Under-recognized renal insufficiency in hospitalized patients: Implications for care

Francisco, A.L.M. de; Fernández, Emilio Luengo; Cruz, Juan; Casas, Mireia; Gómez-Gerique, J.A.; León, Antonio Martín; Cava, Fernando; Bedini, José Luis; Enguix, Alfredo; Ripoll, Eduardo; Borque, L.; Fernández, Ana; Arias, Manuel

doi:10.1016/j.ejim.2010.04.011

Cited by 15 publications

(8 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A meta-analysis found that the odds of death rose by 147% with each 1 g/dl decrease in serum albumin [36], and we also found a significant correlation between low serum albumin and in-hospital deaths (p = 0.001). More than half of our patients had a prior history of CKD, in concordance with a multicenter study directed by our group that found a 28.3% renal insufficiency class 3-5 in 14,658 hospitalized patients [37]. This fact supports previous findings of a relationship between prior CKD and AKI [14,38,39,40].…”

Section: Discussionsupporting

confidence: 80%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

View full text Add to dashboard Cite

Background: Epidemiological studies of acute kidney injury (AKI) have focused on patients admitted to intensive care units (ICUs), and several have studied hospitalized non-ICU patients, but analysis of patients referred to Nephrology is sparse. We analyzed factors associated with short- and long-term morbimortality among hospitalized non-ICU patients with AKI who were referred to Nephrology. Methods: A retrospective study with data prospectively collected from 170 non-ICU patients, with referral to the Nephrology Unit, recruited over a 4-year period, was performed. AKI was classified according to the criteria based on risk, injury, failure, loss of kidney function and end-stage kidney disease (RIFLE). Risk factors that could influence prognosis of AKI and long-term mortality were analyzed at admission. Early on, 1- and 10-year mortalities were correlated with AKI RIFLE class, clinical and demographic characteristics. Results: Most patients were >65 years, with multiple comorbidities and frequent drug intake history. Median Charlson score was 6. Twenty-five percent of patients with previously unknown chronic kidney disease (CKD) were diagnosed with CKD during the study. Dialysis was required in 13.5% of patients. Hospital deaths were 22.4% and significantly associated with older age, RIFLE class L, higher peak serum creatinine, oliguria and decreased serum albumin levels. One-year (38.8%) and 10-year (68.8%) mortalities were significantly associated with age, prior cardiovascular disease, prior CKD and RIFLE class L. According to the Cox proportional hazard model, age, prior CKD and RIFLE class L were independent risk factors of death at 1 and 10 years. Conclusions: AKI in hospitalized non-ICU patients is associated with high early and late mortality. This study increases our understanding of AKI among this specific population and can improve their management.

show abstract

Section: Discussionsupporting

confidence: 80%

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Ruiz-Criado

Ramos-Barron

Fernández‐Fresnedo³

et al. 2015

Nephron

View full text Add to dashboard Cite

show abstract

“…In fact, our study of predominantly older patients with comorbidities, had a higher proportion of patients with reduced renal function than previously described in the literature (17-30%). [2][3][4] This may be partly explained by the fact that the number and rate of hospitalisations due to kidney disease has been increasing in Australia. The number of hospitalisations for CKD as a principal diagnosis (excluding dialysis) increased by 12% from 2000-2001 to 2007-2008.…”

Section: Discussionmentioning

confidence: 99%

“…Renal diseases are present in 17-30% of acute medical admissions. [2][3][4] A reduced estimated GFR (eGFR) is associated with increased risks of death, cardiovascular events and hospitalisation that are independent of the known risk factors (age, sex, income, education, use of dialysis, history of ischaemic stroke, cardiovascular disease, peripheral arterial disease, diabetes mellitus, hypertension, dyslipidaemia, cancer, hypoalbuminaemia, dementia, cirrhosis, chronic lung disease, documented proteinuria and prior hospitalisations). 5 Australian public hospitals translate the diagnoses and procedures to codes, using the international statistical classification of diseases and related health problems, 10th revision, Australian Modification codes (ICD 10), which are reflective of documentation in the discharge summaries completed by the treating clinicians.…”

Section: Introductionmentioning

confidence: 99%

“…Many patients admitted to general internal medicine units have renal insufficiency as defined above. Renal diseases are present in 17–30% of acute medical admissions . A reduced estimated GFR (eGFR) is associated with increased risks of death, cardiovascular events and hospitalisation that are independent of the known risk factors (age, sex, income, education, use of dialysis, history of ischaemic stroke, cardiovascular disease, peripheral arterial disease, diabetes mellitus, hypertension, dyslipidaemia, cancer, hypoalbuminaemia, dementia, cirrhosis, chronic lung disease, documented proteinuria and prior hospitalisations) …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

