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Acute kidney injury (AKI) is one of the most frequent complications of critical illness. We aimed to explore the predictors of renal function recovery and the short-term reversibility after AKI by comparing logistic regression with four machine learning models. We reviewed patients who were diagnosed with AKI in the MIMIC-IV database between 2008 and 2019. Recovery from AKI within 72 h of the initiating event was typically recognized as the short-term reversal of AKI. Conventional logistic regression and four different machine algorithms (XGBoost algorithm model, Bayesian networks [BNs], random forest [RF] model, and support vector machine [SVM] model) were used to develop and validate prediction models. The performance measures were compared through the area under the receiver operating characteristic curve (AU-ROC), calibration curves, and 10-fold cross-validation. A total of 12,321 critically ill adult AKI patients were included in our analysis cohort. The renal function recovery rate after AKI was 67.9%. The maximum and minimum serum creatinine (SCr) within 24 h of AKI diagnosis, the minimum SCr within 24 and 12 h, and antibiotics usage duration were independently associated with renal function recovery after AKI. Among the 8364 recovered patients, the maximum SCr within 24 h of AKI diagnosis, the minimum Glasgow Coma Scale (GCS) score, the maximum blood urea nitrogen (BUN) within 24 h, vasopressin and vancomycin usage, and the maximum lactate within 24 h were the top six predictors for short-term reversibility of AKI. The RF model presented the best performance for predicting both renal functional recovery (AU-ROC [0.8295 ± 0.01]) and early recovery (AU-ROC [0.7683 ± 0.03]) compared with the conventional logistic regression model. The maximum SCr within 24 h of AKI diagnosis was a common independent predictor of renal function recovery and the short-term reversibility of AKI. The RF machine learning algorithms showed a superior ability to predict the prognosis of AKI patients in the ICU compared with the traditional regression models. These models may prove to be clinically helpful and can assist clinicians in providing timely interventions, potentially leading to improved prognoses.

Acute kidney injury (AKI) affects many ICU patients and is responsible for increased morbidity and mortality. Although lifesaving in many situations, renal replacement therapy (RRT) may be associated with complications, and the appropriate timing of its initiation is still the subject of intense debate. An early initiation strategy can prevent some metabolic complications, whereas a delayed one may allow for renal function recovery in some patients without need for this costly and potentially dangerous technique. For years, most of the knowledge on this issue stemmed from observational studies or small randomized controlled trials. Recent randomized controlled trials have indicated that a watchful waiting strategy (in the absence of life-threatening conditions such as severe hyperkalemia or pulmonary edema) during severe AKI allowed many patients to escape RRT and did not seem to adversely affect survival compared with a strategy of immediate RRT. In addition, data suggest that a delayed strategy may reduce the rate of complications (such as catheter infection) and favor renal function recovery. Ongoing studies will have to both confirm these conclusions and clarify to what extent the delay in initiating RRT can be prolonged. Pending those results, the bulk of evidence suggests that, in the absence of potential severe complications of AKI, delaying RRT is a valid and safe strategy that may also allow for considerable cost savings.

This study aimed to evaluate the value of serum intact fibroblast growth factor 23 (iFGF23), C-terminal FGF23 (cFGF23), and kidney injury molecule-1 (KIM-1) in predicting acute kidney injury (AKI) onset, severity, and renal function recovery in critically ill patients. A prospective cohort of 96 adults admitted to the intensive care unit (ICU) was analyzed. Patients were stratified into AKI (  = 51) and non-AKI (  = 45) groups based on KDIGO criteria. Serum iFGF23, cFGF23, and KIM-1 levels were measured at ICU admission. All three biomarkers were significantly elevated in AKI group compared to non-AKI group (all  < 0.01). Receiver operating characteristic (ROC) analysis showed that KIM-1 had the highest accuracy with an area under the curve (AUC) of 0.924 [95% confidence interval (CI) 0.866-0.983], followed by cFGF23 with an AUC of 0.779 (95% CI 0.676-0.881) and iFGF23 with an AUC of 0.672 (95% CI 0.554-0.789). Both iFGF23 (AUC 0.793, 95% CI 0.650-0.935) and cFGF23 (AUC 0.746, 95% CI 0.593-0.899) effectively predicted severe AKI (stages 2-3,  = 25). In contrast, KIM-1 showed no discriminative capacity (  > 0.05). ROC analysis indicated that none of the three biomarkers could predict renal function recovery (  > 0.05). Notably, KIM-1 may serve as a highly accurate marker for early AKI diagnosis, whereas serum FGF23 appears more promising for evaluating AKI severity. These complementary roles highlight the potential value of combining biomarkers to improve risk stratification in critically ill patients.

