scholarly journals POS-053 90-day post-hospital follow-up in survivors after COVID-19-associated acute kidney injury requiring kidney replacement therapy

2021 ◽  
Vol 6 (4) ◽  
pp. S24
Author(s):  
H. Stockmann ◽  
J.H.B. Hardenberg ◽  
C. Hinze ◽  
A. Aigner ◽  
G. Inka ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Kidney Replacement Therapy

scholarly journals Discharge Documentation and Follow-Up of Critically Ill Patients With Acute Kidney Injury Treated With Kidney Replacement Therapy: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Xin Yi Choon ◽  
Nuttha Lumlertgul ◽  
Lynda Cameron ◽  
Andrew Jones ◽  
Joel Meyer ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Kidney Disease ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Disease Stage ◽  
Essential Information ◽  
Kidney Replacement Therapy ◽  
Discharge Summaries

Leading organisations recommend follow-up of acute kidney injury (AKI) survivors, as these patients are at risk of long-term complications and increased mortality. Information transfer between specialties and from tertiary to primary care is essential to ensure timely and appropriate follow-up. Our aim was to examine the association between completeness of discharge documentation and subsequent follow-up of AKI survivors who received kidney replacement therapy (KRT) in the Intensive Care Unit (ICU). We retrospectively analysed the data of 433 patients who had KRT for AKI during ICU admission in a tertiary care centre in the UK between June 2017 and May 2018 and identified patients who were discharged from hospital alive. Patients with pre-existing end-stage kidney disease and patients who were transferred from hospitals outside the catchment area were excluded. The primary objective was to assess the completeness of discharge documentation from critical care and hospital; secondary objectives were to determine cardiovascular medications reconciliation after AKI, and to investigate kidney care and outcomes at 1 year. The development of AKI and the need for KRT were mentioned in 85 and 82% of critical care discharge letters, respectively. Monitoring of kidney function post-discharge was recommended in 51.6% of critical care and 36.3% of hospital discharge summaries. Among 35 patients who were prescribed renin-angiotensin-aldosterone system inhibitors before hospitalisation, 15 (42.9%) were not re-started before discharge from hospital. At 3 months, creatinine and urine protein were measured in 88.2 and 11.8% of survivors, respectively. The prevalence of chronic kidney disease stage III or worse increased from 27.2% pre-hospitalisation to 54.9% at 1 year (p < 0.001). Our data demonstrate that discharge summaries of patients with AKI who received KRT lacked essential information. Furthermore, even in patients with appropriate documentation, renal follow-up was poor suggesting the need for more education and streamlined care pathways.

scholarly journals Long-Term Outcome After Renal Replacement Therapy in Severe Burns

2020 ◽  
Vol 41 (4) ◽  
pp. 866-870
Author(s):  
Ilmari Rakkolainen ◽  
Kukka-Maaria Mustonen ◽  
Jyrki Vuola
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Burn Injury ◽  
Kidney Injury ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Discharged Patients

Abstract Acute kidney injury is a common sequela after major burn injury, but only a small proportion of patients need renal replacement therapy. In the majority of patients, need for renal replacement therapy subsides before discharge from the burn center but limited literature exists on long-term outcomes. A few studies report an increased risk for chronic renal failure after burn injury. We investigated the long-term outcome of severely burned patients receiving renal replacement therapy during acute burn injury treatment. Data on 68 severely burned patients who received renal replacement therapy in Helsinki Burn Centre between November 1988 and December 2015 were collected retrospectively. Thirty-two patients survived and remained for follow-up after the primary hospital stay until December 31, 2016. About 56.3% of discharged patients were alive at the end of follow-up. In 81.3% of discharged patients, need for renal replacement therapy subsided before discharge. Two patients received renal replacement therapy for longer than 3 months; however, need for renal replacement therapy subsided in both patients. One patient required dialysis several years later on after the need for renal replacement therapy had subsided. This study showed that long-term need for renal replacement therapy is rare after severe burn injury. In the vast majority of patients, need for renal replacement therapy subsided before discharge from primary care. Acute kidney injury in association with burns is a potential but small risk factor for later worsening of kidney function in fragile individuals.

scholarly journals Renal replacement therapy-requiring acute kidney injury due to tubulointerstitial nephritis and uveitis syndrome: case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
B. Marahrens ◽  
K. Amann ◽  
K. Asmus ◽  
S. Erfurt ◽  
D. Patschan
Keyword(s):  
Acute Kidney Injury ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Function ◽  
Tubulointerstitial Nephritis ◽  
Kidney Injury ◽  
Rare Type ◽  
Case Presentation ◽  
New Onset

