scholarly journals Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

2021 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Inflammatory Markers ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Inclusion Criteria ◽  
Acid Base ◽  
Acid Base Status ◽  
Worse Prognosis ◽  
D Dimer

Abstract Aim Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI. Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed.Results AKI had 24% mortality in COVID-19 patients who had eGFRs of over 60 ml/min/1,73 m2. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Conclusions AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has a worse prognosis.

scholarly journals Time and the etiology of Acute Kidney Injury define prognosis in the course of COVID-19

2020 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Admission ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Immunologic Response ◽  
Inclusion Criteria ◽  
D Dimer

Abstract Introduction Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. This study aimed to analyze AKI among hospitalized COVID-19 patients in relation to the time and etiologies of AKI.Materials & Methods 1056 patients who were hospitalized with COVID-19 diagnosis in our institution were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI were involved in the final analysis. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels and inflammatory markers as well as changes in these parameters were compared between the groups.Results AKI was seen in 23% of the patients and 23% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day.Conclusion Early AKI was more related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies.

scholarly journals Acute Kidney Injuries of otherwise normal kidneys have different characteristics in different stages of COVID-19

2021 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Inclusion Criteria ◽  
Lower Serum ◽  
Acid Base Status ◽  
Different Characteristics ◽  
Worse Prognosis ◽  
Electrolyte Abnormalities

Abstract BackgroundKidney involvement in COVID-19 may manifest as acute kidney injury (AKI). This study aimed to analyze and compare AKIs in different stages of COVID-19.Methods1056 hospitalized COVID-19 patients were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI, but didn’t have prior kidney diseases were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from the 7th day. Electrolytes, acid-base status and changes in the inflammatory markers were compared. ResultsPatients who developed AKI after the 7th day had higher peak CRP and D-dimer levels and lower nadir lymphocyte counts (p=0.000, 0.004 and 0.003 respectively). AKI that developed later was more related to immunologic response and had significantly higher mortality, reaching as high as 44% for those who developed AKI after 7th day. Patients who died had lower serum albumin levels than those who survived (p=0,000). Hematuria and proteinuria (p=0.001; OR: 2.4; 95% CI: 1.4 – 3.8 and p=0.015; OR: 4.34; 95% CI: 1.3 – 14.3 respectively) were more common in patients who died. Hypernatremia (p=0.000, OR: 6.5; 95% CI:3.0 – 13.9) and hyperchloremia (p=0,002, OR:3,8; 95%CI: 1,7 – 8,4) were also observed more often in patients who died.ConclusionsAKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has a worse prognosis and is more related to electrolyte abnormalities.

scholarly journals Different characteristics of acute kidney injuries in different stages of COVID-19

2021 ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Ridvan Karaali ◽  
...  
Keyword(s):  
Kidney Diseases ◽  
Kidney Injury ◽  
Final Analysis ◽  
Disease Stage ◽  
Inclusion Criteria ◽  
Kidney Involvement ◽  
Acid Base Status ◽  
Different Characteristics ◽  
Worse Prognosis ◽  
Electrolyte Abnormalities

Abstract BackgroundKidney involvement in COVID-19 may manifest as acute kidney injury (AKI). This study aimed to analyze and compare AKIs in different stages of COVID-19.Methods1056 hospitalized COVID-19 patients were retrospectively evaluated and 383 of them met the inclusion criteria. Eighty-nine patients who developed AKI, but didn’t have prior kidney diseases were involved in the final analysis. Patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from the 7th day. Electrolytes, acid-base status and changes in the inflammatory markers were compared. ResultsAKIs that were seen on hospital admission day were generally transient. Patients who developed AKI after the 7th day had higher peak CRP and D-dimer levels and lower nadir lymphocyte counts (p=0.000, 0.004 and 0.003 respectively). AKI that developed later was more related to immunologic response and had significantly higher mortality, reaching as high as 44% for those who developed AKI after 7th day. Hematuria and proteinuria (p=0.001; OR: 2.4; 95% CI: 1.4 – 3.8 and p=0.015; OR: 4.34; 95% CI: 1.3 – 14.3 respectively) were more common in patients who died. Hypernatremia (p=0.000, OR: 6.5; 95% CI:3.0 – 13.9) and hyperchloremia (p=0,002, OR:3,8; 95%CI: 1,7 – 8,4) were also observed more often in patients who died.ConclusionsAKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies. AKI that develops later has worse prognosis and is more related to electrolyte abnormalities.

