Association between hematocrit-to-albumin ratio and acute kidney injury in patients with acute pancreatitis: a retrospective cohort study. Scientific reports Acute pancreatitis (AP) can result in acute kidney injury (AKI), which is linked to poor outcomes. We aimed to assess the relationship between the hematocrit-to-albumin ratio (HAR) and AKI in this population. This retrospective cohort study included consecutive patients diagnosed with AP and admitted to hospital. Data were systematically extracted from electronic medical records, covering baseline demographic and clinical characteristics. Total 1514 AP patients were enrolled, with 17% (257/1514) developing AKI. Multivariable-adjusted regression analysis, curve fitting, threshold effects analyses, and subgroup analyses were conducted to evaluate the relationship between HAR and AKI incidence in AP patients. Compared to the reference tertile of HAR, the adjusted OR values for the lower and higher tertiles of HAR were 1.25 (95% CI, 0.82-1.91, P = 0.297) and 1.50 (95% CI, 1.03-2.20, P = 0.037), respectively, after adjusting for covariates. The curve fitting results showed a J-shaped relationship between HAR and AKI (non-linear, p = 0.001), with an inflection point of 8.969. Furthermore, validation using the Medical Information Mart for Intensive Care (MIMIC-IV) database AP population revealed a similar relationship with an inflection point at 10.257. Our findings suggest a J-shaped relationship between HAR and AKI in AP patients, indicating higher risk of AKI when HAR exceeds 8.969. 10.1038/s41598-024-77842-4

Clinical impact of hypermagnesemia in acute kidney injury patients undergoing continuous kidney replacement therapy: A propensity score analysis utilizing real-world data. Journal of critical care PURPOSE:While hypomagnesemia is known to be a risk factor for acute kidney injury (AKI), the impact of hypermagnesemia on prognosis in AKI patients undergoing continuous kidney replacement therapy (CKRT) remains unclear. This study investigates the relationship between hypermagnesemia and clinical outcomes in this patient population. METHODS:A retrospective analysis was conducted using data from a multicenter medical repository spanning from 2001 to 2019, involving patients who underwent CKRT. Patients were categorized into normomagnesemia (<2 mEq/L) and hypermagnesemia groups based (≥2 mEq/L) on their levels at CKRT initiation. RESULTS:Among the 2625 patients, 1194 (45.5 %) had elevated serum magnesium levels. The hypermagnesemia group exhibited a similar rate of non-recovery of renal function at 90-days compared to the normomagnesemia group (63.1 % vs. 62.8 %, odds ratio [OR] = 1.01, 95 % confidence interval [CI] 0.90-1.14). Furthermore, the high magnesium group demonstrated higher one-year all-cause mortality (hazard ratio [HR] 1.14, 95 % CI 1.07-1.21) and an elevated risk of one-year arrhythmia (HR 4.77, 95 % CI 1.59-14.29). There was no difference of incidence of seizure between hypermagnesemia and normomagnesemia group. CONCLUSIONS:Our study suggests that hypermagnesemia in AKI patients undergoing CKRT is not associated with improved renal recovery but is linked to worse clinical outcomes, including all-cause mortality and arrhythmia. Close monitoring of serum magnesium levels is recommended in this population for optimizing clinical outcomes. 10.1016/j.jcrc.2024.154947

Severe Vitamin D Deficiency is Associated with Mortality Risk in Critically Ill Patients with Acute Kidney Injury. International journal of general medicine Purpose:Deficiency in vitamin D is associated with adverse outcomes in several health conditions. However, the specific impact of vitamin D levels on mortality in acute kidney injury (AKI) patients remains inadequately explored. This study aims to investigate the association between serum vitamin D concentrations and mortality risk in critically ill patients diagnosed with AKI. We hypothesize that severe vitamin D deficiency is associated with an increased risk of 90-day all-cause mortality in these patients. Patients and Methods:This study retrospectively enrolled 259 adult AKI patients admitted to the intensive care unit (ICU) at The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital) between July 2021 and June 2023. Based on 25-hydroxyvitamin D (25-OHD) levels, they were categorized into 4 groups: severe deficiency (<10 ng/mL), deficiency (10-20 ng/mL), insufficiency (20-30 ng/mL), and sufficiency (>30 ng/mL). Multivariate survival analysis using Cox's regression model was used to analyze the impact of vitamin D concentrations on the 90-day all-cause mortality risk after controlling for potential confounders. Results:The 90-day all-cause mortality rate was the highest in patients with severe deficiency (50.8%), followed by those with deficiency (35.0%), insufficiency (23.9%), and sufficiency (12.2%). Multivariate Cox regression showed that compared with sufficiency, severe deficiency (HR=3.34, 95% CI: 1.14-9.77; =0.03) was independently associated with a higher risk of 90-day all-cause mortality, but deficiency and insufficiency were not significantly associated with 90-day all-cause mortality risk. Conclusion:Severe vitamin D deficiency (<10 ng/mL) significantly increases the risk of mortality in AKI patients, underlining the need for monitoring and potentially supplementing vitamin D in this population. 10.2147/IJGM.S477114

