Background
Methods
Study design and patients
Definition of CA-AKI
Data collection
-
Baseline characteristics: age, gender, SAPS II score, Mc Cabe class (class 1, no fatal underlying disease; class 2, underlying disease fatal within 5 years; class 3, underlying disease fatal within 1 year), admission category (medical, scheduled surgery, or unscheduled surgery), and comorbidities (diabetes mellitus, myeloma and other chronic coexisting conditions defined according to the Knaus criteria [17]),
-
Serum creatinine values measured on the CT day before administration of ICM, and 24 hours and 48 hours thereafter,
-
Additional risk factors for AKI occurring within 48 hours before and after administration of ICM: sepsis, hemodynamic failure and prescription of potential nephrotoxic drugs (aminoglycosides, glycopeptides, trimethoprim/sulfamethoxazole, loop diuretics),
-
Presence or absence of preventive measures (N-acetylcysteine or isotonic crystalloids), and
-
Impact of CA-AKI: need for RRT within 48 hours after administration of ICM, ICU mortality, length of ICU stay and persistent need for renal support on ICU discharge.
Endpoints
Statistical analyses
Results
Patients
Incidence of CA-AKI and comparison of patients with and without CA-AKI
No CA-AKI N = 119 | CA-AKI N = 24 |
P
| |
---|---|---|---|
Age (yrs) | 61 [49–73] | 63 [53–78] | 0.33 |
Male sex | 74 (62.2) | 15 (62.5) | 0.98 |
SAPS II score | 40 [28–57] | 57 [41–78] | 0.001 |
Admission category | |||
medical | 83 (69.8) | 14 (58.3) | 0.22 |
scheduled surgery | 11 (9.2) | 1 (4.2) | |
unscheduled surgery | 25 (21) | 9 (37.5) | |
Mc Cabe class | |||
1 | 65 (54.6) | 9 (37.5) | 0.08 |
2 | 38 (31.9) | 8 (33.3) | |
3 | 16 (13.5) | 7 (29.2) | |
Serum creatinine (μmol/L) before administration of ICM | 87 [68–120] | 90 [64–128] | 0.91 |
Preventive measure | 6 (5) | 1(4.2) | 1 |
Risk factors for AKI within 48 hrs before ICM administration | 64 (53.8) | 20 (83.3) | 0.01 |
diabetes mellitus | 24 (20.2) | 4 (16.7) | 1 |
myeloma | 0 (0) | 1 (4.2) | 0.17 |
nephrotoxic drugs | 22 (18.5) | 7 (29.2) | 0.26 |
sepsis | 48 (40.3) | 16 (66.7) | 0.02 |
hemodynamic failure | 14 (11.8) | 11 (45.8) | < 0.001 |
New risk factors for AKI within 48 hrs after ICM administration | 36 (30.2) | 7 (29.2) | 1 |
nephrotoxic drugs | 19 (16) | 4 (16.7) | 1 |
sepsis | 30 (25.2) | 7 (29.2) | 0.63 |
hemodynamic failure | 4 (3.4) | 1 (4.2) | 0.9 |
Association of CA-AKI with renal replacement therapy
No RRT N = 17 | RRT N = 7 |
P
| |
---|---|---|---|
SAPS II | 58 [44–72] | 50 [37–92] | 0.97 |
Non-renal SOFA score before ICM administration | 5 [4-6] | 7 [5-9] | 0.24 |
Serum creatinine (μmol/L) before ICM administration | 90 [63–128] | 83 [66–198] | 0.80 |
Risk factors for AKI within 48 hrs before ICM administration | 14 (82.3) | 6 (85.7) | 1 |
diabetes mellitus | 3 (17.7) | 1 (14.3) | 1 |
myeloma | 1 (5.9) | 0 (0) | 1 |
nephrotoxic drugs | 5 (29.4) | 2 (28.6) | 1 |
sepsis | 10 (58.9) | 6 (85.7) | 0.37 |
hemodynamic failure | 7 (41.2) | 4 (57.1) | 0.76 |
New risk factors for AKI within 48 hrs after ICM administration | 4 (23.5) | 3 (42.9) | 0.37 |
nephrotoxic drugs | 3 (17.7) | 1 (14.3) | 1 |
sepsis | 4 (23.5) | 3 (42.9) | 0.63 |
hemodynamic failure | 0 (0) | 1 (14.3) | 0.3 |
Preventive measure | 0 (0) | 1 (14.3) | 0.3 |
ICU mortality | 7 (41.2) | 5 (71.4) | 0.37 |
Association of CA-AKI with mortality
Variable | OR | 95% CI |
P
|
---|---|---|---|
CA-AKI | 3.48 | 1.10-11.46 | 0.04 |
SAPS II score, per point | 1.03 | 1.01-1.05 | 0.03 |
Non-renal SOFA score, per point | 1.38 | 1.12-1.71 | 0.003 |