Objective Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) are often used together to treat critically ill patients. This systematic review aims to assess mortality and renal recovery with this combination as reported by studies published over the past decade. Methods We searched PubMed, Web of Science, ProQuest Health & Medical Complete, Embase, and Ovid SP. Two reviewers independently screened studies and extracted data. Study quality was assessed using the Newcastle–Ottawa Scale (NOS) for non-randomized controlled trials. We performed statistical analyses with RevMan 5.4. Results Nineteen studies with 1,786 patients met the inclusion criteria. Of these, 1,021 patients were in the ECMO-alone group (495 deaths, 48.5, %) and 765 were in the ECMO with CRRT group (395 deaths, 51.6%). The pooled effect showed no statistically significant difference in mortality between groups (OR 1.2, 95% CI 0.99–1.46, p  = 0.07), though heterogeneity was high (I 2  = 51%). However, when excluding one study which appeared to be driving this heterogeneity in a sensitivity analysis, mortality was significantly higher among patients treated with ECMO and CRRT (OR 1.43, 95% CI 1.15–1.77, p  = 0.001). Subgroup analysis of only adult retrospective studies also yielded a higher mortality rate with ECMO and CRRT (OR 1.42, 95% CI 1.13–1.78; p  = 0.003). No difference in mortality was seen when pooling the two paediatric retrospective studies (OR 0.90, 95% CI 0.68–1.19; p  = 0.45) or the two prospective studies (OR 0.94, 95% CI 0.31–2.83, p  = 0.91). Limited data on recovery of renal function prevented further analysis. Conclusion In conclusion, in contrast to older data, our pooled analysis of recent studies revealed no significant increase in mortality risk associated with CRRT use in patient treated with ECMO. However, after accounting for heterogeneity, mortality remained higher in patients treated with ECMO and CRRT group than in the ECMO-alone group. Additional prospective data are essential to clarify the impact of CRRT on outcomes in patients treated with ECMO.

There are few reports regarding outcomes of anti-glomerular basement membrane (GBM) disease in patients who underwent renal replacement therapy. To help define this we studied all patients with anti-GBM disease who started renal replacement therapy for end-stage renal disease (ESRD) in Australia and New Zealand (ANZDATA Registry) between 1963 and 2010 encompassing 449 individuals (0.8 percent of all ESRD patients). The median survival on dialysis was 5.93 years with death predicted by older age and a history of pulmonary hemorrhage. Thirteen patients recovered renal function, although 10 subsequently experienced renal death after a median period of 1.05 years. Of the 224 patients who received their first renal allograft, the 10-year median patient and renal allograft survival rates were 86% and 63%, respectively. Six patients experienced anti-GBM disease recurrence in their allograft, which led to graft failure in two. Using multivariable Cox regression analysis, patients with anti-GBM disease had comparable survival on dialysis or following renal transplantation (hazard ratios of 0.86 and 1.03, respectively) compared to those with ESRD due to other causes. Also, renal allograft survival (hazard ratio of 1.03) was not altered compared to other diseases requiring a renal transplant. Thus, anti-GBM disease was an uncommon cause of ESRD, and not associated with altered risks of dialysis, transplant or first renal allograft survival. Death on dialysis was predicted by older age and a history of pulmonary hemorrhage.

