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INTRODUCTION: Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS: Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION: Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.

INTRODUCTION: Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial.METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality.RESULTS: Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%).CONCLUSION: Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.

We aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients. To date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap. Elective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications. A total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL ≥2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154-1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047-1.613), but not AKI. Intraoperative RL ≤300 mL was not associated with an increased risk of AKI. Total intraoperative RL ≥2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care.

Background Infective endocarditis (IE) may be complicated by acute kidney injury, yet data on the use of dialysis and subsequent reversibility are sparse. Methods Using Danish nationwide registries, we identified patients with first-time IE from 2000 to 2017. Dialysis-naïve patients were grouped into: those with and those without dialysis during admission with IE. Continuation of dialysis was followed 1 year postdischarge. Multivariable adjusted Cox proportional hazard analysis was used to examine 1-year mortality for patients surviving IE according to use of dialysis. Results We included 7307 patients with IE; 416 patients (5.7%) initiated dialysis treatment during admission with IE and these were younger, had more comorbidities and more often underwent cardiac valve surgery compared with nondialysis patients (47.4% vs 20.9%). In patients with both cardiac valve surgery and dialysis treatment (n = 197), 153 (77.7%) initiated dialysis on or after the date of surgery. The in-hospital mortality was 40.4% and 19.0% for patients with and without dialysis, respectively (P Conclusion In dialysis-naïve patients with IE, approximately 1 in 20 patients initiated dialysis treatment during admission with IE. Dialysis identified a high-risk group with an in-hospital mortality of 40% and an approximate 20% risk of continued dialysis. Those with dialysis during admission with IE showed worse long-term outcomes than those without.

Background Acute kidney injury (AKI) is a recognised complication of coronavirus disease 2019 (COVID-19), yet the reported incidence varies widely and the associated risk factors are poorly understood. Methods Data was collected on all adult patients who returned a positive COVID-19 swab while hospitalised at a large UK teaching hospital between 1st March 2020 and 3rd June 2020. Patients were stratified into community- and hospital-acquired AKI based on the timing of AKI onset. Results Out of the 448 eligible patients with COVID-19, 118 (26.3 %) recorded an AKI during their admission. Significant independent risk factors for community-acquired AKI were chronic kidney disease (CKD), diabetes, clinical frailty score and admission C-reactive protein (CRP), systolic blood pressure and respiratory rate. Similar risk factors were significant for hospital-acquired AKI including CKD and trough systolic blood pressure, peak heart rate, peak CRP and trough lymphocytes during admission. In addition, invasive mechanical ventilation was the most significant risk factor for hospital-acquired AKI (adjusted odds ratio 9.1, p Conclusions AKI occurred in over a quarter of our hospitalised COVID-19 patients. Community- and hospital-acquired AKI have many shared risk factors which appear to converge on a pre-renal mechanism of injury. Hospital- but not community acquired AKI was a significant risk factor for death.

Acute kidney injury (AKI) after hepatectomy occurs in around 10% of cases. AKI is often defined based only on postoperative serum creatinine increase. This study aimed to assess if postoperative urine output (UO) correlated with serum creatinine after hepatectomy. All consecutive hepatectomy patients (2010-2016) were assessed. AKI was defined according to KDIGO criteria: serum creatinine increase ≥26.5 μmol/l, creatinine increase ≥1.5x baseline creatinine, or postoperative oliguria. Oliguria was defined as daily mean UO 360 minutes was the only predictor of creatinine increase (HR = 3.6, 95%CI: 1.1-11.4, p = 0.032). Postoperative UO showed poor correlation with postoperative serum creatinine both in all patients and AKI patients. Surgery duration >360 minutes appeared as the only independent predictor of postoperative serum creatinine increase.

