scholarly journals Evaluation of Quality of Medical Care to Patients with the Risk of Developing Acute Kidney Injury

2018 ◽  
Vol 14 (3) ◽  
pp. 36-45
Author(s):  
A. V. Dats ◽  
L. S. Dats
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Medical Care ◽  
Kidney Injury ◽  
Irkutsk Oblast ◽  
District Hospitals ◽  
Patients At Risk ◽  
Nephrotoxic Drugs ◽  
Quality Of Medical Care

The purpose of the research: to analyze the quality of medical care of patients who are at risk of developing acute kidney injury.Materials and methods. The work is based on a retrospective analysis of medical records of 140 patients with an acute kidney injury developed during their stay the intensive care units, surgical and medical units of district hospitals the Irkutsk Oblast over the period from 2012 to 2017.Results. Inadequate assessment of the risk of an acute kidney injury was identified in 61% of patients. The most common inadequately assessed damaging factors were critical conditions (in 36% (50/140), sepsis (27% (38/140), and nephrotoxic drugs (19% (26/140). Among inadequately evaluated predisposing factors that could be managed, the following ones were most common: chronic heart disease (in 42% (59/140), dehydration/hypovolaemia (34% (47/140), chronic kidney disease (29% (41/140), and anemia (25% (35/140). In patients at risk of an acute kidney injury, an inadequate examination and inadequate maintenance therapy were found in 66% and 56% cases, respectively. Analysis of implementation of supporting therapy in patients at risk of an acute kidney injury the following misconducting events were revealed: (i) no optimal volumic and perfusion support (59% (82/140) and (ii) no cancellation of nephrotoxic and improperly prescribed drugs (31% (44/140).Conclusions. A good quality medical care restricted only by 24% of patients at risk of an acute kidney injury developed in the ICU, surgical and medical departments of district hospitals of the Irkutsk Oblast. The development of an acute kidney injury when exposed to nephrotoxic drugs and dehydration/ hypovolemia in 14% of cases was predictable and preventable. 

scholarly journals Analysis of medical care in Ukraine for nephrological patients in 2019

2020 ◽  
pp. 11-17
Author(s):  
M. O. Kolesnyk ◽  
N. I. Kozliuk ◽  
O. O. Razvazhaieva
Keyword(s):  
Health Care ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Medical Care ◽  
Kidney Injury ◽  
Financial Decisions ◽  
Quality Of Medical Care ◽  
Nephrological Care

The work aimed to conduct a rating of nephrological services in the regions of Ukraine by using the method of complex statistical coefficients. Methods. Evaluation of nephrological services in the regions of Ukraine was made by using indicators of the structure, health care resources, quality and efficiency of renal medical care of patients with chronic kidney disease and patients with acute kidney injury. Results. The place of each province in the national rating of the state of renal medical care was identified. Conclusions. The organization, availability and quality of medical care for nephrological patients in Ukraine do not meet existing needs. The significant differences in the specialized nephrological care between the regions of Ukraine can be solved out through the implementation of appropriate management and financial decisions.

scholarly journals 992 Short Term Effectiveness of Interventions Aimed at Preventing Post-Operative Acute Kidney Injury (AKI) In Patients Undergoing Elective Lower Limb Arthroplasty

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
V Jaitley ◽  
E Phoenix
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Lower Limb ◽  
Kidney Injury ◽  
Nice Guidelines ◽  
Improve Compliance ◽  
Patients At Risk ◽  
Risk Patients ◽  
Nephrotoxic Drugs

Abstract Introduction Acute kidney injury (AKI) is a potentially avoidable complication in patients undergoing elective lower limb arthroplasty. The National Institute for Health and Care Excellence (NICE) offers guidelines to identity and manage AKI. This is a closed loop audit aiming to assess i) adherence to NICE guidelines and ii) whether simple interventions will improve compliance. Method We closed the loop on a departmental audit carried out in 2017. NICE guidelines were applied to stratify patients at risk of post-operative AKI. High risk patients included those on nephrotoxic drugs and with pre-existing co-morbidities. We then applied the AKIN criteria to identify post-operative AKI. We presented this data at our departmental trauma meeting. Following this we implemented the following interventions i) poster & ii) aid memoir on patient admission proformas to identity those at risk. Results In 2017, post-operative AKI incidence was found to be 11.7%. Following intervention, in 2019 the incidence was 10% at 1 month and 5% at 7 months. Additionally, 80% of AKIs were identified on day 1 post-arthroplasty, compared to only 30% in 2017. Conclusions This audit showed that simple interventions reduced the incidence of post-operative AKI. Moving forward, we plan to assess long term effectiveness including the effect of junior doctor rotations.