International statistical classification of diseases and related health problems coding underestimates the incidence and prevalence of acute kidney injury and chronic kidney disease in general medical patients

Venkatesan

Nand

et al. 2018

Internal Medicine Journal

View full text Add to dashboard Cite

Background The international classification of diseases (ICD) code is frequently used to identify renal impairment in epidemiological research. However, Australian studies examining accuracy of this administrative data in coding kidney injury are lacking. Aims To compare the ICD 10 coding with the kidney disease: improving global outcomes (KDIGO) criteria in diagnosing acute kidney injury (AKI) and/or chronic kidney disease (CKD). Methods A retrospective study of 325 patients admitted to general medicine during January 2012 was performed. Sensitivity and specificity of ICD 10 in identifying AKI and CKD were calculated using KDIGO as gold standard. Results The sensitivities of ICD 10 in identifying AKI and CKD were low for both (59.5% and 54.1%), but the specificities were high (86.2% and 90.2%). Using KDIGO criteria, we identified 72 AKI (22%), 56 CKD (17%), 64 AKI on CKD (19%) and 133 controls (40%). Compared to the control group, patients with AKI and AKI on CKD had longer length of stay (3.2 vs 4.9 days and 3.2 vs 4.8 days, P = 0.20). Renal impairment groups had increased in‐hospital mortality rate (5% control, 6% AKI, 10% CKD, 9% AKI on CKD) and re‐admission rate within 30 days (13% control, 20% AKI, 25% CKD, 26% AKI on CKD). After adjusting for age, gender and comorbidities, the difference in outcomes was not statistically significant. Conclusion This study shows that ICD 10 fails to identify almost half of the patients with AKI (40.5%) and CKD (45.9%) in our cohort. A total of 60% had evidence of renal impairment as defined by KDIGO.

show abstract

“…1 In addition, polypharmacy is also quite common in hospitalized patients. 2 Thus, among these drugs, some are excreted or metabolized through the kidneys.…”

Section: Introductionmentioning

confidence: 99%

Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine

Solak¹,

Bıyık

Gaipov³

et al. 2016

American Journal of Therapeutics

View full text Add to dashboard Cite

Many drugs that are administered during hospitalization are metabolized or excreted through kidneys, consequently require dosage adjustment. We aimed to investigate inappropriate prescription of drugs requiring renal dose adjustment (RDA) in various surgical and medical inpatient clinics. We retrospectively determined dialysis patients hospitalized between January 2007 and December 2010. Inpatient clinics, including cardiology, pulmonary medicine, neurology, infectious diseases (medical clinics) and cardiovascular surgery, orthopedics, general surgery, obstetrics and gynecology, and neurosurgery (surgical clinics), were screened via electronic database. Total and RDA medications were determined. RDA drugs correctly adjusted to creatinine clearance were labeled as RDA-A (appropriate), otherwise as RDA-I (inappropriate). Renal doses of RDA medications were based on the "American College of Physicians Drug Prescribing in Renal Failure, fifth Edition." Two hundred seventeen hospitalization records of 172 dialysis patients (92 men and 80 women) were included in the analysis. Mean age of patients was 59.4 ± 14.6 years, and the mean hospitalization duration was 8.5 ± 7.8 days. In total, 247 (84.3%, percentage in drugs requiring dose adjustment) and 175 (46.2%) drugs have been inadequately dosed in surgical and medical clinics, respectively. The percentage of patients to whom at least 1 RDA-I drug was ordered was 92% and 91.4% for surgical and medical clinics, respectively (P > 0.05). Nephrology consultation numbers were 8 (7.1%) in surgical and 32 (30.4%) in medical clinics. The most common RDA-I drugs were aspirin and famotidine. A significant portion of RDA drugs was ordered inappropriately both in surgical and medical clinics. Nephrology consultation rate was very low. Measures to increase physician awareness are required to improve results.

show abstract

Under-recognized renal insufficiency in hospitalized patients: Implications for care

Cited by 15 publications

References 34 publications

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

Long-Term Mortality among Hospitalized Non-ICU Patients with Acute Kidney Injury Referred to Nephrology

International statistical classification of diseases and related health problems coding underestimates the incidence and prevalence of acute kidney injury and chronic kidney disease in general medical patients

Drug Dose Adjustment in Dialysis Patients Admitted in Clinics Other Than Internal Medicine

Contact Info

Product

Resources

About