INTRODUCTION: COVID-19 has spread globally to now be considered a pandemic by the World Health Organisation. Initially patients appeared to have a respiratory limited disease but there are now increasing reports of multiple organ involvement including renal disease in association with COVID-19. We studied the development and outcomes of acute kidney injury (AKI) in patients with COVID-19, in a large multicultural city hospital trust in the UK, to better understand the role renal disease has in the disease process.METHODS: This was a retrospective review using electronic records and laboratory data of adult patients admitted to the four Manchester University Foundation Trust Hospitals between March 10 and April 30 2020 with a diagnosis of COVID-19. Records were reviewed for baseline characteristics, medications, comorbidities, social deprivation index, observations, biochemistry and outcomes including mortality, admission to critical care, mechanical ventilation and the need for renal replacement therapy.RESULTS: There were 1032 patients included in the study of whom 210 (20.3%) had AKI in association with the diagnosis of COVID-19. The overall mortality with AKI was considerably higher at 52.4% compared to 26.3% without AKI (p-value DISCUSSION: We have shown that the development of AKI is associated with dramatically worse outcomes for patients, in both mortality and the requirement for critical care. Patients with COVID-19 presenting with, or at risk of AKI should be closely monitored and appropriately managed to prevent any decline in renal function, given the significant risk of deterioration and death.

RESUMEN Objetivo: Describir la epidemiología de la injuria renal aguda, la relación con la enfermedad renal crónica y los factores asociados a su incidencia. Métodos: Estudio de cohorte y seguimiento en una unidad de terapia intensiva de Montevideo - Uruguay. Se incluyeron pacientes ingresados entre noviembre 2014 a octubre 2015, mayores de 15 años con dos mediciones de creatinina sérica. Se excluyeron pacientes con menos de 48 horas de internación o fallecidos en ese tiempo y portadores de enfermedad renal crónica en hemodiálisis o diálisis peritoneal. No hubo intervenciones. La injuria renal aguda se definió según criterios Acute Kidney Injury Disease Improving Global Outcomes y la enfermedad renal crónica según Cronic Kidney Disease Work Group. Resultados: Se incluyeron 401 pacientes, sexo masculino 56,6%, mediana de edad 68 (rango intercuartílico - RIC 51 - 79) años. El diagnóstico al ingreso fue sepsis grave 36,3%, neurocrítico 16,3%, politrauma 15,2% y otros 32,2%. La incidencia de injuria renal aguda fue de 50,1%. El 14,1% eran portadores de enfermedad renal crónica. La incidencia de injuria renal aguda séptica fue de 75,3%. La mortalidad en los pacientes con o sin injuria renal aguda fue de 41,8 y 14% respectivamente (p < 0,001). En el análisis multivariado las variables de mayor significación para la injuria renal aguda fueron enfermedad renal crónica (odds ratio - OR 5,39 IC95% 2,04 - 14,29 p = 0,001), shock (OR 3,94 IC95% 1,72 - 9,07 p = 0,001) y sepsis grave (OR 7,79 IC 95% 2,02 - 29,97 p = 0,003). Conclusión: La incidencia de injuria renal aguda es elevada principalmente en pacientes sépticos. La enfermedad renal crónica se asoció de forma independiente al desarrollo de injuria renal aguda. ABSTRACT Objective: To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence. Methods: A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group. Results: We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p < 0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003). Conclusion: The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.