scholarly journals Stratifying risk of acute kidney injury in pre and post cardiac surgery patients using a novel biomarker-based algorithm and clinical risk score

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
William T. McBride ◽  
Mary Jo Kurth ◽  
Gavin McLean ◽  
Anna Domanska ◽  
John V. Lamont ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Risk Score ◽  
Kidney Injury ◽  
Predictive Ability ◽  
Clinical Risk Score ◽  
Clinical Risk ◽  
Patients At Risk ◽  
Post Cardiac Surgery

AbstractAcute kidney injury (AKI) following cardiac surgery significantly increases morbidity and mortality risks. Improving existing clinical methods of identifying patients at risk of perioperative AKI may advance management and treatment options. This study investigated whether a combination of biomarkers and clinical factors pre and post cardiac surgery could stratify patients at risk of developing AKI. Patients (n = 401) consecutively scheduled for elective cardiac surgery were prospectively studied. Clinical data was recorded and blood samples were tested for 31 biomarkers. Areas under receiver operating characteristic (AUROCs) were generated for biomarkers pre and postoperatively to stratify patients at risk of AKI. Preoperatively sTNFR1 had the highest predictive ability to identify risk of developing AKI postoperatively (AUROC 0.748). Postoperatively a combination of H-FABP, midkine and sTNFR2 had the highest predictive ability to identify AKI risk (AUROC 0.836). Preoperative clinical risk factors included patient age, body mass index and diabetes. Perioperative factors included cardio pulmonary bypass, cross-clamp and operation times, intra-aortic balloon pump, blood products and resternotomy. Combining biomarker risk score (BRS) with clinical risk score (CRS) enabled pre and postoperative assignment of patients to AKI risk categories. Combining BRS with CRS will allow better management of cardiac patients at risk of developing AKI.

scholarly journals EVALUATION OF QUALITY OF TREATMENT OF PATIENTS WITH POSTTRAUMATIC ACUTE KIDNEY INJURY, DIED IN INTENSIVE CARE UNITS OF DISTRICT HOSPITALS

2020 ◽  
Vol 21 (2) ◽  
pp. 20-27
Author(s):  
A. V. Dats ◽  
L. S. Dats
Keyword(s):  
Acute Kidney Injury ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Kidney Injury ◽  
Quality Of Treatment ◽  
District Hospitals ◽  
Methods Of Treatment

This paper presents an analysis of the quality of treatment of patients with posttraumatic acute kidney injury, died in intensive care units and intensive care district hospitals. Defects treatment in most cases arise from non-compliance with the recommendations for treatment, using outdated methods of treatment and the lack of contraindications when prescribing drugs.

scholarly journals Development and Performance of Electronic Acute Kidney Injury Triggers to Identify Pediatric Patients at Risk for Nephrotoxic Medication-associated Harm

2014 ◽  
Vol 05 (02) ◽  
pp. 313-333 ◽  
Author(s):  
W.L. Spires ◽  
T.A. Mottes ◽  
J.K. Schaffzin ◽  
C. Barclay ◽  
S.L. Goldstein ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Pediatric Patients ◽  
Data Entry ◽  
Kidney Injury ◽  
Clinical Work ◽  
Web Based ◽  
Predictive Values ◽  
Patients At Risk ◽  
And Performance

