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1. Longitudinal biomarkers and kidney disease progression after acute kidney injury

Author

Wen, Yumeng, Xu, Leyuan, Melchinger, Isabel, Thiessen-Philbrook, Heather, Moledina, Dennis G, Coca, Steven G, Hsu, Chi-Yuan, Go, Alan S, Liu, Kathleen D, Siew, Edward D, Ikizler, T Alp, Chinchilli, Vernon M, Kaufman, James S, Kimmel, Paul L, Himmelfarb, Jonathan, Cantley, Lloyd G, Parikh, Chirag R, and ASSESS-AKI Consortium

Subjects
Inflammation, Kidney Disease, Epidemiology, Prevention, Renal and urogenital, Acute Kidney Injury, Kidney, Mice, Good Health and Well Being, Nephrology, Clinical Research, Chronic kidney disease, Disease Progression, Animals, 2.1 Biological and endogenous factors, Prospective Studies, Renal Insufficiency, Chronic, Aetiology, ASSESS-AKI Consortium, Diagnostics, Biomarkers
Abstract

BACKGROUNDLongitudinal investigations of murine acute kidney injury (AKI) suggest that injury and inflammation may persist long after the initial insult. However, the evolution of these processes and their prognostic values are unknown in patients with AKI.METHODSIn a prospective cohort of 656 participants hospitalized with AKI, we measured 7 urine and 2 plasma biomarkers of kidney injury, inflammation, and tubular health at multiple time points from the diagnosis to 12 months after AKI. We used linear mixed-effect models to estimate biomarker changes over time, and we used Cox proportional hazard regressions to determine their associations with a composite outcome of chronic kidney disease (CKD) incidence and progression. We compared the gene expression kinetics of biomarkers in murine models of repair and atrophy after ischemic reperfusion injury (IRI).RESULTSAfter 4.3 years, 106 and 52 participants developed incident CKD and CKD progression, respectively. Each SD increase in the change of urine KIM-1, MCP-1, and plasma TNFR1 from baseline to 12 months was associated with 2- to 3-fold increased risk for CKD, while the increase in urine uromodulin was associated with 40% reduced risk for CKD. The trajectories of these biological processes were associated with progression to kidney atrophy in mice after IRI.CONCLUSIONSustained tissue injury and inflammation, and slower restoration of tubular health, are associated with higher risk of kidney disease progression. Further investigation into these ongoing biological processes may help researchers understand and prevent the AKI-to-CKD transition.FUNDINGNIH and NIDDK (grants U01DK082223, U01DK082185, U01DK082192, U01DK082183, R01DK098233, R01DK101507, R01DK114014, K23DK100468, R03DK111881, K01DK120783, and R01DK093771).

