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

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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The ratio of CRP to prealbumin levels predict mortality in patients with hospital-acquired acute kidney injury

BMC Nephrology ◽

10.1186/1471-2369-12-30 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 39

Author(s):

Qionghong Xie ◽

Ying Zhou ◽

Zhongye Xu ◽

Yanjiao Yang ◽

Dingwei Kuang ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Hospital Acquired

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Hepatorenal Syndrome

10.5772/intechopen.97698 ◽

2021 ◽

Author(s):

Arshpal Gill ◽

Ra’ed Nassar ◽

Ruby Sangha ◽

Mohammed Abureesh ◽

Dhineshreddy Gurala ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Failure ◽

Blood Flow ◽

Mortality Rate ◽

Kidney Injury ◽

Type I ◽

Tubular Necrosis ◽

Cirrhotic Patients

Hepatorenal Syndrome (HRS) is an important condition for clinicians to be aware of in the presence of cirrhosis. In simple terms, HRS is defined as a relative rise in creatinine and relative drop in serum glomerular filtration rate (GFR) alongside renal plasma flow (RPF) in the absence of other competing etiologies of acute kidney injury (AKI) in patients with hepatic cirrhosis. It represents the end stage complication of decompensated cirrhosis in the presence of severe portal hypertension, in the absence of prerenal azotemia, acute tubular necrosis or others. It is a diagnosis of exclusion. The recognition of HRS is of paramount importance for clinicians as it carries a high mortality rate and is an indication for transplantation. Recent advances in understanding the pathophysiology of the disease improved treatment approaches, but the overall prognosis remains poor, with Type I HRS having an average survival under 2 weeks. Generally speaking, AKI and renal failure in cirrhotic patients carry a very high mortality rate, with up to 60% mortality rate for patients with renal failure and cirrhosis and 86.6% of overall mortality rates of patients admitted to the intensive care unit. Of the various etiologies of renal failure in cirrhosis, HRS carries a poor prognosis among cirrhotic patients with acute kidney injury. HRS continues to pose a diagnostic challenge. AKI can be either pre-renal, intrarenal or postrenal. Prerenal causes include hypovolemia, infection, use of vasodilators and functional due to decreased blood flow to the kidney, intra-renal such as glomerulopathy, acute tubular necrosis and post-renal such as obstruction. Patients with cirrhosis are susceptible to developing renal impairment. HRS may be classified as Type 1 or rapidly progressive disease, and Type 2 or slowly progressive disease. There are other types of HRS, but this chapter will focus on Type 1 HRS and Type 2 HRS. HRS is considered a functional etiology of acute kidney injury as there is an apparent lack of nephrological parenchymal damage. It is one several possibilities for acute kidney injury in patients with both acute and chronic liver disease. Acute kidney injury (AKI) is one of the most severe complications that could occur with cirrhosis. Up to 50% of hospitalized patients with cirrhosis can suffer from acute kidney injury, and as mentioned earlier an AKI in the presence of cirrhosis in a hospitalized patient has been associated with nearly a 3.5-fold increase in mortality. The definition of HRS will be discussed in this chapter, but it is characterized specifically as a form of acute kidney injury that occurs in patients with advanced liver cirrhosis which results in a reduction in renal blood flow, unresponsive to fluids this occurs in the setting of portal hypertension and splanchnic vasodilation. This chapter will discuss the incidence of HRS, recognizing HRS, focusing mainly on HRS Type I and Type II, recognizing competing etiologies of renal impairment in cirrhotic patients, and the management HRS.

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Acute kidney injury due to multiple wasp stings: a case report

Paediatrica Indonesiana ◽

10.14238/pi61.2.2021.115-8 ◽

2021 ◽

Vol 61 (2) ◽

pp. 115-8

Author(s):

Tahmina Khandkar ◽

Amina Akter ◽

Asaduzzaman Asaduzzaman ◽

Ranjit Ranjan Roy ◽

Golam Muinuddin

Keyword(s):

Acute Kidney Injury ◽

Case Report ◽

Mortality Rate ◽

Early Treatment ◽

Treatment Protocol ◽

Kidney Injury ◽

Clinical Findings ◽

Wasp Venom ◽

Systemic Reactions ◽

Wasp Stings

The skin is the most commonly affected organ. Wasp venom causes both local and systemic reactions, but acute kidney injury (AKI) is the most serious complication, with a 20% mortality rate. Acute kidney injury can occur from single or multiple stings. Diagnosis depends on history, clinical findings, and investigations. Treatment protocol is same as other causes of AKI, including dialysis, and prognosis is good with early treatment.