Summary Background: Nephrotoxic medication-associated acute kidney injury (NTMx-AKI) is a costly clinical phenomenon and more common than previously recognized. Prior efforts to use technology to identify AKI have focused on detection after renal injury has occurred. Objectives: Describe an approach and provide a technical framework for the creation of risk-stratifying AKI triggers and the development of an application to manage the AKI trigger data. Report the performance characteristics of those triggers and the refinement process and on the challenges of implementation. Methods: Initial manual trigger screening guided design of an automated electronic trigger report. A web-based application was designed to alleviate inefficiency and serve as a user interface and central workspace for the project. Performance of the NTMx exposure trigger reports from September 2011 to September 2013 were evaluated using sensitivity (SN), specificity (SP), positive and negative predictive values (PPV, NPV). Results: Automated reports were created to replace manual screening for NTMx-AKI. The initial performance of the NTMx exposure triggers for SN, SP, PPV, and NPV all were 0.78, and increased over the study, with all four measures reaching 0.95 consistently. A web-based application was implemented that simplifies data entry and couriering from the reports, expedites results viewing, and interfaces with an automated data visualization tool. Sociotechnical challenges were logged and reported. Conclusion: We have built a risk-stratifying system based on electronic triggers that detects patients at-risk for NTMx-AKI before injury occurs. The performance of the NTMx-exposed reports has neared 100% through iterative optimization. The complexity of the trigger logic and clinical work-flows surrounding NTMx-AKI led to a challenging implementation, but one that has been successful from technical, clinical, and quality improvement standpoints. This report summarizes the construction of a trigger-based application, the performance of the triggers, and the challenges uncovered during the design, build, and implementation of the system. Citation: Kirkendall ES, Spires WL, Mottes TA, Schaffzin JK, Barclay C, Goldstein SL. Development and performance of electronic acute kidney injury triggers to identify pediatric patients at risk for nephrotoxic medication-associated harm. Appl Clin Inf 2014; 5: 313–333 http://dx.doi.org/10.4338/ACI-2013-12-RA-0102

scholarly journals Reduction in acute kidney injury post cardiac surgery using balanced forced diuresis: a randomized, controlled trial

2020 ◽  
Author(s):  
Heyman Luckraz ◽  
Ramesh Giri ◽  
Benjamin Wrigley ◽  
Kumaresan Nagarajan ◽  
Eshan Senanayake ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Kidney Injury ◽  
Control Group ◽  
Binary Logistic Regression Analysis ◽  
Number Needed To Treat ◽  
Forced Diuresis ◽  
Patients At Risk

Abstract OBJECTIVES Our goal was to investigate the efficacy of balanced forced diuresis in reducing the rate of acute kidney injury (AKI) in cardiac surgical patients requiring cardiopulmonary bypass (CPB), using the RenalGuard® (RG) system. METHODS Patients at risk of developing AKI (history of diabetes and/or anaemia; estimated glomerular filtration rate 20–60 ml/min/1.73 m2; anticipated CPB time >120 min; log EuroSCORE > 5) were randomized to the RG system group (n = 110) or managed according to current practice (control = 110). The primary end point was the development of AKI within the first 3 postoperative days as defined by the RIFLE (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) criteria. RESULTS There were no significant differences in preoperative and intraoperative characteristics between the 2 groups. Postoperative AKI rates were significantly lower in the RG system group compared to the control group [10% (11/110) vs 20.9% (23/110); P = 0.025]. This effect persisted even after controlling for a number of potential confounders (odds ratio 2.82, 95% confidence interval 1.20–6.60; P = 0.017) when assessed by binary logistic regression analysis. The mean volumes of urine produced during surgery and within the first 24 h postoperatively were significantly higher in the RG system group (P < 0.001). There were no significant differences in the incidence of blood transfusions, atrial fibrillation and infections and in the median duration of intensive care unit stays between the groups. The number needed to treat with the RG system to prevent AKI was 9 patients (95% confidence interval 6.0–19.2). CONCLUSIONS In patients at risk for AKI who had cardiac surgery with CPB, the RS RG system significantly reduced the incidence of AKI and can be used safely and reproducibly. Larger studies are required to confirm cost benefits. Clinical trial registration number: NCT02974946

Management of patients at risk of acute kidney injury

The Lancet ◽  
2017 ◽  
Vol 389 (10084) ◽  
pp. 2139-2151 ◽  
Author(s):  
Jill Vanmassenhove ◽  
Jan Kielstein ◽  
Achim Jörres ◽  
Wim Van Biesen
Keyword(s):  
At Risk ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
Patients At Risk
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