The growth of acute kidney injury: Eastern European perspective

Matuszkiewicz‐Rowińska, Joanna; Żebrowski, Paweł; Kościelska, Małgorzata; Małyszko, Jolanta; Mazur, Anna

doi:10.1038/ki.2015.61

Cited by 4 publications

(4 citation statements)

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“…Yet few studies have previously addressed the incidence rate of dialysis-requiring AKI in general populations. Published incidence rates suggest persistent increase with recent annual growth >10% [ 2 , 6 , 22 – 25 ]. However, updated and comprehensive information is limited, and major publications have predominantly been based on data from the US.…”

Section: Discussionmentioning

confidence: 99%

“…Acute kidney injury (AKI) continues to be a critical illness with profound effects on patient outcomes [ 1 ]. Prior epidemiologic studies on AKI have predominantly focused on incidence and outcome measures [ 2 – 6 ], and in spite of reported prevalences >20% amongst hospitalized adults [ 7 ], research on comorbid predisposition, and particularly concomitant medication, is sparse. Additionally, identification and management of AKI–and particularly dialysis-requirement–is characterized by regional and national disparities partly due to differing availability of treatment resources; such disparity makes comparison difficult [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

et al. 2016

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IntroductionDialysis-requiring acute kidney injury is a severe illness associated with poor prognosis. However, information pertaining to incidence rates and prevalence of risk factors remains limited in spite of increasing focus. We evaluate time trends of incidence rates and changing patterns in prevalence of comorbidities, concurrent medication, and other risk factors in nationwide retrospective cohort study.Materials and MethodsAll patients with dialysis-requiring acute kidney injury were identified between January 1st 2000 and December 31st 2012. By cross-referencing data from national administrative registries, the association of changing patterns in dialysis treatment, comorbidity, concurrent medication and demographics with incidence of dialysis-requiring acute kidney injury was evaluated.ResultsA total of 18,561 adult patients with dialysis-requiring AKI were identified between 2000 and 2012. Crude incidence rate of dialysis-requiring AKI increased from 143 per million (95% confidence interval, 137–144) in 2000 to 366 per million (357–375) in 2006, and remained stable hereafter. Notably, incidence of continuous veno-venous hemodialysis (CRRT) and use of acute renal replacement therapy in elderly >75 years increased substantially from 23 per million (20–26) and 328 per million (300–355) in 2000, to 213 per million (206–220) and 1124 per million (1076–1172) in 2012, respectively. Simultaneously, patient characteristics and demographics shifted towards increased age and comorbidity.ConclusionsAlthough growth in crude incidence rate of dialysis-requiring AKI stabilized in 2006, continuous growth in use of CRRT, and acute renal replacement therapy of elderly patients >75 years, was observed. Our results indicate an underlying shift in clinical paradigm, as opposed to unadulterated growth in incidence of dialysis-requiring AKI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

et al. 2016

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“…Continuous renal replacement therapy (CRRT) is the most commonly selected modality of renal replacement therapy for the dialysis required for acute kidney injury (AKI) patients in the intensive care unit (ICU) [ 1 , 2 ]. Globally, the requirement of CRRT is increasing with the growing incidence of AKI [ 3 – 5 ]. According to a nationwide study conducted in Denmark [ 5 ], the crude incidence of AKI requiring dialysis increased from 143 per million in 2000 to 360 per million in 2012.…”

