Points of Concern in Post Acute Kidney Injury Management

Abstract

The incidence of acute kidney injury (AKI) will in the future remain high, partly due to an increase in comorbidities and other AKI favoring factors such as the rise in high-risk diagnostic and therapeutic interventions. AKI has emerged as a major public health concern with high human and financial costs. It has recently been demonstrated that patients surviving an AKI episode show increased all-cause mortality, chronic kidney disease (CKD), ESRD, cardiovascular events, and reduced quality of life. Although it is important to acknowledge that, after an AKI episode, the risk of dying by far exceeds the risk of developing incident or progressive CKD and/or entering a maintenance renal replacement therapy (RRT) program, currently only a minority of patients are referred for renal follow-up, even after AKI-requiring RRT. On the other hand, renal follow-up for all AKI survivors might not be necessary and would represent an overwhelming work load for the health care system. There are at present no clear guidelines on which patients should be referred and on the elements of post AKI care that may improve non-renal and renal outcomes. In this review, we discuss several points of concern in post-AKI management and propose an algorithm on post-AKI care, mainly based on the renal recovery pattern at discharge from the hospital. Potential opportunities to improve care include appropriate risk stratification, close monitoring of kidney function, management of CKD complications, blood pressure control, medication reconciliation, and education of patients and non-nephrologists on AKI and its downstream complications.

Deleting Death and Dialysis: Conservative Care of Cardio-Vascular Risk and Kidney Function Loss in Chronic Kidney Disease (CKD)

“…Specific therapies targeted at particular renal conditions (e.g., tolvaptan for adult polycystic kidney disease or preventive measures for kidney stones) were not considered. In addition, AKI and its prevention, although definitely linked to CKD [ 12 ] and thus a likely cause of cardio-vascular complications [ 13 ], was not considered and the reader is referred to specific reviews on this topic [ 14 ].…”

Evaluation of acute kidney injury in dogs with complicated or uncomplicated Babesia rossi infection

“…Several studies in humans demonstrated an increased risk for CKD and long-term mortality after an AKI episode (Coca et al, 2009;Heung et al, 2016;Vanmassenhove et al, 2018). This increased risk was documented even after milder forms of AKI with apparent fast recovery (Coca et al, 2009;Heung et al, 2016).…”

“…In a recent study, plasma SDMA was also able to identify dogs with azotemic AKI (Dahlem et al, 2017). In humans, follow-up of renal function after an episode of AKI is advised at least in high-risk patients, because patients surviving an AKI episode have an independently increased risk to develop CKD (Coca et al, 2012;Rimes-Stigare et al, 2015;Heung et al, 2016;Vanmassenhove et al, 2018). Kidney injury biomarkers have the potential to predict renal recovery from AKI in humans (Koraishy and Coca, 2014).…”

EDTAKI: a Nephrology and Public Policy Committee platform call for more European involvement in acute kidney injury

“…in frail AKI patients 24,32,37 . Fourth, and above all, in view of the frequent link with CKD, the nephrologist can play a role in preventing evolution towards CKD and to steer the approach and follow-up if kidney function does not recover 9,38,39 . Thus, we call not only for European research activity on AKI, but also for clinical involvement of the nephrologist in AKI outside the nephrology unit.…”