Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Original research

Post-traumatic acute kidney injury: a cross-sectional study of trauma patients

Authors: Wei-Hung Lai, Cheng-Shyuan Rau, Shao-Chun Wu, Yi-Chun Chen, Pao-Jen Kuo, Shiun-Yuan Hsu, Ching-Hua Hsieh, Hsiao-Yun Hsieh

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

Login to get access

Abstract

Background

The causes of post-traumatic acute kidney injury (AKI) are multifactorial, and shock associated with major trauma has been proposed to result in inadequate renal perfusion and subsequent AKI in trauma patients. This study aimed to investigate the true incidence and clinical presentation of post-traumatic AKI in hospitalized adult patients and its association with shock at a Level I trauma center.

Methods

Detailed data of 78 trauma patients with AKI and 14,504 patients without AKI between January 1, 2009 and December 31, 2014 were retrieved from the Trauma Registry System. Patients with direct renal trauma were excluded from this study. Two-sided Fisher’s exact or Pearson’s chi-square tests were used to compare categorical data, unpaired Student’s t-test was used to analyze normally distributed continuous data, and Mann–Whitney’s U test was used to compare non-normally distributed data. Propensity score matching with a 1:1 ratio with logistic regression was used to evaluate the effect of shock on AKI.

Results

Patients with AKI presented with significantly older age, higher incidence rates of pre-existing comorbidities, higher odds of associated injures (subdural hematoma, intracerebral hematoma, intra-abdominal injury, and hepatic injury), and higher injury severity than patients without AKI. In addition, patients with AKI had a longer hospital stay (18.3 days vs. 9.8 days, respectively; P < 0.001) and intensive care unit (ICU) stay (18.8 days vs. 8.6 days, respectively; P < 0. 001), higher proportion of admission into the ICU (57.7% vs. 19.0%, respectively; P < 0.001), and a higher odds ratio (OR) of short-term mortality (OR 39.0; 95% confidence interval, 24.59–61.82; P < 0.001). However, logistic regression analysis of well-matched pairs after propensity score matching did not show a significant influence of shock on the occurrence of AKI.

Discussion

We believe that early and aggressive resuscitation, to avoid prolonged untreated shock, may help to prevent the occurrence of post-traumatic AKI. However, more evidence is required to support this observation.