Published
2023

2. Outcomes of critically ill solid organ transplant patients with COVID-19 in the United States

Author

Molnar, Miklos Z., Bhalla, Anshul, Azhar, Ambreen, Tsujita, Makoto, Talwar, Manish, Balaraman, Vasanthi, Sodhi, Amik, Kadaria, Dipen, Eason, James D., Hayek, Salim S., Coca, Steven G., Shaefi, Shahzad, Neyra, Javier A., Gupta, Shruti, Leaf, David E., Kovesdy, Csaba P., Walther, Carl P., Anumudu, Samaya J., Arunthamakun, Justin, Kopecky, Kathleen F., Milligan, Gregory P., McCullough, Peter A., Nguyen, Thuy‐Duyen, Krajewski, Megan L., Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D., Waikar, Sushrut S., Kibbelaar, Zoe A., Athavale, Ambarish M., Hart, Peter, Upadhyay, Shristi, Vohra, Ishaan, Oyintayo, Ajiboye, Green, Adam, Rachoin, Jean‐Sebastien, Schorr, Christa A., Shea, Lisa, Edmonston, Daniel L., Mosher, Christopher L., Shehata, Alexandre M, Cohen, Zaza, Allusson, Valerie, Bambrick‐Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Brenner, Samantha K., Walters, Patricia, Go, Ronaldo C., Rose, Keith M., Hernán, Miguel A., Lisk, Rebecca, Zhou, Amy M., Kim, Ethan C., Chan, Lili, Mathews, Kusum S., Altman, Deena R., Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A., Wang, Jing G., Mosoyan, Gohar, Nadkarni, Girish N., Pattharanitima, Pattharawin, Gallagher, Emily J., Friedman, Allon N., Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Kelly, Katherine J., Parikh, Chirag R., Garibaldi, Brian T., Corona‐Villalobos, Celia P., Wen, Yumeng, Menez, Steven, Malik, Rubab F., Cervantes, Carmen Elena, Gautam, Samir C., Mallappallil, Mary C., Ouyang, Jie, John, Sabu, Yap, Ernie, Melaku, Yohannes, Mohamed, Ibrahim, Bajracharya, Siddhartha, Puri, Isha, Thaxton, Mariah, Bhattacharya, Jyotsna, Wagner, John, Boudourakis, Leon, Nguyen, H. Bryant, Ahoubim, Afshin, Kashani, Kianoush, Tehranian, Shahrzad, Thomas, Leslie F., Sirganagari, Dheeraj Reddy, Guru, Pramod K., Zhou, Yan, Bergl, Paul A., Rodriguez, Jesus, Shah, Jatan A., Gupta, Mrigank S., Kumar, Princy N., Lazarous, Deepa G., Kassaye, Seble G., Melamed, Michal L., Johns, Tanya S., Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V., Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Kumar, Neelja, Chang, Michael, Thakkar, Jyotsana, Raichoudhury, Ritesh, Athreya, Akshay, Farag, Mohamed, Schenck, Edward J., Cho, Soo Jung, Plataki, Maria, Alvarez‐Mulett, Sergio L., Gomez‐Escobar, Luis G., Pan, Di, Lee, Stefi, Krishnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Chaudhry, Sobaata, Wu, Benjamin, Modersitzki, Frank, Srivastava, Anand, Leidner, Alexander, Martinez, Carlos, Kruser, Jacqueline M., Wunderink, Richard G., Hodakowski, Alexander J., Velez, Juan Carlos Q., Price‐Haywood, Eboni G., Matute‐Trochez, Luis A., Hasty, Anna E., Mohamed, Muner MB, Avasare, Rupali S., Zonies, David, Leaf, David E, Sise, Meghan E., Newman, Erik T., Omar, Samah Abu, Pokharel, Kapil K., Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Wang, Wei, Yang, Heather, Boateng, Jeffery O., Lee, Meghan, Strohbehn, Ian A., Li, Jiahua, Mueller, Ariel L., Redfern, Roberta E., Cairl, Nicholas S., Naimy, Gabriel, Abu‐Saif, Abeer, Hall, Danyell, Bickley, Laura, Rowan, Chris, Madhani‐Lovely, Farah, Peev, Vasil, Reiser, Jochen, Byun, John J., Vissing, Andrew, Kapania, Esha M., Post, Zoe, Patel, Nilam P., Hermes, Joy‐Marie, Sutherland, Anne K., Patrawalla, Amee, Finkel, Diana G., Danek, Barbara A., Arikapudi, Sowminya, Paer, Jeffrey M., Cangialosi, Peter, Liotta, Mark, Radbel, Jared, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T., Ahmed, Ayesha, Berim, Ilya, Vatson, Jayanth S., Anand, Shuchi, Levitt, Joseph E., Garcia, Pablo, Boyle, Suzanne M., Song, Rui, Arif, Ali, Zhang, Jingjing, Woo, Sang Hoon, Deng, Xiaoying, Katz‐Greenberg, Goni, Senter, Katharine, Sharshir, Moh’d A., Rusnak, Vadym V, Ali, Muhammad Imran, Peters, Terri, Hughes, Kathy, Bansal, Anip, Podoll, Amber S., Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L., Douin, David J., Rashidi, Arash, Hejal, Rana, Judd, Eric, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E., Adams, Jason Y., Chang, Steven Y., Beutler, Rebecca M., Schulze, Carl E., Macedo, Etienne, Rhee, Harin, Liu, Kathleen D., Jotwani, Vasantha K., Koyner, Jay L., Shah, Chintan V., Jaikaransingh, Vishal, Toth‐Manikowski, Stephanie M., Joo, Min J., Lash, James P., Chaaban, Nourhan, Elias, Madona, Ahmad, Yahya, Iardino, Alfredo, Au, Elizabeth H., Sharma, Jill H., Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, Zerda, David De La, Fornoni, Alessia, Gershengorn, Hayley B., Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U., Shadid, Husam, Pan, Michael, Hayer, Patrick O’, Meloche, Chelsea, Feroze, Rafey, Kishan J. Padalia, Bitar, Abbas, Leya, Jeff, Donnelly, John P., Admon, Andrew J., Flythe, Jennifer E., Tugman, Matthew J., Chang, Emily H., Brown, Brent R., Leonberg‐Yoo, Amanda K., Spiardi, Ryan C., Miano, Todd A., Roche, Meaghan S., Vasquez, Charles R., Bansal, Amar D., Ernecoff, Natalie C., Kapoor, Sanjana, Verma, Siddharth, Chen, Huiwen, Hedayati, S. Susan, Nadamuni, Mridula V., Shastri, Shani, Willett, Duwayne L., Short, Samuel A.P., Renaghan, Amanda D., Enfield, Kyle B., Bhatraju, Pavan K., Malik, A. Bilal, Semler, Matthew W., Vijayan, Anitha, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F., Schumaker, Greg L., Goyal, Nitender, Faugno, Anthony J., Hsu, Caroline M., Tariq, Asma, Meyer, Leah, Kshirsagar, Ravi K., Jose, Aju, Weiner, Daniel E., Christov, Marta, Griffiths, Jennifer, Gupta, Sanjeev, Kapoor, Aromma, Wilson, Perry, Arora, Tanima, and Ugwuowo, Ugochukwu

Subjects
Male, medicine.medical_specialty, Critical Illness, medicine.medical_treatment, Comorbidity, 030230 surgery, Organ transplantation, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Intensive care, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Hospital Mortality, Renal replacement therapy, Pandemics, Survival rate, Aged, Transplantation, SARS-CoV-2, business.industry, Acute kidney injury, COVID-19, Original Articles, Organ Transplantation, Middle Aged, medicine.disease, United States, Hospitalization, Survival Rate, Intensive Care Units, Relative risk, Propensity score matching, Original Article, Female, business, Follow-Up Studies, Cohort study
Abstract

National data on patient characteristics, treatment, and outcomes of critically ill coronavirus disease 2019 (COVID-19) solid organ transplant (SOT) patients are limited. We analyzed data from a multicenter cohort study of adults with laboratory-confirmed COVID-19 admitted to intensive care units (ICUs) at 68 hospitals across the United States from March 4 to May 8, 2020. From 4153 patients, we created a propensity score matched cohort of 386 patients, including 98 SOT patients and 288 non-SOT patients. We used a binomial generalized linear model (log-binomial model) to examine the association of SOT status with death and other clinical outcomes. Among the 386 patients, the median age was 60 years, 72% were male, and 41% were black. Death within 28 days of ICU admission was similar in SOT and non-SOT patients (40% and 43%, respectively; relative risk [RR] 0.92; 95% confidence interval [CI]: 0.70-1.22). Other outcomes and requirement for organ support including receipt of mechanical ventilation, development of acute respiratory distress syndrome, and receipt of vasopressors were also similar between groups. There was a trend toward higher risk of acute kidney injury requiring renal replacement therapy in SOT vs. non-SOT patients (37% vs. 27%; RR [95% CI]: 1.34 [0.97-1.85]). Death and organ support requirement were similar between SOT and non-SOT critically ill patients with COVID-19.

