The impact of increased awareness of acute kidney injury in the Neonatal Intensive Care Unit on acute kidney injury incidence and reporting: results of a retrospective cohort study

Starr, Michelle C.; Kula, Alexander J.; Lieberman, Joshua A.; Menon, Shina; Perkins, Anthony J.; Lam, Teresa; Chabra, Shilpi; Hingorani, Sangeeta

doi:10.1038/s41372-020-0725-y

Cited by 23 publications

(15 citation statements)

References 27 publications

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“…(15) Despite these recommendations, neonatal AKI remains under-recognized and is diagnosed in only 10-30% of neonates with AKI. (16)(17)(18) Without a formal diagnosis, neonates may not be identified for long-term follow up, reducing early identification of CKD and limiting opportunities to slow disease progression. Two single-center studies have suggested that a standardized local approach to AKI in the NICU may improve AKI identification.…”

Section: Introductionmentioning

confidence: 99%

Improving the identification of acute kidney injury in the neonatal ICU: three centers’ experiences

et al. 2021

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Objective: To describe 3 different standardized approaches to improving neonatal acute kidney injury (AKI) identification and the impact on AKI identification, incidence, and nephrology consultation and referral.Study Design: Retrospective cohort study in three academic NICUs. We compared AKI identification, AKI incidence, nephrology consultation and nephrology follow-up before and after implantation of local protocols to standardized neonatal AKI identification.Result: Neonatal AKI identification improved in all three NICUs following protocol implementation (26% to 85%, P<0.0001). Each center also saw increases in nephrology consultation (15% to 83%, P<0.0001) and nephrology follow-up (7% to 73%, P<0.0001). AKI incidence decreased significantly (21% to 12%, P<0.0001). Conclusion:Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. This study emphasizes the importance of local standardized approaches to AKI to improve AKI identification and nephrology involvement in the NICU.

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Section: Introductionmentioning

confidence: 99%

Improving the identification of acute kidney injury in the neonatal ICU: three centers’ experiences

et al. 2021

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“…We also note that infants and young children (<5 years of age) had a lower prevalence of AKI than older children and young adults. While our exclusion of those hospitalized in Neonatal Intensive Care Units may have confounded these findings, this rate is lower than reported rates of AKI in other populations of septic neonates 36,37 . An ongoing study is currently reporting AKI prevalence in infants with suspected or confirmed SARS-CoV2 38 and should serve to expand and refine our findings in this age demographic.…”

Section: Discussionmentioning

confidence: 56%

Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection

et al. 2021

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BACKGROUND:We aimed to study the association of suspected versus confirmed infection with the novel SARS-CoV2 virus with the prevalence of acute kidney injury (AKI) in critically ill children. METHODS: Sequential point-prevalence study of children and young adults aged 7 days to 25 years admitted to intensive care units under investigation for SARS-CoV2 infection. AKI was staged in the first 14 days of enrollment using KDIGO creatinine-based staging. SARS-CoV2 positive (CONFIRMED) were compared to SUSPECTED (negative or unknown). Outcome data was censored at 28-days. RESULTS: In 331 patients of both sexes, 179 (54.1%) were CONFIRMED, 4.2% ( 14) died. AKI occurred in 124 (37.5%) and severe AKI occurred in 63 (19.0%). Incidence of AKI in CONFIRMED was 74/179 (41.3%) versus 50/152 (32.9%) for SUSPECTED; severe AKI occurred in 35 (19.6%) of CONFIRMED and 28 (18.4%) of SUSPECTED. Mortality was 6.2% (n = 11) in CONFIRMED, but 9.5% (n = 7) in those CONFIRMED with AKI. On multivariable analysis, only Hispanic ethnicity (relative risk 0.5, 95% CI 0.3-0.9) was associated with less AKI development among those CONFIRMED. CONCLUSIONS: AKI and severe AKI occur commonly in critically ill children with SARS-CoV2 infection, more than double the historical standard. Further investigation is needed during this continuing pandemic to describe and refine the understanding of pediatric AKI epidemiology and outcomes. TRIAL REGISTRATION: NCT01987921.

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“…After the standardizing of the definition of AKI, studies have shown a significant increase in AKI diagnostic records in several countries [ 16 ]. Nevertheless, the coded incidence of AKI remains lower than the real incidence [ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Medical students’ and health professionals’ knowledge regarding acute kidney injury: a cross-sectional study in the city of São Paulo, Brazil

et al. 2022

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Background Acute kidney injury (AKI) is a worldwide public health problem and is often treated by non-nephrologists. The objective of this study was to evaluate the knowledge of non-nephrologists, undergraduate medical students and health professionals regarding AKI. Methods An unsupervised and closed-response electronic questionnaire was sent to sixth-year medical students and non-nephrologist health professionals working in the city of São Paulo, Brazil. Results A total of 424 responses were returned from 650 invitations (40.1% males, 39.2% physicians, 34.0% senior medical students or resident physicians, 16.3% nurses and 10.6% pharmacists). The knowledge of medical students and health professionals about the prevalence and lethality of AKI in hospitals ranged from 40.8% to 59.2%. The most recognized susceptibilities and risk factors for AKI were sepsis/septic shock (95.0%) and diabetes mellitus (91.3%); the less-recognized susceptibilities and risk factors were exposure to gadolinium-based contrast (23.3%) and chronic liver disease (55.7%). The study participants’ rate of knowledge regarding the diagnosis of AKI was 50.9–73.6%, and their rate of knowledge regarding the criteria of increased serum creatinine and reduced urine volume was 52.6%. The most-recognized nephrotoxic medications were vancomycin (82.3%) and diclofenac (80.4%), and the least-recognized were acyclovir (34.0%) and cotrimoxazole (30.4%). The indications for emergency renal replacement therapy that were recognized by the study respondents were metabolic acidosis (82.3%), uremic syndrome (81.6%), hyperkalemia unresponsive to clinical treatment (78.1%) and acute pulmonary edema (71.6%). Conclusion The study showed knowledge gaps that can impact patient care and can be used to guide professional training programs.

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The impact of increased awareness of acute kidney injury in the Neonatal Intensive Care Unit on acute kidney injury incidence and reporting: results of a retrospective cohort study

Cited by 23 publications

References 27 publications

Improving the identification of acute kidney injury in the neonatal ICU: three centers’ experiences

Improving the identification of acute kidney injury in the neonatal ICU: three centers’ experiences

Acute kidney injury in critically Ill children and young adults with suspected SARS-CoV2 infection

Medical students’ and health professionals’ knowledge regarding acute kidney injury: a cross-sectional study in the city of São Paulo, Brazil

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