Plotz FB. Mechanical ventilation and acute renal failure. Crit Care Med. 2005;33(6):1408-1415.

   Not in our library10.1097/01.ccm.0000165808.30416.ef

10. 10.

    Husain-Syed F, Slutsky AS, Ronco C. Lung-kidney cross-talk in the critically ill patient. Am J Respir Crit Care Med. 2016;194(4):402-414.

    Not in our library10.1164/rccm.201602-0420cp

11. 11.

    Sharkey RA, Mulloy EM, O’Neill SJ. The acute effects of oxygen and carbon dioxide on renal vascular resistance in patients with an acute exacerbation of COPD. Chest. 1999;115(6):1588-1592.

    Not in our library10.1378/chest.115.6.1588

12. 12.

    Hepokoski M, Englert JA, Baron RM, et al. Ventilator-induced lung injury increases expression of endothelial inflammatory mediators in the kidney. Am J Physiol Renal Physiol. 2017;312(4):F654-F660.

    Not in our library10.1152/ajprenal.00523.2016

13. 13.

    Pinsky MR, Desmet JM, Vincent JL. Effect of positive end-expiratory pressure on right ventricular function in humans. Am Rev Respir Dis. 1992;146(3):681-687.

    Not in our library10.1164/ajrccm/146.3.681

14. 14.

    Pannu N, Mehta RL. Effect of mechanical ventilation on the kidney. Best Pract Res Clin Anaesthesiol. 2004;18(1):189-203.

    Not in our library10.1016/j.bpa.2003.08.002

15. 15.

    Annat G, Viale JP, Bui Xuan B, et al. Effect of PEEP ventilation on renal function, plasma renin, aldosterone, neurophysins and urinary ADH, and prostaglandins. Anesthesiology. 1983;58(2):136-141.

    Not in our library10.1097/00000542-198302000-00006

16. 16.

    Marquez JM, Douglas ME, Downs JB, et al. Renal function and cardiovascular responses during positive airway pressure. Anesthesiology. 1979;50(5):393-398.

    Not in our library10.1097/00000542-197905000-00004

17. 17.

    Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-2533.

    Not in our library10.1001/jama.2012.5669

18. 18.

    Inker LA, Astor BC, Fox CH, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for the evaluation and management of CKD. Am J Kidney Dis. 2014;63(5):713-735.

    Not in our library10.1053/j.ajkd.2014.01.416

19. 19.

    Kellum JA, Lameire N, Aspelin P, Barsoum RS, Burdmann EA, Goldstein SL, Herzog CA, Joannidis M, Kribben A, Levey AS, MacLeod AM. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2(1):1-138.

    Not in our library10.1038/kisup.2012.1

20. 20.

    Siew ED, Ikizler TA, Matheny ME, et al. Estimating baseline kidney function in hospitalized patients with impaired kidney function. Clin J Am Soc Nephrol. 2012;7(5):712-719.

    Not in our library10.2215/cjn.10821011

21. 21.

    Pickering JW, Endre ZH. Back-calculating baseline creatinine with MDRD misclassifies acute kidney injury in the intensive care unit. Clin J Am Soc Nephrol. 2010;5(7):1165-1173.

    Not in our library10.2215/cjn.08531109

22. 22.

    Sutherland SM, Zappitelli M, Alexander SR, et al. Fluid overload and mortality in children receiving continuous renal replacement therapy: the prospective pediatric continuous renal replacement therapy registry. Am J Kidney Dis. 2010;55(2):316-325.

    Not in our library10.1053/j.ajkd.2009.10.048

23. 23.

    Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801-810.

    Not in our library10.1001/jama.2016.0287

24. 24.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-381.

    Not in our library10.1016/j.jbi.2008.08.010

25. 25.

    White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377-399.

    Not in our library10.1002/sim.4067

26. 26.

    Fuhrman DY, Kane-Gill S, Goldstein SL, Priyanka P, Kellum JA. Acute kidney injury epidemiology, risk factors, and outcomes in critically ill patients 16–25 years of age treated in an adult intensive care unit. Ann Intensive Care. 2018;8(1):26.

