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Community Acquired AKI

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By Isabel Acosta-Ochoa Nephrology senior staff. Valladolid. Spain
David G Warnock
Acute Kidney Injury (AKI) is associated with short- and long-term outcomes that reflect the severity of the injury. Recent studies have suggested that 'early' initiation of renal replacement therapy may alter the course of AKI and improve short-term outcomes like inpatient mortality. The current Kidney Disease Improving Global Outcomes (KDIGO) consensus definition of AKI has been criticized for misclassification bias, lack of sensitivity and the static manner in which AKI stages are defined. This editorial reviews various approaches to improving the specificity and sensitivity of the KDIGO AKI criteria, and also concludes that a staging system based on creatinine trajectories would be better suited for developing a prognostic index for real-time, dynamic risk assessment that the current KDIGO staging criteria...
May 1, 2017: Nephrology, Dialysis, Transplantation
Macaulay Amechi Chukwukadibia Onuigbo, Nneoma Agbasi
Acute kidney injury (AKI) is a relatively common complication of cardiothoracic surgery and has both short- and long-term survival implications, even when AKI does not progress to severe renal failure. Given that currently, there are no active effective treatments for AKI, other than renal replacement therapy when indicated, the focus of clinicians ought to be on prevention and risk factor management. In the AKI-surgery literature, there exists this general consensus that intraoperative hypotension (IH) following hypotensive anesthesia (HA) or controlled hypotension (CH) in the operating room has no significant short-term and long-term impacts on renal function...
2015: Journal of Renal Injury Prevention
Xin Xu, Sheng Nie, Zhangsuo Liu, Chunbo Chen, Gang Xu, Yan Zha, Jing Qian, Bicheng Liu, Shuai Han, Anping Xu, Xing Xu, Fan Fan Hou
BACKGROUND AND OBJECTIVES: Comprehensive epidemiologic data on AKI are particularly lacking in Asian countries. This study sought to assess the epidemiology and clinical correlates of AKI among hospitalized adults in China. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a multicenter retrospective cohort study of 659,945 hospitalized adults from a wide range of clinical settings in nine regional central hospitals across China in 2013. AKI was defined and staged according to Kidney Disease Improving Global Outcomes criteria...
September 4, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Helen Hobbs, Paul Bassett, Toby Wheeler, Michael Bedford, Jean Irving, Paul E Stevens, Christopher K T Farmer
BACKGROUND: The significant impact Acute Kidney Injury (AKI) has on patient morbidity and mortality emphasizes the need for early recognition and effective treatment. AKI presenting to or occurring during hospitalisation has been widely studied but little is known about the incidence and outcomes of patients experiencing acute elevations in serum creatinine in the primary care setting where people are not subsequently admitted to hospital. The aim of this study was to define this incidence and explore its impact on mortality...
2014: BMC Nephrology
Tobias Dreischulte, Daniel R Morales, Samira Bell, Bruce Guthrie
Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with an increased risk of acute kidney injury (AKI) when used in triple combination with renin-angiotensin system inhibitors and diuretics, but previous research reported that NSAIDs in dual combinations with either renin-angiotensin system inhibitors or diuretics alone were not. However, earlier studies relied on hospital coding to define AKI, which may underestimate true risk. This nested case-control study characterized the risk of community-acquired AKI associated with NSAID use among 78,379 users of renin-angiotensin system inhibitors and/or diuretics, where AKI was defined as a 50% or greater increase in creatinine from baseline...
August 2015: Kidney International
Gang Xu, Paul Player, David Shepherd, Nigel J Brunskill
BACKGROUND: Acute kidney injury (AKI) is a serious and common problem that is associated with high mortality. Currently nearly all efforts at improving outcomes in AKI have been focused on secondary care. We now know that a large number of patients most likely develop the condition in primary care. To our knowledge there has been no previous attempts to approach this topic from the primary care perspective. AIM: To test the utility of novel informatics software to identify patients with AKI in the community...