Abstract Background Acute kidney injury is a major challenge for today’s healthcare systems around the globe. Renal replacement therapy has been shown to be beneficial in acute kidney injury, but treatment highly depends on the cause of the acute kidney injury. One less common cause is tubulointerstitial nephritis, which comes in different entities. A very rare type of tubulointerstitial nephritis is tubulointerstitial nephritis and uveitis syndrome, in which the patient presents with additional uveitis. Case presentation A 19-year-old caucasian male presented with mild dyspnea, lack of appetite, weight loss, and moderate itchiness. Lab results showed an acute kidney injury with marked increase of serum creatinine. The patient was started on prednisolone immediately after admission. As the patient in this case showed symptoms of uremia on admission, we decided to establish renal replacement therapy, which is unusual in tubulointerstitial nephritis and uveitis syndrome. During his course of dialysis, the patient developed symptoms of sepsis probably due to a catheter-related infection requiring intensive care and antibiotic treatment, which had to be terminated early as the patient developed a rash. Intensified immunosuppression, combined with antibiotics, significantly resolved excretory kidney dysfunction. Conclusions Since both the primary inflammatory process and the secondary infectious complication significantly impaired excretory kidney function, kidney function of younger individuals with new-onset anterior uveitis should be monitored over time and during follow-up.

scholarly journals Derivation and External Validation of a Risk Index for Predicting Acute Kidney Injury Requiring Kidney Replacement Therapy After Noncardiac Surgery

2021 ◽  
Vol 4 (8) ◽  
pp. e2121901
Author(s):  
Todd A. Wilson ◽  
Lawrence de Koning ◽  
Robert R. Quinn ◽  
Kelly B. Zarnke ◽  
Eric McArthur ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Risk Index ◽  
External Validation ◽  
Kidney Injury ◽  
Noncardiac Surgery ◽  
Kidney Replacement Therapy

MO417NEPHROLOGIST INTERVENTION TO AVOID KIDNEY REPLACEMENT THERAPY IN ACUTE KIDNEY INJURY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jonathan Chávez ◽  
Pablo Maggiani-Aguilera ◽  
Andres De la Torre-Quiroga ◽  
Alejandro Martínez-Gallardo Gonzalez ◽  
Ramón Medina-González ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Prospective Cohort ◽  
Kidney Injury ◽  
Primary Objective ◽  
Early Interventions ◽  
Kidney Replacement Therapy ◽  
The Impact ◽  
First Time ◽  
Antibiotic Dose

Abstract Background and Aims Based on the pathophysiology of acute kidney injury (AKI) it is plausible that certain early interventions by the nephrologist could influence its trajectory. In this study, we investigated the impact of 5 early nephrology interventions on starting kidney replacement therapy (KRT), AKI progression and death. Method In a prospective cohort at Hospital Civil of Guadalajara, we followed-up for 10 days AKI patients in whom a nephrology consultation was requested. We analyzed 5 early interventions of the nephrology team (fluid adjustment, nephrotoxic withdrawal, antibiotic dose adjustment, nutritional adjustment and removal of hyperchloremic solutions) after propensity score and multivariate analysis for the risk of starting KRT (primary objective), AKI progression to stage 3 and death (secondary objectives). Results From 2017 to 2020 we analyzed 288 AKI patients. The mean age was 55.3 years, 60.7% were male, AKI KDIGO stage 3 was present in 50.5% of them, sepsis was the main etiology 50.3%, and 72 (25%) patients started KRT. The overall survival was 84.4%. Fluid adjustment was the only intervention associated with a decreased risk for starting KRT (OR 0.58, 95% CI 0.48-0.70, p = <0.001) and AKI progression to stage 3 (OR 0.59, 95% CI 0.49-0.71, p = <0.001). Receiving vasopressors and KRT were associated with mortality, but neither of these interventions reduced these risks. Conclusion In this prospective cohort study of AKI patients, we found for the first time that early nephrologist intervention and fluid prescription adjustment was associated with a reduction in the risk of starting KRT and progression to AKI stage 3.

Anticoagulation in patients with acute kidney injury undergoing kidney replacement therapy

2021 ◽  
Author(s):  
Rupesh Raina ◽  
Ronith Chakraborty ◽  
Andrew Davenport ◽  
Patrick Brophy ◽  
Sidharth Sethi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Kidney Replacement Therapy

scholarly journals COVID-19-associated acute kidney injury: consensus report of the 25th Acute Disease Quality Initiative (ADQI) Workgroup

2020 ◽  
Author(s):  
Mitra K. Nadim ◽  
Lui G. Forni ◽  
Ravindra L. Mehta ◽  
Michael J. Connor ◽  
Kathleen D. Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Acute Disease ◽  
Future Research ◽  
Hospital Death ◽  
Kidney Involvement ◽  
Kidney Replacement Therapy ◽  
Hospital Resources ◽  
Underlying Processes

AbstractKidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional ‘surges’ in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.

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