Pediatric nephrologist-intensivist interaction in acute kidney injury

Abstract

Introduction: Acute Kidney Injury (AKI) in the Intensive Care Unit (ICU) have concepts of diagnosis and management have water balance as their main point of evaluation. In our ICU, from 2004 to 2012, the nephrologist’s participation was on demand only; and as of 2013 their participation became continuous in meetings to case discussion. The aim of this study was to establish how an intense nephrologist/intensivist interaction influenced the frequency of dialysis indication, fluid balance and pRIFLE classification during these two observation periods. Methods: Retrospective study, longitudinal evaluation of all children with AKI undergoing dialysis (2004 to 2016). Parameters studied: frequency of indication, duration and volume of infusion in the 24 hours preceding dialysis; diuresis and water balance every 8 hours. Non-parametric statistics, p ≤ 0.05. Results: 53 patients (47 before and 6 after 2013). There were no significant differences in the number of hospitalizations or cardiac surgeries between the periods. After 2013, there was a significant decrease in the number of indications for dialysis/year (5.85 vs. 1.5; p = 0.000); infusion volume (p = 0.02), increase in the duration of dialysis (p = 0.002) and improvement in the discrimination of the pRIFLE diuresis component in the AKI development. Conclusion: Integration between the ICU and pediatric nephrology teams in the routine discussion of cases, critically approaching water balance, was decisive to improve the management of AKI in the ICU.

Educação e conscientização na injúria renal aguda em crianças: um apelo à ação

“…Ferrari et al 6 analisaram retrospectivamente como a interação entre nefrologistas pediátricos e intensivistas influenciou a frequência da indicação de diálise, a classificação do equilíbrio hídrico e o pRIFLE em dois períodos sequenciais de observação (antes e depois de 2013) em uma unidade de terapia intensiva pediátrica terciária no Brasil. A principal intervenção foi a discussão periódica de casos pelo nefrologista pediátrico e a discussão de tópicos comuns relacionados à IRA e ao nefrointensivismo.…”

“…Um dos principais méritos do trabalho de Ferrari et al 6 é aumentar a conscientização sobre a escassez de estudos acerca do impacto dos nefrologistas pediátricos e da interação com os intensivistas. Goldstein et al 4 destacaram a falta de pesquisas sobre os efeitos de iniciativas de educação voltadas para o público, pacientes e profissionais sobre a IRA.…”

Education and advocacy in acute kidney injury in children: a call for action

“…Ferrari et al 6 retrospectively analyzed how the interaction between pediatric nephrologists and intensivists influenced the frequency of dialysis indication, fluid balance grading, and pRIFLE over 2 sequential observation periods (before and after 2013) in a tertiary pediatric intensive care unit in Brazil. The main intervention was discussion of cases by the pediatric nephrologist on a regular basis and discussion of common topics regarding AKI and nephrointensivism.…”

“…A major merit of the work by Ferrari et al 6 is to raise awareness of the paucity of studies about the impact of pediatric nephrologists and interaction with intensivists. Goldstein et al 4 highlighted a lack of research on the effects of education initiatives aimed at the public, patients, and professionals on AKI.…”