February 2016: Journal of Nephrology
Erin N Frazee, Heather A Personett, Christina M Wood-Wentz, Vitaly Herasevich, John C Lieske, Kianoush B Kashani
BACKGROUND: Medication use in the intensive care unit (ICU) depends on creatinine-based glomerular filtration rate (GFR) estimates. Urine output deterioration may precede the creatinine rise resulting in delayed recognition of GFR reductions. Our objective was to quantify the disparity between estimated GFR (eGFR) and true GFR in ICU patients with hospital-acquired oligoanuric acute kidney injury (hAKI). METHODS: This single-center cohort study examined adults who met the Acute Kidney Injury Network stage III urine output criterion ≥48 hours after ICU admission...
April 2016: Journal of Pharmacy Practice
Mario Meola, Federico Nalesso, Ilaria Petrucci, Sara Samoni, Claudio Ronco
Approximately 70% of community-acquired cases of acute kidney injury are attributed to pre-renal causes. In most of these cases, the underlying kidney function may be normal, but decreased renal perfusion associated with low intravascular volume or decreased arterial pressure can determine a reduced glomerular filtration rate (GFR). Autoregulatory mechanisms can partially compensate renal perfusion reduction in order to maintain GFR. In patients with pre-existing chronic kidney disease, however, these mechanisms are impaired, and the susceptibility to develop acute-on-chronic renal failure is higher...
2016: Contributions to Nephrology
Nicholas M Selby
No abstract text is available yet for this article.
April 9, 2018: Nephrology, Dialysis, Transplantation
Erika O Bernardo, Andrea T Cruz, Gregory J Buffone, Sridevi Devaraj, Laura L Loftis, Ayse Akcan Arikan
OBJECTIVES: Acute kidney injury (AKI) is a significant risk factor for morbidity and mortality in children. Little is known about community-acquired AKI (CA-AKI) in the pediatric emergency department (PED). Early recognition of AKI allows for nephroprotective measures. The goal of this investigation was to determine the incidence of CA-AKI and the frequency of clinician identified CA-AKI to better inform future nephroprotective interventions. METHODS: This was a retrospective cross-sectional study in the PED of a children's hospital...
April 6, 2018: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Jie-Qiong Liu, Guang-Yan Cai, Shuang Liang, Wen-Ling Wang, Si-Yang Wang, Fang-Lei Zhu, Sa-Sa Nie, Zhe Feng, Xiang-Mei Chen
PURPOSE OF THE STUDY: The incidence of acute kidney injury (AKI) with a poor prognosis in the elderly has been increasing each year. This study aimed to investigate the clinical characteristics of and risk factors for death from AKI in the elderly and help improve prognosis. STUDY DESIGN: This study was a retrospective cohort study based on data from adult patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of AKI in the elderly were compared with those in younger patients...
May 2018: Postgraduate Medical Journal
Muhammad Faisal, Andy Scally, Musab Ahmed Elgaali, Donald Richardson, Kevin Beatson, Mohammed A Mohammed
Hospital-acquired acute kidney injury (H-AKI) is a common cause of avoidable morbidity and mortality. Therefore , in the current study, we investigated whether vital signs data from patients, as defined by a National Early Warning Score (NEWS), can predict H-AKI following emergency admission to hospital. We analysed all emergency admissions (n=33,608) to York Hospital with NEWS data over a 24-month period. Here, we report the area under the curve (AUC) for logistic regression models that used the index NEWS (model A0), plus age and sex (A1), plus subcomponents of NEWS (A2) and two-way interactions (A3), and similarly for maximum NEWS (models B0,B1,B2,B3)...
February 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
Jennifer Holmes, Timothy Rainer, John Geen, John D Williams, Aled O Phillips
Background: Increased mortality related to differences in delivery of weekend clinical care is the subject of much debate. Aims: We compared mortality following detection of AKI on week and weekend days across community and hospital settings. Design. A prospective national cohort study, with AKI identified using the Welsh National electronic AKI reporting system. Methods: Data was collected on outcome for all cases of adult AKI in Wales between 1st November 2013 and 31st January 2017...
January 17, 2018: QJM: Monthly Journal of the Association of Physicians
Charat Thongprayoon, Wisit Cheungpasitporn, Michael A Mao, Ankit Sakhuja, Stephen B Erickson
BACKGROUND: The risk of acute kidney injury (AKI) development among hospitalised patients with elevated calcium levels on admission remains unclear. The aim of this study was to assess the risk of AKI in hospitalised patients stratified by various admission serum calcium levels. METHODS: This is a single-centre retrospective study conducted at a tertiary referral hospital. All hospitalised adult patients who had admission calcium levels available between 2009 and 2013 were enrolled...