scholarly journals MO371TIME AND THE ETIOLOGY OF ACUTE KIDNEY INJURY DEFINE PROGNOSIS IN THE COURSE OF COVID-19

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ahmet Murt ◽  
Mevlut Tamer Dincer ◽  
Cebrail Karaca ◽  
Sinan Trabulus ◽  
Nurhan Seyahi ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Hospital Admissions ◽  
Inflammatory Marker ◽  
Kidney Injury ◽  
Disease Stage ◽  
Immunologic Response ◽  
Electrolyte Disturbances ◽  
Incidence And Mortality ◽  
Depth Analysis ◽  
D Dimer

Abstract Background and Aims Kidneys are among the affected organs in COVID-19 and there may be different etiologies resulting in acute kidney injury (AKI) in different stages of the disease. There have been previous studies focusing on incidence and mortality of AKI in COVID-19 but none has made in depth analysis in relation to the background pathophysiology. Based on previous observations, we hypothesized that all AKIs seen in COVID-19 are not uniform and we aimed to analyze the etiologies and prognosis of AKI among hospitalized COVID-19 patients in relation to the time of AKI during different phases of the disease. Method A total of 1056 patients were admitted to the designated COVID-19 clinics from March to July in 2020. 77 Patients who were younger than 18 years old and 7 kidney transplant patients were excluded from the study. 427 of the remaining patients were confirmed by real time polymerase chain reaction (RT-PCR) test.). As eGFR below 60 mL/min/1,73 m2 was already shown to be related to mortality, these patients (44) were also excluded. As immunologic response is generally accepted to start with the second week of COVID-19 course, patients were classified into three groups, those who had AKI on admission, those who developed AKI in the first week and those who developed AKI starting from 7th day. Initial lymphocyte counts, creatinine levels, electrolytes, acid-base status and changes in the inflammatory markers were compared between the groups. A comparison between patients who survived and who died was also performed. Results 89 of the 383 included COVID-19 patients developed AKI. 24% of those who developed AKI died. Patients who developed AKI later had higher peak CRP and D-dimer levels with lower nadir lymphocyte counts (p=0,000, 0,004 and 0,003 respectively). Additionally, patients who died had higher initial inflammatory marker levels and lower lymphocyte counts than those who survived. Mortality of patients who had AKI on hospital admission (13%) was similar to the overall COVID-19 mortality for inpatients, however it was as high as 44% for those who developed AKI after 7th day. Early AKI was related to pre-renal causes and had a milder course. However, later AKIs were more related to immunologic response and had significantly higher mortality. Patients who died had significantly higher ferritin and d-dimer levels upon their hospital admissions (p=0,000). Electrolyte disturbances, metabolic acidosis and mortality were also higher in patients who developed AKI later. Hypernatremia (OR: 6,5, 95% CI: 3 – 13,9) and phosphorus disturbances (both hyperphosphatemia (OR: 3,3; 95%CI: 1,6 – 6,9) and hypophosphatemia (OR: 3,9; 95% CI: 2,0-7,9)) were related to mortality. Conclusion Findings of this study suggest that AKI in COVID-19 is not of one kind. When developed, AKI should be evaluated in conjunction with the disease stage and possible etiologies

scholarly journals Clearance of inflammatory cytokines in patients with septic acute kidney injury during renal replacement therapy using the EMiC2 filter (Clic-AKI study)

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Nuttha Lumlertgul ◽  
Anna Hall ◽  
Luigi Camporota ◽  
Siobhan Crichton ◽  
Marlies Ostermann
Keyword(s):  
Acute Kidney Injury ◽  
Growth Factor ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Final Analysis ◽  
Adsorptive Capacity ◽  
Clearance Rates ◽  
Plasma Cytokine ◽  
Tnf Α ◽  
Ifn Γ

