Teixeira, J Pedro
Mayo Clinic
Divisions of Nephrology and Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico.
Citations 2
Association of Hepatorenal Syndrome-Acute Kidney Injury with Mortality in Patients with Cirrhosis Requiring Renal Replacement Therapy
Cama-Olivares, Augusto , Ouyang, Tianqi , Takeuchi, Tomonori , Hillien, Shelsea A. St., Robinson, Jevon E. , Cullaro, Giuseppe , Karvellas, Constantine , Levitsky, Josh , Orman, Eric S. , Patidar, Kavish R. , Regner, Kevin R. , Saly, Danielle L. , Teixeira, J. Pedro , Velez, Juan Carlos Q. , Wahid, Nabeel , Allegretti, Andrew S. , Neyra, Javier A. , Belcher, Justin M. , Cullaro, Giuseppe , Karvellas, Constantine , Orman, Eric S , Sawinski, Deirdre , Teixeira, J Pedro , Ufere, Nneka N , Velez, Juan Carlos Q , Wadei, Hani M , Wahid, Nabeel , Neyra, Javier A , Belcher, Justin M , Patidar, Kavish R , Chung, Raymond T. , Sharma, Pratima , Wadei, Hani M.
Kidney360 | September 30, 2024 | Volume: 6 | Issue: 2 | Pages: 247-256
Key Points In patients with cirrhosis and AKI requiring renal replacement therapy (RRT), hepatorenal syndrome-AKI was not associated with an increased 90-day mortality when compared with other AKI etiologies. Etiology of AKI may not be a critical factor regarding decisions to trial RRT in acutely ill patients with cirrhosis and AKI. Although elevated, mortality rates in this study are comparable with those reported in general hospitalized patients with AKI requiring RRT. Background While AKI requiring renal replacement therapy (AKI-RRT) is associated with increased mortality in heterogeneous inpatient populations, the epidemiology of AKI-RRT in hospitalized patients with cirrhosis is not fully known. Herein, we evaluated the association of etiology of AKI with mortality in hospitalized patients with cirrhosis and AKI-RRT in a multicentric contemporary cohort. Methods This is a multicenter retrospective cohort study using data from the HRS-HARMONY consortium, which included 11 US hospital network systems. Consecutive adult patients admitted in 2019 with cirrhosis and AKI-RRT were included. The primary outcome was 90-day mortality, and the main independent variable was AKI etiology, classified as hepatorenal syndrome (HRS-AKI) versus other (non–HRS-AKI). AKI etiology was determined by at least two independent adjudicators. We performed Fine and Gray subdistribution hazard analyses adjusting for relevant clinical variables. Results Of 2063 hospitalized patients with cirrhosis and AKI, 374 (18.1%) had AKI-RRT. Among them, 65 (17.4%) had HRS-AKI and 309 (82.6%) had non–HRS-AKI, which included acute tubular necrosis in most cases (62.6%). Continuous renal replacement therapy was used as the initial modality in 264 (71%) of patients, while intermittent hemodialysis was used in 108 (29%). The HRS-AKI (versus non–HRS-AKI) group received more vasoconstrictors for HRS management (81.5% versus 67.9%), whereas the non–HRS-AKI group received more mechanical ventilation (64.3% versus 50.8%) and more continuous renal replacement therapy (versus intermittent hemodialysis) as the initial RRT modality (73.9% versus 56.9%). In the adjusted model, HRS-AKI (versus non–HRS-AKI) was not independently associated with increased 90-day mortality (subdistribution hazard ratio, 1.36; 95% confidence interval, 0.95 to 1.94). Conclusions In this multicenter contemporary cohort of hospitalized adult patients with cirrhosis and AKI-RRT, HRS-AKI was not independently associated with an increased risk of 90-day mortality when compared with other AKI etiologies. The etiology of AKI appears less relevant than previously considered when evaluating the prognosis of hospitalized adult patients with cirrhosis and AKI requiring RRT.
