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Bagshaw, Sean M.; Laupland, Kevin B.; Doig, Christopher J.; Mortis, Garth; Fick, Gordon H.; Mucenski, Melissa; Godinez-Luna, Tomas; Svenson, Lawrence W.; Rosenal, Tom

doi:10.1186/cc3879

Cited by 526 publications

(176 citation statements)

References 41 publications

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“…[3][4][5] Despite substantial advances in renal replacement therapy and health care delivery, morbidity and mortality rates associated with AKI have remained high. However, our current understanding of the epidemiology of AKI and its impact on morbidity, mortality, cost of medical care, and development of Chronic Kidney Disease (CKD) is based almost exclusively on studies of patients who developed AKI while hospitalized (HA-AKI).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

Bardai¹,

Kabbali²,

Najdi³

et al. 2015

Nephrol Open J

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Section: Introductionmentioning

confidence: 99%

Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

Bardai¹,

Kabbali²,

Najdi³

et al. 2015

Nephrol Open J

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“…1,4,[46][47][48][49][50][51][52][53][54][55][56] Despite the trend of lower mortality in recent years, AKI still remains an important negative prognostic factor, particularly in critically ill patients. Even small isolated increases in serum creatinine levels have an associated increase in short-term morbidity and mortality and in longer-term outcomes, including 1-year mortality; 38,48,[57][58][59][60][61][62] this is even more the case when RRT is required. 5,6,13,34,63 A study from the Medicare Sample Beneficiary Analytical File from 1992 to 2001 found that patients with AKI who required RRT had an in-hospital mortality rate of 32.9%, compared with 27.5% in patients with AKI not requiring RRT, and 4.6% in patients without AKI.…”

Section: Outcomes Of Acute Kidney Injurymentioning

confidence: 99%

“…CKD or comorbid conditions leading to CKD are risk factors that predict dialysis dependence following AKI. 61,62 Wald et al 72 looked at outcomes of chronic dialysis and death in AKI patients requiring in-hospital dialysis who survived free of dialysis for at least 30 days after discharge, from a 10-year cohort of all adult patients in Ontario, Canada. Patients with AKI were three times more likely than those without AKI to require chronic dialysis.…”