Abstract Background The EMiC2 membrane is a medium cut-off haemofilter (45 kiloDalton). Little is known regarding its efficacy in eliminating medium-sized cytokines in sepsis. This study aimed to explore the effects of continuous veno-venous haemodialysis (CVVHD) using the EMiC2 filter on cytokine clearance. Methods This was a prospective observational study conducted in critically ill patients with sepsis and acute kidney injury requiring kidney replacement therapy. We measured concentrations of 12 cytokines [Interleukin (IL) IL-1β, IL-1α, IL-2, IL-4, IL-6, IL-8, IL-10, interferon (IFN)-γ, tumour necrosis factor (TNF)-α, vascular endothelial growth factor, monocyte chemoattractant protein (MCP)-1, epidermal growth factor (EGF)] in plasma at baseline (T0) and pre- and post-dialyzer at 1, 6, 24, and 48 h after CVVHD initiation and in the effluent fluid at corresponding time points. Outcomes were the effluent and adsorptive clearance rates, mass balances, and changes in serial serum concentrations. Results Twelve patients were included in the final analysis. All cytokines except EGF concentrations declined over 48 h (p < 0.001). The effluent clearance rates were variable and ranged from negligible values for IL-2, IFN-γ, IL-1α, IL-1β, and EGF, to 19.0 ml/min for TNF-α. Negative or minimal adsorption was observed. The effluent and adsorptive clearance rates remained steady over time. The percentage of cytokine removal was low for most cytokines throughout the 48-h period. Conclusion EMiC2-CVVHD achieved modest removal of most cytokines and demonstrated small to no adsorptive capacity despite a decline in plasma cytokine concentrations. This suggests that changes in plasma cytokine concentrations may not be solely influenced by extracorporeal removal. Trial registration: NCT03231748, registered on 27th July 2017.

MO388DEVELOPMENT OF ACUTE KIDNEY INJURY DURING A RHABDOMYOLYSIS EPISODE: DIFFERENCES IN LONG-TERM KIDNEY FUNCTION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sara Núñez Delgado ◽  
Miren Iriarte-Abril ◽  
Júlia Farrera-Núñez ◽  
Sergi Pascual-Sánchez ◽  
Laia Sans-Atxer ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Function ◽  
Kidney Injury ◽  
Inpatient Mortality ◽  
Short Term ◽  
Worse Prognosis

Abstract Background and Aims Acute renal failure (AKI) associated to rhabdomyolysis conditions a worse prognosis in short-term, its implication in the long-term renal function has been less evaluated. Method Retrospective analysis of patients diagnosed with rhabdomyolysis defined by creatinine kinase &gt; 5000 IU/L between 2015-2019. Basal and 12-month renal function was evaluated. AKI was classified as either non-severe (AKI-KDIGO 1/2) or severe (AKI-KDIGO 3). Results Eighty-seven patients were included, 25 (28.74%) had some degree of chronic kidney disease (CKD) on admission. 56 (64.37%) had AKI on admission, 17 of which were severe (6 required hemodialysis). The patients with AKI had more cardiovascular disease (CVD) and worse analytical parameters on admission (table). Patients with severe AKI showed no difference in CVD from those with non-severe AKI but were younger and had more hyperkalemia. There were no significant differences between patients with severe AKI who required hemodialysis and those who did not. Inpatient mortality was 8%, higher in patients with AKI but without differences according to severity. In 45 patients kidney function was available 12 months after the episode, loss of eGF was -4.90 ± 14.35 ml/min-1.73m2 (p=0.007). There was no difference between patients who developed AKI and those who did not (-4.10 ± 14.4 vs. -5.39 ± 14.57 ml/min-1.73m2; p=0.67), nor between non-severe and severe AKI (-5.50 ± 14.76 vs. -5.12 ± 15.08ml/min-1.73m2; p=0.98). Of the 33 patients without previous CKD, 5 developed CKD, with greater decrease in eGF than those who did not (-22.69 ± 6.04 vs. -2.63 ± 13.92 ml/min-1.73m2; p=0.003). Female sex (60% vs. 12%; p=0.031) and previous basal eGF (72.22 ± 4.37 vs. 95.6±19.97 ml/min-1.72m2; p=0.016) were related to this deterioration. Conclusion After an episode of rhabdomyolysis, the loss of eGF is similar in patients who develop AKI compared to those who do not.

scholarly journals Preoperative Albuminuria and Intraoperative Chloride Load: Predictors of Acute Kidney Injury Following Major Abdominal Surgery

2018 ◽  
Vol 7 (11) ◽  
pp. 431 ◽  
Author(s):  
Diamantina Marouli ◽  
Kostas Stylianou ◽  
Eleftherios Papadakis ◽  
Nikolaos Kroustalakis ◽  
Stavroula Kolyvaki ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Abdominal Surgery ◽  
Care Center ◽  
Chronic Kidney Disease Stage ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Major Abdominal Surgery ◽  
Disease Stage ◽  
Postoperative Aki