Impact of Early Continuous Kidney Replacement Therapy in Patients With Sepsis-Associated Acute Kidney Injury: An Analysis of the MIMIC-IV Database. Journal of Korean medical science BACKGROUND:Renal replacement therapy (RRT) is an important treatment option for sepsis-associated acute kidney injury (AKI); however, the optimal timing for its initiation remains controversial. Herein, we investigated the clinical outcomes of early continuous kidney replacement therapy (CKRT), defined as CKRT initiation within 6 hours of sepsis-associated AKI onset, which was earlier than the initiation time defined in previous studies. METHODS:We used clinical data sourced from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. This study included patients aged ≥ 18 years who met the sepsis diagnostic criteria and received CKRT because of stage 2 or 3 AKI. Early and late CKRTs were defined as CKRT initiation within 6 hours and after 6 hours of the development of sepsis-associated AKI, respectively. RESULTS:Of the 33,236 patients diagnosed with sepsis, 553 underwent CKRT for sepsis-associated AKI. After excluding cases of early mortality and patients with a dialysis history, 45 and 334 patients were included in the early and late CKRT groups, respectively. After propensity score matching, the 28-day mortality rate was significantly lower in the early CKRT group than in the late CKRT group (26.7% vs. 43.9%, = 0.035). The early CKRT group also had a significantly greater number of days free of mechanical ventilation (median, 19; interquartile range [IQR], 3-25) and vasopressor administration (median, 21; IQR, 5-26) than the late CKRT group did (median, 10.5; IQR, 0-23; = 0.037 and median, 13.5; IQR, 0-25; = 0.028, respectively). The Kaplan-Meier curve also showed that early CKRT initiation was associated with an improved 28-day mortality rate (log-rank test, = 0.040). In contrast, there was no significant difference in the 28-day mortality between patients who started CKRT within 12 hours and those who did not (log-rank test, = 0.237). CONCLUSION:Early CKRT initiation improved the survival of patients with sepsis-associated AKI. Initiation of CKRT should be considered as early as possible after sepsis-associated AKI onset, preferably within 6 hours. 10.3346/jkms.2024.39.e276

Acute Kidney Injury in Deceased Organ Donors: Risk Factors And Impacts on Transplantation Outcomes. Transplantation direct Background:Acute kidney injury in deceased donors (D-AKI) is one of the common causes of donor kidney discard. The risk factors for D-AKI and its impact on kidney transplantation outcomes are not yet fully understood. Methods:This single-center, retrospective cohort study included 388 donors referred between June 2021 and December 2022. D-AKI was defined and staged according to kidney disease: Improving global outcomes criteria, and donor clinical variables were analyzed to identify risk factors for D-AKI. Delayed graft function and estimated glomerular filtration rate (eGFR) at 6 mo were evaluated in 369 kidney grafts transplanted from donors with and without D-AKI. Results:AKI was present in 171 deceased donors (44.1%), with 117 (30.2%) classified as AKI stage 1 and 54 (14%) as AKI stages 2 or 3. Donor history of hypertension (odds ratio [OR] 1.93; 95% confidence interval [CI], 1.21-3.10;  = 0.005), history of diabetes (OR 2.2; 95% CI, 1.21-3.98;  = 0.008), and anoxia as the cause of death (OR 2.61; 95% CI, 1.5-4.61;  < 0.001) were independently associated with an increased risk of D-AKI. Multivariable mixed models identified donor age (β -0.49; 95% CI, -0.71 to -0.28;  < 0.001) as the only independent risk factor for lower eGFR at 6 mo. D-AKI was not associated with delayed graft function or lower eGFR at 6 mo. Conclusions:Hypertension, diabetes, and anoxia as the cause of death were identified as risk factors for AKI in deceased donors. D-AKI should not be used as the sole criterion to assess the risk of poor graft outcomes. A broader range of donor variables should be considered when evaluating graft viability. 10.1097/TXD.0000000000001730