    Not in our library10.1186/s13613-018-0373-y

27. 27.

    Xu X, Nie S, Liu Z, et al. Epidemiology and clinical correlates of AKI in Chinese hospitalized adults. Clin J Am Soc Nephrol. 2015;10(9):1510-1518.

    Not in our library10.2215/cjn.02140215

28. 28.

    Hsu CY, Ordonez JD, Chertow GM, Fan D, McCulloch CE, Go AS. The risk of acute renal failure in patients with chronic kidney disease. Kidney Int. 2008;74(1):101-107.

    Not in our library10.1038/ki.2008.107

29. 29.

    Hoste EA, Bagshaw SM, Bellomo R, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411-1423.

    Not in our library10.1007/s00134-015-3934-7

30. 30.

    Melin J, Hellberg O, Akyurek LM, Kallskog O, Larsson E, Fellstrom BC. Ischemia causes rapidly progressive nephropathy in the diabetic rat. Kidney Int. 1997;52(4):985-991.

    Not in our library10.1038/ki.1997.420

31. 31.

    Soto GJ, Frank AJ, Christiani DC, Gong MN. Body mass index and acute kidney injury in the acute respiratory distress syndrome. Crit Care Med. 2012;40(9):2601-2608.

    Not in our library10.1097/ccm.0b013e3182591ed9

32. 32.

    Cruz-Lagunas A, Jimenez-Alvarez L, Ramirez G, et al. Obesity and pro-inflammatory mediators are associated with acute kidney injury in patients with A/H1N1 influenza and acute respiratory distress syndrome. Exp Mol Pathol. 2014;97(3):453-457.

    Not in our library10.1016/j.yexmp.2014.10.006

33. 33.

    Lombardi R, Nin N, Penuelas O, et al. Acute kidney injury in mechanically ventilated patients: the risk factor profile depends on the timing of Aki onset. Shock. 2017;48(4):411-417.

    Not in our library10.1097/shk.0000000000000871

34. 34.

    Kuiper JW, Vaschetto R, Della Corte F, Plotz FB, Groeneveld AB. Bench-to-bedside review: ventilation-induced renal injury through systemic mediator release–just theory or a causal relationship? Crit Care. 2011;15(4):228.

    Not in our library10.1186/cc10282

35. 35.

    Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301-1308.

    Not in our library10.1056/nejm200005043421801

36. 36.

    Liu KD, Thompson BT, Ancukiewicz M, et al. Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes. Crit Care Med. 2011;39(12):2665-2671.

    Not in our library10.1097/ccm.0b013e318228234b

37. 37.
    Fluid balance and mortality in critically ill patients with acute kidney injury: a multicenter prospective epidemiological study · 2015

    No notice
38. 38.

    Salahuddin N, Sammani M, Hamdan A, et al. Fluid overload is an independent risk factor for acute kidney injury in critically ill patients: results of a cohort study. BMC Nephrol. 2017;18(1):45.

    Not in our library10.1186/s12882-017-0460-6

39. 39.

    Prowle JR, Echeverri JE, Ligabo EV, Ronco C, Bellomo R. Fluid balance and acute kidney injury. Nat Rev Nephrol. 2010;6(2):107-115.

    Not in our library10.1038/nrneph.2009.213

40. 40.

    Ruan SY, Wu HY, Lin HH, Wu HD, Yu CJ, Lai MS. Inhaled nitric oxide and the risk of renal dysfunction in patients with acute respiratory distress syndrome: a propensity-matched cohort study. Crit Care. 2016;20(1):389.

    Not in our library10.1186/s13054-016-1566-0

Cited by papers we hold 3

• Mechanisms of SARS-CoV-2 Infection-Induced Kidney Injury: A Literature Review · 2022
  Not checked
• Biological impact of restrictive and liberal fluid strategies at low and high PEEP levels on lung and distal organs in experimental acute respiratory distress syndrome · 2022
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• Kidney health in the COVID-19 pandemic: An umbrella review of meta-analyses and systematic reviews · 2022
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