Background: Postoperative Acute Kidney Injury (AKI) is a common and serious complication associated with significant morbidity and mortality. While several pre- and intra-operative risk factors for AKI have been recognized in cardiac surgery patients, relatively few data are available regarding the incidence and risk factors for perioperative AKI in other surgical operations. The aim of the present study was to determine the risk factors for perioperative AKI in patients undergoing major abdominal surgery. Methods: This was a prospective, observational study of patients undergoing major abdominal surgery in a tertiary care center. Postoperative AKI was diagnosed according to the Acute Kidney Injury Network criteria within 48 h after surgery. Patients with chronic kidney disease stage IV or V were excluded. Logistic regression analysis was used to evaluate the association between perioperative factors and the risk of developing postoperative AKI. Results: Eleven out of 61 patients developed postoperative AKI. Four intra-operative variables were identified as predictors of AKI: intra-operative blood loss (p = 0.002), transfusion of fresh frozen plasma (p = 0.004) and red blood cells (p = 0.038), as well as high chloride load (p = 0.033, cut-off value > 500 mEq). Multivariate analysis demonstrated an independent association between AKI development and preoperative albuminuria, defined as a urinary Albumin to Creatinine ratio ≥ 30 mg·g−1 (OR = 6.88, 95% CI: 1.43–33.04, p = 0.016) as well as perioperative chloride load > 500 mEq (OR = 6.87, 95% CI: 1.46–32.4, p = 0.015). Conclusion: Preoperative albuminuria, as well as a high intraoperative chloride load, were identified as predictors of postoperative AKI in patients undergoing major abdominal surgery.

scholarly journals Risk factors and mortality in patients with sepsis, septic and non septic acute kidney injury in ICU

2019 ◽  
Vol 41 (4) ◽  
pp. 462-471 ◽  
Author(s):  
Kellen Hyde Elias Pinheiro ◽  
Franciana Aguiar Azêdo ◽  
Kelsy Catherina Nema Areco ◽  
Sandra Maria Rodrigues Laranja
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Icu Patients ◽  
Septic Acute Kidney Injury ◽  
Observational Cohort ◽  
Worse Prognosis

Abstract Acute kidney injury (AKI) has an incidence rate of 5-6% among intensive care unit (ICU) patients and sepsis is the most frequent etiology. Aims: To assess patients in the ICU that developed AKI, AKI on chronic kidney disease (CKD), and/or sepsis, and identify the risk factors and outcomes of these diseases. Methods: A prospective observational cohort quantitative study that included patients who stayed in the ICU > 48 hours and had not been on dialysis previously was carried out. Results: 302 patients were included and divided into: no sepsis and no AKI (nsnAKI), sepsis alone (S), septic AKI (sAKI), non-septic AKI (nsAKI), septic AKI on CKD (sAKI/CKD), and non-septic AKI on CKD (nsAKI/CKD). It was observed that 94% of the patients developed some degree of AKI. Kidney Disease Improving Global Outcomes (KDIGO) stage 3 was predominant in the septic groups (p = 0.018). Nephrologist follow-up in the non-septic patients was only 23% vs. 54% in the septic groups (p < 0.001). Dialysis was performed in 8% of the non-septic and 37% of the septic groups (p < 0.001). Mechanical ventilation (MV) requirement was higher in the septic groups (p < 0.001). Mortality was 38 and 39% in the sAKI and sAKI/CKD groups vs 16% and 0% in the nsAKI and nsAKI/CKD groups, respectively (p < 0.001). Conclusions: Patients with sAKI and sAKI/CKD had worse prognosis than those with nsAKI and nsAKI/CKD. The nephrologist was not contacted in a large number of AKI cases, except for KDIGO stage 3, which directly influenced mortality rates. The urine output was considerably impaired, ICU stay was longer, use of MV and mortality were higher when kidney injury was combined with sepsis.

