Acute kidney injury: summary of NICE guidance

Ftouh, Saoussen; Thomas, Mark

doi:10.1136/bmj.f4930

Cited by 67 publications

(51 citation statements)

References 9 publications

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“…In our study, 40% of patients with CKD admitted to the emergency department had community‐acquired AKI. Although this rate is far higher than the incidence rate found in the largest study on community‐acquired AKI, this is likely explained by our selection criteria that focused our study on patients most susceptible to AKI who present with frequent comorbidities such as moderate to severe CKD, diabetes mellitus, arterial hypertension, and older age . Accordingly, the mean age of our cohort was 77 years, which is consistent with other epidemiologic studies on community‐acquired AKI .…”

Section: Discussionsupporting

confidence: 84%

“…In patients with CKD, RAS blockers are recommended mainly for both arterial hypertension and proteinuria to slow the rate of CKD progression . However, RAS blockers may induce acute kidney injury (AKI) in certain clinical situations such as dehydration or sepsis, which are frequently reported in elderly patients with CKD . In turn, AKI itself may hasten the progression of the underlying CKD by causing cell cycle arrest of tubular cells and the development of interstitial renal fibrosis .…”

Section: Dosing Of Most Prescribed Ace Inhibitors and Arbsmentioning

confidence: 99%

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Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Chaumont

Pourcelet

Nuffelen

et al. 2016

J of Clinical Hypertension

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In contrast to angiotensin receptor blockers (ARBs), mainly excreted by the liver, the dosage of angiotensin-converting enzyme (ACE) inhibitors, cleared by the kidney, must be adapted to account for renal clearance in patients with chronic kidney disease (CKD) to avoid acute kidney injury (AKI). Community-acquired AKI and the use of ACE inhibitors or ARBs in the emergency department were retrospectively assessed in 324 patients with baseline stage 3 or higher CKD. After stepwise regression analysis, the use of ACE inhibitors (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.1; P=.02) and the presence of dehydration (OR, 30.8; 95% CI, 3.9-239.1) were associated with AKI. A total of 45% of patients using ACE inhibitors experienced overdosing, which causes most of the excess risk of AKI. These results suggest that dosage adjustment of ACE inhibitors to renal function or substitution of ACE inhibitors with ARBs could reduce the incidence of AKI. Moreover, ACE inhibitors and ARBs should be stopped in cases of dehydration.

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Section: Discussionsupporting

confidence: 84%

Section: Dosing Of Most Prescribed Ace Inhibitors and Arbsmentioning

confidence: 99%

Acute Kidney Injury in Elderly Patients With Chronic Kidney Disease: Do Angiotensin‐Converting Enzyme Inhibitors Carry a Risk?

Chaumont

Pourcelet

Nuffelen

et al. 2016

J of Clinical Hypertension

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“…34 Moreover, clinical decision support systems that ensure proper drug dosing in patients with AKI may be of particular value, because older adults frequently have impaired drug clearance in addition to polypharmacy. 35 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Acute Kidney Injury in Older Adults With Critical Illness: A Retrospective Cohort Study

Kane‐Gill

Sileanu

Murugan

et al. 2015

American Journal of Kidney Diseases

164

119

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Background Risk for acute kidney injury (AKI) in older adults has not been systematically evaluated. We sought to delineate the determinants of risk for AKI in older compared to younger adults. Study Design Retrospective analysis of patients hospitalized in July 2000–September 2008. Setting & Participants We identified all adult patients admitted to an intensive care unit (ICU) (n=45,655) in a large tertiary care university hospital system. We excluded patients receiving dialysis or kidney transplant prior to hospital admission, and patients with baseline creatinine ≥ 4 mg/dl, liver transplantation, indeterminate AKI status, or unknown age, leaving 39,938 patients. Predictor We collected data on multiple susceptibilities and exposures including age, sex, race, body mass, comorbid conditions, severity of illness, baseline kidney function, sepsis, and shock. Outcomes We defined AKI according to KDIGO (Kidney Disease: Improving Global Outcomes) criteria. We examined susceptibilities and exposures across age strata for impact on development of AKI. Measurements We calculated area under the receiver operating characteristic curve (AUC) for prediction of AKI across age groups. Results 25,230 patients (63.2%) were aged 55 years or older. Overall 25,120 patients (62.9%) developed AKI (69.2% aged 55 years or older). Examples of risk factors for AKI in the oldest age category (75 years or older) were drugs (vancomycin, aminoglycosides, nonsteroidal anti-inflammatories), history of hypertension (OR, 1.13; 95% CI, 1.02–1.25) and sepsis (OR, 2.12; 95% CI, 1.68–2.67). Fewer variables remained predictive of AKI as age increased and the model for older patients was less predictive (p<0.001). For the age categories 18–54, 55–64, 65–74, and 75 years or older, the AUCs were 0.744 (95% CI, 0.735–0.752), 0.714 (95% CI, 0.702–0.726), 0.706 (95% CI, 0.693–0.718), and 0.673 (95% CI, 0.661–0.685), respectively. Limitations Analysis may not apply to non-ICU patients. Conclusions The likelihood of developing AKI increases with age; however the same variables are less predictive for AKI as age increases. Efforts to quantify risk for AKI may be more difficult in older adults.

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“…NICE has suggested that chronic renal disease should be classified to include patients with kidney damage who are at risk of progressing to failure (Table 1). In 2013, the Kidney Disease: Improving Global Outcomes (KDIGO) guidance on the evaluation and management of chronic kidney disease adopted the subdivision of glomerular filtration rate (GFR) categories suggested by the NICE guideline, but also included three albumin:creatinine ratios (ACRs) for each GFR category in an updated classification 3 (Table 2).…”

mentioning

confidence: 99%