Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings

Srisawat, Nattachai; Sintawichai, Nattaya; Kulvichit, Win; Lumlertgul, Nuttha; Sitticharoenchai, Patita; Thamrongsat, Nicha; Peerapornratana, Sadudee

doi:10.1016/j.jcrc.2018.04.007

Cited by 10 publications

(14 citation statements)

References 29 publications

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“…Although not available in all low-resource settings, serum creatinine laboratory values are the most commonly used tools to identify AKI. 1,35,[38][39][40][41][42][43][44][45][46][47][48][49][50] A 2015 multinational cross-sectional study showed that the diagnosis of AKI was made with serum creatinine values alone in 63% of participating facilities, followed by serum creatinine along with urine output in 28% of participating facilities in LMICs. 1 A 2018 qualitative study surveying AKI identification and management practices among 160 intensivists based in provincial and regional hospitals in Thailand showed that the KDIGO criteria for AKI were most commonly used (37%), followed by the AKIN (27.7%) and RIFLE (26.1%) criteria, respectively.…”

Section: Questionsmentioning

confidence: 99%

“…1 A 2018 qualitative study surveying AKI identification and management practices among 160 intensivists based in provincial and regional hospitals in Thailand showed that the KDIGO criteria for AKI were most commonly used (37%), followed by the AKIN (27.7%) and RIFLE (26.1%) criteria, respectively. 45 A common challenge with the use of serum creatinine values to diagnose AKI is the lack of historical laboratory values for many patients presenting with elevated serum creatinine due to the lack of electronic health record infrastructure in LMICs, leading to a delay in AKI diagnosis. 35,51 One published consensus recommendation focused on LMICs suggests addressing this problem by treating any elevated serum creatinine in a patient as AKI until proven otherwise.…”

Section: Questionsmentioning

confidence: 99%

“…50%, and 4% of patients diagnosed with AKI in LMIC facilities, respectively. 1,45 Multiple studies have shown that there is a higher incidence of proteinuria in patients with COVID-19 and AKI, relative to those with COVID-19 and no AKI, with incidence in AKI ranging from 42% to 83%. [53][54][55] Given its excellent availability in LMICs, urinalysis may currently be one of the most feasible ways to identify AKI in patients with COVID-19 in LMICs.…”

Section: Questionsmentioning

confidence: 99%

“…[103][104][105][106] In LMIC facilities with available treatment, intermittent HD is the most available, with reported utilization of 69-95% when dialysis is required. 1,45 Sustained low-efficiency dialysis (SLED) and PD were also used in facilities with dialysis capabilities. 1,35 Provision of acute PD treatments is one practical approach to the management of AKI.…”

Section: Questionmentioning

confidence: 99%

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Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Rudd

Çizmeci

Galli

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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. Current recommendations for the management of patients with COVID-19 and acute kidney injury (AKI) are largely based on evidence from resource-rich settings, mostly located in high-income countries. It is often unpractical to apply these recommendations to resource-restricted settings. We report on a set of pragmatic recommendations for the prevention, diagnosis, and management of patients with COVID-19 and AKI in low- and middle-income countries (LMICs). For the prevention of AKI among patients with COVID-19 in LMICs, we recommend using isotonic crystalloid solutions for expansion of intravascular volume, avoiding nephrotoxic medications, and using a conservative fluid management strategy in patients with respiratory failure. For the diagnosis of AKI, we suggest that any patient with COVID-19 presenting with an elevated serum creatinine level without available historical values be considered as having AKI. If serum creatinine testing is not available, we suggest that patients with proteinuria should be considered to have possible AKI. We suggest expansion of the use of point-of-care serum creatinine and salivary urea nitrogen testing in community health settings, as funding and availability allow. For the management of patients with AKI and COVID-19 in LMICS, we recommend judicious use of intravenous fluid resuscitation. For patients requiring dialysis who do not have acute respiratory distress syndrome (ARDS), we suggest using peritoneal dialysis (PD) as first choice, where available and feasible. For patients requiring dialysis who do have ARDS, we suggest using hemodialysis, where available and feasible, to optimize fluid removal. We suggest using locally produced PD solutions when commercially produced solutions are unavailable or unaffordable.

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Section: Questionsmentioning

confidence: 99%

Section: Questionsmentioning

confidence: 99%

Section: Questionsmentioning

confidence: 99%

Section: Questionmentioning

confidence: 99%

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Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Rudd

Çizmeci

Galli

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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“…Yet, CRRT is not available for treating AKI in 30% of the provincial hospitals. 4 Moreover, in the setting of coronavirus disease 19 (COVID-19) pandemic, even among resource-rich countries, access to CRRT machine can be challenging due to the high demand of dialysis from AKI. 5 –7…”

Section: Introductionmentioning

confidence: 99%

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

2020

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Background: Literature regarding the outcomes of lower dosage peritoneal dialysis (PD) in treating acute kidney injury (AKI) among resource-limited setting is sparse. This study aims to compare the risk of mortality in patients with AKI receiving lower PD dosage and conventional intermittent hemodialysis (IHD) in Thailand. Methods: In a tertiary center in Thailand, a matched case–control study using propensity scores in patients with AKI was conducted to compare the outcomes between lower PD dosage (18 L per day for first two sessions, weekly Kt/ V 2.2) and IHD (three times a week) from February 2015 to January 2016. The primary outcome was a 30-day in-hospital mortality rate. Secondary outcomes included dialysis dependence at 90 days. Results: Eighty-four patients were included (28 PD and 56 IHD). Patient characteristics were comparable between two treatment groups. Overall, the mean age was 58 years. Most of the patients were critically ill (87% need mechanical ventilator; mean acute physiological and chronic health evaluation (APACHE II) score: 25). The 30-day in-hospital mortality rate was similar between the PD and IHD patients (57% vs. 46%, p = 0.36). The dialysis dependence rate was also comparable at 90 days. The risk of death among AKI patients was higher in those with respiratory failure, higher APACHE II score, and starting dialysis with blood urea nitrogen greater than 70 mg dL−1. Conclusion: Clinical outcomes, including risk of mortality and 90-day dialysis dependence among patients with AKI, appear to be comparable between lower dosage PD and IHD.

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Nephrology in Thailand

Praditpornsilpa

Tungsanga

Eiam‐Ong

et al. 2021

Nephrology Worldwide

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Current practice of diagnosis and management of acute kidney injury in intensive care unit in resource limited settings

Cited by 10 publications

References 29 publications

Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Pragmatic Recommendations for the Prevention and Treatment of Acute Kidney Injury in Patients with COVID-19 in Low- and Middle-Income Countries

Peritoneal dialysis with a lower dosage versus conventional intermittent hemodialysis in acute kidney injury: A propensity-matched study

Nephrology in Thailand

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