Published
2020

3. Additional file 1 of Initiation of the SGLT2 inhibitor canagliflozin to prevent kidney and heart failure outcomes guided by HbA1c, albuminuria, and predicted risk of kidney failure

Author

Tye, Sok Cin, Jongs, Niels, Coca, Steven G., Sundström, Johan, Arnott, Clare, Neal, Bruce, Perkovic, Vlado, Mahaffey, Kenneth W., Vart, Priya, and Heerspink, Hiddo. J. L.

Abstract

Additional file 1: Box S1. Prediction of the effect ofcanagliflozin on the composite kidney risk for individual patients with type 2diabetes in the CANVAS trial according to clinical and novel markers model. Table S1. Hazard ratios and P-for-interactions between predictedbaseline risk and treatment variable for both the composite kidney and thecomposite of heart failure or cardiovascular death outcomes. Figure S1. (A) The number of events prevented in patientswith albuminuria (UACR ≥30mg/g, n=1037) based on the HbA1c (red line), urinary-albumin-creatinineratio (UACR) (purple line), clinical markers (green line), or clinical andnovel biomarkers (blue line) strategy for the composite kidney outcome(defined as the composite of sustained 40% decline of eGFR, end-stage kidneydisease with eGFR

Published
2022
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4. A prospective cohort study of acute kidney injury and kidney outcomes, cardiovascular events, and death

Author

Ikizler, T Alp, Parikh, Chirag R, Himmelfarb, Jonathan, Chinchilli, Vernon M, Liu, Kathleen D, Coca, Steven G, Garg, Amit X, Hsu, Chi-Yuan, Siew, Edward D, Wurfel, Mark M, Ware, Lorraine B, Faulkner, Georgia Brown, Tan, Thida C, Kaufman, James S, Kimmel, Paul L, Go, Alan S, and ASSESS-AKI Study Investigators

Subjects
Adult, Aging, Kidney Disease, Clinical Sciences, Renal and urogenital, Aftercare, heart failure, urologic and male genital diseases, Kidney, Cardiovascular, acute renal failure, Risk Factors, cardiovascular disease, Clinical Research, Humans, Prospective Studies, urogenital system, Acute Kidney Injury, Urology & Nephrology, mortality, female genital diseases and pregnancy complications, Patient Discharge, ASSESS-AKI Study Investigators, Good Health and Well Being, Cardiovascular Diseases, chronic kidney disease, Glomerular Filtration Rate
Abstract

Acute kidney injury (AKI) has been reported to be associated with excess risks of death, kidney disease progression and cardiovascular events although previous studies have important limitations. To further examine this, we prospectively studied adults from four clinical centers surviving three months and more after hospitalization with or without AKI who were matched on center, pre-admission CKD status, and an integrated priority score based on age, prior cardiovascular disease or diabetes mellitus, preadmission estimated glomerular filtration rate (eGFR) and treatment in the intensive care unit during the index hospitalization between December 2009-February 2015, with follow-up through November 2018. All participants had assessments of kidney function before (eGFR) and at three months and annually (eGFR and proteinuria) after the index hospitalization. Associations of AKI with outcomes were examined after accounting for pre-admission and three-month post-discharge factors. Among 769 AKI (73% Stage 1, 14% Stage 2, 13% Stage 3) and 769 matched non-AKI adults, AKI was associated with higher adjusted rates of incident CKD (adjusted hazard ratio 3.98, 95% confidence interval 2.51-6.31), CKD progression (2.37,1.28-4.39), heart failure events (1.68, 1.22-2.31) and all-cause death (1.78, 1.24-2.56). AKI was not associated with major atherosclerotic cardiovascular events in multivariable analysis (0.95, 0.70-1.28). After accounting for degree of kidney function recovery and proteinuria at three months after discharge, the associations of AKI with heart failure (1.13, 0.80-1.61) and death (1.29, 0.84-1.98) were attenuated and no longer significant. Thus, assessing kidney function recovery and proteinuria status three months after AKI provides important prognostic information for long-term clinical outcomes.

Published
2021

6. Additional file 1 of Achieved blood pressure post-acute kidney injury and risk of adverse outcomes after AKI: A prospective parallel cohort study

Author

McCoy, Ian, Brar, Sandeep, Liu, Kathleen D., Go, Alan S., Hsu, Raymond K., Chinchilli, Vernon M., Coca, Steven G., Garg, Amit X., Himmelfarb, Jonathan, Ikizler, T. Alp, Kaufman, James, Kimmel, Paul L., Lewis, Julie B., Parikh, Chirag R., Siew, Edward D., Ware, Lorraine B., Zeng, Hui, and Hsu, Chi-yuan

Subjects
Data_FILES
Abstract

Additional file 1.

