Acute kidney injury: outcomes and quality of care

Aitken, Emma; Carruthers, C.; Gall, Le; Kerr, Lynne M.; Geddes, Colin C.; Kingsmore, David

doi:10.1093/qjmed/hcs237

Cited by 102 publications

(97 citation statements)

References 29 publications

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“…We compared this cohort with 334 patients who sustained AKI during a hospital stay. The incidence of CA-AKI was higher in the present study than in other studies (9,(20)(21)(22)(23). However, this probably remains an underestimate of the true amount of CA-AKI that exists because numerous patients with CA-AKI will neither have blood tests performed nor be admitted to the hospital.…”

Section: Discussioncontrasting

confidence: 73%

“…Two of these studies, based in Brazil and China, had less than a third of the patient numbers presented here (27,28). The causes of AKI, as well as the prevalence of various comorbid conditions in these studies, probably differ from those present in our (22,23). A recent meta-analysis of world AKI incidence found an inverse correlation of AKI-associated mortality and percentage of country gross domestic product spent on health expenditure.…”

Section: Discussionmentioning

confidence: 70%

“…The reasons for these differences remain unclear. Interestingly, a study performed in Scotland demonstrated that inadequacies in recognition and management of hospital-based AKI were particularly high in patients with mild AKI (23). Thus, more severe CA-AKI may have been more appropriately managed, leading to better outcomes.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

252

245

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Background and objective Compared with AKI in hospitalized patients, little is known about patients sustaining AKI in the community and how this differs from AKI in hospital. This study compared epidemiology, risk factors, and short-and long-term outcomes for patients with community-acquired (CA) and hospital-acquired (HA) AKI.Design, setting, participants, & measurements A total of 15,976 patients admitted to two district general hospitals between July 11, 2011, and January 15, 2012 were studied. Through use of an electronic database and the AKI Network classification, 686 patients with CA-AKI and 334 patients with HA-AKI were identified. Patients were followed up for 14 months, and data were collated on short-term and long-term renal and patient outcomes.Results The incidence of CA-AKI among all hospital admissions was 4.3% compared with an incidence of 2.1% of HA-AKI, giving an overall AKI incidence of 6.4%. Patients with CA-AKI were younger than patients with HA-AKI. Risks for developing HA and CA-AKI were similar and included preexisting CKD, cardiac failure, ischemic heart disease, hypertension, diabetes, dementia, and cancer. Patients with CA-AKI were more likely to have stage 3 AKI and had shorter lengths of hospital stay than patients with HA-AKI. Those with CA-AKI had better (multivariate-adjusted) survival than patients with HA-AKI (hazard ratio, 1.8 [95% CI, 1.44-2.13; P,0.001] for HA-AKI group). Mortality for the CA-AKI group was 45%; 43.7% of these deaths were acute inhospital deaths. Mortality for the HA-AKI group was 62.9%, with 68.1% of these deaths being acute in-hospital deaths. Renal referral rates were low across the cohorts (8.3%). Renal outcomes were similar in both CA-AKI and HA-AKI groups, with 39.4% and 33.6% of patients in both groups developing de novo CKD or progression of preexisting CKD within 14 months, respectively. ConclusionPatients with CA-AKI sustain more severe AKI than patients with HA-AKI. Despite having risk factors similar to those of patients with HA-AKI, patients with CA AKI have better short-and long-term outcomes.

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Section: Discussioncontrasting

confidence: 73%

Section: Discussionmentioning

confidence: 70%

See 1 more Smart Citation

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Wonnacott

Meran

Amphlett

et al. 2014

Clinical Journal of the American Society of Nephrology

252

245

View full text Add to dashboard Cite

show abstract

“…Although we did not find a significant difference, a larger study that also looked at all cases of AKI within a large UK hospital, and with comparable rates of AKI recognition and some management parameters, found a significantly higher mortality rate in 'hospital-acquired' than 'community-acquired' AKI. 14 Clearly, more in-depth work is necessary to better understand the factors that may have contributed to the lack of improvement in all areas and limited optimal management of all AKI patients. There are several potential reasons: in the UK, there is a high staff turnover of junior medical staff, especially in larger teaching hospitals.…”

Section: Discussionmentioning

confidence: 99%

Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

et al. 2015

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“…In the United Kingdom, AKI affects up to 15% of hospital admissions and 20% of emergency admissions 2, 3 . AKI may result in fluid overload, respiratory failure and metabolic derangements such as hyperkalaemia 4 , and is thus strongly associated with adverse outcomes including death 5 , prolonged hospitalisation 6 , requirement for renal replacement therapy 7 , and a need for high dependency or intensive care 8 . It is also associated with an increased lifetime risk of chronic kidney disease 9 .…”

Section: Introductionmentioning

confidence: 99%

Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury

et al. 2017

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Acute Kidney Injury (AKI), an abrupt deterioration in kidney function, is defined by changes in urine output or serum creatinine. AKI is common (affecting up to 20% of acute hospital admissions in the United Kingdom), associated with significant morbidity and mortality, and expensive (excess costs to the National Health Service in England alone may exceed £1 billion per year). NHS England has mandated the implementation of an automated algorithm to detect AKI based on changes in serum creatinine, and to alert clinicians. It is uncertain, however, whether ‘alerting’ alone improves care quality. We have thus developed a digitally-enabled care pathway as a clinical service to inpatients in the Royal Free Hospital (RFH), a large London hospital. This pathway incorporates a mobile software application - the “Streams-AKI” app, developed by DeepMind Health - that applies the NHS AKI algorithm to routinely collected serum creatinine data in hospital inpatients. Streams-AKI alerts clinicians to potential AKI cases, furnishing them with a trend view of kidney function alongside other relevant data, in real-time, on a mobile device. A clinical response team comprising nephrologists and critical care nurses responds to these AKI alerts by reviewing individual patients and administering interventions according to existing clinical practice guidelines. We propose a mixed methods service evaluation of the implementation of this care pathway. This evaluation will assess how the care pathway meets the health and care needs of service users (RFH inpatients), in terms of clinical outcome, processes of care, and NHS costs. It will also seek to assess acceptance of the pathway by members of the response team and wider hospital community. All analyses will be undertaken by the service evaluation team from UCL (Department of Applied Health Research) and St George’s, University of London (Population Health Research Institute).

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Acute kidney injury: outcomes and quality of care

Cited by 102 publications

References 29 publications

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Epidemiology and Outcomes in Community-Acquired Versus Hospital-Acquired AKI

Recognition and management of acute kidney injury in hospitalised patients can be partially improved with the use of a care bundle

Service evaluation of the implementation of a digitally-enabled care pathway for the recognition and management of acute kidney injury

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