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An Assessment of AKIN Criteria for Hospital-Acquired Acute Kidney Injury: A Prospective Observational Cohort Study

Nephron Clinical Practice ◽

10.1159/000317202 ◽

2010 ◽

Vol 116 (3) ◽

pp. c217-c223 ◽

Cited By ~ 9

Author(s):

Soon Hyo Kwon ◽

Hyunjin Noh ◽

Jin Seok Jeon ◽

Yongbae Kim ◽

Dong Cheol Han

Keyword(s):

Acute Kidney Injury ◽

Cohort Study ◽

Kidney Injury ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Observational Cohort ◽

Hospital Acquired

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Biomarkers of acute kidney injury: time to learn from implementation

Critical Care and Resuscitation ◽

10.51893/2021.2.pov1 ◽

2021 ◽

Vol 23 (2) ◽

pp. 137-140

Author(s):

Zoltán H Endre ◽

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Clinical Problem ◽

Time To Learn ◽

Hospital Acquired ◽

Major Clinical Problem

Acute kidney injury (AKI) is a major clinical problem in the community and in hospital, with hospital-acquired AKI reported in about 20% of adult and 30% of paediatric admissions.

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Community- and Hospital-Acquired Acute Kidney Injury

Acute Kidney Injury and Regenerative Medicine ◽

10.1007/978-981-15-1108-0_10 ◽

2020 ◽

pp. 125-144

Author(s):

Sadudee Peerapornratana ◽

Nattachai Srisawat

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Hospital Acquired

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Severe burns complicated by acute kidney injury: Some nuances regarding risk factors and mortality rate

Journal of Translational Critical Care Medicine ◽

10.4103/jtccm.jtccm_9_20 ◽

2020 ◽

Vol 2 (2) ◽

pp. 46

Author(s):

PatrickM Honore ◽

Aude Mugisha ◽

Luc Kugener ◽

Sebastien Redant ◽

Rachid Attou ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Mortality Rate ◽

Kidney Injury ◽

Severe Burns

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Admission plasma uromodulin and the risk of acute kidney injury in hospitalized patients with cirrhosis: a pilot study

AJP Gastrointestinal and Liver Physiology ◽

10.1152/ajpgi.00158.2019 ◽

2019 ◽

Vol 317 (4) ◽

pp. G447-G452

Author(s):

Kavish R. Patidar ◽

Pranav S. Garimella ◽

Etienne Macedo ◽

James E. Slaven ◽

Marwan S. Ghabril ◽

...

Keyword(s):

Acute Kidney Injury ◽

Kidney Injury ◽

Predictive Biomarker ◽

Hospitalized Patients ◽

Susceptible Population ◽

Baseline Creatinine ◽

Low Levels ◽

Time Of Admission ◽

Hospital Acquired

Acute kidney injury (AKI) is a common complication in hospitalized patients with cirrhosis. Uromodulin, a protein uniquely produced by the kidney and released both in the urine and circulation, has been shown to regulate AKI and is linked to tubular reserve. Although low levels of urine uromodulin are associated with AKI after cardiac surgery, it is unclear whether circulating uromodulin can stratify the risk of AKI, particularly in a susceptible population such as hospitalized patients with cirrhosis. Thus, we investigated whether plasma uromodulin measured at the time of admission is associated with subsequent hospital-acquired AKI (defined by a rise in serum creatinine >0.3mg/dL within 48 h or ≥ 1.5 times baseline) in patients with cirrhosis. A total of 98 patients [mean age 54 yr, Model for Endstage Liver Disease Sodium (MELD-Na) score 19, and baseline creatinine of 0.95 mg/dL] were included, of which 13% ( n = 13) developed AKI. Median uromodulin levels were significantly lower in patients who developed AKI compared with patients who did not (9.30 vs. 13.35 ng/mL, P = 0.02). After adjusting for age, sex, diabetes, hypertension, albumin, and MELD-Na score as covariates on multivariable logistic regression, uromodulin was independently associated with AKI [odd ratios of 1.19 (95% confidence interval 1.02, 1.37; P = 0.02)]. Lower uromodulin levels on admission are associated with increased odds of subsequent AKI in hospitalized patients with cirrhosis. Further studies are needed to better understand the role of uromodulin in the pathogenesis and as a predictive biomarker of AKI in this population. NEW & NOTEWORTHY In this study, we found that admission plasma uromodulin levels are significantly lower in patients who developed subsequent acute kidney injury (AKI) during their hospital stay compared with patients who did not. Additionally, uromodulin is independently associated with AKI development after adjusting for clinically relevant parameters such as age, sex, diabetes, hypertension, severity of cirrhosis, and kidney function. To our knowledge, this is the first study linking plasma uromodulin with AKI development in patients with cirrhosis.

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