Acute Renal Injury in Patients with ARDS: Presence and Associated Factors
Same as above
DOI:
https://doi.org/10.51253/pafmj.v74iSUPPL-2.11702Keywords:
Acute Kidney injury, AKI, Acute Respiratory Distress Syndrome (ARDS), SepsisAbstract
Objective: To determine the occurrence of Acute Renal Injury in Acute Respiratory Distress Syndrome patients along with
contribution of co-morbidities and risk factors for the development of AKI.
Study Design: Comparative Cross Sectional study.
Place and Duration of Study: This study was done at medical ICU, Department of Medicine, Combined Military Hospital
(CMH), Rawalpindi from Jan 2023 to Oct 2023.
Methodology: A total of 68 patients, with confirmed ARDS, 18yrs or above were included. The presence of co-morbidities in
all patients was recorded. Patients BMI and SOFA score were calculated. Patients were divided as Group 1 (those who
develop AKI) and Group 2 (those who did not develop AKI). On the basis of serum creatinine level group 1 patients were
further categorized into three groups: stage I AKI, stage II AKI, and stage III AKI. The median (IQR) was calculated for nonnormal variables. Chi-square test, unpaired t-test, and Mann-Whitney U test were applied and p≤0.05 was taken as statistically
significant.
Results: Acute Kidney Injury was observed in 39(57.4%) patients (Group 1) while 29(42.6%) patients did not develop any AKI
(Group 2). Group 1, had a significantly higher BMI, SOFA score, Comorbidities like Diabetes Mellitus (DM), Malignancies and
liver Disease. Non-pulmonary sepsis was high in Group 2. There was a statistically significant association between AKI stages
and specific characteristics.
Conclusion: AKI was quite common among ARDS individual. A Higher BMI, SOFA score, presence of DM, active malignancy,
liver and cardiac illness showed strong association with the development of AKI.
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References
Yang Y, Dong J, Chen X, Chen R, Wang H. Incidence, risk factors and
clinical outcomes of septic acute renal injury in cancer patients with
sepsis admitted to the ICU: A retrospective study. Front Med 2022; 9:
https://doi.org/10.3389/fmed.2022.1015735
Table-II: Stratification of AKI staging with respect to BMI, Sofa, DM, Sepsis, Liver disease and Malignancy (n=68)
Characteristics Stage Total p-value No AKI Stage-I Stage-II Stage-III
-25 14(73.7%) 1(5.3%) 2(10.5%) 2(10.5%) 19(27.9%)
BMI 26-30 10(45.5%) 3(13.6%) 5(22.7%) 4(18.2%) 22(32.4%) 0.009
>30 5(18.5%) 2(7.4%) 7(25.9%) 13(48.1%) 27(39.7%)
Sofa <10 23(74.1%) 3(9.7%) 3(9.7%) 2(6.5%) 31(45.6%)
<0.0001 >10 6(16.2%) 3(8.1%) 11(29.7%) 17(45.9%) 37(54.4%)
DM Yes 6(25.0%) 1(4.2%) 2(8.3%) 15(62.5%) 24(35.3%)
<0.0001 No 23(52.3%) 5(11.4%) 12(27.3%) 4(9.1%) 44(64.7%)
Sepsis Yes (23.3%) 2(6.7%) 10(33.3%) 11(36.7%) 30(44.1%)
014 No 22(57.9%) 4(10.5%) 4(10.5%) 8(21.1%) 38(55.9%)
Liver Disease Yes 5(25.0%) 0 5(25.0%) 10(50.0%) 20(29.4%) 0.021
No 24(50.0%) 6(12.5%) 9(18.8%) 9(18.8%) 48(70.6%)
Malignancy Yes 4(22.1%) 1(5.6%) 3(16.7%) 10(55.6%) 18(26.5%) 0.023
No 25(50.0%) 5(10.0%) 11(22.0%) 9(18.0%) 50(73.0%)
Injury in Patients with ARDS
Pak Armed Forces Med J 2024; 74(Suppl-2): S319
Nalesso F, Garzotto F, Cattarin L, Gobbi L, Qassim L, Sgarabotto L,
Tiberio I, Calò LA. A continuous renal replacement therapy protocol for
patients with acute kidney injury in intensive care unit with COVID-19.
J Clin Med 2020 19; 9(5): 1529. https://doi.org/10.3390/jcm9051529
Cesta MC, Zippoli M, Marsiglia C, Gavioli EM, Cremonesi G, Khan A,
Mantelli F, Allegretti M, Balk R. Neutrophil activation and neutrophil
extracellular traps (NETs) in COVID-19 ARDS and immunothrombosis.
Eur J Immuno 2023; 53(1): 2250010.
https://doi.org/10.1002/eji.202250010
Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome.
The Lancet. 2021 Aug 14; 398(10300):
-37. https://doi.org/10.1016/S0140-6736(21)00439-6
Asghar MS, Ahsan MN, Akram M, Hassan M, Rasheed U, Adnan SM.