Published
2021
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7. Factors Associated With Death in Critically Ill Patients With Coronavirus Disease 2019 in the US

Author

Gupta, Shruti, Hayek, Salim S., Wang, Wei, Chan, Lili, Mathews, Kusum S., Melamed, Michal L., Brenner, Samantha K., Leonberg-Yoo, Amanda, Schenck, Edward J., Radbel, Jared, Reiser, Jochen, Bansal, Anip, Srivastava, Anand, Zhou, Yan, Sutherland, Anne, Green, Adam, Shehata, Alexandre M., Goyal, Nitender, Vijayan, Anitha, Velez, Juan Carlos Q., Shaefi, Shahzad, Parikh, Chirag R., Arunthamakun, Justin, Athavale, Ambarish M., Friedman, Allon N., Short, Samuel A. P., Kibbelaar, Zoe A., Abu Omar, Samah, Admon, Andrew J., Donnelly, John P., Gershengorn, Hayley B., Hernán, Miguel A., Semler, Matthew W., Leaf, David E., Walther, Carl P, Anumudu, Samaya J, Kopecky, Kathleen F, Milligan, Gregory P, McCullough, Peter A, Nguyen, Thuy-Duyen, Krajewski, Megan L, Shankar, Sidharth, Pannu, Ameeka, Valencia, Juan D, Waikar, Sushrut S, Hart, Peter, Ajiboye, Oyintayo, Itteera, Matthew, Rachoin, Jean-Sebastien, Schorr, Christa A, Shea, Lisa, Edmonston, Daniel L, Mosher, Christopher L, Karp, Aaron, Cohen, Zaza, Allusson, Valerie, Bambrick-Santoyo, Gabriela, Bhatti, Noor ul aain, Mehta, Bijal, Williams, Aquino, Walters, Patricia, Go, Rolando C, Rose, Keith M, Zhou, Amy M, Kim, Ethan C, Lisk, Rebecca, Coca, Steven G, Altman, Deena R, Saha, Aparna, Soh, Howard, Wen, Huei Hsun, Bose, Sonali, Leven, Emily A, Wang, Jing G, Mosoyan, Gohar, Nadkarni, Girish N, Guirguis, John, Kapoor, Rajat, Meshberger, Christopher, Garibaldi, Brian T, Corona-Villalobos, Celia P, Wen, Yumeng, Menez, Steven, Malik, Rubab F, Cervantes, Carmen Elena, Gautam, Samir C, Nguyen, H Byrant, Ahoubim, Afshin, Thomas, Leslie F, Sirganagari, Dheeraj Reddy, Guru, Pramod K, Bergl, Paul A, Rodriguez, Jesus, Shah, Jatan A, Gupta, Mrigank S, Kumar, Princy N, Lazarous, Deepa G, Kassaye, Seble G, Johns, Tanya S, Mocerino, Ryan, Prudhvi, Kalyan, Zhu, Denzel, Levy, Rebecca V, Azzi, Yorg, Fisher, Molly, Yunes, Milagros, Sedaliu, Kaltrina, Golestaneh, Ladan, Brogan, Maureen, Raichoudhury, Ritesh, Cho, Soo Jung, Plataki, Maria, Alvarez-Mulett, Sergio L, Gomez-Escobar, Luis G, Pan, Di, Lee, Stefi, Kirshnan, Jamuna, Whalen, William, Charytan, David, Macina, Ashley, Ross, Daniel W, Leidner, Alexander S, Martinez, Carlos, Kruser, Jacqueline M, Wunderink, Richard G, Hodakowski, Alexander J, Price-Haywood, Eboni G, Matute-Trochez, Luis A, Hasty, Anne E, Mohamed, Muner MB, Avasare, Rupali S, Zonies, David, Baron, Rebecca M, Sise, Meghan E, Newman, Erik T, Pokharel, Kapil K, Sharma, Shreyak, Singh, Harkarandeep, Correa, Simon, Shaukat, Tanveer, Kamal, Omer, Yang, Heather, Boateng, Jeffery O, Lee, Meghan, Strohbehn, Ian A, Li, Jiahua, Muhsin, Saif A, Mandel, Ernest I, Mueller, Ariel L, Cairl, Nicholas S, Rowan, Chris, Madhai-Lovely, Farah, Peev, Vasil, Byun, John J, Vissing, Andrew, Kapania, Esha M, Post, Zoe, Patel, Nilam P, Hermes, Joy-Marie, Patrawalla, Amee, Finkel, Diana G, Danek, Barbara A, Arikapudi, Sowminya, Paer, Jeffery M, Puri, Sonika, Sunderram, Jag, Scharf, Matthew T, Ahmed, Ayesha, Berim, Ilya, Hussain, Sabiha, Anand, Shuchi, Levitt, Joseph E, Garcia, Pablo, Boyle, Suzanne M, Song, Rui, Zhang, Jingjing, Sharshir, Mohd A, Rusnak, Vadym V, Podoll, Amber S, Chonchol, Michel, Sharma, Sunita, Burnham, Ellen L, Rashidi, Arash, Hejal, Rana, Judd, Erik T, Latta, Laura, Tolwani, Ashita, Albertson, Timothy E, Adams, Jason Y, Chang, Steven Y, Beutler, Rebecca M, Schulze, Carl E, Macedo, Etienne, Rhee, Harin, Liu, Kathleen D, Jotwani, Vasantha K, Koyner, Jay L, Shah, Chintan V, Jaikaransingh, Vishal, Toth-Manikowski, Stephanie M, Joo, Min J, Lash, James P, Neyra, Javier A, Chaaban, Nourhan, Iardino, Alfredo, Au, Elizabeth H, Sharma, Jill H, Sosa, Marie Anne, Taldone, Sabrina, Contreras, Gabriel, Zerda, David De La, Blakely, Pennelope, Berlin, Hanna, Azam, Tariq U, Shadid, Husam, Pan, Michael, OHayer, Patrick, Meloche, Chelsea, Feroze, Rafey, Padalia, Kishan J, Bitar, Abbas, Flythe, Jennifer E, Tugman, Matthew J, Brown, Brent R, Spiardi, Ryan C, Miano, Todd A, Roche, Meaghan S, Vasquez, Charles R, Bansal, Amar D, Ernecoff, Natalie C, Kovesdy, Csaba P, Molnar, Miklos Z, Azhar, Ambreen, Hedayati, Susan S, Nadamuni, Mridula V, Khan, Sadaf S, Willett, Duwayne L, Renaghan, Amanda D, Bhatraju, Pavan K, Malik, Bilal A, Joy, Christina Mariyam, Li, Tingting, Goldberg, Seth, Kao, Patricia F, Schumaker, Greg L, Faugno, Anthony J, Hsu, Caroline M, Tariq, Asma, Meyer, Leah, Weiner, Daniel E, Christov, Marta, Wilson, Francis P, Arora, Tanima, and Ugwuowo, Ugochukwu