Abstract 13306: Combined Assessment of Acute Kidney Injury and Increased Plasma Concentration of D-dimer Is Useful for Evaluating 1-year Mortality in Patients Hospitalized to Coronary Care Units

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Shigeru Matsui ◽  
Junichi Ishii ◽  
Ryuunosuke Okuyama ◽  
Hiroshi Takahashi ◽  
Hideki Kawai ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Relative Risk ◽  
Kidney Injury ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Absolute Increase ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
Coronary Care ◽  
D Dimer

Background: Acute kidney injury (AKI) detected after admission to coronary care unit (CCU) is associated with very poor outcomes. We prospectively investigated the prognostic value of a combination of AKI and high plasma D-dimer levels for 1-year mortality in patients hospitalized to CCUs. Methods: D-dimer, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and high-sensitive C-reactive protein (hsCRP) levels were measured in 1228 patients on admission to CCUs, of whom 56% had decompensated heart failure and 38% had acute coronary syndrome. AKI was defined as an increase of >25% in creatinine from baseline or an absolute increase of ≥0.5 mg/dL within 48 h after admission. Left ventricular ejection fraction (LVEF) and E/e’ ratio were estimated using echocardiography with tissue Doppler imaging. Results: AKI was detected in 163 (13%) patients. During 1-year follow-up period, there were 149 (12%) deaths. The patients who died were older (median: 77 vs. 73 years; p < 0.0001) and exhibited higher D-dimer (2.7 vs. 1.3 μg/mL; p < 0.0001), NT-proBNP (5495 vs. 1525 pg/mL; p < 0.0001), and hsCRP levels (0.92 vs, 0.26 mg/L; p < 0.0001) and E/e’ ratio (15.0 vs. 13.2; p = 0.006). They also had a higher incidence of AKI (26% vs. 12%; p < 0.0001) and lower LVEF (39% vs. 49%; p < 0.0001) and estimated glomerular filtration rate (45 vs. 62 mL/min/1.73 m 2 ; p < 0.0001) than patients who survived. Multivariate Cox regression analysis, including 12 clinical, biochemical, and echocardiographic variables, identified AKI (relative risk: 1.79; p = 0.008) and increased D-dimer level (relative risk: 1.83 per 10-fold increment; p = 0.002) as independent predictors of 1-yeart mortality. The combined assessment of AKI and D-dimer quartiles was significantly associated with 1-year mortality rates (Figure). Conclusions: The combined assessment of AKI and high D-dimer levels may be useful for evaluating the risk of 1-year mortality in patients admitted to CCUs.

Nephrology In-Reach Services Lead to Improvement in Mortality in Acute Kidney Injury – 3 (AKI-3)

2020 ◽  
Author(s):  
E. Gkekas ◽  
TYT. Tang ◽  
M. Brazell ◽  
M. Brennan ◽  
H. Ayub ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mortality Rate ◽  
District Hospital ◽  
Care Pathway ◽  
Kidney Injury ◽  
Evaluation Study ◽  
Community Settings ◽  
Inclusion Criteria ◽  
Hospital Acquired ◽  
Overall Mortality

Abstract Background: Acute Kidney Injury (AKI) is a sudden decline in kidney function. Early detection and prompt treatment of AKI is vital in improving the outcome of patients. We introduced in-reach nephrology services at South Tyneside District Hospital (STDH) as part of a reconfiguration of local NHS services. Aims: The principal aim of this study is to analyse patient outcomes relating to service developments and to explore prognostic characteristics among a cohort of AKI-3 patients Design: This was a single centre retrospective impact evaluation study.Methods: We studied all patients (n=246) who either presented with or developed AKI-3 during their admission at South Tyneside District Hospital from 2016 to 2018. The inclusion criteria included age 18-95 years and a diagnosis of AKI-3 as per KDIGO classification. Exclusion include those on established dialysis regime or on palliative care. Results: A total of 246 patients were admitted with AKI-3. There were 64 deaths from AKI-3 over the three-year period. Mortality decreased from 29.5% to 20.7% from 2016 to 2018. In patients with Community Acquired (CA-AKI3) the overall mortality rate was 24.2% (n=182), whereas the overall mortality rate of those with Hospital Acquired (HA-AKI3) was 31.3% (n=64). The pre-AKI use of ACEi, A2RB or diuretics increased from 39.7% in 2016 (n=78), to 59.3% in 2017 (n=86) and 64.6% in 2018 (n=82). Conversely, mortality associated with the use of these medications reduced each consecutive year (32.3%, 25.5%, 18.9%).Conclusion: Development of nephrology in-reach services, staff education measures and a primary care pathway could reduce AKI-3 mortality among patients in inpatient and community settings.

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