Acute kidney injury after in-hospital cardiac arrest

Kenneth E. Mah; Jeffrey A. Alten; Timothy T. Cornell; David T. Selewski; David Askenazi; Julie C. Fitzgerald; Alexis Topjian; Kent Page; Richard Holubkov; Beth S. Slomine; James R. Christensen; J. Michael Dean; Frank W. Moler

doi:10.1016/j.resuscitation.2020.12.023

Acute kidney injury after in-hospital cardiac arrest

Kenneth E. Mah, Jeffrey A. Alten, Timothy T. Cornell, David T. Selewski, David Askenazi, Julie C. Fitzgerald, Alexis Topjian, Kent Page, Richard Holubkov, Beth S. Slomine, James R. Christensen, J. Michael Dean, Frank W. Moler

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Aim: Determine 1) frequency and risk factors for acute kidney injury (AKI) after in-hospital cardiac arrest (IHCA) in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial and associated outcomes; 2) impact of temperature management on post-IHCA AKI. Methods: Secondary analysis of THAPCA-IH; a randomized controlled multi-national trial at 37 children's hospitals. Eligibility: Serum creatinine (Cr) within 24 h of randomization. Outcomes: Prevalence of severe AKI defined by Stage 2 or 3 Kidney Disease Improving Global Outcomes Cr criteria. 12-month survival with favorable neurobehavioral outcome. Analyses stratified by entire cohort and cardiac subgroup. Risk factors and outcomes compared among cohorts with and without severe AKI. Results: Subject randomization: 159 to hypothermia, 154 to normothermia. Overall, 80% (249) developed AKI (any stage), and 66% (207) developed severe AKI. Cardiac patients (204, 65%) were more likely to develop severe AKI (72% vs 56%,p = 0.006). Preexisting cardiac or renal conditions, baseline lactate, vasoactive support, and systolic blood pressure were associated with severe AKI. Comparing hypothermia versus normothermia, there were no differences in severe AKI rate (63% vs 70%,p = 0.23), peak Cr, time to peak Cr, or freedom from mortality or severe AKI (p = 0.14). Severe AKI was associated with decreased hospital survival (48% vs 65%,p = 0.006) and decreased 12-month survival with favorable neurobehavioral outcome (30% vs 53%,p < 0.001). Conclusion: Severe post-IHCA AKI occurred frequently especially in those with preexisting cardiac or renal conditions and peri-arrest hemodynamic instability. Severe AKI was associated with decreased survival with favorable neurobehavioral outcome. Hypothermia did not decrease incidence of severe AKI post-IHCA.

Original language	English (US)
Pages (from-to)	49-58
Number of pages	10
Journal	Resuscitation
Volume	160
DOIs	https://doi.org/10.1016/j.resuscitation.2020.12.023
State	Published - Mar 2021

Keywords

Acute kidney injury
In-Hospital
Post-Cardiac arrest
Therapeutic hypothermia

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2020.12.023

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@article{7545b18b3991425fa8b4e4c9174504e2,

title = "Acute kidney injury after in-hospital cardiac arrest",

abstract = "Aim: Determine 1) frequency and risk factors for acute kidney injury (AKI) after in-hospital cardiac arrest (IHCA) in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial and associated outcomes; 2) impact of temperature management on post-IHCA AKI. Methods: Secondary analysis of THAPCA-IH; a randomized controlled multi-national trial at 37 children's hospitals. Eligibility: Serum creatinine (Cr) within 24 h of randomization. Outcomes: Prevalence of severe AKI defined by Stage 2 or 3 Kidney Disease Improving Global Outcomes Cr criteria. 12-month survival with favorable neurobehavioral outcome. Analyses stratified by entire cohort and cardiac subgroup. Risk factors and outcomes compared among cohorts with and without severe AKI. Results: Subject randomization: 159 to hypothermia, 154 to normothermia. Overall, 80% (249) developed AKI (any stage), and 66% (207) developed severe AKI. Cardiac patients (204, 65%) were more likely to develop severe AKI (72% vs 56%,p = 0.006). Preexisting cardiac or renal conditions, baseline lactate, vasoactive support, and systolic blood pressure were associated with severe AKI. Comparing hypothermia versus normothermia, there were no differences in severe AKI rate (63% vs 70%,p = 0.23), peak Cr, time to peak Cr, or freedom from mortality or severe AKI (p = 0.14). Severe AKI was associated with decreased hospital survival (48% vs 65%,p = 0.006) and decreased 12-month survival with favorable neurobehavioral outcome (30% vs 53%,p < 0.001). Conclusion: Severe post-IHCA AKI occurred frequently especially in those with preexisting cardiac or renal conditions and peri-arrest hemodynamic instability. Severe AKI was associated with decreased survival with favorable neurobehavioral outcome. Hypothermia did not decrease incidence of severe AKI post-IHCA.",