Subjects
medicine.medical_specialty, business.industry, 010102 general mathematics, Organ dysfunction, Odds ratio, medicine.disease, 01 natural sciences, Intensive care unit, Comorbidity, law.invention, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, law, Intensive care, Internal medicine, Internal Medicine, Medicine, 030212 general & internal medicine, 0101 mathematics, medicine.symptom, business, Body mass index, Cohort study
Abstract

Importance: The US is currently an epicenter of the coronavirus disease 2019 (COVID-19) pandemic, yet few national data are available on patient characteristics, treatment, and outcomes of critical illness from COVID-19. Objectives: To assess factors associated with death and to examine interhospital variation in treatment and outcomes for patients with COVID-19. Design, Setting, and Participants: This multicenter cohort study assessed 2215 adults with laboratory-confirmed COVID-19 who were admitted to intensive care units (ICUs) at 65 hospitals across the US from March 4 to April 4, 2020. Exposures: Patient-level data, including demographics, comorbidities, and organ dysfunction, and hospital characteristics, including number of ICU beds. Main Outcomes and Measures: The primary outcome was 28-day in-hospital mortality. Multilevel logistic regression was used to evaluate factors associated with death and to examine interhospital variation in treatment and outcomes. Results: A total of 2215 patients (mean [SD] age, 60.5 [14.5] years; 1436 [64.8%] male; 1738 [78.5%] with at least 1 chronic comorbidity) were included in the study. At 28 days after ICU admission, 784 patients (35.4%) had died, 824 (37.2%) were discharged, and 607 (27.4%) remained hospitalized. At the end of study follow-up (median, 16 days; interquartile range, 8-28 days), 875 patients (39.5%) had died, 1203 (54.3%) were discharged, and 137 (6.2%) remained hospitalized. Factors independently associated with death included older age (≥80 vs