Efficacy and Safety of Remdesivir in People With Impaired Kidney Function Hospitalized for COVID-19 Pneumonia: A Randomized Clinical Trial
Sise, Meghan E. , Santos, José Ramón, Goldman, Jason D. , Tuttle, Katherine R, Teixeira, J. Pedro , Seibert, A. F., Koullias, Yiannis , Llewellyn, Joe , Zhao, Yang , Hyland, Robert H. , Osinusi, Anu, Winter, Helen , Humeniuk, Rita , Hulter, Henry N., Gottlieb, Robert , Fusco, Dahlene N. , Birne, Rita , Small, Catherine B. , Plate, Markus, McPhail, Mark , Investigators, for the REDPINE, Ballesteros, Rosa , Malheiro, Luís , Silva, Gil, Correia, João Paulo , Vida, Ana Carlota, Silva, André, Carujo, Antonio, Fernandez, Jordi Carratala, Cruzado, Josep M. , Sandoval, Diego , Gimeno, Fransesc Puchades, Gómez‐Muñoz, Neus, Roma, María Martínez, Gallego, Juan Horcajada, Pablo, Castañeda, Silvia, Padilla Urrea, Sergio, Rial Crestelo, David, Santos Fernandez, Jose, Ramon, Benet, Susanna, Benítez, Rosa, Bracke, Carmen, Chamorro, Anna, Graterol, Fredzzia, Lladós, Gemma , Mateu, Lourdes , Rebollo, Boris, Romero, Alba , Soldevila, Laura , Abad, Elena, José, Alba San, Viladomiu, Alex Soriano, Abolnik, Igor Z., Acharya, Anjali , Allen, Leland, Bellovich, Keith, Burton, Mary Jane , Cameron, Miriam L., Criner, Gerard J., Criner, Lii-Yoong H, Lambert, Joseph, Rashid, Marium, Shore-Brown, Heidi, Diaz, George A., Dougherty, David W. , Erdmann, Nathaniel, Berrington, William R., Logar, Christine M., Vadivel, Nidyanandh, Everett, Allison, Lourdes, Gonzalez Suarez Maria, Berhe, Mezgebe , Colbert, Gates B. , Hebert, Christopher, Mehta, Ankit , Spak, Cedric W. , Estrada, Lorie, Vargas, Richard, Pham, Alex, Mason, Lynn, Tallmadge, Catherine, Braddom, Ariana, Nicholas, Melissa, Jamil, Aayla K. , McAllister, Ashley , Guerra, Christina, Sam, Teena , Solis, Edilia, Goyal, Munish, Laurence, Brett, Malhotra, Vinay , Manrique, Luis, McKinnell, James A., McMahon, Blaithin A. , Campbell, Ruth , Morse, Caryn G. , Navarro, Jesús, Ostrosky, Luis, Patel, Bela , Grimes, Carolyn Z. , Hernández, María , Mammadova, Mehriban, Nielsen, Laura, Umana, Virginia, Pusch, Tobias, Schrager, Harry, Mallada, Jason, Siegel, Marc , Slim, Jihad , Apodaca, Krystle D., Harkins, Michelle , Cunningham, Amy, Tuttle, Katherine R, Criner, Gerard J. , Tuttle, Katherine R. , Tuttle, Katherine R , Gottlieb, Robert L , Criner, Gerard , Teixeira, J Pedro , Tuttle, Katherine R, Regan, S. P. , Huang, Hailin , Stancampiano, Fernando F. , Libertin, Claudia R. , Investigators, for the REDPINE, Belhassen‐García, Moncef , Abelenda-Alonso, Gabriela , Rombauts, Alexander , Deltoro, Miguel García , España, Sergio, López, C. , Paredes, Roger , Viladomiu, Alex Soriano, Medjeral‐Thomas, Nicholas , Lobo, Suzana Margareth , Allen, Leland, Lambert, Joseph, Dougherty, David, Hebert, Christopher, Choe, Jennifer, McAllister, Ashley, Gotur, Deepa Bangalore , Koraishy, Farrukh M. , Malhotra, Vinay, Robinson, Philip Alan , Sanyal, Arun J. , Sriram, Peruvemba , Cunningham, Amy G, Tuttle, Katherine R
Clinical Infectious Diseases | June 24, 2024 | Volume: 79 | Issue: 5 | Pages: 1172-1181
Abstract Background Few antiviral therapies have been studied in patients with coronavirus disease 2019 (COVID-19) and kidney impairment. Herein, the efficacy, safety, and pharmacokinetics of remdesivir, its metabolites, and sulfobutylether-β-cyclodextrin excipient were evaluated in hospitalized patients with COVID-19 and severe kidney impairment. Methods In REDPINE, a phase 3, randomized, double-blind, placebo-controlled study, participants aged ≥12 years hospitalized for COVID-19 pneumonia with acute kidney injury, chronic kidney disease, or kidney failure were randomized 2:1 to receive intravenous remdesivir (200 mg on day 1; 100 mg daily up to day 5) or placebo (enrollment from March 2021 to March 2022). The primary efficacy end point was the composite of the all-cause mortality rate or invasive mechanical ventilation rate through day 29. Safety was evaluated through day 60. Results Although enrollment concluded early, 243 participants were enrolled and treated (remdesivir, n = 163; placebo, n = 80). At baseline, 90 participants (37.0%) had acute kidney injury (remdesivir, n = 60; placebo, n = 30), 64 (26.3%) had chronic kidney disease (remdesivir, n = 44; placebo, n = 20), and 89 (36.6%) had kidney failure (remdesivir, n = 59; placebo, n = 30); and 31 (12.8%) were vaccinated against COVID-19. Composite all-cause mortality or invasive mechanical ventilation rates through day 29 were 29.4% and 32.5% in the remdesivir and placebo group, respectively (P = .61). Treatment-emergent adverse events were reported in 80.4% for remdesivir versus 77.5% for placebo, and serious adverse events in 50.3% versus 50.0%, respectively. Pharmacokinetic plasma exposure to remdesivir was not affected by kidney function. Conclusions Although the study was underpowered, no significant difference in efficacy was observed between treatment groups. REDPINE demonstrated that remdesivir is safe in patients with COVID-19 and severe kidney impairment. Clinical Trials Registration EudraCT 2020-005416-22; Clinical Trials.gov NCT04745351.