Section: Outcomes Of Acute Kidney Injurymentioning

confidence: 99%

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

Bedford

Stevens

Coulton

et al. 2016

Health Serv Deliv Res

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BackgroundAcute kidney injury (AKI) is a common clinical problem with significant morbidity and mortality. All hospitalised patients are at risk. AKI is often preventable and reversible; however, the 2009 National Confidential Enquiry into Patient Outcome and Death highlighted systematic failings of identification and management, and recommended risk assessment of all emergency admissions.ObjectivesTo develop three predictive models to stratify the risk of (1) AKI on arrival in hospital; (2) developing AKI during admission; and (3) worsening AKI if already present; and also to (4) develop a clinical algorithm for patients admitted to hospital and explore effective methods of delivery of this information at the point of care.Study designQuantitative methodology (1) to formulate predictive risk models and (2) to validate the models in both our population and a second population. Qualitative methodology to plan clinical decision support system (CDSS) development and effective integration into clinical care.Settings and participantsQuantitative analysis – the study population comprised hospital admissions to three acute hospitals of East Kent Hospitals University NHS Foundation Trust in 2011, excluding maternity and elective admissions. For validation in a second population the study included hospital admissions to Medway NHS Foundation Trust. Qualitative analysis – the sample consisted of six renal consultants (interviews) and six outreach nurses (focus group), with representation from all sites.Data collectionData (comprising age, sex, comorbidities, hospital admission and outpatient history, relevant pathology tests, drug history, baseline creatinine and chronic kidney disease stage, proteinuria, operative procedures and microbiology) were collected from the hospital data warehouse and the pathology and surgical procedure databases.Data analysisQuantitative – both traditional and Bayesian regression methods were used. Traditional methods were performed using ordinal logistic regression with univariable analyses to inform the development of multivariable analyses. Backwards selection was used to retain only statistically significant variables in the final models. The models were validated using actual and predicted probabilities, an area under the receiver operating characteristic (AUROC) curve analysis and the Hosmer–Lemeshow test. Qualitative – content analysis was employed.Main outcome measures(1) A clinical pratice algorithm to guide clinical alerting and risk modeling for AKI in emergency hospital admissions; (2) identification of the key variables that are associated with the risk of AKI; (3) validated risk models for AKI in acute hospital admissions; and (4) a qualitative analysis providing guidance as to the best approach to the implementation of clinical alerting to highlight patients at risk of AKI in hospitals.FindingsQuantitative – we have defined a clinical practice algorithm for risk assessment within the first 24 hours of hospital admission. Bayesian methodology enabled prediction of low risk but could not reliably identify high-risk patients. Traditional methods identified key variables, which predict AKI both on admission and at 72 hours post admission. Validation demonstrated an AUROC curve of 0.75 and 0.68, respectively. Predicting worsening AKI during admission was unsuccessful. Qualitative – analysis of AKI alerting gave valuable insights in terms of user friendliness, information availability, clinical communication and clinical responsibility, and has informed CDSS development.ConclusionsThis study provides valuable evidence of relationships between key variables and AKI. We have developed a clinical algorithm and risk models for risk assessment within the first 24 hours of hospital admission. However, the study has its limitations, and further analysis and testing, including continuous modelling, non-linear modelling and interaction exploration, may further refine the models. The qualitative study has highlighted the complexity regarding the implementation and delivery of alerting systems in clinical practice.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Recent studies would suggest the incidence is far greater than previously appreciated. Observational data have shown that AKI occurs in an estimated 36–67% of all ICU patients [1,2,3], while AKI severe enough to warrant commencement of renal replacement therapy (RRT) occurs in 4–6% [4,5,6]. Moreover, numerous investigations have now shown the incidence of AKI continues to rise [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, numerous investigations have now shown the incidence of AKI continues to rise [7,8,9]. This high and increasing burden of AKI also remains associated with an unacceptably high morbidity and mortality [5, 6,8,9,10,11,12]. …”

Section: Introductionmentioning

confidence: 99%

New Insights on Intravenous Fluids, Diuretics and Acute Kidney Injury

Townsend¹,

Bagshaw²

2008

Nephron Clin Pract

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Acute kidney injury (AKI) is commonly and increasingly encountered in patients with critical illness. Fluid therapy is the cornerstone for the prevention and management of critically ill patients with AKI. New data have emerged that have raised concern that specific types of fluid (i.e. hydroxyethylstarch) may either contribute to or exacerbate AKI. Additional data have accumulated to indicate that the unnecessary accumulation of fluid and volume overload can negatively impact clinical outcomes. This finding may be further compounded in patients with oliguric AKI where solute and free water elimination are impaired. Diuretic therapy in AKI remains controversial. However, diuretic use is common, despite a paucity of evidence to show improved clinical outcomes. There are few therapeutic interventions proven to impact the clinical course and outcome of critically ill patients with established AKI. Current management strategies center largely on supportive care, with rapid resuscitation, removal of the stimulus contributing to AKI, judicious avoidance of complications, and allowing time for recovery. In this review, we explore recent insights on intravenous fluid therapy, volume overload, and diuretic therapy in the context of the critically ill patients with AKI.

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Abstract: Introduction Severe acute renal failure (sARF) is associated with considerable morbidity, mortality and use of healthcare resources; however, its precise epidemiology and long-term outcomes have not been well described in a non-specified population.

Cited by 526 publications

References 41 publications

Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

Comparison of Hospital-Acquired and Community-Acquired Acute Kidney Injury in Hospitalized Patients

Development of risk models for the prediction of new or worsening acute kidney injury on or during hospital admission: a cohort and nested study

New Insights on Intravenous Fluids, Diuretics and Acute Kidney Injury

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