Published
2020

8. In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study

Author

Hayek, Salim S, Brenner, Samantha K, Azam, Tariq U, Shadid, Husam R, Anderson, Elizabeth, Berlin, Hanna, Pan, Michael, Meloche, Chelsea, Feroz, Rafey, O’Hayer, Patrick, Kaakati, Rayan, Bitar, Abbas, Padalia, Kishan, Perry, Daniel, Blakely, Pennelope, Gupta, Shruti, Shaefi, Shahzad, Srivastava, Anand, Charytan, David M, Bansal, Anip, Mallappallil, Mary, Melamed, Michal L, Shehata, Alexandre M, Sunderram, Jag, Mathews, Kusum S, Sutherland, Anne K, Nallamothu, Brahmajee K, Leaf, David E, Malik, A Bilal, Abu-Saif, Abeer, Green, Adam, Ahoubim, Afshin, Oyintayo, Ajiboye, Jose, Aju, Athreya, Akshay, Jacobs, Alanna L, Fornoni, Alessia, Hodakowski, Alexander J, Leidner, Alexander S, Iardino, Alfredo, Friedman, Allon N, Renaghan, Amanda D, Leonberg-Yoo, Amanda K, Bansal, Amar D, Athavale, Ambarish M, Podoll, Amber S, Azhar, Ambreen, Patrawalla, Amee, Pannu, Ameeka, Zhou, Amy M, Admon, Andrew J, Vissing, Andrew, Vijayan, Anitha, Hasty, Anna E, Faugno, Anthony J, Saha, Aparna, Williams, Aquino, Rashidi, Arash, Mueller, Ariel L, Kapoor, Aromma, Tolwani, Ashita, Macina, Ashley, Tariq, Asma, Ahmed, Ayesha, Danek, Barbara A, Wu, Benjamin, Shukla, Bhavarth, Mehta, Bijal, Brown, Brent R, Garibaldi, Brian T, Schulze, Carl E, Walther, Carl P, Martinez, Carlos, Hsu, Caroline M, Corona-Villalobos, Celia P, Vasquez, Charles R, Shah, Chintan V, Parikh, Chirag R, Rowan, Chris, Schorr, Christa A, Joy, Christina Mariyam, Mosher, Christopher L, Meshberger, Christopher, Kovesdy, Csaba P, Weiner, Daniel E, Edmonston, Daniel L, Perry, Danny, Hall, Danyell, Charytan, David, De La Zerda, David, Zonies, David, Altman, Deena R, Lazarous, Deepa G, Zhu, Denzel, Sirganagari, Dheeraj Reddy, Pan, Di, Finkel, Diana G, Willett, Duwayne L, Price-Haywood, Eboni G, Schenck, Edward J, Cervantes, Carmen Elena, Au, Elizabeth H, Burnham, Ellen L, Leven, Emily A, Chang, Emily H, Gallagher, Emily J, Judd, Eric, Newman, Erik T, Yap, Ernie, Kapania, Esha M, Kim, Ethan C, Macedo, Etienne, Madhani-Lovely, Farah, Modersitzki, Frank, Contreras, Gabriel, Naimy, Gabriel, Bambrick-Santoyo, Gabriela, Nadkarni, Girish N, Mosoyan, Gohar, Katz-Greenberg, Goni, Schumaker, Greg L, Milligan, Gregory P, Nguyen, H Bryant, Rhee, Harin, Singh, Harkarandeep, Gershengorn, Hayley B, Yang, Heather, Soh, Howard, Wen, Huei Hsun, Chen, Huiwen, Shadid, Husam, Strohbehn, Ian A, Mohamed, Ibrahim, Berim, Ilya, Puri, Isha, Vohra, Ishaan, Kruser, Jacqueline M, Lash, James P, Krishnan, Jamuna, Radbel, Jared, Adams, Jason Y, Shah, Jatan A, Neyra, Javier A, Koyner, Jay L, Vatson, Jayanth S, Rachoin, Jean-Sebastien, Boateng, Jeffery O, Paer, Jeffrey M, Flythe, Jennifer E, Griffiths, Jennifer, Rodriguez, Jesus, Li, Jiahua, Ouyang, Jie, Sharma, Jill H, Wang, Jing G, Zhang, Jingjing, Reiser, Jochen, Guirguis, John, Byun, John J, Donnelly, John P, Wagner, John, Levitt, Joseph E, Hermes, Joy-Marie, Velez, Juan Carlos Q, Valencia, Juan D, Arunthamakun, Justin, Thakkar, Jyotsana, Bhattacharya, Jyotsna, Sedaliu, Kaltrina, Prudhvi, Kalyan, Pokharel, Kapil K, Senter, Katharine, Kelly, Katherine J, Liu, Kathleen D, Kopecky, Kathleen F, Rose, Keith M, Kashani, Kianoush, Padalia, Kishan J, Hess, Kristen M, Enfield, Kyle B, Golestaneh, Ladan, Bickley, Laura, Latta, Laura, Meyer, Leah, Boudourakis, Leon, Thomas, Leslie F, Chan, Lili, Shea, Lisa, Matute-Trochez, Luis A, Gomez-Escobar, Luis G, Elias, Madona, Plataki, Maria, Thaxton, Mariah, Sosa, Marie Anne, Liotta, Mark, Christov, Marta, Mallappallil, Mary C, Tugman, Matthew J, Scharf, Matthew T, Semler, Matthew W, Brogan, Maureen, Roche, Meaghan S, Krajewski, Megan L, Sise, Meghan E, Lee, Meghan, Chang, Michael, Chonchol, Michel, Hernán, Miguel A, Molnar, Miklos Z, Yunes, Milagros, Joo, Min J, Sharshir, Moh’d A, Farag, Mohamed, Fisher, Molly, Nadamuni, Mridula V, Gupta, Mrigank S, Ali, Muhammad Imran, Mohamed, Muner MB, Ernecoff, Natalie C, Kumar, Neelja, Cairl, Nicholas S, Patel, Nilam P, Goyal, Nitender, ul aain Bhatti, Noor, Chaaban, Nourhan, Kamal, Omer, Garcia, Pablo, Kao, Patricia F, Walters, Patricia, O’ Hayer, Patrick, Pattharanitima, Pattharawin, Bergl, Paul A, Bhatraju, Pavan K, Wilson, Perry, McCullough, Peter A, Cangialosi, Peter, Hart, Peter, Guru, Pramod K, Kumar, Princy N, Feroze, Rafey, Kapoor, Rajat, Hejal, Rana, Kshirsagar, Ravi K, Lisk, Rebecca, Beutler, Rebecca M, Levy, Rebecca V, Wunderink, Richard G, Raichoudhury, Ritesh, Redfern, Roberta E, Go, Ronaldo C, Malik, Rubab F, Song, Rui, Avasare, Rupali S, Mocerino, Ryan, Spiardi, Ryan C, Hedayati, S Susan, Taldone, Sabrina, John, Sabu, Abu Omar, Samah, Anumudu, Samaya J, Gautam, Samir C, Short, Samuel AP, Woo, Sang Hoon, Kapoor, Sanjana, Gupta, Sanjeev, Kassaye, Seble G, Alvarez-Mulett, Sergio L, Goldberg, Seth, Tehranian, Shahrzad, Shastri, Shani, Sharma, Shreyak, Upadhyay, Shristi, Anand, Shuchi, Bajracharya, Siddhartha, Verma, Siddharth, Shankar, Sidharth, Correa, Simon, Chaudhry, Sobaata, Bose, Sonali, Puri, Sonika, Cho, Soo Jung, Arikapudi, Sowminya, Lee, Stefi, Toth-Manikowski, Stephanie M, Coca, Steven G, Menez, Steven, Chang, Steven Y, Sharma, Sunita, Waikar, Sushrut S, Boyle, Suzanne M, Arora, Tanima, Ferreira, Tanira, Shaukat, Tanveer, Johns, Tanya S, Nguyen, Thuy-Duyen, Albertson, Timothy E, Li, Tingting, Miano, Todd A, Ugwuowo, Ugochukwu, Rusnak, Vadym V, Allusson, Valerie, Jotwani, Vasantha K, Peev, Vasil, Jaikaransingh, Vishal, Cruz, Vivian S, Wang, Wei, Whalen, William, Deng, Xiaoying, Ahmad, Yahya, Zhou, Yan, Melaku, Yohannes, Azzi, Yorg, Wen, Yumeng, Cohen, Zaza, Kibbelaar, Zoe A, and Post, Zoe

