scholarly journals International Society of Nephrology’s 0by25 initiative (zero preventable deaths from acute kidney injury by 2025): focus on diagnosis of acute kidney injury in low-income countries

2017 ◽  
Vol 11 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Jochen G Raimann ◽  
Miguel C Riella ◽  
Nathan W Levin
Keyword(s):  
Acute Kidney Injury ◽  
International Society ◽  
Low Income ◽  
Kidney Injury ◽  
Low Income Countries

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

Epidemiology of Acute Kidney Injury

2017 ◽  
Author(s):  
Verônica Torres Costa e Silva ◽  
Renato Antunes Caires ◽  
Elerson Carlos Costalonga ◽  
Emmanuel A. Burdmann
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Low Income ◽  
Rural Areas ◽  
Hospital Admissions ◽  
De Novo ◽  
Residual Disease ◽  
Multiorgan Failure ◽  
Kidney Injury ◽  
Low Income Countries

The worldwide incidence of acute kidney injury (AKI) is increasing. Recent surveys demonstrated that AKI occurs in 21% of hospital admissions. In low-income countries, AKI has a bimodal presentation. In large urban centers, the pattern of AKI is very similar to that found in high and upper middle-income countries, with a predominance of hospital-acquired AKI, occurring mostly in older, critically ill, multiorgan failure patients with comorbidities. At the same time, in regional hospitals in small urban communities and rural areas, AKI is usually a community-acquired disease (related to diarrheal and infectious diseases, animal venom, and septic abortion). Although AKI mortality seems to be decreasing, it remains extremely high, varying from 23.9 to 60% in recent series. The most important risk factors for short-term mortality (in hospital or < 90 days) in AKI are the primary diagnosis (sepsis) and the severity of the acute illness, expressed by the presence of nonrenal organ dysfunction. New biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, cystatin C, and interleukin-18 measurements, have been able to identify patients with AKI who are at risk for a less favorable prognosis, such as the likelihood of the need for renal replacement therapy, nonrecovery of kidney function, and higher mortality. Several studies have demonstrated an association between hospital-associated AKI and postdischarge mortality in a variety of contexts, and the most important risk factors for this late lethality are older age, preexisting comorbid disease (chronic kidney disease [CKD], cardiovascular disease, or malignancy), and incomplete organ recovery with ongoing residual disease. AKI is associated with de novo end-stage renal disease (ESRD) (CKD, progression of preexisting CKD) and the occurrence of ESRD in the long term. Herein, it is suggested that high-risk patients recovering from an AKI episode, such as those with baseline CKD, diabetes mellitus, or heart failure and those dialyzed for AKI, should likely be followed by a nephrologist. 

Acute kidney injury (AKI)

2021 ◽  
pp. 490-525
Keyword(s):  
Acute Kidney Injury ◽  
Kidney Function ◽  
Low Income ◽  
Urine Output ◽  
Incidental Finding ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Electrolyte Disorders ◽  
Severe Condition ◽  
Renal Replacement Therapies

Acute kidney injury (AKI) can generally be considered as sudden reduction in kidney function occurring over hours to days, and is commonly but not always associated with a reduction in urine output. Its definition was based on rises in serum creatinine and reductions in urine output criteria. Its incidence, prevalence, and aetiology vary according to the country/region profile (low income, high income, tropical, etc.), age (children, adult, or elderly), and clinical setting (outpatients versus inpatient, hospital versus intensive care unit). The incidence of AKI is increasing in the hospital setting, and is more common with increasing age, male sex, pre-existing CKD, and comorbidity (congestive cardiac failure, diabetes, hypertension). The majority of cases result from multiple insults: dehydration, drugs in conjunction with inflammation and/or sepsis. AKI may have a spectrum of being an incidental finding with no signs or symptoms to a moderate to severe condition with increased morbidity and mortality due to accumulation of nitrogenous waste products and fluid–electrolyte disorders. The aetiologies of AKI are numerous and can broadly be classified as pre-renal, intrinsic renal, and post-renal (obstructive). A thorough evaluation of the patients with AKI for diagnosis and treatment are required. There are no specific treatments, but eliminating aetiological reasons and protection from further kidney function loss are crucial. A balanced haemodynamic management along with a balanced fluid–electrolyte replacement and arranging drug dosages are important. Various modes of renal replacement therapies may be used for treating severe cases.

scholarly journals The ISN 0by25 Global Snapshot Study

2016 ◽  
Vol 68 (Suppl. 2) ◽  
pp. 29-31 ◽  
Author(s):  
John Feehally
Keyword(s):  
Low Income ◽  
Kidney Injury ◽  
Complete Recovery ◽  
Cross Sectional Study ◽  
Low Income Countries ◽  
Clinical Indication ◽  
Partial Recovery ◽  
Cross Sectional ◽  
Middle Income ◽  
New Information

