scholarly journals CSN COVID-19 Rapid Review Program: Management of Acute Kidney Injury

2020 ◽  
Vol 7 ◽  
pp. 205435812094167 ◽  
Author(s):  
Edward G. Clark ◽  
Swapnil Hiremath ◽  
Steven D. Soroka ◽  
Ron Wald ◽  
Matthew A. Weir ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Replacement Therapy ◽  
Fluid Management ◽  
Kidney Injury ◽  
Rapid Review ◽  
Local Context ◽  
Number Of Patients ◽  
Review Team ◽  
Kidney Replacement Therapy

Purpose: Severe acute kidney injury (AKI) is a potential complication of COVID-19-associated critical illness. This has implications for the management of COVID-19-associated AKI and the resulting increased need for kidney replacement therapy (KRT) in the intensive care unit (ICU) and elsewhere in the hospital. The Canadian Society of Nephrology COVID-19 Rapid Review Team has sought to collate and synthesize currently available resources to inform ethically justifiable decisions. The goal is the provision of the best possible care for the largest number of patients with kidney disease while considering how best to ensure the safety of the health care team. Information sources: Local, provincial, national, and international guidance and planning documents related to the COVID-19 pandemic; guidance documents available from nephrology and critical care-related professional organizations; recent journal articles and preprints related to the COVID-19 pandemic; expert opinion from nephrologists from across Canada. Methods: A working group of kidney specialist physicians was established with representation from across Canada. Kidney physician specialists met via teleconference and exchanged e-mails to refine and agree on the proposed suggestions in this document. Key findings: (1) Nephrology programs should work with ICU programs to plan for the possibility that up to 30% or more of critically ill patients with COVID-19 admitted to ICU will require kidney replacement therapy (KRT). (2) Specific suggestions pertinent to the optimal management of AKI and KRT in patients with COVID-19. These suggestions include, but are not limited to, aspects of fluid management, KRT vascular access, and KRT modality choice. (3) We describe considerations related to ensuring adequate provision of KRT, should resources become scarce during the COVID-19 pandemic. Limitations: A systematic review or meta-analysis was not conducted. Our suggestions have not been specifically evaluated in the clinical environment. The local context, including how the provision of acute KRT is organized, may impede the implementation of many suggestions. Knowledge is advancing rapidly in the area of COVID-19 and suggestions may become outdated quickly. Implications: Given that most acute KRT related to COVID-19 is likely to be required initially in the ICU setting, close collaboration and planning between critical care and nephrology programs is required. Suggestions may be updated as newer evidence becomes available.

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 Renal replacement therapy in critical care in patients with acute kidney injury

2018 ◽  
Vol 51 (2) ◽  
pp. 141-148
Author(s):  
Shigeo Negi ◽  
Daisuke Koreeda ◽  
Masaki Higashiura ◽  
Takuro Yano ◽  
Sou Kobayashi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critical Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Kidney Injury

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
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