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Pneumonia, Viral, 030204 cardiovascular system & hematology, law.invention, Cohort Studies, Betacoronavirus, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Humans, Medicine, Hospital Mortality, Cardiopulmonary resuscitation, Asystole, Pandemics, Aged, Aged, 80 and over, SARS-CoV-2, business.industry, Research, Incidence (epidemiology), COVID-19, 030208 emergency & critical care medicine, General Medicine, Middle Aged, medicine.disease, Intensive care unit, United States, Heart Arrest, Intensive Care Units, Pneumonia, Pulseless electrical activity, Emergency medicine, Female, Coronavirus Infections, business, Cohort study
Abstract

Objectives To estimate the incidence, risk factors, and outcomes associated with in-hospital cardiac arrest and cardiopulmonary resuscitation in critically ill adults with coronavirus disease 2019 (covid-19). Design Multicenter cohort study. Setting Intensive care units at 68 geographically diverse hospitals across the United States. Participants Critically ill adults (age ≥18 years) with laboratory confirmed covid-19. Main outcome measures In-hospital cardiac arrest within 14 days of admission to an intensive care unit and in-hospital mortality. Results Among 5019 critically ill patients with covid-19, 14.0% (701/5019) had in-hospital cardiac arrest, 57.1% (400/701) of whom received cardiopulmonary resuscitation. Patients who had in-hospital cardiac arrest were older (mean age 63 (standard deviation 14) v 60 (15) years), had more comorbidities, and were more likely to be admitted to a hospital with a smaller number of intensive care unit beds compared with those who did not have in-hospital cardiac arrest. Patients who received cardiopulmonary resuscitation were younger than those who did not (mean age 61 (standard deviation 14) v 67 (14) years). The most common rhythms at the time of cardiopulmonary resuscitation were pulseless electrical activity (49.8%, 199/400) and asystole (23.8%, 95/400). 48 of the 400 patients (12.0%) who received cardiopulmonary resuscitation survived to hospital discharge, and only 7.0% (28/400) survived to hospital discharge with normal or mildly impaired neurological status. Survival to hospital discharge differed by age, with 21.2% (11/52) of patients younger than 45 years surviving compared with 2.9% (1/34) of those aged 80 or older. Conclusions Cardiac arrest is common in critically ill patients with covid-19 and is associated with poor survival, particularly among older patients.

Published
2020

9. Pre-exposure Prophylaxis With Tenofovir Disoproxil Fumarate/Emtricitabine and Kidney Tubular Dysfunction in HIV-Uninfected Individuals

Author

Jotwani, Vasantha, Scherzer, Rebecca, Glidden, David V, Mehrotra, Megha, Defechereux, Patricia, Liu, Albert, Gandhi, Monica, Bennett, Michael, Coca, Steven G, Parikh, Chirag R, Grant, Robert M, and Shlipak, Michael G

Subjects
Adult, Male, Kidney Disease, Anti-HIV Agents, Clinical Trials and Supportive Activities, HIV prevention, Clinical Sciences, Renal and urogenital, HIV Infections, Urine, Kidney Function Tests, Transgender Persons, alpha-1 microglobulin, Young Adult, Clinical Research, Virology, Alpha-Globulins, Humans, Albuminuria, Emtricitabine, Tenofovir, pre-exposure prophylaxis, Prevention, nephrotoxicity, tubular dysfunction, HIV, Evaluation of treatments and therapeutic interventions, urine biomarkers, Proteinuria, Cross-Sectional Studies, Infectious Diseases, 6.1 Pharmaceuticals, kidney injury, Public Health and Health Services, HIV/AIDS, Kidney Diseases, Female, Biomarkers, Glomerular Filtration Rate
Abstract

BACKGROUND:Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) is becoming increasingly adopted for HIV prevention. Tenofovir can cause proximal tubular damage and chronic kidney disease in HIV-infected persons, but little is known regarding its nephrotoxic potential among HIV-uninfected persons. In this study, we evaluated the effects of PrEP on urine levels of the following: α1-microglobulin (α1m), a marker of impaired tubular reabsorption; albuminuria, a measure of glomerular injury; and total proteinuria. SETTING:The Iniciativa Profilaxis Pre-Exposicion (iPrEx) study randomized HIV-seronegative men and transgender women who have sex with men to oral TDF/FTC or placebo. The iPrEx open-label extension (iPrEx-OLE) study enrolled former PrEP trial participants to receive open-label TDF/FTC. METHODS:A cross-sectional analysis compared urine biomarker levels by study arm in iPrEx (N = 100 treatment arm, N = 100 placebo arm). Then, urine biomarker levels were compared before and after PrEP initiation in 109 participants of iPrEx-OLE. RESULTS:In iPrEx, there were no significant differences in urine α1m, albuminuria, or proteinuria by treatment arm. In iPrEx-OLE, after 24 weeks on PrEP, urine α1m and proteinuria increased by 21% [95% confidence interval (CI): 10 to 33] and 18% (95% CI: 8 to 28), respectively. The prevalence of detectable α1m increased from 44% to 65% (P < 0.001) and estimated glomerular filtration rate declined by 4 mL/min/1.73 m (P < 0.001). There was no significant change in albuminuria (6%; 95% CI: -7% to 20%). CONCLUSION:PrEP with TDF/FTC was associated with a statistically significant rise in urine α1m and proteinuria after 6 months, suggesting that PrEP may result in subclinical tubule dysfunction.