The International Society of Nephrology's (ISN) 0by25 initiative aims to prevent avoidable deaths from acute kidney injury (AKI) by 2025, most of which occur in low and lower middle-income countries (LLMICs). To increase evidence about the epidemiology of AKI, especially in LLMICs, ISN conducted a ‘Global Snapshot', a multinational, cross-sectional study in which 322 physicians from 72 countries in 6 continents identified 3,664 adults and 354 children with AKI who were under their care of which 45% were from LLMICs, nevertheless low-income countries were under-represented. In LLMICs, patients with AKI were younger, and community acquired AKI was more common. Hypotension (40%) and dehydration (39%) were the most common causes of AKI. Dehydration was a more common cause in LLMIC, as were sepsis, pregnancy-related AKI and animal envenomation. Acute dialysis was performed in 23% of patients. Eight percent had a clinical indication for this but were not dialyzed. In LLMICs, lack of resources (16%) and inability to afford therapy (30%) accounted for almost half of these cases. Overall mortality at 7 days was 11% and was higher in LLMICs. Complete recovery from AKI occurred in 30% of patients and partial recovery 37%, and was more often complete in LLMICs. The 0by25 Global Snapshot provides new information about the worldwide epidemiology of AKI, helping to identify elements that would be amenable in intervention to reduce preventable deaths.

scholarly journals Acute kidney injury among adult patients with sepsis in a low-income country: clinical patterns and short-term outcomes

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Peace Bagasha ◽  
Frederick Nakwagala ◽  
Arthur Kwizera ◽  
Emmanuel Ssekasanvu ◽  
Robert Kalyesubula
Keyword(s):  
Acute Kidney Injury ◽  
Low Income ◽  
Kidney Injury ◽  
Adult Patients ◽  
Income Country ◽  
Short Term ◽  
Low Income Country ◽  
Clinical Patterns

scholarly journals Acute Kidney Injury among Adult Patients with Diabetic Ketoacidosis in a Referral Hospital of Bangladesh

2017 ◽  
Vol 8 (1) ◽  
pp. 26-29
Author(s):  
Muhammad Abdur Rahim ◽  
Mehruba Alam Ananna ◽  
Tabassum Samad ◽  
Shahana Zaman ◽  
Rozana Rouf ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Pancreatitis ◽  
Diabetic Ketoacidosis ◽  
Low Income ◽  
Kidney Injury ◽  
Income Group ◽  
Acute Kidney Injury Network ◽  
Medical Emergency ◽  
Diabetic Patients ◽  
Cross Sectional

Background: Diabetic ketoacidosis (DKA) is a medical emergency. DKA may be complicated by acute kidney injury (AKI) and may require renal replacement therapy. Early detection and treatment including treatment of underlying cause and complication(s), if present, is important in determining outcome of DKA. This study was designed to evaluate the incidence of AKI among patients with DKA.Methods: This cross-sectional study was done in BIRDEM General Hospital, Dhaka, Bangladesh from 2008 to 2011. AKI was diagnosed by using acute kidney injury network (AKIN) criteria.Results: Total patients were 200 with slight female predominance (56%). Mean age of the study subjects was 37.6±7.5 years. Incidence of DKA was more in known diabetic patients (71%), more among rural population (53%) and low income group (76.5%). Infection (40.5%) was the commonest precipitating cause followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common causes and aetiology could not be identified in 14% cases. Fifty nine (29.5%) cases were complicated by AKI and among them three (5%) patients required haemodialysis. AKI was more in severe DKA (pH <7) cases and when precipitated by acute pancreatitis and infections. In spite of standard management overall mortality was 6.5%.Conclusion: Almost one-third of DKA cases had AKI in this study, more in DKA cases precipitated by acute pancreatitis and sepsis. Fluid resuscitation resolved AKI in most cases but few cases required renal replacement therapy.Birdem Med J 2018; 8(1): 26-29

scholarly journals International Society of Nephrology 0 by 25 Project: Lessons Learned

2019 ◽  
Vol 74 (Suppl. 3) ◽  
pp. 45-50 ◽  
Author(s):  
Etienne Macedo ◽  
Guillermo Garcia-Garcia ◽  
Ravindra L. Mehta ◽  
Michael V. Rocco
Keyword(s):  
International Society ◽  
Low Income ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Pilot Project ◽  
Lessons Learned ◽  
Classification Systems ◽  
Low Resource ◽  
Low Middle Income Countries ◽  
Increased Risk