Conclusion

Compared to patients without AKI, patients with AKI presented with different injury characteristics and worse outcome. However, an association between shock and post-traumatic AKI could not be identified.
Appendix
Available only for authorised users
Literature
1.
Morris Jr JA, Mucha Jr P, Ross SE, et al. Acute posttraumatic renal failure: a multicenter perspective. J Trauma. 1991;31:1584–90.CrossRefPubMed
2.
Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRefPubMed
3.
Qureshi AI, Palesch YY, Martin R, et al. Systolic blood pressure reduction and risk of acute renal injury in patients with intracerebral hemorrhage. Am J Med. 2012;125:718.e711–716.CrossRef
4.
Jalal DI, Chonchol M, Targher G. Disorders of hemostasis associated with chronic kidney disease. Semin Thromb Hemost. 2010;36:34–40.CrossRefPubMed
5.
Hoste EA, Schurgers M. Epidemiology of acute kidney injury: how big is the problem? Crit Care Med. 2008;36:S146–51.CrossRefPubMed
6.
Awad AS, Rouse M, Huang L, et al. Compartmentalization of neutrophils in the kidney and lung following acute ischemic kidney injury. Kidney Int. 2009;75:689–98.CrossRefPubMedPubMedCentral
7.
Avila Martinez RJ, Hernandez Voth A, Marron Fernandez C, et al. Evolution and complications of chest trauma. Arch Bronconeumol. 2013;49:177–80.PubMed
8.
Mehta RL, Pascual MT, Soroko S, Chertow GM. Diuretics, mortality, and nonrecovery of renal function in acute renal failure. JAMA. 2002;288:2547–53.CrossRefPubMed
9.
Brown CV, Dubose JJ, Hadjizacharia P, et al. Natural history and outcomes of renal failure after trauma. J Am Coll Surg. 2008;206:426–31.CrossRefPubMed
10.
Guly UM, Turney JH. Post-traumatic acute renal failure, 1956–1988. Clin Nephrol. 1990;34:79–83.PubMed
11.
12.
Gallagher M, Cass A, Bellomo R, et al. Long-term survival and dialysis dependency following acute kidney injury in intensive care: extended follow-up of a randomized controlled trial. PLoS Med. 2014;11:e1001601.CrossRefPubMedPubMedCentral
13.
Brinkman S, de Jonge E, Abu-Hanna A, Arbous MS, de Lange DW, de Keizer NF. Mortality after hospital discharge in ICU patients. Crit Care Med. 2013;41:1229–36.CrossRefPubMed
14.
Thakar CV, Christianson A, Himmelfarb J, Leonard AC. Acute kidney injury episodes and chronic kidney disease risk in diabetes mellitus. Clin J Am Soc Nephrol. 2011;6:2567–72.CrossRefPubMedPubMedCentral
15.
Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10:R73.CrossRefPubMedPubMedCentral
16.
Wohlauer MV, Sauaia A, Moore EE, Burlew CC, Banerjee A, Johnson J. Acute kidney injury and posttrauma multiple organ failure: the canary in the coal mine. J Trauma Acute Care Surg. 2012;72:373–8. discussion 379–380.CrossRefPubMed
17.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204–12.CrossRefPubMedPubMedCentral
18.
Levin A, Warnock DG, Mehta RL, et al. Improving outcomes from acute kidney injury: report of an initiative. Am J Kidney Dis. 2007;50:1–4.CrossRefPubMed
19.
National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1–S266.
20.
Ympa YP, Sakr Y, Reinhart K, Vincent JL. Has mortality from acute renal failure decreased? A systematic review of the literature. Am J Med. 2005;118:827–32.CrossRefPubMed
21.
Stene JK. Renal failure in the trauma patient. Crit Care Clin. 1990;6:111–9.PubMed
22.
Bihorac A, Baslanti TO, Cuenca AG, et al. Acute kidney injury is associated with early cytokine changes after trauma. J Trauma Acute Care Surg. 2013;74:1005–13.CrossRefPubMedPubMedCentral
23.
Okusa MD. The changing pattern of acute kidney injury: from one to multiple organ failure. Contrib Nephrol. 2010;165:153–8.CrossRefPubMed
24.
Ala-Kokko T, Ohtonen P, Laurila J, Martikainen M, Kaukoranta P. Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients. Acta Anaesthesiol Scand. 2006;50:828–32.CrossRefPubMed
25.
Nadvi SS, Mokoena T, Gouws E, Haffejee AA. Prognosis in posttraumatic acute renal failure is adversely influenced by hypotension and hyperkalaemia. Eur J Surg. 1996;162:121–4.PubMed
26.
Gettings LG, Reynolds HN, Scalea T. Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med. 1999;25:805–13.CrossRefPubMed
27.
Rasmussen HH, Ibels LS. Acute renal failure. Multivariate analysis of causes and risk factors. Am J Med. 1982;73:211–8.CrossRefPubMed
28.
Regel G, Lobenhoffer P, Grotz M, Pape HC, Lehmann U, Tscherne H. Treatment results of patients with multiple trauma: an analysis of 3406 cases treated between 1972 and 1991 at a German Level I Trauma Center. J Trauma. 1995;38:70–8.CrossRefPubMed
29.
Chuang JF, Rau CS, Wu SC, et al. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Scand J Trauma Resusc Emerg Med. 2016;24:12.CrossRefPubMedPubMedCentral
30.
Lai WH, Rau CS, Hsu SY, et al. Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study. Int J Environ Res Public Health. 2016;13:E357.CrossRefPubMed
31.
Huang CY, Rau CS, Chuang JF, et al. Characteristics and Outcomes of Patients Injured in Road Traffic Crashes and Transported by Emergency Medical Services. Int J Environ Res Public Health. 2016;13:E236.CrossRefPubMed
32.
Cutting S, Castro C, Lee VH, Prabhakaran S. Impaired renal function is not associated with increased volume of intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2014;23:86–90.CrossRefPubMed
33.
Jivraj S, Mazer CD, Baker AJ, Choi M, Hare GM. Case report: profound hypotension associated with labetalol therapy in a patient with cerebral aneurysms and subarachnoid hemorrhage. Can J Anaesth. 2006;53:678–83.CrossRefPubMed
34.
Rodriguez GJ, Cordina SM, Vazquez G, et al. The hydration influence on the risk of stroke (THIRST) study. Neurocrit Care. 2009;10:187–94.CrossRefPubMed
35.
36.
Lee SY, Kim DH, Sung SA, et al. Sphingosine-1-phosphate reduces hepatic ischaemia/reperfusion-induced acute kidney injury through attenuation of endothelial injury in mice. Nephrology (Carlton). 2011;16:163–73.CrossRef
37.
Pawarode A, Fine DM, Thuluvath PJ. Independent risk factors and natural history of renal dysfunction in liver transplant recipients. Liver Transpl. 2003;9:741–7.CrossRefPubMed
38.
Eachempati SR, Wang JC, Hydo LJ, Shou J, Barie PS. Acute renal failure in critically ill surgical patients: persistent lethality despite new modes of renal replacement therapy. J Trauma. 2007;63:987–99.CrossRefPubMed
39.
Elterman J, Zonies D, Stewart I, Fang R, Schreiber M. Rhabdomyolysis and acute kidney injury in the injured war fighter. J Trauma Acute Care Surg. 2015;79:S171–4.CrossRefPubMed
40.
Polderman KH. Acute renal failure and rhabdomyolysis. Int J Artif Organs. 2004;27:1030–3.PubMed
Metadata
Title
Post-traumatic acute kidney injury: a cross-sectional study of trauma patients
Authors
Wei-Hung Lai
Cheng-Shyuan Rau
Shao-Chun Wu
Yi-Chun Chen
Pao-Jen Kuo
Shiun-Yuan Hsu
Ching-Hua Hsieh
Hsiao-Yun Hsieh
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0330-4

Other articles of this Issue 1/2016

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016 Go to the issue

Original research

Use of the reverse shock index for identifying high-risk patients in a five-level triage system

Original research

What helps or hinders the transformation from a major tertiary center to a major trauma center? Identifying barriers and enablers using the Theoretical Domains Framework

Original research

Impact of Cushing’s sign in the prehospital setting on predicting the need for immediate neurosurgical intervention in trauma patients: a nationwide retrospective observational study

Original research

Which score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores

Original research

The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine

Original research

Validation of the PECARN clinical decision rule for children with minor head trauma: a French multicenter prospective study