keywords = "Acute kidney injury, In-Hospital, Post-Cardiac arrest, Therapeutic hypothermia",

author = "Mah, {Kenneth E.} and Alten, {Jeffrey A.} and Cornell, {Timothy T.} and Selewski, {David T.} and David Askenazi and Fitzgerald, {Julie C.} and Alexis Topjian and Kent Page and Richard Holubkov and Slomine, {Beth S.} and Christensen, {James R.} and Dean, {J. Michael} and Moler, {Frank W.}",

note = "Funding Information: Supported by grants from the National Heart, Lung, and Blood Institute ( HL094345 , to Dr. Moler; and HL094339 , to Dr. Dean), federal planning grants for the planning of the THAPCA trials (HD044955 and HD050531, both to Dr. Moler), cooperative agreements from the Pediatric Emergency Care Applied Research Network ( U03MC00001 , U03MC00003 , U03MC00006 , U03MC00007 , and U03MC00008 ) and the Collaborative Pediatric Critical Care Research Network ( U10HD500009 , U10HD050096 , U10HD049981 , U10HD049945 , U10HD049983 , U10HD050012 and U01HD049934 ), and a National Emergency Medical Services for Children Data Analysis Resource Center Demonstration grant ( U07MC09174 ). Several centers were supported by supplemental grants or cooperative agreements ( UL1RR024986 , UL1TR000433 , U54HD087011 , UL1TR000003 , and P30HD040677 ). Funding Information: Timothy T. Cornell receives funding for studies not related to this manuscript from National Institutes of Health – NHLBI (R01 HL119542). David J. Askenazi is consultant for Baxter, CHF Solutions Inc. and Medtronic. He also receives grant funding for studies not related to this project from Baxter, CHF Solutions Inc., and National Institutes of Health NIH-FDA (R01 FD005092) and the Pediatric and Infant Center for Acute Nephrology (PICAN). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children{\textquoteright}s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB{\textquoteright}s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Kenneth E. Mah receives funding for studies not related to this manuscript from the National Science Foundation (SBIR Phase I 2028008). Publisher Copyright: {\textcopyright} 2021 Elsevier B.V.",

year = "2021",

month = mar,

doi = "10.1016/j.resuscitation.2020.12.023",

language = "English (US)",

volume = "160",

pages = "49--58",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Acute kidney injury after in-hospital cardiac arrest

AU - Mah, Kenneth E.

AU - Alten, Jeffrey A.

AU - Cornell, Timothy T.

AU - Selewski, David T.

AU - Askenazi, David

AU - Fitzgerald, Julie C.

AU - Topjian, Alexis

AU - Page, Kent

AU - Holubkov, Richard

AU - Slomine, Beth S.

AU - Christensen, James R.

AU - Dean, J. Michael

AU - Moler, Frank W.

N1 - Funding Information: Supported by grants from the National Heart, Lung, and Blood Institute ( HL094345 , to Dr. Moler; and HL094339 , to Dr. Dean), federal planning grants for the planning of the THAPCA trials (HD044955 and HD050531, both to Dr. Moler), cooperative agreements from the Pediatric Emergency Care Applied Research Network ( U03MC00001 , U03MC00003 , U03MC00006 , U03MC00007 , and U03MC00008 ) and the Collaborative Pediatric Critical Care Research Network ( U10HD500009 , U10HD050096 , U10HD049981 , U10HD049945 , U10HD049983 , U10HD050012 and U01HD049934 ), and a National Emergency Medical Services for Children Data Analysis Resource Center Demonstration grant ( U07MC09174 ). Several centers were supported by supplemental grants or cooperative agreements ( UL1RR024986 , UL1TR000433 , U54HD087011 , UL1TR000003 , and P30HD040677 ). Funding Information: Timothy T. Cornell receives funding for studies not related to this manuscript from National Institutes of Health – NHLBI (R01 HL119542). David J. Askenazi is consultant for Baxter, CHF Solutions Inc. and Medtronic. He also receives grant funding for studies not related to this project from Baxter, CHF Solutions Inc., and National Institutes of Health NIH-FDA (R01 FD005092) and the Pediatric and Infant Center for Acute Nephrology (PICAN). PICAN is part of the Department of Pediatrics at the University of Alabama at Birmingham (UAB), and is funded by Children’s of Alabama Hospital, the Department of Pediatrics, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (CCTS, NIH grant UL1TR001417). Kenneth E. Mah receives funding for studies not related to this manuscript from the National Science Foundation (SBIR Phase I 2028008). Publisher Copyright: © 2021 Elsevier B.V.