To describe the epidemiology of acute kidney injury, its relationship to chronic kidney disease, and the factors associated with its incidence.A cohort study and follow-up were conducted in an intensive care unit in Montevideo, Uruguay. We included patients admitted between November 2014 and October 2015 who were older than 15 years of age and who had at least two measurements of serum creatinine. We excluded patients who were hospitalized for less than 48 hours, patients who died at the time of hospitalization, and patients with chronic renal disease who were on hemodialysis or peritoneal dialysis. There were no interventions. Acute kidney injury was defined according to the criteria set forth in Acute Kidney Injury Disease: Improving Global Outcomes, and chronic kidney disease was defined according to the Chronic Kidney Disease Work Group.We included 401 patients, 56.6% male, median age of 68 years (interquartile range (IQR) 51-79 years). The diagnosis at admission was severe sepsis 36.3%, neurocritical 16.3%, polytrauma 15.2%, and other 32.2%. The incidence of acute kidney injury was 50.1%, and 14.1% of the patients suffered from chronic kidney disease. The incidence of acute septic kidney injury was 75.3%. Mortality in patients with or without acute kidney injury was 41.8% and 14%, respectively (p0.001). In the multivariate analysis, the most significant variables for acute kidney injury were chronic kidney disease (odds ratio (OR) 5.39, 95%CI 2.04 - 14.29, p = 0.001), shock (OR 3.94, 95%CI 1.72 - 9.07, p = 0.001), and severe sepsis (OR 7.79, 95%CI 2.02 - 29.97, p = 0.003).The incidence of acute kidney injury is high mainly in septic patients. Chronic kidney disease was independently associated with the development of acute kidney injury.Describir la epidemiología de la injuria renal aguda, la relación con la enfermedad renal crónica y los factores asociados a su incidencia.Estudio de cohorte y seguimiento en una unidad de terapia intensiva de Montevideo - Uruguay. Se incluyeron pacientes ingresados entre noviembre 2014 a octubre 2015, mayores de 15 años con dos mediciones de creatinina sérica. Se excluyeron pacientes con menos de 48 horas de internación o fallecidos en ese tiempo y portadores de enfermedad renal crónica en hemodiálisis o diálisis peritoneal. No hubo intervenciones. La injuria renal aguda se definió según criterios Acute Kidney Injury Disease Improving Global Outcomes y la enfermedad renal crónica según Cronic Kidney Disease Work Group.Se incluyeron 401 pacientes, sexo masculino 56,6%, mediana de edad 68 (rango intercuartílico - RIC 51 - 79) años. El diagnóstico al ingreso fue sepsis grave 36,3%, neurocrítico 16,3%, politrauma 15,2% y otros 32,2%. La incidencia de injuria renal aguda fue de 50,1%. El 14,1% eran portadores de enfermedad renal crónica. La incidencia de injuria renal aguda séptica fue de 75,3%. La mortalidad en los pacientes con o sin injuria renal aguda fue de 41,8 y 14% respectivamente (p0,001). En el análisis multivariado las variables de mayor significación para la injuria renal aguda fueron enfermedad renal crónica (odds ratio - OR 5,39 IC95% 2,04 - 14,29 p = 0,001), shock (OR 3,94 IC95% 1,72 - 9,07 p = 0,001) y sepsis grave (OR 7,79 IC 95% 2,02 - 29,97 p = 0,003).La incidencia de injuria renal aguda es elevada principalmente en pacientes sépticos. La enfermedad renal crónica se asoció de forma independiente al desarrollo de injuria renal aguda.

Background There is recent evidence to show that patients suffering from acute kidney injury are at increased risk of developing chronic kidney disease despite the fact that surviving tubular epithelial cells have the capacity to fully regenerate renal tubules and restore renal function within days or weeks. The aim of the study was to investigate the impact of acute kidney injury on de novo chronic kidney disease. Methods The authors conducted a retrospective population-based cohort study of patients initially free from chronic kidney disease who were scheduled for elective cardiac surgery with cardiopulmonary bypass and who developed an episode of acute kidney injury from which they recovered. The study was conducted at two French university hospitals between 2005 and 2015. These individuals were matched with patients without acute kidney injury according to a propensity score for developing acute kidney injury. Results Among the 4,791 patients meeting the authors’ inclusion criteria, 1,375 (29%) developed acute kidney injury and 685 fully recovered. Propensity score matching was used to balance the distribution of covariates between acute kidney injury and non- acute kidney injury control patients. Matching was possible for 597 cases. During follow-up, 34 (5.7%) had reached a diagnosis of chronic kidney disease as opposed to 17 (2.8%) in the control population (hazard ratio, 2.3; bootstrapping 95% CI, 1.9 to 2.6). Conclusions The authors’ data consolidate the recent paradigm shift, reporting acute kidney injury as a strong risk factor for the rapid development of chronic kidney disease.

BACKGROUND: Limited data exist on the risk factors for acute renal failure (ARF) following cardiac surgery in children with congenital heart disease. This cohort study was conducted to examine this subject, as well as changes in the incidence of ARF from 1993 to 2002, the in-hospital mortality and the time spent in the intensive care unit (ICU).METHODS: One thousand, one hundred and twenty-eight children, operated on for congenital heart disease between 1993 and 2002, were identified from our prospectively collected ICU database to obtain data on potential risk factors.RESULTS: A total of 130 children (11.5%) developed ARF after surgery. A young age [> or =1.0 vs. or =90 min vs. none; OR, 12.94; 95% CI, 5.46-30.67) were independent risk factors for ARF. The risk of ARF decreased during the study period. Children with ARF spent a significantly longer time in the ICU (2-7 days vs. or =7 days vs. CONCLUSION: A young age, high RACHS-1 score and CPB were independent risk factors for ARF after surgical procedures for congenital heart disease in children. The risk of ARF decreased during the study period. Children with severe ARF spent a longer time in the ICU, and the mortality in ARF patients was higher than that in non-ARF patients.