Section: Introductionmentioning

confidence: 99%

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

et al. 2017

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BackgroundThe requirement of continuous renal replacement therapy (CRRT) is increasing with the growing incidence of acute kidney injury (AKI). The decision to initiate CRRT is not difficult if an adequate medical history is obtained. However, the handling and maintenance of CRRT constitute a labor-intensive intervention that requires specialized skills. For these reasons, our center organized a specialized CRRT team in March 2013. The aim of this study is to report on the role of a specialized CRRT team and to evaluate the team’s outcome.MethodsThis retrospective single-center study evaluated AKI patients who underwent CRRT in the intensive care unit (ICU) from March 2011 to February 2015. Patients were divided into two groups based on whether they received specialized CRRT team intervention. We collected information on demographic characteristics, laboratory parameters, SOFA score, CRRT initiation time, actual delivered dose and CRRT down-time. In-hospital mortality was defined by medical chart review. Binary logistic regression analysis was used to define factors associated with in-hospital mortality.ResultsA total of 1104 patients were included in this study. The mean patient age was 63.85 ± 14.39 years old, and 62.8% of the patients were male. After the specialized CRRT team intervention, there was a significant reduction in CRRT initiation time (5.30 ± 13.86 vs. 3.60 ± 11.59 days, p = 0.027) and CRRT down-time (1.78 ± 2.23 vs. 1.38 ± 2.08 h/day, p = 0.002). The rate of in-hospital mortality decreased after the specialized CRRT team intervention (57.5 vs. 49.2%, p = 0.007). When the multivariable analysis was adjusted, delayed CRRT initiation (HR 1.054(1.036–1.072), p < 0.001) was a significant factor in predicting in-hospital mortality, along with an increased SOFA score, lower serum albumin and prolonged prothrombin time.ConclusionsOur study shows that specialized CRRT team intervention reduced CRRT initiation time, down-time and in-hospital mortality. This study could serve as a logical basis for implementing specialized CRRT teams hospital-wide.Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0746-8) contains supplementary material, which is available to authorized users.

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A cute kidney injury (AKI) is increasingly common in the hospitalized patient 1,2 with recent adult and pediatric multinational studies reporting AKI rates of 57% and 27%, respectively. 3,4 The development of AKI is associated with significant adverse outcomes including an increased risk of mortality.

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mentioning

confidence: 99%

Nephrotoxin‐Related Acute Kidney Injury and Predicting High‐Risk Medication Combinations in the Hospitalized Child

Yonekawa

Zhou

Haaland

et al. 2019

Journal of Hospital Medicine

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BACKGROUND: In the hospitalized patient, nephrotoxin exposure is one potentially modifiable risk factor for acute kidney injury (AKI). Clinical decision support based on nephrotoxin ordering was developed at our hospital to assist inpatient providers with the prevention or mitigation of nephrotoxin-related AKI. The initial decision support algorithm (Algorithm 1) was modified in order to align with a national AKI collaborative (Algorithm 2). OBJECTIVE: Our first aim was to determine the impact of this alignment on the sensitivity and specificity of our nephrotoxin-related AKI detection system. Second, if the system efficacy was found to be suboptimal, we then sought to develop an improved model. DESIGN: A retrospective cohort study in hospitalized patients between December 1, 2013 and November 30, 2015 (N = 14,779) was conducted. INTERVENTIONS: With the goal of increasing nephrotoxin-related AKI detection sensitivity, a novel model based on the identification of combinations of high-risk medications was developed. RESULTS: Application of the algorithms to our nephrotoxin use and AKI data resulted in sensitivities of 46.9% (Algorithm 1) and 43.3% (Algorithm 2, P = .22) and specificities of 73.6% and 89.3%, respectively (P < .001). Our novel AKI detection model was able to deliver a sensitivity of 74% and a specificity of 70%. CONCLUSIONS: Modifications to our AKI detection system by adopting Algorithm 2, which included an expanded list of nephrotoxins and equally weighting each medication, did not improve our nephrotoxin-related AKI detection. It did improve our system’s specificity. Sensitivity increased by >50% when we applied a novel algorithm based on observed data with identification of key medication combinations.

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The growth of acute kidney injury: Eastern European perspective

Cited by 4 publications

References 3 publications

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

Dialysis-Requiring Acute Kidney Injury in Denmark 2000-2012: Time Trends of Incidence and Prevalence of Risk Factors—A Nationwide Study

The role of the specialized team in the operation of continuous renal replacement therapy: a single-center experience

Nephrotoxin‐Related Acute Kidney Injury and Predicting High‐Risk Medication Combinations in the Hospitalized Child

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