Delayed Nephrology Consultation and High Mortality on Acute Kidney Injury: A Meta-Analysis

Abstract

Background: Acute kidney injury (AKI) is a complex syndrome associated with substantial morbidity, mortality and costs. Despite advancements in diagnosis and care practice, AKI remains a disorder usually under/late-recognized with high mortality. One of the hidden reasons for poor outcome might be delayed nephrology consultation, with the involvement of the specialist only in severe stages of AKI when renal replacement therapy (RRT) is required. Methods: We searched PubMed, EMBASE and Cochrane central register for related work on the subject. Six studies were identified for the meta-analysis, correlating time of nephrology consultation and mortality in AKI. Results: We found that delayed nephrology consultation is associated with higher mortality in AKI, with an OR 0.79 (95% CI 0.48-1.10, p < 0.05). Conclusion: Delayed nephrology consultation contributes to higher mortality in AKI. The early involvement of nephrologist may present an advantage in terms of early recognition, prevention and effective treatment of AKI. An early involvement of multidisciplinary task force may contribute to better treatment, before the preventable complications of AKI occur or an emergency RRT is required.

Impact of Electronic Acute Kidney Injury (AKI) Alerts With Automated Nephrologist Consultation on Detection and Severity of AKI: A Quality Improvement Study

“…[10][11][12] There is a consensus that early detection of AKI events is crucial to improving patients' outcomes. 13,14 The role of a nephrologist has also been previously highlighted. [14][15][16] Mainly, AKI is defined by serum creatinine (Scr)-based criteria.…”

“…13,14 The role of a nephrologist has also been previously highlighted. [14][15][16] Mainly, AKI is defined by serum creatinine (Scr)-based criteria. 17,18 Because Scr is widely tested and can be quickly reported using comprehensible numeric values, there have been attempts to build an efficient surveillance system for AKI, also known as an AKI alert.…”

A Call to Action to Develop Integrated Curricula in Cardiorenal Medicine

“…Very little interaction is institutionally defined. Occasional interdisciplinary activity may take place on the basis of a consultation, but often comes too late in patient care [55]. There is no uniform utilization of novel biomarkers to phenotypically classify and manage patients [53,56,57].…”

Biomarkers of acute kidney injury: a step forward

“…One of the hidden reasons for persistent poor clinical outcomes may be the delay in timing for nephrology consultation as nephrologists are usually involved when severe AKI has already settled. According to the "iceberg of AKI" concept, many conditions are actually hidden under the cover of the tip of the iceberg although they should require the same or more attention by nephrologists but are usually unnoticed or self-managed by clinicians [2]. The Vicenza ADQI consensus conference group has introduced RIFLE criteria in 2004, allowing to make a standardized diagnosis of AKI and to define its clinical stage [3].…”

“…For this reason, a conceptual model of AKI has been developed encompassing all the steps of the syndrome and the relevant clinical consequences [5]. The RIFLE classification has made a significant progress [2][3][4], but it still relies on creatinine, precluding the possibility of a timely and accurate AKI diagnosis. Creatinine in fact is a poor marker for injury, and its elevation may occur 24-48 h after a significant insult to the kidney has occurred.…”