{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T22:16:37Z","timestamp":1782944197801,"version":"3.54.5"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T00:00:00Z","timestamp":1684800000000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,29]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Acute kidney injury (AKI) requiring renal replacement therapy (RRT) in the intensive care unit (ICU) portends a poor prognosis. We aimed to better characterize predictors of survival and the mechanism of kidney failure in these patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This was a retrospective observational study using clinical and radiological electronic health records, analysed by univariable and multivariable binary logistic regression. Histopathological examination of post-mortem renal tissue was performed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 157 patients with AKI requiring RRT, higher serum creatinine at RRT initiation associated with increased ICU survival [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.17\u20130.62, P\u00a0=\u00a0.001]; however, muscle mass (a marker of frailty) interacted with creatinine (P\u00a0=\u00a0.02) and superseded creatinine as a predictor of survival (OR 0.26, 95% CI 0.08\u20130.82; P\u00a0=\u00a0.02). Achieving lower cumulative fluid balance (mL\/kg) predicted ICU survival (OR 1.01, 95% CI 1.00\u20131.01, P\u00a0&amp;lt;\u00a0.001), as supported by sensitivity analyses showing improved ICU survival with the use of furosemide (OR 0.40, 95% CI 0.18\u20130.87, P\u00a0=\u00a0.02) and increasing net ultrafiltration (OR 0.97, 95% CI 0.95\u20130.99, P\u00a0=\u00a0.02). A urine output of &amp;gt;500 mL\/24 h strongly predicted successful liberation from RRT (OR 0.125, 95% CI 0.05\u20130.35, P\u00a0&amp;lt;\u00a0.001). Post-mortem reports were available for 32 patients; clinically unrecognized renal findings were described in 6 patients, 1 of whom had interstitial nephritis. Experimental staining of renal tissue from patients with sepsis-associated AKI (S-AKI) showed glomerular loss of synaptopodin (P\u00a0=\u00a0.02).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Confounding of creatinine by muscle mass undermines its use as a marker of AKI severity in clinical studies. Volume management and urine output are key determinants of outcome. Loss of synaptopodin implicates glomerular injury in the pathogenesis of S-AKI.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ckj\/sfad113","type":"journal-article","created":{"date-parts":[[2023,5,23]],"date-time":"2023-05-23T11:15:40Z","timestamp":1684840540000},"page":"1664-1673","source":"Crossref","is-referenced-by-count":9,"title":["Critically ill patients with acute kidney injury: clinical determinants and post-mortem histology"],"prefix":"10.1093","volume":"16","author":[{"given":"Patrick James","family":"Gleeson","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels , Belgium"},{"name":"Universit\u00e9 de Paris Cit\u00e9, INSERM UMR1149 & CNRS EMR8252, Centre de Recherche sur l'Inflammation, Inflamex Laboratory of Excellence , Paris , France"},{"name":"Department of Renal Medicine, Cork University Hospital , Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria Alice","family":"Crippa","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels , Belgium"},{"name":"Department of Anesthesiology, San Marco Hospital, San Donato Group , Zingonia , Bergame, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aur\u00e9lie","family":"Sannier","sequence":"additional","affiliation":[{"name":"AP-HP, Nord\/Universit\u00e9 de Paris, H\u00f4pital Bichat-Claude Bernard, Service d'Anatomie-Pathologique , Paris , France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Koopmansch","sequence":"additional","affiliation":[{"name":"Department of Pathology, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels, Belgium"},{"name":"Institut de Pathologie et de G\u00e9n\u00e9tique , Avenue George Lema\u00eetre, Gosselies , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Bienfait","sequence":"additional","affiliation":[{"name":"Department of Pathology, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justine","family":"Allard","sequence":"additional","affiliation":[{"name":"DIAPath, Center for Microscopy and Molecular Imaging, Universit\u00e9 Libre de Bruxelles , Gosselies , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donal J","family":"Sexton","sequence":"additional","affiliation":[{"name":"Trinity Health Kidney Center, Trinity College Dublin, Dublin , Ireland"},{"name":"Department of Nephrology, St James\u2019 Hospital , Dublin , Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito","family":"Fontana","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels , Belgium"},{"name":"Department of Intensive Care Medicine, Clinique Saint-Jean , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandrine","family":"Rorive","sequence":"additional","affiliation":[{"name":"Department of Pathology, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Louis","family":"Vincent","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Creteur","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles , Brussels , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio 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