Survival and recovery modeling of acute kidney injury in critically ill adults
Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidn...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2022-05-01
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| Series: | SAGE Open Medicine |
| Online Access: | https://doi.org/10.1177/20503121221099359 |
| _version_ | 1818209970494111744 |
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| author | Todd N Brothers Jacob Strock Traci J LeMasters Jayne Pawasauskas Ronald C Reed Mohammad A Al-Mamun |
| author_facet | Todd N Brothers Jacob Strock Traci J LeMasters Jayne Pawasauskas Ronald C Reed Mohammad A Al-Mamun |
| author_sort | Todd N Brothers |
| collection | DOAJ |
| description | Objectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant ( p -value < 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention. |
| first_indexed | 2024-12-12T05:09:10Z |
| format | Article |
| id | doaj.art-d7aaffd5eb5e44f59c8f0fb4351ea8f1 |
| institution | Directory Open Access Journal |
| issn | 2050-3121 |
| language | English |
| last_indexed | 2024-12-12T05:09:10Z |
| publishDate | 2022-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | SAGE Open Medicine |
| spelling | doaj.art-d7aaffd5eb5e44f59c8f0fb4351ea8f12022-12-22T00:36:59ZengSAGE PublishingSAGE Open Medicine2050-31212022-05-011010.1177/20503121221099359Survival and recovery modeling of acute kidney injury in critically ill adultsTodd N Brothers0Jacob Strock1Traci J LeMasters2Jayne Pawasauskas3Ronald C Reed4Mohammad A Al-Mamun5College of Pharmacy, The University of Rhode Island, Kingston, RI, USAGraduate School of Oceanography, The University of Rhode Island, Narragansett, RI, USASchool of Pharmacy, University of West Virginia, Morgantown, WV, USACollege of Pharmacy, The University of Rhode Island, Kingston, RI, USAGraduate School of Oceanography, The University of Rhode Island, Narragansett, RI, USAGraduate School of Oceanography, The University of Rhode Island, Narragansett, RI, USAObjectives: Acute kidney injury is common among the critically ill. However, the incidence, medication use, and outcomes of acute kidney injury have been variably described. We conducted a single-center, retrospective cohort study to examine the risk factors and correlates associated with acute kidney injury in critically ill adults with a particular focus on medication class usage. Methods: We reviewed the electronic medical records of all adult patients admitted to an intensive care unit between 1 February and 30 August 2020. Acute kidney injury was defined by the 2012 Kidney Disease: Improving Global Outcomes guidelines. Data included were demographics, comorbidities, symptoms, laboratory parameters, interventions, and outcomes. The primary outcome was acute kidney injury incidence. A Least Absolute Shrinkage and Selection Operator regression model was used to determine risk factors associated with acute kidney injury. Secondary outcomes including acute kidney injury recovery and intensive care unit mortality were analyzed using a Cox regression model. Results: Among 226 admitted patients, 108 (47.8%) experienced acute kidney injury. 37 (34.3%), 39 (36.1%), and 32 patients (29.6%) were classified as acute kidney injury stages I–III, respectively. Among the recovery and mortality cohorts, analgesics/sedatives, anti-infectives, and intravenous fluids were significant ( p -value < 0.05). The medication classes IV-fluid electrolytes nutrition (96.7%), gastrointestinal (90.2%), and anti-infectives (81.5%) were associated with an increased odds of developing acute kidney injury, odd ratios: 1.27, 1.71, and 1.70, respectively. Cox regression analyses revealed a significantly increased time-varying mortality risk for acute kidney injury-stage III, hazard ratio: 4.72 (95% confidence interval: 1–22.33). In the recovery cohort, time to acute kidney injury recovery was significantly faster in stage I, hazard ratio: 9.14 (95% confidence interval: 2.14–39.06) cohort when compared to the stage III cohort. Conclusion: Evaluation of vital signs, laboratory, and medication use data may be useful to determine acute kidney injury risk stratification. The influence of particular medication classes further impacts the risk of developing acute kidney injury, necessitating the importance of examining pharmacotherapeutic regimens for early recognition of renal impairment and prevention.https://doi.org/10.1177/20503121221099359 |
| spellingShingle | Todd N Brothers Jacob Strock Traci J LeMasters Jayne Pawasauskas Ronald C Reed Mohammad A Al-Mamun Survival and recovery modeling of acute kidney injury in critically ill adults SAGE Open Medicine |
| title | Survival and recovery modeling of acute kidney injury in critically ill adults |
| title_full | Survival and recovery modeling of acute kidney injury in critically ill adults |
| title_fullStr | Survival and recovery modeling of acute kidney injury in critically ill adults |
| title_full_unstemmed | Survival and recovery modeling of acute kidney injury in critically ill adults |
| title_short | Survival and recovery modeling of acute kidney injury in critically ill adults |
| title_sort | survival and recovery modeling of acute kidney injury in critically ill adults |
| url | https://doi.org/10.1177/20503121221099359 |
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