Acute kidney injury (AKI) is a common disorder with a high risk of mortality and development of chronic kidney disease. With the validation of the recent classification systems, RIFLE in 2004 and KDIGO, in use today, our understanding of AKI has evolved. We now know that community-acquired AKI is also associated with an increased risk of worse outcomes. In addition, several epidemiological studies, including cohorts from low-income and low-middle income countries, have confirmed common risk factors for community-acquired AKI. In 2013, the International Society of Nephrology launched the 0 by 25 campaign with the goal that no patient should die from preventable or untreated AKI in low-resource areas by 2025 [Mehta et al.: Lancet 2015;385:2616–43]. The initial effort of the initiative was a meta-analysis of AKI epidemiology around the world. The second project of the 0 by 25 initiative, the Global AKI Snapshot (GSN) study, provided insights into the recognition, treatment, and outcomes of AKI worldwide [Mehta et al.: Lancet 2016;387:2017–25]. Following the GSN, a Pilot Project was designed to test whether education and a simple protocol-based approach can improve outcomes in patients at risk of community-acquired AKI in low-resource settings [Macedo: J Am Soc Nephrol 2017]. In this review, we will comment on the main findings and lessons learned from the 0 by 25 initiative.

scholarly journals Clinical Characteristics and 30-Day Outcomes of Intermittent Hemodialysis for Acute Kidney Injury in an African Intensive Care Unit

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Arthur Kwizera ◽  
Janat Tumukunde ◽  
Lameck Ssemogerere ◽  
Emmanuel Ayebale ◽  
Peter Agaba ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Low Income ◽  
Clinical Characteristics ◽  
Kidney Injury ◽  
Intermittent Hemodialysis

Introduction. Acute kidney injury (AKI) is a common occurrence in the intensive care unit (ICU). Studies have looked at outcomes of renal replacement therapy using intermittent haemodialysis (IHD) in ICUs with varying results. Little is known about the outcomes of using IHD in resource-limited settings where continuous renal replacement therapy (CRRT) is limited. We sought to determine outcomes of IHD among critically ill patients admitted to a low-income country ICU.Methods. A retrospective review of patient records was conducted. Patients admitted to the ICU who underwent IHD for AKI were included in the study. Patients’ demographic and clinical characteristics, cause of AKI, laboratory parameters, haemodialysis characteristics, and survival were interpreted and analyzed. Primary outcome was mortality.Results. Of 62 patients, 40 had complete records. Median age of patients was 38.5 years. Etiologic diagnoses associated with AKI included sepsis, malaria, and ARDS. Mortality was 52.5%. APACHE II (OR 4.550; 95% CI 1.2–17.5,p=0.028), mechanical ventilation (OR 13.063; 95% CI 2.3–72,p=0.003), and need for vasopressors (OR 16.8; 95% CI 3.4–82.6,p=0.001) had statistically significant association with mortality.Conclusion. IHD may be a feasible alternative for RRT in critically ill haemodynamically stable patients in low resource settings where CRRT may not be available.

scholarly journals Mortality and predictors of acute kidney injury in adults: a hospital-based prospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Abinet Abebe ◽  
Kabaye Kumela ◽  
Maekel Belay ◽  
Bezie Kebede ◽  
Yohannes Wobie
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Low Income ◽  
Statistical Significance ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
Public Health Problem ◽  
Medical Ward ◽  
High Rate

AbstractAcute kidney injury (AKI) is a major global public health problem. It is expensive to manage and associated with a high rate of prolonged hospitalization and in-hospital mortality. Little is known about the burden of acute kidney injury in moderate to low-income countries. We aim to assess predictors of in-hospital mortality among AKI patients admitted to the medical ward. We prospectively identified patients meeting kidney disease improving global outcomes (KIDGO) AKI definitions from April to August 2019. Patients with underlying CKD and patients hospitalized for less than 48 h were excluded. The Cox regression model was fitted to identify predictors of mortality and statistical significance was considered at the p-value of less than 0.05. A total of 203 patients were enrolled over 5 months. Out of this, 121(59.6%) were males, 58(28.6%) were aged greater than 60 years, and 141(69.5%) had community-acquired acute kidney injury. The most common causes of AKI were Hypovolemia 99(48.77%), Glomerulonephritis 51(25.11%), and sepsis 32(15.79%). The overall in-hospital mortality rate was 12.8%. Stage 3 AKI (AHR = 9.61, 95% CI 1.17–28.52, p = 0.035), duration of AKI (AHR = 7.04, 95% CI 1.37–36.08, p = 0.019), length of hospital stay (AHR = 0.19, 95% CI 0.05–0.73, p = 0.012), and hyperkalemia (AHR = 3.61, 95% CI 1.12–11.71, p = 0.032) were significantly associated with in-hospital mortality. There is a high rate of acute kidney injury-related in-hospital mortality in adult patients admitted to the medical ward. The severity of AKI, hyperkalemia duration of AKI, and a short length of hospital stay were predictors of 30-days in-hospital mortality. Most of the causes of AKI are preventable and patients may benefit from early identification and treatment of these reversible causes.

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