PY - 2021/3

Y1 - 2021/3

N2 - Aim: Determine 1) frequency and risk factors for acute kidney injury (AKI) after in-hospital cardiac arrest (IHCA) in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial and associated outcomes; 2) impact of temperature management on post-IHCA AKI. Methods: Secondary analysis of THAPCA-IH; a randomized controlled multi-national trial at 37 children's hospitals. Eligibility: Serum creatinine (Cr) within 24 h of randomization. Outcomes: Prevalence of severe AKI defined by Stage 2 or 3 Kidney Disease Improving Global Outcomes Cr criteria. 12-month survival with favorable neurobehavioral outcome. Analyses stratified by entire cohort and cardiac subgroup. Risk factors and outcomes compared among cohorts with and without severe AKI. Results: Subject randomization: 159 to hypothermia, 154 to normothermia. Overall, 80% (249) developed AKI (any stage), and 66% (207) developed severe AKI. Cardiac patients (204, 65%) were more likely to develop severe AKI (72% vs 56%,p = 0.006). Preexisting cardiac or renal conditions, baseline lactate, vasoactive support, and systolic blood pressure were associated with severe AKI. Comparing hypothermia versus normothermia, there were no differences in severe AKI rate (63% vs 70%,p = 0.23), peak Cr, time to peak Cr, or freedom from mortality or severe AKI (p = 0.14). Severe AKI was associated with decreased hospital survival (48% vs 65%,p = 0.006) and decreased 12-month survival with favorable neurobehavioral outcome (30% vs 53%,p < 0.001). Conclusion: Severe post-IHCA AKI occurred frequently especially in those with preexisting cardiac or renal conditions and peri-arrest hemodynamic instability. Severe AKI was associated with decreased survival with favorable neurobehavioral outcome. Hypothermia did not decrease incidence of severe AKI post-IHCA.

AB - Aim: Determine 1) frequency and risk factors for acute kidney injury (AKI) after in-hospital cardiac arrest (IHCA) in the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) trial and associated outcomes; 2) impact of temperature management on post-IHCA AKI. Methods: Secondary analysis of THAPCA-IH; a randomized controlled multi-national trial at 37 children's hospitals. Eligibility: Serum creatinine (Cr) within 24 h of randomization. Outcomes: Prevalence of severe AKI defined by Stage 2 or 3 Kidney Disease Improving Global Outcomes Cr criteria. 12-month survival with favorable neurobehavioral outcome. Analyses stratified by entire cohort and cardiac subgroup. Risk factors and outcomes compared among cohorts with and without severe AKI. Results: Subject randomization: 159 to hypothermia, 154 to normothermia. Overall, 80% (249) developed AKI (any stage), and 66% (207) developed severe AKI. Cardiac patients (204, 65%) were more likely to develop severe AKI (72% vs 56%,p = 0.006). Preexisting cardiac or renal conditions, baseline lactate, vasoactive support, and systolic blood pressure were associated with severe AKI. Comparing hypothermia versus normothermia, there were no differences in severe AKI rate (63% vs 70%,p = 0.23), peak Cr, time to peak Cr, or freedom from mortality or severe AKI (p = 0.14). Severe AKI was associated with decreased hospital survival (48% vs 65%,p = 0.006) and decreased 12-month survival with favorable neurobehavioral outcome (30% vs 53%,p < 0.001). Conclusion: Severe post-IHCA AKI occurred frequently especially in those with preexisting cardiac or renal conditions and peri-arrest hemodynamic instability. Severe AKI was associated with decreased survival with favorable neurobehavioral outcome. Hypothermia did not decrease incidence of severe AKI post-IHCA.

KW - Acute kidney injury

KW - In-Hospital

KW - Post-Cardiac arrest

KW - Therapeutic hypothermia

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U2 - 10.1016/j.resuscitation.2020.12.023

DO - 10.1016/j.resuscitation.2020.12.023

M3 - Article

C2 - 33450335

AN - SCOPUS:85099646332

VL - 160

SP - 49

EP - 58

JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

ER -

Acute kidney injury after in-hospital cardiac arrest

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