Frequency of deranged renal profile in patients with COVID-19: Tertiary
Care Experience from a developing country. Saudi Journal of Kidney
Diseases and Transplantation 2021; 32(2): 377-86.
https://doi.org/10.4103/1319-2442.335450
Wang F, Ran L, Qian C, Hua J, Luo Z, Ding M, Zhang X, Guo W, Gao S,
Gao W, Li C. Epidemiology and outcomes of acute kidney injury in
COVID-19 patients with acute respiratory distress syndrome: a
multicenter retrospective study. Blood Purif 2021; 50(4-5): 499-505.
https://doi.org/10.1159/000512371
Zinter MS, Spicer AC, Liu KD, Orwoll B, Alkhouli MF, Brakeman PR,
Calfee CS, Matthay MA, Sapru A. Positive Cumulative Fluid Balance is
Associated with Mortality in Pediatric ARDS in the Setting of Acute
Kidney Injury. Pediatr Crit Care Med 2019; 20(4):323.
https://doi.org/10.1097%2FPCC.0000000000001845
Ronco C, Reis T, Husain-Syed F. Management of acute kidney injury in
patients with COVID-19. Lancet Respir Med 2020; 8(7): 738-42.
https://doi.org/10.1016/S2213-2600(20)30229-0
Ronco C, Bellomo R, Kellum JA. Acute kidney injury. The Lancet 2019;
(10212): 1949-64.
https://doi.org/10.1016/S0140-6736(19)32563-2
Chaibi K, Dao M, Pham T, Gumucio-Sanguino VD, Di Paolo FA, Pavot
A, Cohen Y, Dreyfuss D, Pérez-Fernandez X, Gaudry S. Severe acute
kidney injury in patients with COVID-19 and acute respiratory distress
syndrome. Am J Respir CritCare Med 2020; 202(9): 1299-301.
https://doi.org/10.1164/rccm.202005-1524LE
Treamtrakanpon W, Khongkha W. Impact and Incidence of acute
kidney injury (AKI): a one-year period of study at a center hospital in
Thailand. Srinagarind Med J 2016; 31(2): 178-84.
Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H.
Acute respiratory distress syndrome: new definition,
currentandfuturetherapeuticoptions.JThoracDis.2013Jun;5(3):326.
https://doi.org/10.3978%2Fj.issn.2072-1439.2013.04.05
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 Mar;2(1):1-
https://doi.org/10.1038/kisup.2012.1
Anees M, Farooq O, Raza M, Mumtaz A. Frequency and Risk Factors for
Acute Kidney Injury in patients with COVID-19. Pakistan Journal of
Medical Sciences. 2022 Mar;38(4PartII):816.https://doi.org/10.12669%2Fpjms.38.4.4980
Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN,
Edipidis K, Forni LG, Gomersall CD, Govil D, Honoré PM.
Epidemiology of acute kidney injury in critically ill patients: the
multinational AKI-EPI study. Intens Care Med. 2015 Aug;41:1411
https://doi.org/10.1007/s00134-015-3934-7
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 Dec;8(1):1-1. https://doi.org/10.1186/s13613-018-
-y
Wang N, Wang M, Jiang L, Du B, Zhu B, Xi X. The predictive value of
the Oxford Acute Severity of Illness Score for clinical outcomes in
patients with acute kidney injury. Renal failure. 2022 Dec 31;44(1):320-8
Anandh U, Noorin A, Kazmi SK, Bannur S, Shah SS, Farooq M,
Yedlapati G, Amer W, Prasad B, Dasgupta I. Acute kidney injury in
critically ill COVID-19
infected patients requiring dialysis: experience from India and Pakistan.
BMC nephrology. 2022 Dec;23(1):1-6.
https://doi.org/10.1186/s12882-022-02931-3
.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 Sep;40(9):2601.
https://doi.org/10.1097%2FCCM.0b013e3182591ed9
Chawla LS, Amdur RL, Faselis C, Li P, Kimmel PL, Palant CE. Impact of
acute kidney injury in patients hospitalized with pneumonia. Crit Care
Med. 2017 Apr 1;45(4):600-6.
https://doi.org/10.1097/CCM.0000000000002245
Singbartl K, Bishop JV, Wen X, Murugan R, Chandra S, Filippi MD,
Kellum JA. Differential effects of kidney–lung cross-talk during acute
kidney injury and bacterial pneumonia. Kidney Int. 2011 Sep 2;80(6):633-
https://doi.org/10.1038/ki.2011.201
Luciano RL, Brewster UC. Kidney involvement in leukemia and
lymphoma. Adv Chronic Kidney Dis. 2014 Jan 1;21(1):27-35.
https://doi.org/10.1053/j.ackd.2013.07.004
Gallieni M, Cosmai L, Porta C. Acute kidney injury in cancer patients.
InAcute Kidney Injury-Basic Research and Clinical Practice 2018 (Vol.
, pp. 137-148). Karger Publishers.
https://doi.org/10.1159/000484970
Chancharoenthana W, Leelahavanichkul A. Acute kidney injury
spectrum in patients with chronic liver disease: Where do we stand?.
World J Gastoentrol. 2019 Jul 7;25(28):3684.
https://doi.org/10.3748%2Fwjg.v25.i28.3684
Deep A, Saxena R, Jose B. Acute kidney injury in children with chronic
liver disease. Pediatr Nephrol. 2019
Jan;34:45-59.https://doi.org/10.1007/s00467-018-3893-
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