Published
2018

10. Urine Biomarkers and Perioperative Acute Kidney Injury: The Impact of Preoperative Estimated GFR

Author

Koyner, Jay L, Coca, Steven G, Thiessen-Philbrook, Heather, Patel, Uptal D, Shlipak, Michael G, Garg, Amit X, Parikh, Chirag R, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) Consortium, and Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury TRIBE-AKI Consortium

Subjects
Male, Kidney Disease, estimated glomerular filtration rate, interleukin 18, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury TRIBE-AKI Consortium, Clinical Sciences, Renal and urogenital, acute renal failure, Cohort Studies, Postoperative Complications, surgical complication, Clinical Research, 80 and over, Humans, Prospective Studies, liver-type fatty acid binding protein, Cardiac Surgical Procedures, Cystatin C, Aged, Middle Aged, Acute Kidney Injury, Urology & Nephrology, perioperative AKI, Translational Research Investigating Biomarker Endpoints for Acute Kidney Injury (TRIBE-AKI) Consortium, Creatinine, Urine biomarkers, Public Health and Health Services, Female, prognosis, effect modification, Biomarkers, cardiac surgery, Glomerular Filtration Rate
Abstract

BackgroundThe interaction between baseline kidney function and the performance of biomarkers of acute kidney injury (AKI) on the development of AKI is unclear.Study designPost hoc analysis of prospective cohort study.Setting & participantsThe 1,219 TRIBE-AKI Consortium adult cardiac surgery cohort participants.PredictorUnadjusted postoperative urinary biomarkers of AKI measured within 6 hours of surgery.OutcomeAKI was defined as AKI Network stage 1 (any AKI) or higher, as well as a doubling of serum creatinine level from the preoperative value or the need for post-operative dialysis (severe AKI).MeasurementsStratified analyses by preoperative estimated glomerular filtration rate (eGFR)≤ 60 versus > 60mL/min/1.73m(2).Results180 (42%) patients with preoperative eGFRs≤60mL/min/1.73m(2) developed clinical AKI compared with 246 (31%) of those with eGFRs>60mL/min/1.73m(2) (P

Published
2015

11. Acute kidney injury in the elderly: predisposition to chronic kidney disease and vice versa

Author

Coca, Steven G, Cho, Kerry C, and Hsu, Chi-yuan

Subjects
Cardiac Catheterization, Aging, Kidney Disease, Population Dynamics, Clinical Sciences, Medical Physiology, Renal and urogenital, Kaplan-Meier Estimate, Kidney Failure, Diabetes Complications, Cohort Studies, Risk Factors, Chronic kidney disease, Prevalence, 80 and over, Humans, Chronic, Age of Onset, Aged, Incidence, Prevention, Age Factors, Acute Kidney Injury, Urology & Nephrology, United States, Cardiovascular Diseases, Hypertension, Disease Progression, Kidney Diseases, Disease Susceptibility, Glomerular filtration rate
Abstract

There have been considerable advances in the past few years in our understanding of how chronic kidney disease (CKD) predisposes to acute kidney injury (AKI) and vice versa. This review shows, however, that few studies have focused on the elderly or conducted stratified analysis by age. It does appear that elderly patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1.73 m(2) are at higher risk for AKI compared with their counterparts with eGFR >60 ml/min/1.73 m(2). This is a similar relationship to that seen in younger patients, although effect size appears smaller. As the incidence of AKI has been increasing over the past several years, the proportion of elderly patients surviving after AKI has also been increasing. Since AKI heightens the risk for the development and acceleration of CKD, this implies significant public health concerns with regard to the absolute number of elderly persons developing incident CKD.

Published
2011

12. Acute kidney injury in the elderly: predisposition to chronic kidney disease and vice versa

Author

Coca, Steven G, Cho, Kerry C, and Hsu, Chi-yuan

Subjects
Cardiac Catheterization, Aging, Population Dynamics, Clinical Sciences, Medical Physiology, Kaplan-Meier Estimate, and over, urologic and male genital diseases, Kidney Failure, Diabetes Complications, Cohort Studies, Risk Factors, Chronic kidney disease, Prevalence, 80 and over, Humans, Chronic, Age of Onset, Aged, urogenital system, Incidence, Age Factors, Acute Kidney Injury, Urology & Nephrology, female genital diseases and pregnancy complications, United States, Cardiovascular Diseases, Hypertension, Disease Progression, Kidney Diseases, Disease Susceptibility, Glomerular filtration rate
Abstract

There have been considerable advances in the past few years in our understanding of how chronic kidney disease (CKD) predisposes to acute kidney injury (AKI) and vice versa. This review shows, however, that few studies have focused on the elderly or conducted stratified analysis by age. It does appear that elderly patients with estimated glomerular filtration rate (eGFR) 45-59 ml/min/1.73 m(2) are at higher risk for AKI compared with their counterparts with eGFR >60 ml/min/1.73 m(2). This is a similar relationship to that seen in younger patients, although effect size appears smaller. As the incidence of AKI has been increasing over the past several years, the proportion of elderly patients surviving after AKI has also been increasing. Since AKI heightens the risk for the development and acceleration of CKD, this implies significant public health concerns with regard to the absolute number of elderly persons developing incident CKD.

Published
2011

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