Early Nephrologist Involvement in Hospital-Acquired Acute Kidney Injury: A Pilot Study

Balasubramanian, Geetha; Al‐Aly, Ziyad; Moiz, Abdul; Rauchman, Michael; Zhang, Zhiwei; Gopalakrishnan, Rajalakshmi; Balasubramanian, Sumitra; El‐Achkar, Tarek M.

doi:10.1053/j.ajkd.2010.08.026

Cited by 144 publications

(124 citation statements)

References 16 publications

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“…Our results clearly show that nrHA-AKI or lrHA-AKI represents a common condition among hospitalized patients and is associated with inhospital mortality, recovery of renal function, and need for RRT. As one of the few studies examining the nephrology referral patterns for HA-AKI patients, our results may suggest that timely nephrologic interventions to prevent HA-AKI in medicine and surgical wards over time could benefit clinical and research studies aimed at improving renal outcomes as recently shown by Balasubramanian et al (22). However, because the goal of our study was not to evaluate institutional nephrologists' activity per se, we could not determine whether the investigations were not done versus done and not available and whether the nephrologic care had modified patient outcome.…”

Section: Discussionmentioning

confidence: 58%

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Meier¹,

Bonfils²,

Vogt³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI.Design, setting, participants, & measurements Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification.Results During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean Ϯ SD age of the patients was 61 Ϯ 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality.Conclusions These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality.

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Section: Discussionmentioning

confidence: 58%

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Meier¹,

Bonfils²,

Vogt³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…31 If the AKI-BP elevation association is causal, then reducing the risk of AKI may not only reduce mortality and morbidity in the short term but also, confer large long-term public health benefits.…”

Section: Discussionmentioning

confidence: 99%

Elevated BP after AKI

Hsu

Hsu²,

Yang

et al. 2016

Journal of the American Society of Nephrology

146

111

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The connection between AKI and BP elevation is unclear. We conducted a retrospective cohort study to evaluate whether AKI in the hospital is independently associated with BP elevation during the first 2 years after discharge among previously normotensive adults. We studied adult members of Kaiser Permanente Northern California, a large integrated health care delivery system, who were hospitalized between 2008 and 2011, had available preadmission serum creatinine and BP measures, and were not known to be hypertensive or have BP.140/90 mmHg. Among 43,611 eligible patients, 2451 experienced AKI defined using observed changes in serum creatinine concentration measured during hospitalization. Survivors of AKI were more likely than those without AKI to have elevated BP-defined as documented BP.140/90 mmHg measured during an ambulatory, nonemergency department visit-during follow-up (46.1% versus 41.2% at 730 days; P,0.001). This difference was evident within the first 180 days (30.6% versus 23.1%; P,0.001). In multivariable models, AKI was independently associated with a 22% (95% confidence interval, 12% to 33%) increase in the odds of developing elevated BP during follow-up, with higher adjusted odds with more severe AKI. Results were similar in sensitivity analyses when elevated BP was defined as having at least two BP readings of .140/90 mmHg or those with evidence of CKD were excluded. We conclude that AKI is an independent risk factor for subsequent development of elevated BP. Preventing AKI during a hospitalization may have clinical and public health benefits beyond the immediate hospitalization.

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“…Although the current consensus guidelines have helped reveal AKI's association with in-hospital mortality (5), the recognition that peak SCr has occurred is required to assign AKI stage (potentially days after the peak). Using newer urine biomarkers and/or manual microscopy on the first day of AKI allows for risk stratification without delay to make informed decisions regarding more aggressive care (e.g., fluid management, renal replacement therapy) or early nephrologist involvement, which may improve outcomes (27).…”

Section: Discussionmentioning

confidence: 99%

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

Hall

Coca

Perazella³

et al. 2011

Clinical Journal of the American Society of Nephrology

107

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SummaryBackground and objectives Studies have evaluated acute kidney injury (AKI) using biomarkers in various settings, but their prognostic utility within current practice is unclear. Thus, we sought to determine the prognostic utility of newer biomarkers or traditional markers (fractional excretion of sodium [FeNa] and urea [FeUrea] and microscopy) over clinical assessment alone.Design, setting, participants, & measurements This is a prospective cohort study of adults on the first day of meeting AKI criteria. We measured urine concentrations of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and IL-18 and determined FeNa, FeUrea, and microscopy score for casts and tubular cells. Primary outcome was worsened AKI stage from enrollment to peak serum creatinine or in-hospital death.Results In 249 recipients, 57% were Ն65 years old, 48% were from intensive care, and mean baseline GFR was 69 Ϯ 30 ml/min per 1.73 m 2 . AKI was considered prerenal in 164 (66%), acute tubular necrosis (ATN) in 51 (20%), and "other" in 34 (14%). All mean protein biomarker concentrations, FeNa, FeUrea, and microscopy scores were statistically different between prerenal and ATN. Seventy-two patients (29%) developed the primary outcome. There was an approximate three-fold increase in adjusted risk for the outcome for upper versus lower values of NGAL, KIM-1, IL-18, and microscopy score (P values Ͻ0.05). Net reclassification improved after adding these to baseline clinical assessment. FeNa and FeUrea were not useful. ConclusionsOn the first day of AKI, urine protein biomarkers and microscopy significantly improve upon clinical determination of prognosis, indicating their potential utility in current practice.

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Early Nephrologist Involvement in Hospital-Acquired Acute Kidney Injury: A Pilot Study

Cited by 144 publications

References 16 publications

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Referral Patterns and Outcomes in Noncritically Ill Patients with Hospital-Acquired Acute Kidney Injury

Elevated BP after AKI

Risk of Poor Outcomes with Novel and Traditional Biomarkers at Clinical AKI Diagnosis

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