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Acute kidney injury in neurocritical patients: a retrospective cohort study

  • Nephrology - Original Paper
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Abstract

Background /Objective

Acute kidney injury (AKI) is a significant complication in critical care units (CCU). Non-neurological complications such as AKI are an independent predictor of poor clinical outcomes, with an increase in morbidity and mortality, financial costs, and worse functional recovery. This work aims to estimate the incidence of AKI and evaluate the risk factors and complications of AKI in neurocritical patients hospitalized in the CCU.

Methods

A retrospective cohort study was conducted. Patients admitted to the neurocritical care unit between 2016 and 2018 with a stay longer than 48 h were retrospectively analyzed in regard to the incidence, risk factors, and outcomes of AKI.

Results

The study population comprised 213 neurocritical patients. The incidence of AKI was 23.5%, with 58% KDIGO 1 and 2% requiring renal replacement therapy. AKI was an independent predictor of prolonged use of mechanical ventilation, cerebral edema, and mortality. Cerebral edema [OR 4.40 (95% CI 1.98–9.75) p < 0.001] and a change in chloride levels greater than 4 mmol/L at 48 h (OR 2.44 (95% CI 1.10–5.37) p = 0.027) were risk factors for developing AKI in the first 14 days of hospitalization.

Conclusion

There is a high incidence of AKI in neurocritical patients; it is associated with worse clinical outcomes regardless of the CCU admission etiology or AKI severity.

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Availability of data and materials

All data generated or analyzed during this study are included in this published article.

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Acknowledgements

We thank Anita Zurita Poza for her technical assistance in the design of this article.

Funding

There was no funding for the study.

Author information

Authors and Affiliations

  1. Critical Patients Unit, Carlos Van Buren Hospital, San Ignacio #725, Valparaiso, Chile

    Gonzalo Ramírez-Guerrero, Cristian Lucero, Francisco Villagrán-Cortés, Ernesto Hauway, Vicente Torres-Cifuentes, Romyna Baghetti-Hernández & Osvaldo Garay

  2. Dialysis and Renal Transplantation Unit, Carlos Van Buren Hospital, Valparaiso, Chile

    Gonzalo Ramírez-Guerrero, Francisco Villagrán-Cortés, Vicente Torres-Cifuentes, Romyna Baghetti-Hernández & Osvaldo Garay

  3. Departamento de Medicina Interna, Facultad de Medicina, Universidad de Valparaíso, Valparaiso, Chile

    Gonzalo Ramírez-Guerrero, Cristian Lucero, Francisco Villagrán-Cortés, Ernesto Hauway, Vicente Torres-Cifuentes, Romyna Baghetti-Hernández & Osvaldo Garay

  4. Nephrology, Dialysis and Transplantation Unit, Las Higueras Hospital, Talcahuano, Chile

    Vicente Torres-Cifuentes

  5. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Romyna Baghetti-Hernández

  6. Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó, Chile

    Aldo Vera-Calzaretta

  7. Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy

    Claudio Ronco

  8. International Renal Research Institute of Vicenza, Vicenza, Italy

    Claudio Ronco

Authors
  1. Gonzalo Ramírez-Guerrero
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  2. Cristian Lucero
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  3. Francisco Villagrán-Cortés
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  4. Ernesto Hauway
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  5. Vicente Torres-Cifuentes
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  6. Romyna Baghetti-Hernández
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  7. Aldo Vera-Calzaretta
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  8. Claudio Ronco
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  9. Osvaldo Garay
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Contributions

GRG, CL, FVC designed the work; GRG, CL, FVC, VTC, AVC, and EH collected and analyzed the data; GRG, FVC, VTC, RBH, CR, OG drafted the work or substantively revised it; and all authors read and approved the final manuscript.

Corresponding author

Correspondence to Gonzalo Ramírez-Guerrero.

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Conflict of interest

GRG has received funding for lectures for Baxter. CR has received funding for lectures, been consultant or advisory board member for Asahi, Astute, B. Braun, Baxter, bioM´erieux, Bioporto, CytoSorbents, Estor, Fresenius Medical Care, General Electric (GE), Jafron, Medtronic, Toray. None of the other authors declare any competing interests.

Ethics approval and consent to participate

Biochemical and clinical parameters were collected under the approval of the scientific ethics committee of the health service of Valparaiso—San Antonio.

Statement of ethics

Waiver of informed consent was authorized by the local ethics committee due to the retrospective nature of the study and anonymization of the data.

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Supplementary Information

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11255_2023_3502_MOESM1_ESM.png

Plasma Glycemia. Shown are the mean change in plasma glycemia in each group during the first 14 days from admission to critical care unit. During the first 14 days, no significant difference was observed between both groups (PNG 87 KB)

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Ramírez-Guerrero, G., Lucero, C., Villagrán-Cortés, F. et al. Acute kidney injury in neurocritical patients: a retrospective cohort study. Int Urol Nephrol 55, 1875–1883 (2023). https://doi.org/10.1007/s11255-023-03502-7

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  • DOI: https://doi.org/10.1007/s11255-023-03502-7

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