Background and objectives The clinical and pathological impact factors for renal function recovery in acute kidney injury (AKI) on the progression of renal function in primary membranous nephropathy (PMN) with AKI patients have not yet been reported, we sought to investigate the factors that may influence renal function recovery and develop a nomogram model for predicting renal function recovery in PMN with AKI patients. Methods Two PMN with AKI cohorts from the Nephrology Department, the First Affiliated Hospital of Wenzhou Medical University during 2012–2018 and 2019–2020 were included, i.e., a derivation cohort during 2012–2018 and a validation cohort during 2019–2020. Clinical characteristics and renal pathological features were obtained. The outcome measurement was the recovery of renal function within 12 months. Lasso regression was used for clinical and pathological features selection. Prediction model was built and nomogram was plotted. Model evaluations including calibration curves were performed. Result Renal function recovery was found in 72 of 124 (58.1%) patients and 41 of 72 (56.9%) patients in the derivation and validation cohorts, respectively. The prognostic nomogram model included determinants of sex, age, the comorbidity of hypertensive nephropathy, the stage of glomerular basement membrane and diuretic treatment with a reasonable concordance index of 0.773 (95%CI,0.716–0.830) in the derivation cohort and 0.773 (95%CI, 0.693–0.853) in the validation cohort. Diuretic use was a significant impact factor with decrease of renal function recovery in PMN with AKI patients. Conclusion The predictive nomogram model provides useful prognostic tool for renal function recovery in PMN patients with AKI.

Background Acute kidney injury (AKI) in patients with multiple myeloma (MM) requiring renal replacement treatment (RRT) is associated with high morbidity and mortality. Early reduction of serum free light chains (FLC) using both targeted therapy against MM and intensive hemodialysis (IHD) may improve renal outcomes. We evaluated the effectiveness of two different RRT techniques on renal recovery in an MM patient population: standard dialysis procedure vs IHD with either polymethylmethacrylate (PMMA) or hemodiafiltration with endogenous reinfusion (HFR). Methods This was a multicentric retrospective study with severe AKI related to MM, between 2011 and 2018. Twenty-five consecutive patients with AKI secondary to MM requiring RRT were included. Patients that underwent IHD received six dialysis sessions per week during the first 14 days (PMMA vs HFR). All patients were diagnosed with de novo MM or first relapsed MM. Primary outcome was renal recovery defined as dialysis-free at 6 months follow-up. Results A total of 25 patients were included. Seventeen patients received IHD and eight standard dialysis. All patients were treated with targeted therapy, 84% bortezomib-based. Of the 25 patients included, 14 (56%) became dialysis independent. We observed a higher proportion of patients who received IHD in the group who recovered kidney function compared with those who remained in HD (92.9% vs 36.4%, P = .007). In our study, the use of IHD to remove FLC had a statistically significant association with renal recovery compared with the standard dialysis group (P = .024). Conclusion Early reduction of FLC with IHD as an adjuvant treatment along with MM-targeted therapy may exert a positive impact on renal recovery. Lay Summary This is a retrospective multicenter study that evaluated the effectiveness of intensive haemodialysis (IHD) vs standards dialysis on renal recovery in patients with acute kidney injury (AKI) associated with myeloma multiple (MM). In this paper, we demonstrated that IHD for early light chain reduction was associated with a better renal prognosis. Another finding is the importance of maintenance diuresis as a marker of good prognosis of renal function. To our knowledge few studies have been focused in the comparison between IHD vs standard dialysis in MM patients with AKI. We consider that if we manage to recover the renal function, we achieve a great clinical impact since the patient with chronic kidney disease and especially in hemodialysis, an increased risk of mortality as well as poorer quality of life. Graphical Abstract Graphical Abstract