January 5, 2018: International Journal of Clinical Practice
Fabien Stucker, Belen Ponte, Victoria De la Fuente, Cyrielle Alves, Olivier Rutschmann, Sebastian Carballo, Nicolas Vuilleumier, Pierre-Yves Martin, Thomas Perneger, Patrick Saudan
BACKGROUND: We aimed to describe clinical characteristics of patients with community-acquired acute kidney injury (CA-AKI), the effectiveness of initial management of CA-AKI, its prognosis and the impact of medication on its occurrence in patients with previous chronic kidney injury (CKI). METHODS: We undertook a prospective observational study within the Emergency Department (ED) of a University Hospital, screening for any patient >16 years admitted with an eGFR <60 ml/mn/1...
December 29, 2017: BMC Nephrology
Abdullah H Almalki, Sherine E Ismail, Mohammad A Qureshi, Zuhair Abunijem, Mohamed E Balla, Saliman Karsou, Rehan A Qureshi, Akram Ahmad, Salhah AlSulami, Maryam Khalil, Jani Hafez, Jane E H Thomson, Muhammad A Siddiqui, Oyindamola B Yusuf, Zeyad A Zahrani, Abdulhameed Gasim, K H Mujtaba Quadri
Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial...
November 2017: Saudi Journal of Kidney Diseases and Transplantation
Chien-Ning Hsu, Hsiao-Ling Chen, You-Lin Tain
BackgroundHospital-acquired acute kidney injury (HA-AKI) is associated with an increased risk of childhood mortality; however, only a few studies have addressed community-acquired AKI (CA-AKI).MethodsAKI network classification was used to assess CA- and HA-AKI, 2010-2014. Patients with CA-AKI who were admitted to an inpatient setting were categorized as CAA-AKI. CANA-AKI was for CA-AKI not admitted to inpatient care. Epidemiology, factors associated with AKI, and in-hospital outcomes were assessed for variation...
March 2018: Pediatric Research
Jennifer Holmes, Gethin Roberts, John Geen, Alan Dodd, Nicholas M Selby, Andrew Lewington, Gareth Scholey, John D Williams, Aled O Phillips
BACKGROUND: Electronic AKI alerts highlight changes in serum creatinine compared to the patient's own baseline. Our aim was to identify all AKI alerts and describe the relationship between electronic AKI alerts and outcome for AKI treated in the Intensive Care Unit (ICU) in a national multicentre cohort. METHODS: A prospective cohort study was undertaken between November 2013 and April 2016, collecting data on electronic AKI alerts issued. RESULTS: 10% of 47,090 incident AKI alerts were associated with ICU admission...
April 2018: Journal of Critical Care
Jennifer Holmes, Gethin Roberts, Soma Meran, John D Williams, Aled O Phillips
Introduction: Automated acute kidney injury (AKI) electronic alerts are based on comparing creatinine with historic results. Methods: We report the significance of AKI defined by 3 "rules" differing in the time period from which the baseline creatinine is obtained, and AKI with creatinine within the normal range. Results: A total of 47,090 incident episodes of AKI occurred between November 2013 and April 2016. Rule 1 (>26 μmol/l increase in creatinine within 48 hours) accounted for 9...
May 2017: KI Reports
Yu Pan, Wenji Wang, Jinwei Wang, Li Yang, Feng Ding
This study aimed to describe the mortality and risk factors of in-hospital mortality from acute kidney injury (AKI) after non-cardiovascular operation in China based on a nationwide survey about AKI. The study sample was drawn from ISN AKF 0by25 China Consortiums, which is a nationwide, cross-sectional survey from 22 provinces in mainland China. AKI after non-cardiovascular operation was identified according to the 2012 KDIGO AKI creatinine criteria or expanded criteria. In total, 3468 cases were identified as hospital-acquired AKI (HA-AKI)...
October 24, 2017: Scientific Reports
2017-10-29 22:24:33
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