Background Acute kidney injury (AKI) represents a major complication of cardiac surgery. Our aim was to evaluate, in patients undergoing continuous renal replacement therapy (CRRT) for cardiac surgery-associated AKI (CS-AKI), prognostic factors related to in-hospital survival and renal function recovery to independence from RRT. Methods We conducted a retrospective analysis in patients with severe CS-AKI who underwent CRRT for at least 48 h. The sequential organ failure assessment (SOFA) score was calculated on a daily basis to evaluate illness severity throughout the intensive care unit (ICU) stay. Results In 264 patients (age 66.4 ± 11.7 years, 192 males), 30-day survival was 57.6 % while survival to discharge from the hospital was 40.5 %. Renal function recovery occurred in 96.3 % of survivors and in 13.4 % of non-survivors (p < 0.001). Multivariate analysis selected advancing age, oliguria, sepsis and the highest level of SOFA score within the first week of CRRT (SOFA-max) as independent prognostic factors for failure to recover renal function. Female gender was associated with a higher probability of survival, while higher serum creatinine at the start of CRRT, oliguria, sepsis and SOFA-max were independently associated with mortality. The subgroup of patients with a day-1 SOFA score above the median (≥10) showed a lower probability of survival and a lower cumulative incidence of renal function recovery. Conclusions In a selected population of patients with severe CS-AKI requiring RRT, short-term outcomes appear strongly associated with the worst grade of illness severity during the first week of CRRT, thus reflecting the sequential occurrence of additional major complications during ICU stay. Renal function recovery and in-hospital survival appear mutually linked, sharing oliguria, sepsis and SOFA score as the main determinants of both outcomes.

Background/Objectives: Optimal timing to initiate renal replacement therapy (RRT) in critically ill patients with acute kidney injury (AKI) remains uncertain. This study evaluated the impact of early RRT initiation (<24 h after severe AKI diagnosis) on renal recovery and mortality in intensive care unit (ICU) patients. Methods: This prospective cohort included 119 patients with dialysis-requiring AKI admitted to two ICUs between December 2022 and December 2024. Patients were categorized according to RRT initiation timing (early < 24 h or delayed >24 h). Mortality (at 20, 30, and 76 days) and renal recovery (at 3, 10, and 30 days) were assessed using Kaplan–Meier curves and a log-rank test. Moreover, multivariate logistic regression was performed to identify factors associated with renal recovery. Results: Early RRT was initiated in 39 (32.8%) patients, and delayed RRT was initiated in 80 (67.2%). The early group had higher clinical severity (SOFA: 10 vs. 7; p = 0.016). Mortality did not differ between the groups (log-rank p = 0.396, 0.742, and 0.932 at 20, 30, and 76 days, respectively). However, early renal recovery (within 3 days) was more frequent in the early group (51.3% vs. 27.5%; p = 0.010), and early RRT was an independent predictor of this outcome (OR 3.26; 95% CI: 1.37–7.75 p = 0.008). Conclusions: Early RRT did not reduce mortality but was associated with improved early renal recovery in critically ill patients with AKI.

Background and purpose: Ischemia–reperfusion injury is encountered in numerous processes such as cardiovascular diseases or kidney transplantation; however, the latter involves cold ischemia, different from the warm ischemia found in vascular surgery by arterial clamping. The nature and the intensity of the processes induced by ischemia types are different, hence the therapeutic strategy should be adapted. Herein, we investigated the protective role of tannic acid, a natural polyphenol in a rat model reproducing both renal warm ischemia and kidney allotransplantation. The follow-up was done after 1 week. Experimental approach: To characterize the effect of tannic acid, an in vitro model of endothelial cells subjected to hypoxia–reoxygenation was used. Key results: Tannic acid statistically improved recovery after warm ischemia but not after cold ischemia. In kidneys biopsies, 3 h after warm ischemia–reperfusion, oxidative stress development was limited by tannic acid and the production of reactive oxygen species was inhibited, potentially through Nuclear Factor erythroid-2-Related factor 2 (NRF2) activation. In vitro, tannic acid and its derivatives limited cytotoxicity and the generation of reactive oxygen species. Molecular dynamics simulations showed that tannic acid efficiently interacts with biological membranes, allowing efficient lipid oxidation inhibition. Tannic acid also promoted endothelial cell migration and proliferation during hypoxia. Conclusions: Tannic acid was able to improve renal recovery after renal warm ischemia with an antioxidant effect putatively extended by the production of its derivatives in the body and promoted cell regeneration during hypoxia. This suggests that the mechanisms induced by warm and cold ischemia are different and require specific therapeutic strategies.